Abstract
BackgroundUganda 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 FindingsUsing 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.ConclusionsExisting FP use contributes as much or more than ARV-PMTCT in mitigating pediatric HIV in Uganda. Expanding FP services can substantially contribute towards PMTCT.
Highlights
Mother-to-child HIV transmission (MTCT) is the second largest mode of HIV transmission worldwide, accounting for some 370,000 infections in 2007 [1]
Expanding family planning (FP) services can substantially contribute towards prevention of mother-to-child HIV transmission (PMTCT)
25,000 vertical HIV infections occurred in the presence of the existing FP use and ARV-PMTCT program
Summary
Mother-to-child HIV transmission (MTCT) is the second largest mode of HIV transmission worldwide, accounting for some 370,000 infections in 2007 [1]. In many countries PMTCT programs focus on antenatal HIV testing, provision of ARV prophylaxis to HIV-infected women and their newborns, and counseling on safer infant feeding practices. These three components constitute just one of four pillars for PMTCT; the remaining being primary HIV prevention in women of child-bearing age, family planning (FP) for the prevention of unwanted pregnancies, as well as care and treatment for HIV-infected women [3] and their HIV-affected children [4]. 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
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