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Does facility readiness promote high-quality of provider-initiated HIV testing and counseling to pregnant women? A national survey for improving policy of prevention of mother-to-child transmission of HIV in Tanzania

Does facility readiness promote high-quality of provider-initiated HIV testing and counseling to... Background: Provider-initiated HIV testing and counseling (PITC) is a recommended approach to screen for HIV to all pregnant women during antenatal care (ANC) visits, and all with HIV positive results have to be enrolled into prevention of mother-to-child transmission of HIV (PMTCT ) program. However, little is known about the relationship between facility readiness and the uptake of PITC to pregnant women attending ANC in Tanzania. Therefore, this study assessed whether the facility readiness promotes the uptake of PITC to the pregnant women attending ANC for the purpose of improving the PMTCT interventions in Tanzania. Methods: This study analyzed data for health facilities obtained from the 2014–2015 Tanzania service provision assessment survey. The Primary outcome measure was a composite variable (with score of 0–5) in which its higher scores indicates provision of high-quality of PITC. Also, facilities scored higher in the PMTCT service readiness index were considered to have high readiness to provide PMTCT services. In Poisson regression analyses, a series of models were fitted to assess whether there is an association between provision of high-quality of PITC and facility readiness. In all statistical analysis, a P < 0.05 was considered significant. Results: Out of 1853 included first-visit ANC consultations, only about one-third of pregnant women received all five components required for PITC. The mean percentage of PMTCT readiness score was moderate 63.96 [61.32–66.59]%. In adjusted model, we found that facility with high readiness to provide PMTCT services was significantly associated with the provision of high-quality of PITC (model 2: [β = 0.075, P = 0.00]). Conclusion: In order to increase high-quality of PITC services, efforts should be made to improve the PMTCT facility readiness by increasing availability of trained staffs, diagnostic tools, and ARTs among health facilities in Tanzania. *Correspondence: bintabaradeo@gmail.com Department of Community Medicine, The University of Dodoma, Dodoma, Tanzania Full list of author information is available at the end of the article © The Author(s) 2021. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Bintabara et al. AIDS Res Ther (2021) 18:38 Page 2 of 11 Keywords: Facility readiness, High-quality, Antenatal care, Provider-initiated HIV testing and counseling, PMTCT , Tanzania Background ANC or follow-up visits are expected to receive HIV Even though sub-Saharan Africa (SSA) contains only testing and counseling, those diagnosed with HIV are about 11% of the World’s population, the region is supposed to be enrolled into the PMTCT program as home to about 70% of worldwide people infected with early as possible [18]. Although about 98% of preg- HIV [1]. In this region, the main mode of HIV trans- nant women attended ANC at least once [19], not all mission is through heterosexual sex, with women dis- received PITC services. This affect the enrollment of proportionally affected [1 , 2]. It is estimated that 95% of HIV positive pregnant women into the PMTCT pro- all HIV positive women and 80% of the 3,80,000 young gram and subsequently missed opportunities for the women who are newly infected with HIV live in SSA [3, timely initiation of treatment with antiretroviral ther- 4]. Besides, as the pregnancy status increases the risk apy [17]. of acquiring HIV infection [5], thisplacewomen in SSA The limited information regarding the observed dis - which is the area with high fertility rate and burden crepancy between high proportions of women attend- of sexually transmitted diseases to be at most vulner- ing to ANC with the availability of PMTCT service and able for HIV infection [6]. Hence, in the absence of any the poor provision of high-quality of PITC prompted preventive measures, about 25–40% of HIV-positive researches on this area. Some of the researches aimed women will transmit the virus to their newborns [7]. to identify factors associated with poor uptake of PITC The rates of Mother-To-Child Transmission (MTCT) at multiple levels such as poor knowledge of HIV verti- is relatively high in SSA with approximately 1000 new- cal transmission, age, maternal education, psychological borns infected every day [8, 9]. problems after HIV diagnosis, stigma and fear of status In Tanzania, MTCT accounts for about 18% of new disclosure to partners, family or community members. HIV infections and approximately 99,000 HIV-positive Other reported factors were poor staff-patient interac - women are estimated to deliver exposed infants annu- tions, staff shortages, service accessibility, and home ally [10]. To eliminate this burden of MTCT, in the early deliveries [20, 21]. Despite the efforts of these research - 2000s, the Tanzanian government established and then ers to identify those factors, no one examined the level of scaled up the program for the Prevention of Mother-to- facility readiness to enhance the provision of high-quality Child Transmission of HIV (PMTCT) as suggested by of PITC for PMTCT. World Health Organization (WHO) for the countries Facility readiness defined as “willingness or capacity of with limited-resource [11, 12]. The package of PMTCT health facility to provide PITC services for the PMTCT” program has been integrated into routine Reproductive is important to evaluate how the facility is committed to and Child Health (RCH) services to ensure that there fighting against MTCT of HIV infection. For that reason, is a reduced vertical transmission [12]. Similar to other not only availability of services but also together with SSA countries, Tanzania made tremendous progress in facility readiness will promise patient to receive