Contraceptive Counseling Strategies for Women Living With Human Immunodeficiency Virus: The Role of Integrating Reproductive Health and Human Immunodeficiency Virus Services to Prevent Perinatal Transmission in Colombia

• Published in: Value in health regional issues Vol. 29; pp. 100 - 107
• Main Authors: Gómez-Suárez, Marcela, Díaz-Rojas, Jorge A., Alzate-Posada, Martha Lucía, Eslava-Schmalbach, Javier
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2022
• Subjects: Colombia; contraception; Contraceptive Agents; cost-effectiveness; Counseling; Female; HIV; HIV Infections - prevention & control; human immunodeficiency virus infections; Humans; Infectious Disease Transmission, Vertical - prevention & control; Pregnancy; public health; Reproductive Health; reproductive health services; women’s health services; Colombia; cost-effectiveness; reproductive health services; contraception; women’s health services; human immunodeficiency virus infections; public health
• ISSN: 2212-1099; 2212-1102
• DOI: 10.1016/j.vhri.2021.09.004

This study aimed to evaluate the cost-effectiveness of 2 contraceptive counseling strategies in Colombia for women living with human immunodeficiency virus (HIV). The first integrates (1) reproductive health and HIV services (integrated model [IM]), and the second (2) offers these services separately (non-IM). Cost-effectiveness analysis from the third-party payer perspective (Colombian healthcare system). A decision analysis tree was used over a 24-month time horizon at a 3% discount rate, considering only direct costs. The outcome was the number of averted HIV perinatal transmission infections. We performed a discrete sensibility analysis and a probabilistic second-order sensitivity analysis with 10 000 iterations (Monte Carlo simulation). Compared with the non-IM, the IM prevented 3% additional HIV perinatal transmission infections, with an incremental cost-effectiveness of US dollar 525 and the highest net monetary benefit at the proposed willingness to pay. In the probabilistic sensitivity analysis, we found a substantial amount of parameter uncertainty that challenges the evidence in favor of the cost-effectiveness of the IM strategy. This study opens the possibility of integrating reproductive health and HIV services for women living with HIV in Colombia. In addition, it raises the necessity to produce additional good quality local empirical evidence to inform better and support the estimation of the economic efficiency of such a model in the country. •Women living with human immunodeficiency virus (WHIV) have 3 times higher unmet contraceptive necessities than women without this condition, leading to more unplanned pregnancies and increasing the risk of human immunodeficiency virus (HIV) perinatal transmission.•Every woman has the right to decide about her reproductive life. For WHIV who do not want or are not ready at the time, pregnancy increases their risk of perinatal transmission and maternal mortality because of higher attrition rates from prenatal services and poor antiretroviral adherence.•In generalized epidemic settings, such as in Africa, evidence shows that the integration of sexual and reproductive health with HIV services for WHIV with counseling and the availability of modern contraceptive methods reduces unplanned pregnancies and HIV perinatal transmission. The evidence in Latin America is scarce, and most countries continue to use a nonintegrated strategy with stable HIV perinatal transmission rates.•This study opens the possibility for integrating these services in Colombia, a concentrated epidemic setting, to inform local stakeholders of the benefits of this strategy and serves as an input for health policy decisions in similar Latin American countries.