THE OUTCOME OF PMTCT GUIDELINE IMPLEMENTATION TOWARDS THE PROGRAM PERFORMANCE FOR THE ELIMINATION OF HIV TRANSMISSION FROM MOTHER TO CHILD IN DENPASAR CITY

Abstract

UNAIDS report on the level of HIV transmission from mother to child shows that Indonesia is in the highest rank in the world. This study aims to conduct rapid assessment about the full extent of PMTCT program and services in Denpasar City, Bali. This study located Denpasar City as a capital of Bali with high HIV cases and currently apply PMTCT services. The study conducted through FGDs, in-depth interview and observation in the primary health centers and hospitals. The data was validated by triangulating data from several sources. The results showed that the there is no specific local policy for PMTCT programs and services. There is no PMTCT program management guideline or SOP for PMTCT services at the Health Office and primary health centers. In Denpasar City there are already 5 primary health centers that provide comprehensive HIV and AIDS prevention and treatment services (LKB), and this includes providing PMTCT services consisting of HIV testing and ARV treatment for pregnant women. However, there is no ARV treatment for infant, this service must be obtained at general hospital through a referral mechanism. There is funding from local government (APBD) to buy diagnostic test for HIV and to capacity strengthening of human resources, but no support for further laboratory examinations. The empowerment for midwives to be involved in PMTCT program is limited, there has never been a comprehensive training on PMTCT and no empowerment of private practice midwives for PMTCT. The assistance’s activities to ensure ARV adherence is limited. There has been assistance for HIV positive mothers by NGOs in Denpasar City. Women with HIV still get stigma and discrimination from the community and health workers. There are also some challenges in data input, including error in inputting the data that need permission to edit it. It is recommended to improve: the HIV test coverage to 100% for pregnant women (for the first 90); the coverage and quality of ARV treatment (for the second 90); the capacity of PMTCT human resources; the commitment of local government; and data utilization.