Addressing the Unmet Need of Preconception Counseling for HIV Positive Women

Abstract

Background: Perinatal transmission of HIV, or mother-to-child transmission (MTCT), can occur during pregnancy, labor and delivery, and breastfeeding. Advances in HIV treatment have reduced the risk of MTCT to less than 1% and increased the quality of life of women living with HIV (WLWHIV) and their children, therefore, the Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) recommend routine preconception care (PCC) for all WLWHIV. Unfortunately, more than 70% of WLWHIV of childbearing age are not offered PCC or family planning counseling as part of their routine medical care, contributing to the challenge of preventing mother-to-child HIV transmission. Objective: The purpose of this DNP project is to address the unmet need of preconception care and family planning counseling provided to women living with HIV (WLWHIV) of childbearing age. The aim is to develop an evidence-based best-practice toolkit to be used by the HIV and OBGYN providers at McDowell Health Care Center (McDowell Clinic) for preconception counseling of WLWHIV. Design: The design of this DNP project is quality improvement utilizing the plan-do-study-act (PDSA) cycle to determine: 1) What do providers want in a toolkit for preconception counseling for women living with HIV? Setting: The McDowell Clinic, a family health center within the Maricopa Integrated Health System (MIHS). Participants: Seven HIV and three OBGYN providers consisting of physicians, nurse practitioners, physician assistants, and nurse midwives at the McDowell Clinic. Measurements: HIV and OBGYN specialty providers at the McDowell Clinic answered a fourteen open-ended and closed question survey designed with Qualtrics (2017) in order to obtain information about perceptions of preconception care, usefulness of a preconception toolkit, and suggestions regarding necessary content of a preconception care toolkit. Results: Seventy percent of the providers surveyed completed the survey prior to the survey closing date. Data received from the survey questions show that the McDowell Clinic providers ask sexual health questions including contraceptive care and pregnancy history but do not routinely offer PCC. Items recommended to be included in a preconception toolkit, ranked in order of importance, are: patient educational materials, patient preconception questionnaire, community resources, link to evidence-based guidelines, and national resources. Conclusion: PCC for WLWHIV was not routinely being offered during scheduled clinic visits. A preconception toolkit will be helpful in providing routine PCC for HIV+ female patients of childbearing age at the McDowell Clinic.