HIV This Week

H W Reynolds, B Janowitz, R Wilcher, W Cates. Contraception to prevent HIV-positive births: current contribution and potential cost savings in PEPFAR countries. Sex. Transm. Inf. 2008;84;ii49-ii53

Reynolds et al aimed to estimate the number of HIV-positive births currently prevented by contraceptive use in the President’s Emergency Plan for AIDS Relief (PEPFAR) focus countries and to estimate the first year cost savings to each country if unintended and unwanted HIV-positive births were prevented via contraceptive use rather than providing antiretroviral prophylaxis for HIV-positive pregnant women (prevention of mother-to-child transmission services). Data from publicly available sources yielded estimates of (1) contraceptive and HIV prevalence; (2) the number of women of reproductive age; (3) the number of annual births to HIV-infected women; (4) the rates of pregnancy and vertical HIV transmission; (5) the proportions of unintended and unwanted births; and (6) the cost per HIV-positive birth averted by family planning and prevention of mother-to-child transmission services. The number of HIV-positive births currently averted by contraceptive use and the number of unwanted and unintended HIV-positive births are the product of these estimates. Cost savings are the difference in the costs of family planning and prevention of mother-to-child transmission services. The study found that the annual number of unintended HIV-positive births currently averted by contraceptive use ranges from 178 in Guyana to over 120,000 in South Africa. The minimum annual cost savings to prevent just the unwanted HIV-positive births ranges from $26,000 in Vietnam to over $2.2 million in South Africa. The authors concluded that contraception is already having an important effect on reducing the number of infant HIV infections. This contribution could be strengthened by additional efforts to provide contraception to HIV-infected women who do not wish to become pregnant. Moreover, the effect of contraception can be achieved at a cost savings compared with prevention of mother-to-child transmission services.

Editors’ note: Despite low contraceptive prevalence rates, contraception is already preventing many unintended HIV-positive births. Contraception helps women with HIV delay pregnancy until they are emotionally and physically ready and can access appropriate antenatal and safe delivery care, as well as antiretroviral regimens. Important cost savings could be incurred if more women living with HIV were able to prevent mistimed or unwanted pregnancy in the first place rather than interrupting mother-to-child transmission through antiretroviral prophylaxis. Cost-effective compared with other approaches to prevent mother-to-child transmission, family planning really is the best-kept secret of HIV prevention.