Improving uptake of effective family planning (FP) and modern contraceptives and combatting HIV are components of the Sustainable Development Goals (SDG 3) [
1] but remain a challenge in Sub-Saharan Africa [
2]. In this region, only 28% of married (or in union) women aged 15-49 years use any effective FP method [
3,
4]. The unmet need for FP (defined as women who are fecund and sexually active and report not wanting any more children or wanting to delay the next child but are not using any method of contraception) is estimated at 24% [
2‐
4]. Family Planning is a key component of prevention of mother-to-child transmission (PMTCT) of HIV in high HIV prevalence settings [
5]. Moreover unintended pregnancies irrespective of the HIV status, lead to high numbers of pregnancies, abortions, and other pregnancy and/or delivery complications; which constrain the health care systems [
6]. There are also psychosocial and economic burdens to mothers and their families that come along with these unintended pregnancies [
7].
Sub-Saharan Africa has the highest HIV burden with 24.7 million individuals living with HIV, accounting for 71% of all HIV-infected individuals globally, the majority of whom are women (58%) [
8]. Pregnancies in HIV infected women pose additional health risks that are associated with increased mortality and morbidity for both mothers [
9‐
13] and their infants [
14‐
17]. Therefore, prevention of unintended pregnancies among HIV-infected women is crucial both to curb rates of mother-to-child transmission of HIV [
5,
18‐
20] and to promote better health outcomes for HIV-infected mothers and their children [
9‐
13] .
In Uganda, the HIV prevalence in the 15-49 year-old population is high at 7.3% and even higher at 8.3% among women in this age category [
21]. At the same time, Uganda has an extremely high life time fertility rate which was 6.2 in 2011 [
21] and is currently estimated at 5.8 [
22]. The use of any contraceptive method among married Ugandan women aged 15-49 years is only at 30% while the unmet need for FP is 34% [
4,
21] . This is of particular concern as the low use of modern FP methods has led to a high incidence of unintended pregnancies among both HIV-infected and HIV-uninfected women [
23]. To increase opportunities for FP uptake, health care systems strive to provide integrated HIV, FP and other reproductive health services. However, the scale-up of FP service delivery in Uganda, has been hampered by the shortages of human resources for health (HRH) [
24]: in 2010, the ratio of midwives to patients was 1: 9000, nurses to patients was 1: 1700, and doctors to patients was 1:25,000. The current staffing, skill level, and service structure within the Ugandan health care system does not provide for adequate and equitable FP services access to the population [
24]. In addition, FP uptake is further hampered by patient bias, pervasive misbeliefs, and lack of information. The missed opportunity is that HIV-infected women regularly come to the health units but do not receive family planning services. These problems have been associated with limited human and financial resources; and low priority attached to FP by health care workers [
24]. The rationale of employing peer family planning champion was premised on the notion that people often understand health education messages if delivered to them by a peer or someone who they perceive has or is experiencing similar situations. For this reason peer family planning champions may be more acceptable communicators than trained health workers in influencing individual behavior of peer mothers. The peer to peer interaction increases the social acceptability of health advice and services. In our previous paper we demonstrated that use of peers, influential community lay persons and Village Health Team (VHT) members increased 6-week mother-baby postnatal attendance from 37.1% at baseline to 78.5% and increased early infant diagnosis from 53.6% to 86.3% among mothers and their infants. The increase was majorly attributed to the peer mothers’ support, because the mothers reported to be more comfortable sharing their problems with the peers than the community lay persons; most mothers only disclosed their HIV status to peers and the project staff and declined to be followed by the community lay persons [
25] . In another study conducted in Western Uganda, employing peer mothers resulted in increased uptake of family planning services among women living with HIV by 79% (
p < 0.001) [
26] However, in areas where PMTCT is well managed with high services uptake, peer mothers have limited additional benefit in increasing uptake of core PMTCT services. In Western Cape Province of South Africa, a study conducted in a setting with high PMTCT core services uptake, mentor mothers provided no additional increase in services uptake when compared with the standard of using traditional health worker to offer counselling. The study however, showed that the mentor mothers were more effective in conveying information and improving participants’ emotional outlook and hopefulness compared to the standard arm [
27]. The ACCLIAM study conducted in Swaziland, Uganda, and Zimbabwe, to assess the effect of a package of multilevel community interventions (a social learning and action component, community dialogues, and peer-led discussion groups), on the demand for, uptake of, and retention of HIV positive pregnant/postpartum women in MCH/PMTCT service, found no incremental benefit resulting from peer-led discussion groups. This may have been associated to spurious effect of peer mother that were employed to work in the same health facilities by other projects [
28]. This study therefore sought to further understand the impact of delivering FP counselling and education by mothers living with HIV (Family Planning Peer Champions) on 1) identifying women with unmet need for FP; 2) improving referrals for FP; and 3) increasing uptake of FP among HIV-infected women attending antenatal care (ANC) or postnatal care (PNC) at Mulago National Referral Hospital.