Improving access to PMTCT services via a novel implementation model: organizational support, health education, and HIV testing at the community level of West Java, Indonesia

ABSTRACT

In Indonesia, access to services for the prevention of mother-to-child transmission (PMTCT) is quite low. The objective of this study was to design and implement a model to improve access to PMTCT services. This study was a quasi-experimental design involving 770 pregnant women in 2 districts (intervention and control district; n = 385 each). The implementation model had four stages: exploration, installation, initial implementation, and full implementation. The key activities included the provision of health education, an offering HIV testing, and the implementation of HIV tests for pregnant women in the community. The success of the model was assessed using three indicators: 1) the increase in the proportion of health facilities offering PMTCT services, 2) increase in the proportion of pregnant women who were offered HIV testing, and 3) increase in the proportion of pregnant women underwent HIV testing. The effectiveness of the model was assessed using multiple logistic regression analysis. In the intervention district, the number of facilities that offered PMTCT services increased from 6% to 34%, and the number of pregnant women who underwent HIV tests increased from 4.7% to 85.5%. Pregnant women in the intervention district showed greater access to PMTCT after controlling by the education of pregnant women, the role of decision making in the family, education and knowledge of the husband (odds ratio = 63.6; 95% confidence interval: 38.9–103.8; p = 0.000). The implementation model effectively improved access to PMTCT services. A multi-phased approach implemented in this study was able to overcome the barriers to access PMTCT services.

KEYWORDS:

• Implementation model
• PMTCT
• HIV testing
• health education
• West Java

Acknowledgments

We would like to thank dr. (Mr.) Asep Hidayat Lukman, the head of the District Health Office in Karawang District, for giving us permission to implement the study. We would also like to thank dr. (Mrs.) Rina Listiana and dr. (Mrs.) Yayuk, who facilitated the HIV training for midwives. We also thank all midwives in Karawang District for providing health education and HIV testing services to pregnant women in the community. We would also like to thank the pregnant women in Karawang and Bekasi Districts for participating in the study.

Disclosure statement

No potential conflict of interest was reported by the authors.