high- coverage and accessibility of PMTCT services. How- quality of care [22, 23]. Therefore, a full understanding of ever, the country faces the challenge to enroll all HIV- the relationship between facility readiness and provision positive pregnant women due to inadequate uptake of of high-quality of PITC to pregnant women attending HIV testing and counseling [13]. This slow the efforts ANC is crucial as little is known about this relationship. toward achieving the elimination of MTCT (EMTCT) The current study was conducted to assess whether the goal, defined as a reduction of the number of new HIV facility readiness associated with provision of high-qual- infections occurring during MTCT by 90%, reduction ity of PITC to pregnant women attending first-visit ANC in the final MTCT rate to ≤ 5% among breastfeeding, in Tanzania. and ≤ 2% among non-breastfeeding populations [14, 15]. Until 2016, Tanzania achieved 69% MTCT reduc- Methods tion and the MTCT rate at the end of breastfeeding Data source gone down to 8% [16]. This study analyzed data from the 2014–2015 Tanza - The cascade of PMTCT services in Tanzania starts nia Service Provision Assessment (TSPA) survey. TSPA with provider-initiated HIV testing and counseling was designed to assess all health facilities in Tanzania (PITC) during antenatal care (ANC) attendance [17]. [24]. The survey provides information on the availabil - Through PITC all pregnant women at the first-visit of ity of basic and essential health care services and service Bin tabara et al. AIDS Res Ther (2021) 18:38 Page 3 of 11 readiness. One of the issues the survey assessed is the meet these criteria were excluded from the study (seven presence and functions of components essential for high- refused to participate, four were closed on the day of quality service delivery for antenatal care services includ- the interview, one could not be reached, 157 did not ing HIV counseling and testing services as a package of provide ANC services, 216 were not selected for ANC PMTCT. observation, 167 did not have first ANC visit observa - tions). Therefore, after excluding all facilities that did Study sample and sampling procedure not meet the inclusion criteria, a total of 648 health A list of all the formal sector health facilities such as facilities in which 1853 first-visit ANC consultations hospitals, health centres, dispensaries, and clinics pro- were performed were included for this analysis (Fig. 1). vided by the Ministry of Health and Social Welfare During data collection, the interviewers used the (MoHSW) in Tanzania Mainland and the Ministry Observation Questionnaire to assess whether the pro- of Health (MOH) in Zanzibar was used as a sampling cesses followed in observed client-provider consulta- frame in which a sample of 1200 facilities was selected tions met standards for acceptable content and quality to participate in the survey. More details about TSPA during service delivery. In this case, the interviewers survey sampling procedures are available online [24]. acting as observers sat in on consultations for ANC ser- Based on the objectives of this research, the current vices. They recorded the information shared between analysis was restricted to health facilities with at least client and provider and the processes the provider one observed first-visit ANC consultation. Hence, facil - followed when assessing the client, conducting pro- ities that reported providing ANC services, selected to cedures, and providing treatment. In our analysis, we participate for ANC observation, were open on the day focused only on the provision of PITC related services of the interview, and agreed to participate were eligible for the PMTCT. and were selected in this study. Facilities that did not Fig. 1 Selection procedure of the health facilities and ANC visits included in this analysis Bintabara et al. AIDS Res Ther (2021) 18:38 Page 4 of 11 Measurement of variables those without were categorized as "No." The fourth Outcome variable domain was medicine and commodities which has three “Provision of high-quality of PITC,” was a composite indicators, i.e., the availabilities of Zidovudine syrup, score created by using the responses observed by inter- Nevirapine syrup, and Maternal Antiretroviral (ARV) viewers if the provider performed the following five prophylaxis (either Option A: AZT, NVP, and 3TC or important services of PITC to the pregnant women dur- Option B: AZT + 3TC + LPV or AZT + 3TC + ABC or ing first-visit ANC consultations. These included (i) AZT + 3TC + EFV or TDF + 3TC (or FTC) + EF V ). Each establishing client’s HIV status, (ii) provide or refer for of the medicine indicators was categorized as “Yes” for counseling related to HIV test, (iii) perform or refer for the facilities reported the availability of that medicine(s) HIV test, (iv) provided post-test counseling and v) dis- and otherwise was categorized as “No.” For details see cussed partner testing. Each of these services scored Additional file 1: Table S1. “1” if the provider was observed to perform it, other- The PMTCT service readiness index was then totaled wise scored “0.” The composite score ranges from 0 to 5. by adding the presence of each indicator, with equal The higher scores regarded as provision of high-quality weight given to each of the domains and each of the of PITC during first-visit consultation compared to the indicators within the domains. As the target was 100%, lower scores. each domain accounted for 25% (100%/4) of the index. The percentage for each indicator within the domain was Key independent variable equal to 25% divided by the number of indicators in that Facility readiness; in this study was measured based on domain. The PMTCT service readiness index for each the score of PMTCT specific services readiness index. facility was then calculated by summing the percentages. This score was determined using a WHO approach, while The facility with less or more score in PMTCT readiness the PMTCT readiness indicators were identified accord - index were considered