MIDWIVES’ PERFORMANCE IN IMPLEMENTING THE PREVENTION OF MOTHER-TO-CHILD HIV TRANSMISSION PROGRAM: A QUALITATIVE STUDY IN TWO INDONESIAN HEALTH CENTERS

Abstract

Mother-to-child transmission (MTCT) remains an important route of HIV infection in children. Indonesia’s Prevention of Mother-to-Child HIV Transmission (PPIA) program integrates HIV counseling and screening into antenatal care (ANC), with midwives playing a key role in service delivery. However, qualitative evidence from Indonesia examining midwives’ implementation of PPIA against service standards remains limited. Previous studies have largely focused on program-level challenges, health-system readiness, or the experiences of mothers living with HIV. This study addresses this gap by examining both the quality and coverage of PPIA services, triangulating perspectives from midwives, health-center managers, and pregnant women with direct observations, and exploring implementation across two health-center settings. This study aims to assess midwives' performance in implementing the PPIA program in ANC services. The research was conducted at Bandar Baru and Padang Pasir Health Centers, focusing on VCT services. This descriptive qualitative study was conducted at Bandar Baru Health Center, North Sumatra, and Padang Pasir Health Center, West Sumatra, in 2024. The study involved 26 informants, comprising 12 midwives, four health-center managers, and 10 pregnant women. Data were collected through in-depth interviews, observation, and document review. Data were analyzed using qualitative content analysis, with triangulation of sources, methods, and study sites employed to enhance the trustworthiness of the findings. The results indicate that midwives' performance in implementing the PPIA program in ANC services is still suboptimal in terms of both quality and quantity. Factors affecting midwives' performance that need improvement for the PPIA program include job description distribution. PPIA training, provision of counseling aids, collaboration with private HIV prevention foundations, and religious leaders.