1. Models of HIV Preconception Care and Key Elements Influencing These Services: Findings from Healthcare Providers in Seven US Cities
- Author
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Mary Jo Hoyt, Sarah Finocchario-Kessler, Deborah S. Storm, and Joanne Phillips Simone
- Subjects
Adult ,Male ,Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,Health Personnel ,Human immunodeficiency virus (HIV) ,HIV Infections ,medicine.disease_cause ,Preconception Care ,Infant outcomes ,Interviews as Topic ,03 medical and health sciences ,Health personnel ,0302 clinical medicine ,Pregnancy ,medicine ,Humans ,030212 general & internal medicine ,Cities ,Referral and Consultation ,Qualitative Research ,preconception care ,attitudes ,030505 public health ,business.industry ,Clinical and Epidemiologic Research ,Public Health, Environmental and Occupational Health ,HIV ,food and beverages ,medicine.disease ,practice ,Infectious Diseases ,health knowledge ,Family medicine ,Grounded Theory ,Key (cryptography) ,models of clinical care ,Female ,Pre-Exposure Prophylaxis ,0305 other medical science ,business ,Delivery of Health Care ,Healthcare providers ,Qualitative research - Abstract
Preconception care can improve maternal and infant outcomes by identifying and modifying health risks before pregnancy and reducing unplanned pregnancies. However, information about how preconception care is provided to persons living with HIV (PLWH) is lacking. This study uses qualitative interviews with HIV care providers to describe current models of preconception care and explore factors influencing services. Single, anonymous, telephone interviews were conducted with 92 purposively selected HIV healthcare providers in Atlanta, Baltimore, Houston, Kansas City, Newark, Philadelphia, and San Francisco in 2013โ2014. Content analysis and a grounded theory approach were used to analyze data. Participants included 57% physicians with a median of 10 [interquartile range (IQR) = 5โ17] years HIV care experience; the mean proportion of female patients was 45%. Participants described Individual Provider (48.9%), Team-based (43.2%), and Referral-only (7.6%) models of preconception care, with 63% incorporating referrals outside their clinics. Thematic analysis identified five key elements influencing the provision of preconception care within and across models: consistency of delivery, knowledge and attitudes, clinic characteristics, coordination of care, and referral accessibility. Described models of preconception care reflect the complexity of our healthcare system. Qualitative analysis offers insights about how HIV clinicians provide preconception care and how key elements influence services. However, additional research about the models and outcomes of preconception care services are needed. To improve preconception care for PLWH, research and quality improvement initiatives must utilize available strengths and tackle existing barriers, identified by our study and others, to define and implement effective models of preconception care services.
- Published
- 2018
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