Midwest D-CFAR Investigator Examines Infant Feeding Practice Guidelines for Individuals With HIV
August 7, 2026
In 2023, WHO and CDC guidelines for birthing people living with HIV (BPLWH) shifted from generally discouraging breastfeeding/chestfeeding to supporting shared decision-making for individuals who maintain sustained viral suppression. This change reflected advancements in antiretroviral therapy (ART), as well as “the benefits of breastfeeding/chestfeeding and the importance of individual choice, cultural considerations, and equity through the shared decision-making process between patients and healthcare workers” (López 2026).
Julia López, PhD, MPH, LCSW
In 2025, Julia López, PhD, MPH, LCSW received a Midwest D-CFAR Investigator Pilot Award to analyze the adoption of updated guidelines utlizing a sociological framework known as Normalization Process Theory (NPT). Dr. López is a bilingual public health researcher and mental health clinician who leverages her extensive clinical expertise in trauma, stigma, mental wellness, and substance use disorders to drive systemic change in health equity among underserved minority populations.
“The initial funding truly kick-started [the project],” stated López. “Qualitative research like this often struggles to secure funding through traditional channels because there's usually no preliminary data to present, yet that's exactly the kind of data the funding helps generate. The D-CFAR pilot support addresses this classic 'chicken-and-egg' situation, making it possible to move forward and gather the necessary insights. Concretely, it also let us build the interdisciplinary team across ID, OB/GYN, MFM, and implementation science. Those relationships are a big part of why a small pilot could reach across specialties as it has.”
Dr. López and her collaborators recently published early findings from the project in a paper titled Evaluating infant feeding practice guidelines for individuals with HIV: a pilot study using qualitative findings with healthcare workers and normalization process theory. A detailed summary of the paper is available here.
Dr. López shared that what excites her most about this work is “catching a guideline change as it transitions into practice. Using [NPT] reveals that providers mostly agree with the guidelines, but implementation remains inconsistent.” She continued, “This is a systems issue rather than a science one. We already have the evidence; what we're really looking for now is better coordination, clear operational guidance on matters like suppression and infant prophylaxis, and consistent care pathways. These steps can help us prevent patients from feeling like they're in silos and ensure everyone gets the best possible care.”
The recent publication is just the beginning. Looking ahead, Dr. López emphasized two main priorities for the research team: “continue interviews with birthing people with HIV and turn findings into practical tools. The paper focuses on providers, but 2023 guidelines are based on shared decision-making, which requires patient input about messages, feeding, and trust. Participants want clear guidance for gaps in the guidelines. We're developing a decision-making guide and care pathway for clear OB-to-pediatrics-to-ID handoffs.”
In the long term, they hope to implement a trial totest whether “structured decision aids and coordinated care improve consistency and patient experience.”
Congratulations on this accomplishment, Dr. López and team!
Written by Kate Gershwin.