to have lower or higher readiness ing to WHO Service Availability and Readiness Assess- respectively. ment (WHO-SARA) reference manual [25]. Using this approach, the PMTCT service readiness index was cat- Controlling (adjusting) factors egorized into four domains. The first domain was “staff These included facilities, provider and client level vari - and guidelines,” which had four indicators, i.e., guide- ables. The facility variables were: facility location cat - lines for PMTCT, guidelines for infant and young child egorized as “urban” and “rural;”managing authorityas feeding counseling, staff trained in PMTCT, and staff “public” and “private;” facility type categorized as “hospi- trained in infant and young child feeding. The facilities tal,” “health center,” and “dispensary;”quality assurance as that reported having guidelines for PMTCT or guide- “performed” and “not performed;” and routine manage- lines for PMTCT and infant and young child feeding ment meeting as “performed” and “not performed.”The counseling was categorized as “Yes,” while those without provider variables were sex coded as “male” and “female;” such guidelines were categorized as “No.” Also, facili- cadre coded as “clinician” and “nurses;” working experi- ties with at least one staff member that had received ence coded as “ ≤ 5  years” and “ > 5  years.” Client vari- refresher training in PMTCT and infant and young child ableswere: age coded as “ < 20,” “20–34,” and “ ≥ 35;” and feeding counseling within two years before the interview level of formal education coded as “primary,” “secondary,” was categorized as “Yes,” while those without such staff and “tertiary.” members were categorized as “No.” The second domain was equipment, which had one indicator, i.e., the pres- Statistical analysis ence of visual and auditory privacy. Facilities with the During descriptive analyses, all categorical variables private room or screened off area for PMTCT that a nor - were summarized using frequencies and percentages mal conversation can be held without being overheard, and then presented in either tables or graphs. The series and without the client being observed were categorized of Poisson regression models were fitted to estimate the as “Yes,” while those without were categorized as “No.” effect of key independent variable (facility readiness) The third domain was diagnostics, which had two indi - on the outcome variable (Provision of high-quality of cators, i.e., HIV diagnostic capacity for adults and HIV PITC). The Poisson regression models were preferred diagnostic capacity for infant/ young child. Facilities than the others such as zero inflated and negative bino - with HIV Rapid Diagnostic Test (RDT) or ELISA for HIV mial models because the response variable did not have testing of adults were categorized as “Yes,” while those excessive number of zeros and did not show over-dis- without were categorized as “No.” in addition, facilities persion respectively. Moreover, the Poisson model uses with Dried Blood Spot (DBS) filter paper for diagnos - the log link function that allows all of the predicted ing HIV in newborns were categorized as "Yes," while values of the outcome variable being non-negative. Bin tabara et al. AIDS Res Ther (2021) 18:38 Page 5 of 11 Initially, unadjusted Poisson regression model (model PITC to pregnant women during the first-visit ANC 1) was fitted to identify controlling (adjusting) vari - consultations. Although the performance of all five ables that would be included for multivariable analysis. PITC services was relatively low (35.8%), there was a All variables with P < 0.05 were selected and included in satisfactory proportion of high-quality in some sepa- the multiple Poisson regression model (model 2) using a rate individual components such as counseling on HIV criterion based procedure known as Akaike’s Informa- tests (77.2%) and performing or referring to HIV tests tion Criterion (AIC). Despite AIC use similar approach (71.2%). like backward elimination method, it tends to retain some important variables that needed to be included Availability of PMTCT service readiness indicators in the final model. Similar approach was used to per - Table  2 presents the distribution of PMTCT services form a sensitivity analysis of each domain of the facility readiness indicator. About 80% of the facilities had readiness score (staff and guidelines, equipment, diag - “PMTCT guidelines” and “visual and auditory pri- nostics, and medicine and commodities), to see which vacy” area for PMTCT. More than half of the facilities domain(s) were most strongly associated with provi- had observed not having HIV diagnostic capacity for sion of high-quality PITC. A Pearson’s chi-square (χ ) adults. Majority of the facilities had maternal Antiret- test and its corresponding P < 0.05 was considered sta- roviral (76.2%) and Nevirapine syrup (69.1%) while tistically significant. The generalized variance inflation few had Zidovudine syrup (3.7%). The mean percent - factor (VIF) was performed to test for multicollinear- age of PMTCT readiness score were relatively low 63.96 ity, which usually should not exceed 5. In this analysis [61.32–66.59]%. each variable presented with VIF < 2.0, suggesting the absence of multicollinearity in the fitted models. All sta - Association between facility readiness and provision tistical analyses were performed using STATA 15 (Stata- of high‑quality of PITC Corp, College Station, TX). All estimates were weighted Table  3 presents the results of unadjusted (model 1) and to correct for non- responses and disproportionate sam- adjusted (model 2 models that examine the association pling. We properly adjusted for clustering observed at between facility readiness and provision of high-qual- provider level by using survey method (“svy” command ity of PITC. The results of the adjusted Poisson model in STATA) to correct the standard errors for design (model 2) shows that, given the other variables are held effect. constant in the model, the provision of high-quality