Breastfeeding with HIV: faculty and trainee clinical experience with updated 2023 HHS guidelines

In 2023, the Department of Health and Human Services (HHS) updated the U.S. prevention of perinatal HIV transmission guidelines to recommend that providers support the decision to breastfeed for people with HIV on antiretroviral therapy with sustained viral suppression.

We conducted an online survey of University of California, San Diego (UCSD) attendings, fellows and residents from Obstetrics, Gynecology, and Reproductive Sciences (OB/GYN&RS), Pediatrics, and Infectious Disease (ID) departments. Likert scales assessed respondent familiarity with, education on, and comfort with implementing the updated breastfeeding with HIV (BFHIV) guidelines. Kruskal Wallis tests were used to examine differences in familiarity, education, and comfort between respondent characteristics. A p-value < 0.05 was considered statistically significant.

Of 51 surveys obtained, 25% of respondents were OB/GYN&RS, 65% were Pediatrics, and 10% adult ID physicians. 50% of respondents reported experience caring for patients with HIV and 65% were familiar with BFHIV guidelines. Prior clinical experience working with a person with HIV who chose to breastfeed was significantly associated with increased familiarity (p 0.01) with the guidelines and comfort with implementation (p 0.02). There were no differences in familiarity or comfort with implementation based on department or level of training. OB/GYN&RS physicians were significantly less likely to have received education on the guidelines (p 0.01).

While most UCSD physicians were aware of the updated HHS guidelines, our results demonstrate that as national guidelines change, increased dissemination and clinical education is necessary. Future directions include targeted education for OB/GYN&RS physicians, and further trainee clinical exposure working with people with HIV.