HIV testing uptake among pregnant women attending private midwife clinics. Challenges of scaling up universal HIV testing at the private sectors in Indonesia

Introduction Being ranked seventh among countries with the highest number of new pediatric HIV infection, around 3% of new pediatric HIV infection worldwide occurs in Indonesia. UNAIDS has set a goal of elimination of mother?to?child HIV transmission, and private sector plays a critical role in achieving this goal. More than half of pregnant women in Indonesia seek antenatal care (ANC) services at private sectors, particularly at private midwife clinics. However, no published data is available on the rates of HIV testing uptake among pregnant women at these clinics, reflecting important gap on prevention of mother to child HIV transmission programmatic data. Purpose A longitudinal study was conducted to examine the rates of HIV testing uptake among pregnant women attending private midwife clinics in Bali and were referred to Voluntary HIV counselling and testing (VCT) clinics for a HIV test. Methods Seventy midwives from private clinics were asked to suggest women, who were deemed to be at risk of HIV, to seek HIV testing at the nominated VCT clinics and to provide the women with a referral. Data were then analyzed to identify the percentage of women who took HIV testing at the VCT clinics among those referred by the midwives. Results The midwives referred 619 women to VCT clinics. Of the referred women, only 321 (52%; 95% CI, 47.8%?55.9%) took a HIV test at the appointed clinics. Among these who tested, three (0.9%) were HIV positive. This study identified a challenge in scaling up HIV testing coverage among women seeking ANC services at private sectors. Implications and recommendations are discussed.