PITC was expected to increase by 7.5% more for each per- Sensitivity analysis centage increase of facility readiness score ( β = 0.075, We disaggregated the key independent variable (facility P = 0.00). readiness) into four predetermined domains (staff and guidelines, equipment, diagnostics, and medicine and Results of sensitivity analysis commodities) and performed the sensitivity analysis to Table  4 presents the summary of sensitivity analysis, identify which domain had stronger association with pro- which indicates that the provision of high-quality of vision of high-quality PITC. PITC were expected to increase more for each percent- age increase of score in domain of equipment, diagnos- Results tics, and medicines and commodities. In addition, in Baseline characteristics of the observed firstvisit ANC ‑ module 5 and 6 the provision of high-quality of PITC consultations tend to decrease by 17.5% in private compared to public Table  1 presents a summary of the baseline characteris- facilities. tics of the observed first-visit ANC consultations accord - ing to the health facilities, health providers, and clients’ Discussion characteristics. Out of 1853 included first-visit ANC This study was conducted to examine whether the facility consultations, about 82% were observed in publicly readiness to provide PMTCT services promotes the pro- owned facilities and 68% were observed in lower-level vision of high-quality PITC to pregnant women during facilities (dispensary or clinics). Less than one-fifth of the the first-visit ANC. The findings presented in this study observed consultations included clients with secondary indicated moderate average score of facilities readiness to or above education level. provide PMTCT services and the high-quality of PITC to pregnant women during the first-visit ANC. In addition, Provision of high‑quality of PITC services the study indicated that the provision of high-quality of Figure  2 shows the percentages of the five compo- PITC to the pregnant women was expected to increase nents used to assess the provision of high-quality of Bintabara et al. AIDS Res Ther (2021) 18:38 Page 6 of 11 Table 1 Baseline characteristics of first-visit ANC consultations, Tanzania SPA 2014–2015 (n = 1853) Variable n(%) Managing authority Public 1519 (81.98) Private 334 (18.02) Facility location Rural 1383 (74.64) Urban 470 (25.36) Facility type Clinic and dispensary 1253 (67.62) Health center 336 (18.13) Hospital 264 (14.25) Quality assurance Not Performed < 1 year 1375 (74.20) Per formed < 1 year 478 (25.80) Routine management meeting 404 (62.4) Not Performed 348 (18.78) Performed 1505 (81.22) Provider’s sex (Female) Male 309 (16.68) Female 1544 (88.32) Cadre 782 (95.1) Nurses 1744 (94.12) Clinicians 109 (5.88) Working experience 392 (47.7) < 5 years 1057 (57.04) ≥ 5 years 796 (42.96) Maternal age < 20 years 351 (18.94) 20–35 years 1229 (66.34) > 35 years 273 (14.73) Maternal education level None 430 (23.21) Primary 1145 (61.79) Secondary and above 278 (15.00) more for each percentage increase of facility readiness Similar to an earlier study conducted in Tanzania score. [29], more than two-thirds of the observed consulta- The unsatisfactory facility readiness to provide PMTCT tions in this study providers performed HIV tests to services reported in this study indicates the existing chal- the pregnant women. However, the Tanzanian national lenges to Tanzanian health systems which limit the real- guideline for PMTCT recommends that every preg- life effectiveness of PMTCT interventions [16], such as nant woman during first-visit ANC should receive all shortage of human resources, diagnostic tools, and medi- five components of PITC. In this study, only about one- cines [26, 27]. This situation hinders the progress towards third of pregnant women received all five components the EMTCT target across the Global Plan priority coun- required for PITC. This low provision of high-quality tries (22 countries that accounted for 90% of pregnant of PITC indicates that the majority of pregnant women women living with HIV worldwide) that including Tan- are not receiving the full package of PITC components. zania [28]. This might compromise the acceptance, adherence, Bin tabara et al. AIDS Res Ther (2021) 18:38 Page 7 of 11 Fig. 2 Overall and specific service of PITC during observed first ANC visit, TSPA 2014–2015 (n = 1853) providers to consider the comprehensive provision of Table 2 Distribution of PMTCT service readiness indicators, TSPA high-quality of PITC to pregnant women. The provision 2014–2015 (n = 648) of inadequate quality of PITC was reported in studies Variable n (%) conducted in Ethiopia and Nepal [34, 35]. Staff and training Provision of PMTCT services can be broadly com Presence of guidelines for PMTCT 513 (79.17) promised by health systems factors. Therefore, for the Availability of trained staff 385 (59.41) health provider to deliver the high-quality PMTCT Equipment services that are accessible, equitable, safe, and respon Presence of visual and auditory privacy 533 (82.25) sive to the patients, the high readiness of the facilities Diagnostics is required [36, 37]. This argument is supported by the HIV diagnostic capacity for adults 300 (46.30) findings of the current study which indicated a strong HIV diagnostic capacity for infants 407 (62.81) association between the facilities with high readiness to provide PMTCT and provision of high-quality of PITC Medicines and commodities during first-visit ANC in Tanzania. The observed asso Zidovudine syrup 24 (3.70) - Nevirapine syrup 448 (69.14) ciation may be because facility with high readiness is more likely to be committed to providing all PMTTCT Maternal Antiretroviral 494 (76.23) services including provision of high-quality PITC ser The mean PMTCT readiness score Mean [95% CI] - Facility readiness 63.96 [61.32–66.59] vices to identify pregnant women with HIV at the early gestational period. Therefore, these facilities tend to Total 648 have all diagnostic tools, equipment, and medical sup