Patient navigation to improve outcomes among low-income women in the postpartum period

PROJECT SUMMARY Pregnancy is a critical window of opportunity for preventive health interventions, including vaccines. Yet, vaccine hesitancy is a known global phenomenon. Uptake of the currently recommended vaccines in pregnancy (influenza and tetanus, diphtheria, and pertussis [TDaP]) is suboptimal, with only 50% of individuals receiving recommended vaccines. Disparities in vaccine uptake exist, yet this issue has not been thoroughly investigated from the patient perspective. Little is known about the perspectives of pregnant women who identify as racial or ethnic minorities or pregnant women living with HIV (WLHIV), both of whom are underrepresented and understudied populations who are at greater risk of complications from conditions such as influenza. Additionally, the COVID-19 pandemic and introduction of a novel vaccine to health care presents an urgent need to understand factors driving vaccination uptake, particularly in vulnerable populations such as racial and ethnic minority pregnant and postpartum women and WLHIV. Early data suggest that pregnant women and immunocompromised people - such as those living with HIV - are at increased risk of morbidity and mortality from COVID-19. Understanding the evolving perspectives of these populations will inform educational and counseling strategies to enhance vaccination uptake in pregnancy and reduce vaccination disparities. Aim 1 will assess the experiences and preferences of racial and ethnic minority pregnant and postpartum WLHIV and HIV-seronegative women with regard to standard of care vaccines during pregnancy. Individual interviews will address perceptions, experiences, and decisions surrounding routine vaccinations during pregnancy, including issues of trust, access, and knowledge. Analyses will additionally compare perspectives on routine vaccines that may differ by HIV status. Aim 2 will examine the perspectives of this population on the novel COVID-19 vaccine. We will explore motivations and sociocultural underpinnings that may clarify the concerns, beliefs, and experiences surrounding COVID-19 vaccination in pregnancy. We will additionally compare the perspectives of women with and without HIV, and we will analyze differences in attitudes for the COVID-19 vaccine versus standard of care vaccines. To accomplish these aims, we will recruit 40 pregnant or recently postpartum women in partnership with the NICHD-funded Navigating New Motherhood 2 study and the Northwestern Memorial Hospital Women's Infectious Diseases Program. Women with and without HIV will be demographically similar in order to focus on a diverse population of understudied women who are largely low- income and from a racial or ethnic minority. This proposal aims to fill an unmet need for a systematic, in-depth, and unbiased evaluation of the attitudes and preferences of understudied populations of women regarding routine and novel vaccinations during pregnancy. This project directly aligns with the Trans-NIH Strategic Plan for Women's Health Research goals and the aims will address intersections of social determinants of health in diverse populations of women.