PS24-040 UPLIFT Study (Understanding Parental Lactation and Infant Feeding decisions Tailored to people with HIV.\\\")

There has been a monumental shift in the breast/chestfeeding (B/CF) recommendations for mothers and other parents with HIV (MoPWH) in the United States (US) from complete avoidance to a shared decision-making approach. For decades following the start of the HIV epidemic, US guidelines recommended against B/CF for MoPWH to avoid any risk of HIV transmission to infants. However, current US guidelines now recommend an evidence-based, shared decision-making approach to infant feeding counseling between providers and MoPWH who desire to B/CF. Yet, there is very limited evidence on infant feeding decision-making, practices, and outcomes among MoPWH in the US to inform best practices of this shared decision-making approach. Data are unavailable to identify which demographic, psychosocial, and clinical factors influence infant feeding intention, practices, and outcomes. Further, there is a need to better understand current institutional practices regarding infant feeding and the perspectives of the multidisciplinary teams who care for MoPWH and their infants. To best support shared decision-making while minimizing HIV transmission, there is an urgent need to collect representative epidemiologic data from B/CF MoPWH in the US as well as comprehensive insight from MoPWH and other key stakeholders on their perspectives and experiences. The proposed UPLIFT Study (Understanding Parental Lactation and Infant Feeding decisions Tailored to people with HIV) will address the knowledge gaps outlined above in response to the Centers for Disease Control and Prevention Request for Applications RFA-PS-24-040: Understanding Infant Feeding Preferences, Practices, and Outcomes for Mothers and other Parents with HIV in the United States. In collaboration with the International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) Network and by leveraging IMPAACT’s US sites, we will use a convergent mixed methods research design to accomplish three overarching core activities. In Core Activity 1, we will explore the multifaceted process of infant feeding decision-making via in-depth interviews with key stakeholders, including a diverse sample of MoPWH, their partners and other influential individuals, and care providers. In Core Activity 2, we will establish an observational longitudinal cohort of N=450 MoPWH at 10-15 representative sites across the US to examine current infant feeding practices and outcomes. We will characterize current standards of practice for infant feeding in the US using a landscape analysis; assess factors associated with infant feeding decisions and outcomes; carry out human milk HIV viral laboratory assays; conduct exit interviews and mixed methods integration; and perform costing analysis. Finally, in Core Activity 3, we will develop and pilot a national voluntary registry to capture data from the diverse population of MoPWH who B/CF in the US. Findings from the three proposed core activities in the UPLIFT study will inform best practices for infant feeding counseling to promote equitable patient-centered care for MoPWH in the US.