plies related to PMTCT and PITC services. In contrast, facilities with low readiness are usually facing inade and retention rates for PMTCT interventions because quate access to important equipment, medical supplies, women receive inadequate PITC services during ANC. and trained staff to provide PMTCT and PITC services [30, 31] Previous studies conducted in Tanzania showed [27, 38]. that adherence to ART and retention are poorly asso- The current study had some limitations including ciated with the readiness indicators listed above which the inability to provide a causal connection due to the might be expected to work primarily on detection study design. What has been presented are only asso and treatment initiation [32, 33]. Despite the reported ciations and should be presented with this word of shortage of human resources in Tanzanian health sys- caution. As the study restricted to the first-visit ANC, tems, the emphases should be made to ANC health Bintabara et al. AIDS Res Ther (2021) 18:38 Page 8 of 11 Table 3 Poisson regression analyses for provision of high-quality of PITC and facility readiness unadjusted (Model 1) and adjusted by the selected factors (model 2) Variable Model 1 Model 2 β (Robust SE) β (Robust SE) Facility readiness score Score 0.069 (0.016)** 0.075 (0.017)** Managing authority (ref. Public) Private − 0.129 (0.082)* − 0.123 (0.070)* Facility location (ref. Rural) Urban − 0.022 (0.060) Facility type (ref. Clinic/dispensary) Health centre 0.068 (0.054)* − 0.083 (0.062)* Hospital 0.053 (0.055)* − 0.069 (0.073)* Quality assurance (ref. Not performed < 1 year) Per formed < 1 year 0.068 (0.055)* − 0.015 (0.068) Routine management meeting (ref. Not performed) Performed 0.088 (0.099) Provider’s sex (ref. Male) Female − 0.034 (0.070) Cadre (ref. Nurses) Clinicians 0.239 (0.144)* 0.179 (0.114)* Working experience (ref. < 5 years) ≥ 5 years 0.026 (0.054) Age (ref. < 20 years) 20–35 years 0.061 (0.052)* 0.059 (0.047)* > 35 years 0.042 (0.066)* 0.055 (0.062)* Education level (ref. None) Primary 0.005 (0.049) Secondary and above 0.047 (0.062) the findings may have limited generalizability to all current situation about PMTCT and quality of PITC in other ANC visits. Although the use of direct observa- Tanzanian health systems. tion is regarded as the gold standard, this approach is susceptible to observation biases as well as the Haw- thorne effect “the alteration of behaviour by the partici - Conclusion pants of a study as a result of their awareness of being In summary, even though the majority of pregnant observed” [39]. Despite the limitations, this is the first women in Tanzania receives HIV tests during first-visit study to show the association of PMTCT facility readi- ANC, only a few of them receives high-quality of PITC ness and provision of high-quality of PITC to preg- services as recommended by WHO. In order to increase nant women attending the first-visit ANC in Tanzania. high-quality of PITC, efforts should be made to improve Also, the study used a nationally-representative sample the PMTCT facility readiness by increasing availability of with a high response rate and robust sampling proce- trained staffs, diagnostic tools, and ARTs among health dure, which suggest our findings accurately reflect the facilities in Tanzania. Bin tabara et al. AIDS Res Ther (2021) 18:38 Page 9 of 11 Table 4 Adjusted Poisson regression analyses for provision of high-quality of PITC and domain-specific of facility readiness (Model 3, 4, 5, and 6) Variable Model 3 Model 4 Model 5 Model 6 β (Robust SE) β (Robust SE) β (Robust SE) β (Robust SE) Facility readiness score Score 0.080 (0.041)* 0.165 (0.041)** 0.104 (0.040)** 0.168 (0.048)** Managing authority (ref. Public) Private − 0.144 (0.081)* − 0.097 (0.072)* − 0.175 (0.083)** − 0.175 (0.084)** Facility type (ref. Clinic/dispensary) Health center 0.020 (0.058) 0.032 (0.054) − 0.041 (0.063) 0.030 (0.058) Hospital 0.038 (0.072) 0.068 (0.071) − 0.035 (0.077) 0.023 (0.075) Quality assurance (ref. Not performed < 1 year) Per formed < 1 year 0.033 (0.066) 0.027 (0.064) 0.012 (0.069) 0.027 (0.064) Cadre (ref. Nurses) Clinicians 0.212 (0.131)* 0.200 (0.121)* 0.181 (0.134)* 0.238 (0.128)* Age (ref. < 20 years) 20–35 years 0.053 (0.051)* 0.053 (0.050)* 0.064 (0.050)* 0.059 (0.048)* > 35 years 0.049 (0.063)* 0.055 (0.062)* 0.059 (0.062)* 0.043 (0.062)* Model 3 for the domain of “Staff and training” Model 4 for the domain of “Equipment” Model 6 for the domain of “Diagnostics” Model 5 for the domain of “Medicines and commodities” = p < 0.2, ** = p < 0.05 Abbreviations Availability of data and materials AIDS: Acquired immunodeficiency syndrome; ANC: Antenatal; HIV: Human The dataset used for this secondary analysis was generated from the original immunodeficiency virus; MoHCDGEC: Ministry of health, community develop - Tanzanian SPA datasets available in the DHS Program repository: http:// dhspr ment, gender, elderly, and children; MTCT : Mother-to-child transmission; PITC: ogram. com/ data/ avail able- datas ets. cfm. The generated dataset is currently Provider-initiated HIV testing and counseling; PMTCT : Prevention of mother- stored and accessible by the first author. However, it is available upon request to-child transmission; SE: Standard error; SPA: Service provision assessment; to the first author at the contact address provided in this article. SSA: Sub-Saharan Africa; WHO: World Health Organization. Declarations Supplementary Information Ethics approval and consent to participate The online version contains supplementary material available at https:// doi. This study was based on analysis of existing public domain survey data sets org/ 10. 