Evaluation of Quality of Prevention of Mother to Child Transmission of HIV Service Provision and Its Determinants: The Case of Health Facility Readiness and Mothers’ Perspectives

Figures & data

Table 1 Socio-Demographic Characteristics of Pregnant Mothers PMTCT Service Users in Gondar City Public Health Facilities, Northwest Ethiopia, 2022 (n=334)

Quality of PMTCT	Frequency	Percentage
Variables
Age
15–24	112	34
25–34	157	47
35–50	65	19
Religion
Orthodox Christian	264	79
Muslim	57	17
Others*	13	4
Marital status
Not married	44	13
Married	290	87
Number of pregnancies
First time	90	27
Not first time	244	73
Place of residence
Gondar city	277	83
Out of Gondar city	57	17
Ethnicity
Amhara	263	79
Kimant	54	16
Others**	17	5
Level of education
Unable to read and write	60	18
Primary school	117	35
Secondary and above	157	47
Occupation status
Housewife	130	39
Governmental employed	100	30
Merchant	90	27
Others$	14	4

Notes: Others ethnicity **=Tigre, Oromia and others, *Others religion= Protestant, Catholic, Others occupation$=day labor, privet worker, waitress.

Table 2 Public Health Facilities Not Fulfilling 100% of Input Service Quality Performance Verification Indicators in Gondar City, Northern Ethiopia, 2022 (n=09)

Quality Items for Input	Number of Facilities	Percentage
Human resource and infrastructure related
Well-ventilated waiting room	5	55.56
Well-ventilated counseling room	6	66.67
Cleanness of counseling rooms	7	77.78
Trained service providers for PMTCT	9	100
Medical supplies
Cotrimoxazole prophylaxis	7	77.78
DBS sample collection kit	3	33.34
Job aid IEC materials
PMTCT broachers	4	44.45
PMTCT leaflets	4	44.45
Technical guide line	3	33.34
PMTCT cure card	5	55.56
Patient forms and registers
Referral slips	6	66.67
Referral linkage slips	4	44.45
Appointment cards	8	88.89
PMTCT link with other MCH units	5	55.56

Table 3 Public Health Facilities Not Fulfilling 90% of Process Service Quality Performance Verification Indicators in Gondar City, Northern Ethiopia, 2022 (n=09)

Quality Items for Process	Number of Facilities	Percentage
Facility suitable opening hour	5	55.56
Client greeting and welcoming	7	77.78
Introducing himself to clients	3	33.34
Waiting time to the counselor	6	66.67
Adequacy of counseling session	5	55.56
Counselor confidence during counseling	8	88.89
Conduct history taking	9	100
Conduct physical examination	9	100
Screening for opportunistic infection	6	66.67
Discus issues of reproductive health	3	33.34
Support for disclosure	8	88.89
Reviewing need of partner notification	6	66.67
Reviewing ARV drug adherence	9	100
Reviewing about safe sex practice	8	88.89
Reviewing of HIV infection	8	88.89
Screening for substance abuse	3	33.34
Discus issues of psychosocial support	4	44.45
Counseling for nutritional support	8	88.89
Screening for STI	7	77.78
Screening for cervical cancer	4	44.45
Calling clients by name	2	22.22
Encouraging women to ask questions	4	44.45
Reviewing mothers understanding	5	55.56
Conduct child growth assessment	9	100
Review issues of child immunization	9	100
Reviewing issues of infant feeding	8	88.89
Initiating cotrimoxazole therapy	9	100
Review TB risk assessment	8	88.89
Conduct virologic test at 6 weeks of age	9	100
Conduct anti-body test at 18 months of age	8	88.89

Table 4 Public Health Facilities Not Fulfilling 90% of Output Service Quality Performance Verification Indicators in Gondar City, Northern Ethiopia, 2022 (n=09)

Quality items for Output Service	Number of Facilities	Percentage
Client satisfaction per standard	6	66.67
Clients with good treatment adherence	8	88.89
Clients involved partner testing	8	88.89
Early infant diagnosis for virological test	9	100
Confirmatory antibody test	9	100
DBS result turnaround time per standard	5	55.56
Enrolling HIV positive pediatrics to HIV chronic care	9	100
Perform CD4 count as base line during their initial visit	9	100
Perform CD4 count at least one as follow up visit	9	100

