Cost-effectiveness of linking HIV and family planning services to prevent unintended pregnancies among women living with HIV

The incidence of unintended pregnancies and transmission of infection from mother-to-child could be averted by implementation of linked HIV care and family planning services (prong-2). The objective of the study was to assess the cost-effectiveness of strengthening prong-2 interventions through linked HIV-family planning services, to prevent unintended pregnancies among women living with HIV. A Markov decision analytical model was performed from a disaggregated societal perspective. A hypothetical cohort of married, sexually active women living with HIV in reproductive age, availing services from public health settings in India, were followed to estimate the costs and health outcomes. The intervention was strengthening linkage of HIV with family planning services through training healthcare providers and improving focus of dual methods of contraception. The standard of care with focus on condom promotion primarily for infection control was the comparator. The outcome was measured as Incremental Cost-effectiveness Ratio in terms of unintended pregnancies, live-births, abortions, maternal deaths and infant infections averted. We conducted Probabilistic Sensitivity Analysis to evaluate uncertainties. The intervention was found to be cost-effective. Among a cohort of 782107, 72604 unintended pregnancies, 41610 induced abortions, 17425 unintended live-births, and 8722 deaths were averted by the intervention. At 2% mother-to-child transmission rate, 2752 infant infections were averted. An incremental cost of INR 100000 (USD1272.3) could avert one death, two unintended live-births, five abortions and nine unintended pregnancies. Linking HIV and family planning services to prevent unintended pregnancy by use of dual contraception among women living with HIV is cost-effective.