1186/ s12981- 021- 00362-y. that are freely available online with all identifier information detached. The original survey was approved by the Ethics Committee of the ICF Macro at Calverton in the USA and by the National Institute of Medical Research Ethics Additional file1: Table S1. Summary of the measurement procedure of Committee in Tanzania. Therefore, the ethical approval for the current analysis key independent variable “Facility readiness.” was automatically deemed unnecessary; however, permission to access the Tanzania SPA dataset was requested and granted by ICF Institutional Review Acknowledgements Board through DHS program. We would like to acknowledge ICF International, Rockville, Maryland, USA, through DHS program for permitting us to Access the Tanzania SPA 2014-2015 Consent for publication dataset. Not applicable. Authors’ contributions Competing interests DB originated the design of the study; DB and BCT performed statistical The authors have no commercial or other associations that might pose a analysis and interpretation of data; DB, AL, SJ, MMN, and BCT drafted the conflict of interest. manuscript and critically revised the drafted manuscript. All authors read and approved the final manuscript. Author details Department of Community Medicine, The University of Dodoma, Dodoma, Funding Tanzania. Department of Obstetrics and Gynecology, The University There was no funding associated with this study. of Dodoma, Dodoma, Tanzania. Department of Pediatrics and Child Health, Bintabara et al. AIDS Res Ther (2021) 18:38 Page 10 of 11 The University of Dodoma, Dodoma, Tanzania. Department of Obstetrics 17. Gourlay A, Wringe A, Todd J, et al. Uptake of services for prevention of and Gynecology, Dodoma Regional Referral Hospital, Dodoma, Tanzania. mother-to-child transmission of HIV in a community cohort in rural Department of Internal Medicine, The University of Dodoma, Dodoma, Tanzania from 2005 to 2012. BMC Health Serv Res. 2015;16:4. https:// doi. Tanzania. org/ 10. 1186/ s12913- 015- 1249-6. 18. Ministry of Health, Community Development, Gender, Elderly and Received: 5 March 2020 Accepted: 26 June 2021 Children (MoHCDGEC). National Guidelines for Comprehensive Care of Prevention of Mother-to-Child Transmission of HIV and Keeping Mothers Alive. Dar es Salaam, Tanzania: 2013. http:// ihi. eprin ts. org/ 3335/1/ tz_ guide lines_ ccs_ optio nb_ all. pdf Accessed 5 Dec 2019. 19. Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) [ Tanzania Mainland], Ministry of Health (MoH) References [Zanzibar], National Bureau of Statistics (NBS), Office of the Chief Govern- 1. Kharsany ABM, Karim QA. HIV infection and AIDS in Sub-Saharan Africa: ment Statistician (OCGS), and ICF. 2016. Tanzania Demographic and current status challenges and opportunities. Open AIDS J. 2016;10:34–48. Health Survey and Malaria Indicator Survey ( TDHSMIS) 2015–16. Dar es https:// doi. org/ 10. 2174/ 18746 13601 61001 0034. Salaam, Tanzania, and Rockville, Maryland, USA: MoHCDGEC, MoH, NBS, 2. Ramjee G, Daniels B. Women and HIV in Sub-Saharan Africa. AIDS Res OCGS, and ICF. 2016. https:// dhspr ogram. com/ pubs/ pdf/ FR321/ FR321. Ther. 2013;10:30. https:// doi. org/ 10. 1186/ 1742- 6405- 10- 30. pdf Accessed 5 Dec 2019. 3. UNAIDS. The Gap Report. 2014. http:// www. unaids. org/ sites/ defau lt/ files/ 20. Gourlay A, Birdthistle I, Mburu G, et al. Barriers and facilitating factors media_ asset/ UNAIDS_ Gap_ report_ en. pdf Accessed 5 Dec 2019. to the uptake of antiretroviral drugs for prevention of mother-to-child 4. Kuhn L, Aldrovandi GM, Sinkala M, et al. Eec ff ts of early, abrupt weaning transmission of HIV in sub-Saharan Africa: a systematic review. J Int AIDS on HIV-free survival of children in Zambia. N Engl J Med. 2008;359:130– Soc. 2013;16:18588. https:// doi. org/ 10. 7448/ IAS. 16.1. 18588. 41. https:// doi. org/ 10. 1056/ NEJMo a0737 88. 21. Gourlay A, Wringe A, Todd J, et al. Factors associated with uptake of 5. Chersich MF, Rees HV. Vulnerability of women in southern Africa to infec- services to prevent mother-to-child transmission of HIV in a community tion with HIV: biological determinants and priority health sector interven- cohort in rural Tanzania. Sex Transm Infect. 2015;91:520–7. https:// doi. tions. AIDS. 2008;22:S27-40. https:// doi. org/ 10. 1097/ 01. aids. 00003 41775. org/ 10. 1136/ sextr ans- 2014- 051907. 94123. 75. 22. Dussault G, Dubois CA. Human resources for health policies: a critical 6. Torrone EA, Morrison CS, Chen P-L, et al. Prevalence of sexually transmit- component in health policies. Hum Resour Health. 2003. https:// doi. org/ ted infections and bacterial vaginosis among women in sub-Saharan 10. 1186/ 1478- 4491-1-1. Africa: an individual participant data meta-analysis of 18 HIV prevention 23. Bintabara D, Nakamura K, Seino K. Determinants of facility readiness for studies. PLOS Med. 2018;15:e1002511. https:// doi. org/ 10. 1371/ journ al. integration of family planning with HIV testing and counseling services: pmed. 10025 11. evidence from the Tanzania service provision assessment survey, 7. World Health Organization ( WHO). Global Update on the Health Sector 2014–2015. BMC Health Serv Res. 2017;17:844. https:// doi. org/ 10. 1186/ Response to HIV, 2014. s12913- 017- 2809-8. 8. Mutabazi JC, Zarowsky C, Trottier H. The impact of programs for preven- 24. Ministry of Health and Social Welfare (MoHSW ) [ Tanzania Mainland], tion of mother-to-child transmission of HIV on health care services and Ministry of Health (MoH) [Zanzibar], National Bureau of Statistics (NBS), systems in sub-Saharan Africa—a review. Public Health Rev. 2017;38:28. Office of the Chief Government Statistician (OCGS), and ICF International https:// doi. org/ 10. 1186/ s40985- 017- 0072-5. 2015. Tanzania Service Provision Assessment. 2015. https:// dhspr ogram. 9. Hampanda K. Vertical transmission of HIV in Sub-Saharan Africa: applying com/ pubs/ pdf/ SPA22/ SPA22. pdf Accessed 5 Dec 2019. theoretical frameworks to understand social barriers to PMTCT. ISRN 25. Health Statistics and Information Systems, World Health Organization Infect Dis. 2013;2013:1–5. https:// doi. org/ 10. 5402/ 2013/ 420361. ( WHO). Service Availability and Readiness Assessment (SARA): an annual 10. UNICEF. Elimination of mother-to-child transmission of HIV (eMTCT ). monitoring system for service delivery: Reference Manual, Version 2.2. 