Abstract
BACKGROUND: Understanding current clinical practices and barriers to the implementation of the updated infant feeding guidelines in perinatal HIV exposure can inform the development of interventions to improve practice in the United States (US). METHODS: Between August and December 2024, we electronically administered a survey to actively practicing neonatologists and pediatric infectious diseases (PID) physicians in the US. We conducted a multivariate logistic regression to assess the association between physician characteristics and breastfeeding support. RESULTS: Of 389 respondents, 21% were PID specialists, and 79% were neonatologists. More PID specialists (64%) than neonatologists (42%) (P < .01) indicated breastmilk from the virally suppressed parent with HIV as a feeding option. A few PID physicians (35%) and neonatologists (28%) practiced at centers with guidelines for feeding breastmilk from a parent with HIV. Concern for HIV transmission was the strongest barrier to supporting breastmilk feeding across both subspecialties and all geographical regions, as reported by 61% of PID specialists and 63% of neonatologists. Neonatologists (adjusted Odds ratio (aOR), 0.47; 95% Confidence Interval (CI), .28-.78), attending physicians with 0-5 years (aOR, 0.49; 95% CI, .27-.87) and 6-10 years of experience (aOR, 0.40; 95% CI, .22-.74) compared to those >20years of experience, and those at nonacademic centers (aOR, 0.35; 95% CI, .21-.58), were less likely to offer breastmilk. CONCLUSIONS: In the United States, concerns for perinatal HIV transmission remain a significant barrier to breastfeeding support among both PID subspecialists and neonatologists. Accordingly, interventions to promote breastfeeding support should target persisting concerns for lactational HIV transmission.