Supply-side readiness to deliver HIV testing and treatment services in Indonesia: Going the last mile to eliminate mother-to-child transmission of HIV.
Supply-side readiness to deliver HIV testing and treatment services in Indonesia: Going the last mile to eliminate mother-to-child transmission of HIV.
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DOI：
10.1371/journal.pgph.0000845
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发表时间：
2022
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尽管印度尼西亚全国努力将预防艾滋病毒母婴传播服务纳入产前保健，但艾滋病毒母婴传播率仍然是世界上最高的。已经查明了接受和长期参与护理的一系列障碍，但对卫生系统提供防止母婴传播艾滋病毒服务的准备情况知之甚少。这项研究探讨了在印度尼西亚提供预防母婴传播服务的供方障碍，以及这些因素是否与产前艾滋病毒检测的摄取有关。进行了生态分析，将世界银行质量服务和交付调查（2016年）的数据与印度尼西亚艾滋病毒和艾滋病病例监测系统和地区健康状况报告（2016年）的常规数据联系起来。供应方准备得分--由准备指数产生，该指数衡量总体结构能力，通常用作护理质量的替代指标--改编自世卫组织服务可用性和准备评估，并按部门和地理区域列出。采用单因素和多因素回归分析，探讨与公共设施产前艾滋病毒检测的相关因素。一般而言，公共设施在大多数投入方面的得分高于私人设施。与农村地区相比，城市地区的设施在大多数投入方面得分更高。与产前护理和艾滋病毒护理和支助服务相比，预防母婴传播服务的准备程度得分最低，特别是在齐多夫定和奈韦拉平等药物的供应方面。全国预防母婴传播准备情况综合得分仅为0.13（最高分为1），公共设施的综合得分为0.21，私人设施为0.06。多变量分析表明，在准备程度较高、受过培训的咨询人员数量较多的设施中，接受艾滋病毒检测的孕妇比例更有可能大于或等于10%，而在爪哇巴厘岛以外的设施和支持较多乡村助产士的设施中，接受艾滋病毒检测的孕妇比例则不太可能大于或等于10%。尽管印度尼西亚政府和多国机构做出了有针对性的努力，但在提供预防母婴传播方面仍存在重大差距，影响了印度尼西亚提供的护理标准。今后的战略应侧重于改善检测和治疗的提供，特别是在私营部门和农村地区。
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. 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. 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. 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.