Contraception to prevent HIV-positive births: current contribution and potential cost savings in PEPFAR countries

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 ("PMTCT 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 PMTCT 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 PMTCT services.

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.

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 PMTCT services.