Preventing mother-to-child transmission of HIV in Vietnam and Indonesia: Diverging care dynamics

Hardon, Anita; Oosterhoff, Pauline; Imelda, Johanna Debora; Nguyen, Thi Anh Huong; Hidayana, Irwan Martua

doi:10.1016/j.socscimed.2009.05.043

Cited by 27 publications

(24 citation statements)

References 20 publications

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“…This PMTCT arrangement needs more client-oriented system in Indonesia, like the one in the routine provider-initiated approach in Vietnam. 12 In the fourth prong, the need for better integration of HIV care, treatment and support for women and their families was found to be positive. There were reports of loss to follow up related incidence of HIV positive-infected mothers.…”

Section: Discussionmentioning

confidence: 99%

Implementation of Prevention of Mother to Child Transmission of HIV Program in South Jakarta

Badriah

Tahangnacca

Alkaff

et al. 2018

Kesmas: National Public Health Journal

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Even though Prevention of Mother to Child Transmission (PMTCT) program has been running in Indonesia since 2006, the proportion of human immunodeficiency virus (HIV)-infected pregnant women remains high in some districts in Indonesia. The PMTCT program aims to reduce transmission of HIV from mother to child. Thus it requires an examination of the PMTCT program implementation. The study was a qualitative study on PMTCT program implementation in South Jakarta, Indonesia, whereas the proportion of children with HIV positive in the area was quite high. The analysis used domain analysis by looking the implementation of PMTCT as a system consisting of input, process and output. PMTCT strategy is based on a comprehensive four-pronged strategy. This study found that scaling-up communication and education about PMTCT program from health provider to community was needed. In the first prong, there was no specific health provider for PMTCT program, it was still integrated with the MCH staff. PMTCT program did not disseminate information to the community.Therefore, it seemed that it was underutilized. In the second prong, implementation of HIV testing and counseling for couples of women living with HIV remained a bottleneck because women living with HIV felt fear to inform their HIV status to their partners. Thus, counseling and HIV testing for couples have not benefited at all. These women were unsatisfied with the quality of counseling, and the failure to provide antiretroviral treatments. This study found the low coverage and less responsiveness of PMTCT program to build a network of partners with various elements of government.

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Section: Discussionmentioning

confidence: 99%

Implementation of Prevention of Mother to Child Transmission of HIV Program in South Jakarta

Badriah

Tahangnacca

Alkaff

et al. 2018

Kesmas: National Public Health Journal

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“…Outcomes other than intervention coverage such as cost-effectiveness, impact on quality of care, human resources and stigma [48], [58] and the wide range of contexts in which these programs are implemented should also be considered [59]–[62]. The effectiveness of PMTCT program delivery models depends also on HIV prevalence, health seeking behavior and the dominant mode of horizontal HIV transmission among attendees.…”

Section: Discussionmentioning

confidence: 99%

Integrating Prevention of Mother-to-Child HIV Transmission Programs to Improve Uptake: A Systematic Review

et al. 2012

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BackgroundWe performed a systematic review to assess the effect of integrated perinatal prevention of mother-to-child transmission of HIV interventions compared to non- or partially integrated services on the uptake in low- and middle-income countries.MethodsWe searched for experimental, quasi-experimental and controlled observational studies in any language from 21 databases and grey literature sources.ResultsOut of 28 654 citations retrieved, five studies met our inclusion criteria. A cluster randomized controlled trial reported higher probability of nevirapine uptake at the labor wards implementing HIV testing and structured nevirapine adherence assessment (RRR 1.37, bootstrapped 95% CI, 1.04–1.77). A stepped wedge design study showed marked improvement in antiretroviral therapy (ART) enrolment (44.4% versus 25.3%, p<0.001) and initiation (32.9% versus 14.4%, p<0.001) in integrated care, but the median gestational age of ART initiation (27.1 versus 27.7 weeks, p = 0.4), ART duration (10.8 versus 10.0 weeks, p = 0.3) or 90 days ART retention (87.8% versus 91.3%, p = 0.3) did not differ significantly. A cohort study reported no significant difference either in the ART coverage (55% versus 48% versus 47%, p = 0.29) or eight weeks of ART duration before the delivery (50% versus 42% versus 52%; p = 0.96) between integrated, proximal and distal partially integrated care. Two before and after studies assessed the impact of integration on HIV testing uptake in antenatal care. The first study reported that significantly more women received information on PMTCT (92% versus 77%, p<0.001), were tested (76% versus 62%, p<0.001) and learned their HIV status (66% versus 55%, p<0.001) after integration. The second study also reported significant increase in HIV testing uptake after integration (98.8% versus 52.6%, p<0.001).ConclusionLimited, non-generalizable evidence supports the effectiveness of integrated PMTCT programs. More research measuring coverage and other relevant outcomes is urgently needed to inform the design of services delivering PMTCT programs.

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“…Among people living with HIV/AIDS in the region, the proportion of females rose from 19% in 2000 to 35% in 2008 [7]. Therefore, in order to protect women from HIV and reduce the rate of HIV transmission among infants born to HIV-infected mothers, PMTCT programmes have been launched in a number of Asian countries, including Thailand, India, Malaysia, China and Vietnam [5,8-10]. …”

Section: Introductionmentioning

confidence: 99%

Number and timing of antenatal HIV testing: Evidence from a community-based study in Northern Vietnam

2011

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BackgroundHIV testing for pregnant women is an important component for the success of prevention of mother-to-child transmission of HIV (PMTCT). A lack of antenatal HIV testing results in loss of benefits for HIV-infected mothers and their children. However, the provision of unnecessary repeat tests at a very late stage of pregnancy will reduce the beneficial effects of PMTCT and impose unnecessary costs for the individual woman as well as the health system. This study aims to assess the number and timing of antenatal HIV testing in a low-income setting where PMTCT programmes have been scaled up to reach first level health facilities.MethodsA cross-sectional community-based study was conducted among 1108 recently delivered mothers through face-to-face interviews following a structured questionnaire that focused on socio-economic characteristics, experiences of antenatal care and HIV testing.ResultsThe prevalence of women who lacked HIV testing among the study group was 10% while more than half of the women tested had had more than two tests during pregnancy. The following factors were associated with the lack of antenatal HIV test: having two children (aOR 2.1, 95% CI 1.3-3.4), living in a remote rural area (aOR 7.8, 95% CI 3.4-17.8), late antenatal care attendance (aOR 3.6, 95% CI 1.3-10.1) and not being informed about PMTCT at their first antenatal care visits (aOR 7.4, 95% CI 2.6-21.1). Among women who had multiple tests, 80% had the second test after 36 weeks of gestation. Women who had first ANC and first HIV testing at health facilities at primary level were more likely to be tested multiple times (OR 2.9 95% CI 1.9-4.3 and OR = 4.7 95% CI 3.5-6.4), respectively.ConclusionsNot having an HIV test during pregnancy was associated with poor socio-economic characteristics among the women and with not receiving information about PMTCT at the first ANC visit. Multiple testing during pregnancy prevailed; the second tests were often provided at a late stage of gestation.

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Preventing mother-to-child transmission of HIV in Vietnam and Indonesia: Diverging care dynamics

Cited by 27 publications

References 20 publications

Implementation of Prevention of Mother to Child Transmission of HIV Program in South Jakarta

Implementation of Prevention of Mother to Child Transmission of HIV Program in South Jakarta

Integrating Prevention of Mother-to-Child HIV Transmission Programs to Improve Uptake: A Systematic Review

Number and timing of antenatal HIV testing: Evidence from a community-based study in Northern Vietnam

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