Abstract

In Indonesia, more than half of pregnant women seek antenatal care (ANC) at private midwifery clinics. The midwives play an important role in advocating for voluntary counseling and testing (VCT) uptake among pregnant women during ANC. This study examined midwives’ perception of barriers and enabling factors with regards to refer pregnant women for HIV testing. The study was conducted in Denpasar City and Badung District, two localities in Bali with high HIV prevalence. Two focus groups discussions with 15 private midwives and five in-depth interviews were conducted. Data were transcribed verbatim and thematic analysis methods were used to examine patterns emerging from the data. Results showed that private midwives face personal barriers in the form of stigma as well as institutional barriers such as VCT operational hours that limit how and when they refer women for VCT. Barriers are strengthened by lack of support or reward from the health office. However, opportunities for integrated and comprehensive support systems within the health system and supportive social environment which would make it easy and rewarding for midwives to refer women to VCT clinics were seen as enabling factors. Increasing uptake of VCT is a necessity for eliminating mother to child HIV transmission.

References

1. United Nations Programme on HIV/AIDS. Global Report: UNAIDS report on the global AIDS epidemic 2013. UNAIDS; 2013.

2. United Nations Programme on HIV/AIDS. HIV in Asia and the Pacific: UNAIDS report 2013. Bangkok, Thailand: UNAIDS; 2013.

3. Kementerian Kesehatan Republik Indonesia. Laporan perkembangan HIV-AIDS (HIV/AIDS report). Jakarta: Direktorat Pengendalian Penyakit dan Penyehatan Lingkungan; 2013.

4. Drake AL, Wagner A, Richardson B, John-Stewart G. Incident HIV during pregnancy and postpartum and risk of mother-to-child hiv transmission: A systematic review and meta-analysis. PLOS Medicine. 2014; 11 (2): e1001608.5.

5. Bali Provincial Health Office. Prevention of mother to child HIV transmission program report 2010. Bali: Bali Provincial Health Office; 2010.

6. Wulandari LPL, Lubis DS, Widarini P, Widyanthini DN, Wirawan IMA, Wirawan DN. HIV testing uptake among pregnant women who attending private midwife clinics: Challenges of scaling up universal HIV testing at the private sectors in Indonesia. The International Journal of Health Planning and Management; 2019.

7. World Health Organization. PMTCT strategic vision 2010-2015: Preventing mother-to-child transmission of HIV to reach the UNGASS and Millennium Development Goals: Moving towards the elimination of paediatric HIV, December 2009-2010 [cited 2019 Jun 15]. Available f rom: https://apps.who.int/iris/bitstream/handle/10665/44268/ - 9789241599030_eng.pdf

8. Ministry of Health Indonesia. Guideline of program prevention of HIV and Sifilis from mother to children (Pedoman manajemen program pencegahan penularan HIV dan Sifilis dari ibu ke Anak) Ministry of Health of Indonesia; 2015.

9. United Nations Programme on HIV/AIDS. Start free stay free AIDS free 2017 progress report 2017; 2017 [cited 2019 June 10]. Avail able from:http://www.unaids.org/sites/default/files/media_asset/JC2923_S FSFAF_2017progressreport_en.pdf.

10. Braun V, Clarke V, Hayfield N, Terry G. Thematic analysis. In: Liamputtong P, editor. Handbook of research methods in health social sciences. Singapore: Springer; 2019.

12. Peraturan Menteri Kesehatan Republik Indonesia nomor 52 tahun 2017 tentang eliminasi penularan human immunodeficiency virus, sifilis, dan hepatitis B dari ibu ke anak (Ministry of Health Regulation Number 52 Year 2017: Elimination of HIV, Sifilis and Hepatitis B from mother to child); 2017

13. Arniti NK, Wulandari LPL, Wirawan DN. Factors related to acceptance of HIV testing by pregnant mothers in health centres in Denpasar City. Public Health and Preventive Medicine Archieve (PHPMA). 2014; 2 (1): 63-9.

14. Setiyawati N, Meilani N. Determinan perilaku tes HIV pada ibu hamil. Kesmas: National Public Health Journal. 2015; 9 (3): 201-6.

15. Handayani S, Andajani S, Djuari L. Determinants of HIV provider-initiated testing and counseling screening service used by pregnant women in primary health centers in Suranstya. Medical Journal of Indonesia. 2018; 26 (4): 293-301.

16. Freedman LP, Ramsey K, Abuya T, Bellows B, Ndwiga C, Warren CE, et al. Defining disrespect and abuse of women in childbirth: A research, policy and rights agenda. Bulletin of the World Health Organization. 2014; 92: 915-7.

17. Mannava P, Durrant K, Fisher J, Chersich M, Luchters S. Attitudes and behaviours of maternal health care providers in interactions with clients: A systematic review. Globalization and Health. 2015; 11 (1): 36.

18. Samaran SZ, Sriatmi A. Impementasi program penjaringan “Prevention of mother to child transmission of HIV” (PMTCT) oleh bidan di pusat kesehatan masyarakat wilayah kerja dinas kesehatan Kota Sorong Provinsi Papua Barat. Jurnal Manajemen Kesehatan Indonesia. 2013; 1 (3): 206-15.

19. Stinson K, Giddy J, Cox V, Burton R, Ibeto M, Cragg C, et al. Reflections on a decade of delivering PMTCT in Khayelitsha, South Africa. Southern African Journal of HIV Medicine. 2014; 15 (1): 30-2.

20. Larasaty Nd, Purwanti IA. Kajian niat ibu hamil dalam melakukan voluntari counseling and tesing di puskesmas kota Semarang. Jurnal Kebidanan. 2016; 4 (2): 103-13.

21. Badriah F, Tahangnacca M, Alkaff R, Abe T, Hanifah L. Implementation of prevention of mother to child transmission of HIV program in South Jakarta. Kesmas: National Public Health Journal. 2018; 12 (4): 159-64.

22. Masters SH, Agot K, Obonyo B, Napierala Mavedzenge S, Maman S, Thirumurthy H. Promoting partner testing and couples testing through secondary distribution of HIV self-tests: A randomized clinical trial. PLOS Medicine. 2016; 13 (11): e1002166.

23. Thirumurthy H, Masters SH, Mavedzenge SN, Maman S, Omanga E, Agot K. Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: A cohort study. The Lancet HIV. 2016; 3(6): e266-74.

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