Challenges to integrating programs for the elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B into antenatal care: Experiences from Indonesia
Issued Date
2024-03-06
Resource Type
eISSN
27673375
Scopus ID
2-s2.0-85195448827
Journal Title
PLOS Global Public Health
Volume
4
Issue
3
Rights Holder(s)
SCOPUS
Bibliographic Citation
PLOS Global Public Health Vol.4 No.3 (2024)
Suggested Citation
Wulandari L.P.L., Lubis D.S., Kurniati D.P.Y., Sumintang K., Ardrini D.A.M., Mariani P., Januraga P.P., Camellia A., Laksmi N.M.D.P., Mahmudah L., Ong J.J., Causer L., Liverani M., Guy R., Wiseman V. Challenges to integrating programs for the elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B into antenatal care: Experiences from Indonesia. PLOS Global Public Health Vol.4 No.3 (2024). doi:10.1371/journal.pgph.0002977 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/98800
Title
Challenges to integrating programs for the elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B into antenatal care: Experiences from Indonesia
Author's Affiliation
Universitas Udayana
London School of Hygiene & Tropical Medicine
School of Basic Medical Sciences
The Kirby Institute
Melbourne Sexual Health Centre
Faculty of Medicine, Nursing and Health Sciences
Mahidol University
Nagasaki University
UNICEF
Indonesia Ministry of Health
Provincial Health Office
London School of Hygiene & Tropical Medicine
School of Basic Medical Sciences
The Kirby Institute
Melbourne Sexual Health Centre
Faculty of Medicine, Nursing and Health Sciences
Mahidol University
Nagasaki University
UNICEF
Indonesia Ministry of Health
Provincial Health Office
Corresponding Author(s)
Other Contributor(s)
Abstract
The WHO's Asia-Pacific framework for triple elimination recommends that countries evaluate their programs for the elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B (EMTCT), including identifying gaps to improve program planning and the implementation of elimination strategies in antenatal care (ANC) services. In 2022, the Indonesian Ministry of Health reported that only 39% of pregnant women were tested for HIV, 14% for syphilis, and 28% for hepatitis B, respectively. We conducted a qualitative study involving a focus group discussion (FGD) and in-depth interviews with 25 key stakeholders in Bali and West Nusa Tenggara Provinces to identify specific challenges to testing for HIV, syphilis, and hepatitis B in ANC settings. Thematic analysis was used to identify the themes generated from the data. Health system bottlenecks experienced by stakeholders included supply chain management issues involving stock forecasting and stock monitoring, stock-outs of rapid test reagents which were particularly most frequent and for longer durations for syphilis and hepatitis B, high staff turnover, lack of staff training on how to perform the test, the complexity and time needed to record the data on women's characteristics, risk behaviours, and testing in both paper format and into the computer-based surveillance systems, discrepancies in program coverage data from different divisions of the district health office involved in the reporting system, high levels of stigma that prevented women from being followed up, challenges in notifying partners, and inadequate reporting and referral of women from private providers to public ones for testing. Interventions addressing the above challenges are worthy of consideration to improve the health system function and integrate EMTCT into the ANC settings.