Barriers to Pregnancy Spacing in Women Living with HIV: A Series of Informational Interviews

For reproductive-age women living with HIV, birth spacing allows for optimization of maternal health and viral suppression to prevent mother-to-child transmission of HIV. We conducted semi-structured informational interviews to explore use of contraception for birth spacing. Interviews were transcribed and analyzed. Audio files were reviewed to capture non-explicit data. We interviewed 18 multiparous HIV positive women. All described experiences with at least one contraceptive method. Six themes emerged: Burden of contraception, Failure of birth control, Impact of youth and lack of life experience, Community beliefs about birth control, Lack of partner cooperation, and Altruism. Women viewed birth spacing favorably. Young age at first delivery, contraceptive side effects, non-adherence to short-acting methods, lack of partner cooperation, and prior contraceptive failure were identified as barriers to ideal birth spacing. Additional outreach is needed in women living with HIV to overcome barriers to planned pregnancy and birth spacing

PREGNANCY SPACING IN WOMEN LIVING WITH HIV: A SERIES OF INFORMATIONAL INTERVIEWS

For reproductive-age women living with HIV, birth spacing allows for optimization of maternal health and viral suppression to prevent mother-to-child transmission. We conducted semi-structured informational interviews to explore use of contraception for birth spacing. Interviews were transcribed and analyzed. Audio files were reviewed to capture non-explicit data. We interviewed 18 multiparous HIV positive women. All described experiences with at least one contraceptive method. Six themes emerged: Burden of contraception, Failure of birth control, Impact of youth and lack of life experience, Community beliefs about birth control, Lack of partner cooperation, and Altruism. Women viewed birth spacing favorably. Young age at first delivery, contraceptive side effects, non-adherence to short-acting methods, lack of partner cooperation, and prior contraceptive failure were identified as barriers to ideal birth spacing. Additional outreach is needed in women living with HIV to overcome barriers to planned pregnancy and birth spacing

FAmily-CEntered (FACE) Advance Care Planning Among African-American and Non-African-American Adults Living With HIV in Washington, DC: A Randomized Controlled Trial to Increase Documentation and Health Equity

© 2018 American Academy of Hospice and Palliative Medicine Context: No prospective studies address disease-specific advance care planning (ACP) for adults living with HIV/AIDS. Objective: To examine the efficacy of FAmily-CEntered (FACE) ACP in increasing ACP and advance directive documentation in the medical record. Methods: Longitudinal, two-arm, randomized controlled trial with intent-to-treat design recruited from five hospital-based outpatient HIV clinics in Washington, DC. Adults living with HIV and their surrogate decision-makers (N = 233 dyads) were randomized to either an intensive facilitated two-session FACE ACP (Next Steps: Respecting Choices goals of care conversation and Five Wishes advance directive) or healthy living control (conversations about developmental/relationship history and nutrition). Results: Patients (n = 223) mean age: 51 years, 56% male, 86% African-American. One hundred ninety-nine dyads participated in the intervention. At baseline, only 13% of patients had an advance directive. Three months after intervention, this increased to 59% for the FACE ACP group versus 17% in the control group (P \u3c 0.0001). Controlling for race, the odds of having an advance directive in the medical record in the FACE ACP group was approximately seven times greater than controls (adjusted odds ratio = 6.58, 95% CI: 3.21–13.51, P \u3c 0.0001). Among African-Americans randomized to FACE, 58% had completed/documented advance directives versus 20% of controls (P \u3c 0.0001). Conclusions: The FACE ACP intervention significantly improved ACP completion and advance directive documentation in the medical record among both African-American and non-African-American adults living with HIV in Washington, DC, providing health equity in ACP, which can inform best practices