Table 5 Client Satisfaction with the Comfort and Privacy of Counseling Room, and Adequacy of Counseling Session; Quality of PMTCT Services in Public Health Facilities in Gondar City, Northwest, Ethiopia 2022 (n=334)

Items: How do You Rate Your Satisfaction With	Very Dissatisfied n (%)	Dissatisfied n (%)	Neutral n (%)	Satisfied n (%)	Very Satisfied n (%)
Provider’s greeting was good and friendly?	23 (6.87)	99 (29.64)	50 (15.97)	112 (33.53)	50 (15.97)
Comfort of the waiting room	32 (9.58)	60 (17.96)	67 (20.06)	112 (33.53)	63 (18.86)
Waiting time	90 (26.95)	61 (18.26)	29 (8.68)	103 (30.84)	51 (15.27)
Comfort of the counseling room	31 (9.28)	73 (21.85)	39 (11.68)	123 (36.83)	68 (20.36)
Adequacy of duration of the counseling session	12 (3.60)	77 (23.05)	9(2.69)	200 (59.88)	36 (10.77)
Privacy of the counseling room	9(2.70)	19 (5.69)	37 (11.08)	118 (35.33)	151 (45.21)
The cleanliness and sanitation of procedure	11 (3.29)	102 (30.54)	0(0.00)	137 (41.02)	84 (25.15)
Fairness of total time you spent	67 (20.06)	98 (29.34)	88 (26.35)	33 (9.88)	48 (14.37)
Open time of health facility	70 (20.10)	109 (32.63)	61 (18.26)	35 (10.50)	59 (17.66)

Table 6 Client Satisfaction by Counselor’s Characteristics and Availability of Services, Quality of PMTCT Services in Public Health Facilities in Gondar City, Northwest, Ethiopia 2022 (n=334)

Items: How do You Rate Your Satisfaction with:	Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very satisfied
Respectfulness of the counselor	0 (0.00)	101 (30.24)	28 (8.38)	100 (10.00)	105 (31.44)
Trustworthiness of the counselor	9 (2.69)	89 (26.65)	9 (2.69)	125 (37.43)	102 (30.54)
Clarity of the counselor’s explanation	7 (2.10)	9 (2.69)	98 (29.34)	190 (56.89)	30 (8.98)
The counselor’s competency	0 (0.00)	13 (3.89)	87 (26.05)	121 (36.23)	113 (33.83)
Laboratory service available when always needed	102 (30.54)	97 (29.04)	8 (2.40)	115 (34.43)	12 (3.60)
Availability of information to MTCT and PMTCT	8 (2.40)	44 (13.17)	45 (13.47)	93 (27.84)	144 (43.11)
Clear explanation about Appointment date	0 (0.00)	9 (2.69)	78 (23.35)	186 (55.69)	61 (18.26)

Table 7 Direct Observation of HCT Quality of PMTCT Services in Public Health Facilities in Gondar City, Northwest, Ethiopia 2022 (n=135)

Observation items	Met, n (%)	Not met, n (%)
Invite client into the room and offer chair to sit	130 (96.30)	5 (3,70)
Greet patient with respect	131 (97.04)	4 (2.96)
Introduce self to client	90 (66.67)	45 (33.33)
Call client by name	29 (21.48)	106 (78.52)
Discuss the need and benefits of HIV testing	99 (73.33)	36 (26.67)
Ensure understanding of the client by asking pertinent questions	87 (64.44)	48 (35.56)
Explain the HIV testing procedure	100 (74.07)	35 (25.93)
Explain the possible HIV test result	119 (88.15)	16 (11.85)
Inform the client when the result will be ready and how and where to receive	101 (74.82)	34 (25.18)
Complete below for negative test result only
Test result ready before post-test counseling session begins	103 (76.30)	32 (23.70)
Close the door or draws the curtains of the room to ensure privacy	111 (82.22)	24 (17.78)
Invite client into the room	121 (89.63)	14 (10.37)
Offers client a seat	130 (96.30)	5 (3.70)
Thank the client for waiting	34 (25.19)	101 (74.81)
Inform client that the test result is available	89 (65.93)	46 (34.07)
Provide result clearly and simply	127 (94.07)	8 (5.93)
Review meaning of the result, including window period	109 (80.74)	26 (19.26)
Reinforce the need to consider the test result in reference to most recent risk exposure	34 (100)	0 (0.00)
Use language that client can understand	132 (97.78)	3 (2.22)
Maintain eye contact	67 (49.63)	68 (50.37)
Answer client’s questions	120 (100)	0 (0.00)
Reinforce prevention massages (A, B, C) so that patient can stay negative	89 (65.93)	46 (34.07)
Remind the client that her result does not indicate partner’s HIV status	56 (41.48)	79 (58.52)

