BRIDGES: a patient-centered, community-informed HIV doula program that supports infant feeding choice among Hispanic...

In 2023, U.S. Perinatal HIV Guidelines shifted from recommending exclusive formula feeding to endorsing shared decision-making for infant feeding among pregnant and postpartum persons with HIV (PPWH) on antiretroviral therapy (ART) with sustained viral suppression. While the risk of HIV transmission through breastfeeding is small (< 1%) with sustained viral suppression, adherence protocols are complex and clinical support infrastructure remains underdeveloped. Doula care has demonstrated benefits for breastfeeding initiation, maternal anxiety reduction, and postpartum follow-up, yet no studies have examined HIV-specialized doula programs supporting infant feeding choice among non-English speaking PPWH in North America.

Using a patient-centered, community-informed framework, BRIDGES (BReast and Infant feeding Doulas to address Gaps in Education and Support) is an HIV Doula education and support program designed to improve maternal/child health outcomes and reduce perinatal transmission. The program aims to support heterogeneous infant feeding options through doula-mediated prenatal education, ART adherence support, lactation counseling, and postnatal care coordination.

In collaboration with the Pediatric Community Advisory Board, South Florida Health Departments' Perinatal HIV Programs, and University of Miami (UM) Ob/Gyn, a doula-based intervention was developed for pregnant and postpartum women with HIV. The study employs a sequential mixed-methods design: Aim 1 builds the BRIDGES intervention through community engagement, embedding an Infant Feeding Choice Community Advisory Group; Aim 2 evaluates BRIDGES in a single-arm interventional study of 15 mother-baby dyads. Data collection includes sociodemographic, clinical, obstetrical, and psychosocial measures (HIV stigma, medical mistrust, resilience), along with individual and group interviews. The Consolidated Framework for Implementation Research (CFIR) guides evaluation of implementation determinants.

The BRIDGES intervention pairs each mother-infant dyad with an HIV-trained doula from enrollment during pregnancy through 12 weeks postpartum. The doula supplements clinic education with prenatal education on infant feeding options (breastfeeding, formula, banked donor milk), ART adherence support, lactation counseling, and guidance on clinical monitoring protocols specific to feeding choice. Clinical monitoring protocols differentiate between breastfeeding dyads (monthly maternal viral load, infant ARV prophylaxis until weaning, enhanced infant HIV testing) and formula-feeding dyads (standard of care).

BRIDGES addresses a critical gap at the intersection of evolving HIV infant feeding guidelines and doula-supported perinatal care. This intervention was shaped by a collaborative effort that ensures its cultural relevance, linguistic inclusivity, and alignment with community needs, amplifying its potential impact on supporting infant feeding choice among PPWH. Findings may inform other U.S.-based HIV clinics providing pregnancy care services to PPWH.

Identifier: NCT07664423. https://clinicaltrials.gov/study/NCT07664423.