The contribution of family planning towards the prevention of vertical HIV transmission

Background: Uganda has one of the highest total fertility rates (TFR) worldwide. We compared the effects of antiretroviral (ARV) prophylaxis for the prevention of mother-to-child HIV transmission (PMTCT) to that of existing family planning (FP) use and estimated the burden of pediatric HIV disease due to unwanted fertility. Methodology/Principal Findings: Using the demographic software Spectrum, a baseline mathematical projection to estimate the current pediatric HIV burden in Uganda was compared to three hypothetical projections: 1) without ARV-PMTCT (to estimate the effect of ARV-PMTCT), 2) without contraception (effect of existing FP use), 3) without unwanted fertility (effect of unmet FP needs). Key input parameters included HIV prevalence, ARV-PMTCT uptake, MTCT probabilities, and TFR. We estimate that in 2007, an estimated 25,000 vertical infections and 17,000 pediatric AIDS deaths occurred (baseline projection). Existing ARV-PMTCT likely averted 8.1 % of infections and 8.5 % of deaths. FP use likely averted 19.7 % of infections and 13.1 % of deaths. Unwanted fertility accounted for 21.3 % of infections and 13.4 % of deaths. During 2008– 2012, an estimated 131,000 vertical infections and 71,000 pediatric AIDS deaths will occur. The projected scale up of ARV-PMTCT (from 39%–57%) may avert 18.1 % of infections and 24.5 % of deaths. Projected FP use may avert 21.6 % of infections and 18.5 % of deaths. Unwanted fertility will account for 24.5 % of infections and 19.8 % of deaths