Table 8 Direct Observation Result of Adherence Support Session of PMTCT Services in Public Health Facilities in Gondar City, Northwest, Ethiopia 2022 (n=135)

Observation Items	Met	Not Met
Invite client into the room and offer chair to sit	120 (88.89)	15 (11.11)
Greet client with respect	130 (96.30)	5 (3.70)
Introduce self to client	103 (76.30)	32 (23.70)
Call client by name	78 (57.78)	57 (42.22)
Discuss current health status with client including overall health and current problems; the latest laboratory result including CD4	34 (100)	0 (0.00)
Review with client possible barriers to adherence; stigma, living situation	31 (91.18)	3 (8.82)
Refill the client with standard ART regimen with clear explanation	34 (100)	0 (0.00)
Review possible drug interaction	29 (85.29)	5 (14.71)
Schedule next, discuss what should prompt and earlier visit	34 (100)	0 (0.00)
Review understanding of the client including: asking client to describe her ARV regimen	27 (79.41)	7 (20.59)

Table 9 Binary and Multiple Logistic Regression Analysis of Associated Variables with Overall Satisfaction of Pregnant Women Attending in Gondar City Public Health Facilities Northwest Ethiopia 2022

Variables	Satisfaction		COR (95%, CI)	AOR (95%, CI)
	Not Satisfied, n (%)	Satisfied, n (%)
Age
15–24	81	31	0.59 (0.37, 0.88)	0.31 (0.06, 0.79)*
25–34	79	78	1.26 (1.07,1.54)	1.19 (0.98,1.43)
35–50	24	41	1	1
Marital status
Not married	21	23	1	1
Married	90	200	2.03 (0.96,1.28)	1.12 (0.99,1.37)
Level of education
Unable to read and write	31	29	1	1
Primary school	76	41	1.25 (0.68,2.29)	1.09 (0.58,2.05)
Secondary and above	101	56	0.69 (0.49,0.85)	0.59 (0.35,0.67)*
Occupation status
Housewife	71	59	0.81 (0.66, 1.01)	0.72 (0.44, 1.15)
Governmental employed	41	59	1.17 (0.94, 1.44)	0.68 (0.39, 1.17)
Merchant	40	50	0.85 (0.66, 1.08)	1.23 (0.67, 2.22)
Others	9	5	1.15 (0.99,1.34)	0.99 (0.84,1.15)
Time of arrival
<30 minutes	23	45	1	1
30 minutes-1 hours	90	56	0.32 (0.58, 1.46)	0.96 (0.61, 1.51)
>1 hour	40	80	3.20 (1.57, 3.38)	0.71 (0.55, 0.93)*
Waiting time
<30 minutes	59	78	1	1
>30 minutes	86	111	0.94 (0.21,0.46)	0.23 (0.11,0.37)*
Counseling time adequacy
Not adequate (<15 minutes)	83	84	1	1
Adequate (> 15 minutes)	57	110	1.91 (1.34,2.99)	2.83 (1.72,3.97)*
Sex preference
No	78	89	1	1
Yes	67	100	1.31 (0.49,1.97)	1.32 (0.61,2.02)
Client perception with total time spent to finish all the services
Unfair	81	89	1	1
Fair	63	101	1.46 (0.95, 2.29)	1.31 (0.83, 2.09)
Accessibility of toilet
Dissatisfied	87	66	1	1
Satisfied	103	78	0.99 (0.16, 1.33)	0.87 (0.25, 1.47)
Opening hours of this clinic convenient
No	109	69	2.34 (2.27, 4.21)	4.27 (2.09, 6.67)*
Yes	63	93	1	1
Is there anything you did? Not like during the discussion about HIV/AIDS
No	100	99	1	1
Yes	79	56	0.72 (0.31,1.31)	0.81 (0.59,1.09)

Note: *Significant at p value <0.05.