Public and private antenatal care access and utilisation as determinants of triple antenatal test for HIV, syphilis, and HBV: Evidence from the Indonesian Health Survey

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BACKGROUND: The Asia-Pacific regional roadmap for the triple elimination of mother-to-child transmission (EMTCT) of HIV, syphilis and Hepatitis B virus emphasises the importance of data-driven policymaking and private sector engagement. Utilising secondary data from a nationally representative household-based Indonesian Health Survey 2023 (IHS 2023), we examined the role of public and private sectors in the coverage of triple antenatal tests as an indicator for EMTCT. METHODS: Using data from IHS 2023, the analysis was limited to women and girls aged 10-54 years who self-reported a pregnancy with an antenatal care (ANC) visit between 2018 and 2023. Test coverage was defined as a self-reported history of antenatal testing for HIV, syphilis, and hepatitis B during their most recent pregnancy. Independent variables included access and utilisation of public & private healthcare facilities. Covariates included demographics, obstetric history, and socioeconomic status. Multivariable logistic regression models were developed using complex sample weighted analysis. RESULTS: Antenatal testing coverage for all three infections was 58.0 %. Unavailability of public health centres (PHCs, or puskesmas locally) (aOR=0.61, 95 %CI=0.45-0.84), hospitals (aOR=0.76, 95 %CI=0.66-0.89), laboratories (aOR=0.73, 95 %CI=65-0.83), and private providers (aOR=0.84, 95 %CI=0.75-0.94) were found as negative predictors, as was reliance on private providers for ANC compared to PHCs (aOR=0.65, 95 %CI=0.61-0.71). CONCLUSION: Testing coverage of these infections among pregnant women was below both the national (100 %) and global (95 %) targets. Poor access to healthcare facilities and reliance on private providers for ANC were negative predictors of testing for HIV, syphilis and Hepatitis B, suggesting potential gaps in private sector engagement with the EMTCT effort.

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