The contribution of family planning towards the prevention of vertical HIV transmission in Uganda.

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 25000 vertical infections and 17000 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 131000 vertical infections and 71000 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. CONCLUSIONS: Existing FP use contributes as much or more than ARV-PMTCT in mitigating pediatric HIV in Uganda. Expanding FP services can substantially contribute towards PMTCT.