2010. https:// www. unicef. org/ tanza nia/ 6912_ 10623. html Accessed 5 Dec 2015. http:// www. who. int/ healt hinfo/ syste ms/ sara_ refer ence_ manual/ en/ Accessed 5 Dec 2019. 11. World Health Organization ( WHO). Guidance on Global Scale-Up of the 26. Naburi H, Ekström AM, Mujinja P, et al. The potential of task-shifting in Prevention of Mother-Child Transmission of HIV: Towards universal access scaling up services for prevention of mother-to-child transmission of HIV: for women, infants and young children and eliminating HIV and AIDS a time and motion study in Dar es Salaam Tanzania. Hum Resour Health. among children. 2007. http:// www. who. int/ hiv/ pub/ toolk its/ PMTCT 2017;15:35. https:// doi. org/ 10. 1186/ s12960- 017- 0207-2. 97892 41596 015_ eng. pdf Accessed 5 Dec 2019. 27. An SJ, George AS, LeFevre AE, et al. Supply-side dimensions and dynam- 12. Ministry of Health Community Development Gender Elderly and Children ics of integrating HIV testing and counselling into routine antenatal care: (MOHCDGEC). Tanzania elimination of Mother to Child Transmission of a facility assessment from Morogoro Region, Tanzania. BMC Health Serv HIV plan, 2012–2015. 2012. https:// www. healt hprom otion tanza nia. org/ Res. 2015;15:451. https:// doi. org/ 10. 1186/ s12913- 015- 1111-x. index. php/ en/ libra ry122/ doc_ view/ 152- costed- emtct- plan- final- 16- may- 28. UNAIDS. 2015 Progress Report on the Global Plan towards elimination 2. html Accessed 5 Dec 2019. of new HIV infections among children and keeping their mothers alive. 13. Isangula KG, Holmes A, Brownie S. HIV Testing for PMTCT in Tanzania: Time 2015. http:// www. unaids. org/ sites/ defau lt/ files/ media_ asset/ JC2774_ to move from ‘Voluntary’ to ‘Mandatory’? Adv Soc Sci Res J. 2015;2:131–8. 2015P rogre ssRep ort_ Globa lPlan_ en. pdf Accessed 5 Dec 2019. https:// doi. org/ 10. 14738/ assrj. 22. 895. 29. Balira R, Mabey D, Weiss H, et al. The need for further integration of 14. World Health Organisation ( WHO). PMTCT strategic vision 2010–2015 : services to prevent mother-to-child transmission of HIV and syphilis in preventing mother-to-child transmission of HIV to reach the UNGASS Mwanza City, Tanzania. Int J Gynecol Obstet. 2015;130:S51–7. https:// doi. and Millennium Development Goals. 2015. org/ 10. 1016/j. ijgo. 2015. 04. 016. 15. Joint United Nations Programme on HIV/AIDS (UNAIDS). On the fast-track 30. Gruskin S, Ahmed S, Ferguson L. Provider-initiated HIV testing and to an AIDS-free generation; the incredible journey of the global plan counseling in health facilities—what does this mean for the health and towards the elimination of new HIV infections among children by 2015 human rights of pregnant women? Dev World Bioeth. 2008;8:23–32. and keeping their mothers alive. 2016. http:// www. unaids. org/ sites/ defau https:// doi. org/ 10. 1111/j. 1471- 8847. 2007. 00222.x. lt/ files/ media_ asset/ Globa lPlan 2016_ en. pdf Accessed 5 Dec 2019. 31. Kennedy CE, Fonner VA, Sweat MD, et al. Provider-initiated HIV testing 16. Joint United Nations Programme on HIV/AIDS (UNAIDS). Prevention gap and counseling in low- and middle-income countries: a system- report Geneva, Switzeland. 2016. http:// www. unaids. org/ sites/ defau lt/ atic review. AIDS Behav. 2013;17:1571–90. https:// doi. org/ 10. 1007/ files/ media_ asset/ 2016- preve ntion- gap- report_ en. pdf Accessed 5 Dec s10461- 012- 0241-y. 2019. Bin tabara et al. AIDS Res Ther (2021) 18:38 Page 11 of 11 32. Ngarina M, Kilewo C, Karlsson K, et al. Virologic and immunologic failure, 36. Gunn JKL, Asaolu IO, Center KE, et al. Antenatal care and uptake of HIV drug resistance and mortality during the first 24 months postpartum testing among pregnant women in sub-Saharan Africa: a cross-sectional among HIV-infected women initiated on antiretroviral therapy for life in study. J Int AIDS Soc. 2016;19:20605. the Mitra plus Study, Dar es Salaam Tanzania. BMC Infect Dis. 2015;15:175. 37. World Health Organization ( WHO). Everybody’s business: strengthening https:// doi. org/ 10. 1186/ s12879- 015- 0914-z. health systems to improve health outcomes: WHO’s framework for action. 33. Gamell A, Luwanda LB, Kalinjuma AV, et al. Prevention of mother-to-child 2007. transmission of HIV Option B+ cascade in rural Tanzania: The One Stop 38. Ministry of Health and Social Welfare (MoHSW ). Tanzania Service Avail- Clinic model. PLoS ONE. 2017;12:e0181096. https:// doi. org/ 10. 1371/ journ ability and Readiness Assessment (SARA) 2012.https:// ihi. eprin ts. org/ al. pone. 01810 96.2448/1/ SARA_ 2012_ Report. pdf Accessed 5 Dec 2019. 34. Gebremedhin KB, Tian B, Tang C, et al. Factors associated with acceptance 39. Leonard K, Masatu MC. Outpatient process quality evaluation and the of provider-initiated HIV testing and counseling among pregnant women Hawthorne Eec ff t. Soc Sci Med. 2006;63:2330–40. https:// doi. org/ 10. in Ethiopia. Patient Prefer Adherence. 2018;12:183–91. https:// doi. org/ 10. 1016/j. socsc imed. 2006. 06. 003. 2147/ PPA. S1486 87. 35. Kumar R, Probandari A, Ojha B, et al. 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Does facility readiness promote high-quality of provider-initiated HIV testing and counseling to pregnant women? A national survey for improving policy of prevention of mother-to-child transmission of HIV in Tanzania

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Abstract

