Supply-side readiness to deliver HIV testing and treatment services in Indonesia: Going the last mile to eliminate mother-to-child transmission of HIV

Abstract

Introduction Despite national efforts to integrate Prevention of Mother-to-Child Transmission (PMTCT) of HIV services into antenatal care in Indonesia, the rate of mother-to-child transmission of HIV remains the highest in the world. A range of barriers to uptake and long-term engagement in care have been identified, but far less is known about health system preparedness to deliver PMTCT of HIV services. This study explored supply-side barriers to the delivery of PMTCT services in Indonesia and whether these factors are associated with the uptake of antenatal HIV testing. Materials and methods An ecological analysis was undertaken, linking data from the World Bank Quality Service and Delivery Survey (2016) with routine data from Indonesia’s HIV and AIDS case surveillance system and district health profile reports (2016). Supply-side readiness scores—generated from a readiness index that measures overall structural capacity and is often used as proxy for quality of care—were adapted from the WHO Service Availability and Readiness Assessment and presented by sector and geographic area. Univariate and multivariate regression analysis was used to explore factors associated with the uptake of antenatal HIV testing in public facilities. Results In general, public facilities scored more highly in most inputs compared to private facilities. Facilities located in urban areas also scored more highly in the majority of inputs compared to ones in rural areas. Readiness scores were lowest for PMTCT services compared to Antenatal Care and HIV Care and Support services, especially for the availability of medicines such as zidovudine and nevirapine. The national composite readiness score for PMTCT was only 0.13 (based on a maximum score of 1) with a composite score of 0.21 for public facilities and 0.06 for private facilities. The multivariate analysis shows that the proportion of pregnant women tested for HIV was more likely to be greater than or equal to 10% in facilities with a higher readiness score and a higher number of trained counsellors available, and less likely in facilities located outside of Java-Bali and in facilities supporting a higher number of village midwives. Discussion Despite targeted efforts by the Indonesian government and multinational agencies, significant gaps exist in the delivery of PMTCT that compromise the standard of care delivered in Indonesia. Future strategies should focus on improving the availability of tests and treatment, especially in the private sector and in rural areas.

Investigating health service availability and readiness for antenatal testing and treatment for HIV and syphilis in Papua New Guinea

“…Factors that had a statistically significant association with testing and treatment were the size of the catchment population and the type of health facility. Similar studies recognize the association between supply-side factors, such as health facility readiness, and testing and treating for HIV and syphilis [ 18 , 73 , 74 ]. Thus, future research that includes additional variables, such as trained staff and guidelines, and a larger sample would improve our understanding of the relationship between supply side readiness and antenatal testing and treatment for HIV and syphilis in PNG.…”

Challenges to integrating programs for the elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B into antenatal care: Experiences from Indonesia

“…In the same report, the government pledged its commitment to reducing maternal and newborn mortality, in the context of achieving the Sustainable Development Goals for maternal and newborn health by 2030 [ 23 ]. ANC services in Indonesia are delivered through the MCH program, by both public ( puskesmas (a government-funded primary and public health care centre at the subdistrict level), their network, and government hospitals) and private providers (private midwife clinics, private obstetrician clinics, private clinics, and private hospitals [ 22 , 24 ]. These services are organised into three tiers—primary care, secondary care, and tertiary care.…”

“…Previous studies in Indonesia examining the implementation of HIV and/or syphilis testing by ANC services in Indonesia have identified a number of challenges, including lack of district guidelines and clinic standard operating procedures (SOPs) to support the national policy for the EMTCT [ 16 ], lack of access to testing by pregnant women due to distance and the limited number of primary health care centres offering testing [ 17 ], inconvenient opening hours of testing services [ 18 ], low level of knowledge on HIV and/ or syphilis testing policies among health providers [ 19 ], poor quality counselling [ 20 ], lack of privacy and confidentiality [ 21 ], and significant variation in the level of health infrastructure needed for service delivery across geographic areas and by provider type (i.e. private/public) [ 22 ]. There have been no recent studies exploring the perspectives of policymakers and frontline health workers on challenges in the integration of the EMTCT of HIV, syphilis, and hepatitis B program into ANC services since its implementation in 2018.…”

Human Immunodeficiency Virus management in pregnant women at Kupang City Hospital East Nusa Tenggara

“…Another study in Indonesia stated that to achieve the target of reducing the transmission of HIV, syphilis, and hepatitis B from mother to child threefold, strengthening the capacity of all primary healthcare providers in providing PMTCT services must be a priority. This includes better integration of private providers, particularly private midwives, into the Indonesian healthcare system (24). Screening activities require mother cards that are integrated with PMTCT and reagents for HIV testing, while referral activities require two-way communication between MCH (Mother and Child Health Department) and VCT clinics (18).…”

“…Indonesia has adopted the Prevention of Mother-to-Child Transmission (PMTCT) as a national policy, following a voluntary counseling and testing approach (5). Assessing the implementation of programs in the province of Nusa Tenggara Timur (NTT), especially in the city of Kupang, as a barometer for the implementation of health programs in the province of NTT, it is necessary to survey the implementation of the Prevention of Mother to Child Transmission (PPIA) program implemented in hospitals.…”