Abstract

Nearly 10 million perinatal HIV transmissions have occurred globally, with around 3,000 U.S. births annually involving people living with HIV (PLWH). Antiretroviral therapy (ART) and universal HIV screening have significantly reduced transmission rates, including those through chest and breastfeeding, which were historically at 16%. Despite updated 2023 WHO guidelines emphasizing ART to lower transmission risks, implementation varies due to factors like provider knowledge, biases, and systemic barriers. Normalization Process Theory (NPT) offers a framework to analyze the adoption of healthcare interventions, focusing on coherence, cognitive participation, collective action, and reflexive monitoring. Applying NPT to integrate HIV chest and breastfeeding guidelines highlights the need for tailored strategies and stakeholder collaboration. The goal is to create a user-friendly decision-making guide for providers, improving care for birthing individuals living with HIV and their infants. This aligns with NIH priorities and requires preliminary data and a validated guide for future implementation research.