Background: Provider-initiated HIV testing and counseling (PITC) is a recommended approach to screen for HIV to all pregnant women during antenatal care (ANC) visits, and all with HIV positive results have to be enrolled into prevention of mother-to-child transmission of HIV (PMTCT ) program. However, little is known about the relationship between facility readiness and the uptake of PITC to pregnant women attending ANC in Tanzania. Therefore, this study assessed whether the facility readiness promotes the uptake of PITC to the pregnant women attending ANC for the purpose of improving the PMTCT interventions in Tanzania. Methods: This study analyzed data for health facilities obtained from the 2014–2015 Tanzania service provision assessment survey. The Primary outcome measure was a composite variable (with score of 0–5) in which its higher scores indicates provision of high-quality of PITC. Also, facilities scored higher in the PMTCT service readiness index were considered to have high readiness to provide PMTCT services. In Poisson regression analyses, a series of models were fitted to assess whether there is an association between provision of high-quality of PITC and facility readiness. In all statistical analysis, a P < 0.05 was considered significant. Results: Out of 1853 included first-visit ANC consultations, only about one-third of pregnant women received all five components required for PITC. The mean percentage of PMTCT readiness score was moderate 63.96 [61.32–66.59]%. In adjusted model, we found that facility with high readiness to provide PMTCT services was significantly associated with the provision of high-quality of PITC (model 2: [β = 0.075, P = 0.00]). Conclusion: In order to increase high-quality of PITC services, efforts should be made to improve the PMTCT facility readiness by increasing availability of trained staffs, diagnostic tools, and ARTs among health facilities in Tanzania. *Correspondence: bintabaradeo@gmail.com Department of Community Medicine, The University of Dodoma, Dodoma, Tanzania Full list of author information is available at the end of the article © The Author(s) 2021. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Bintabara et al. AIDS Res Ther (2021) 18:38 Page 2 of 11 Keywords: Facility readiness, High-quality, Antenatal care, Provider-initiated HIV testing and counseling, PMTCT , Tanzania Background ANC or follow-up visits are expected to receive HIV Even though sub-Saharan Africa (SSA) contains only testing and counseling, those diagnosed with HIV are about 11% of the World’s population, the region is supposed to be enrolled into the PMTCT program as home to about 70% of worldwide people infected with early as possible [18]. Although about 98% of preg- HIV [1]. In this region, the main mode of HIV trans- nant women attended ANC at least once [19], not all mission is through heterosexual sex, with women dis- received PITC services. This affect the enrollment of proportionally affected [1 , 2]. It is estimated that 95% of HIV positive pregnant women into the PMTCT pro- all HIV positive women and 80% of the 3,80,000 young gram and subsequently missed opportunities for the women who are newly infected with HIV live in SSA [3, timely initiation of treatment with antiretroviral ther- 4]. Besides, as the pregnancy status increases the risk apy [17]. of acquiring HIV infection [5], thisplacewomen in SSA The limited information regarding the observed dis - which is the area with high fertility rate and burden crepancy between high proportions of women attend- of sexually transmitted diseases to be at most vulner- ing to ANC with the availability of PMTCT service and able for HIV infection [6]. Hence, in the absence of any the poor provision of high-quality of PITC prompted preventive measures, about 25–40% of HIV-positive researches on this area. Some of the researches aimed women will transmit the virus to their newborns [7]. to identify factors associated with poor uptake of PITC The rates of Mother-To-Child Transmission (MTCT) at multiple levels such as poor knowledge of HIV verti- is relatively high in SSA with approximately 1000 new- cal transmission, age, maternal education, psychological borns infected every day [8, 9]. problems after HIV diagnosis, stigma and fear of status In Tanzania, MTCT accounts for about 18% of new disclosure to partners, family or community members. HIV infections and approximately 99,000 HIV-positive Other reported factors were poor staff-patient interac - women are estimated to deliver exposed infants annu- tions, staff shortages, service accessibility, and home ally [10]. To eliminate this burden of MTCT, in the early deliveries [20, 21]. Despite the efforts of these research - 2000s, the Tanzanian government established and then ers to identify those factors, no one examined the level of scaled up the program for the Prevention of Mother-to- facility readiness to enhance the provision of high-quality Child Transmission of HIV (PMTCT) as suggested by of PITC for PMTCT. World Health Organization (WHO) for the countries Facility readiness defined as “willingness or capacity of with limited-resource [11, 12]. The package of PMTCT health facility to provide PITC services for the PMTCT” program has been integrated into routine Reproductive is important to evaluate how the facility is committed to and Child Health (RCH) services to ensure that there fighting against MTCT of HIV infection. For that reason, is a reduced vertical transmission [12]. Similar to other not only availability of services but also together with SSA countries, Tanzania made tremendous progress in facility readiness will promise patient to receive high- coverage and accessibility of PMTCT services. How- quality of care [22, 23]. Therefore, a full understanding of ever, the country faces the challenge to enroll all HIV- the relationship between facility readiness and provision positive pregnant women due to inadequate uptake of of high-quality of PITC to pregnant women attending HIV testing and counseling [13]. This slow the efforts ANC is crucial as little is known about this relationship. toward achieving the elimination of MTCT (EMTCT) The current study was conducted to assess whether the goal, defined as a reduction of the number of new HIV facility readiness associated with provision of high-qual- infections occurring during MTCT by 90%, reduction ity of PITC to pregnant women attending first-visit ANC in the final MTCT rate to ≤ 5% among breastfeeding, in Tanzania. and ≤ 2% among non-breastfeeding populations [14, 15]. Until 2016, Tanzania achieved 69% MTCT reduc- Methods tion and the MTCT rate at the end of breastfeeding Data source gone down to 8% [16]. This study analyzed data from the 2014–2015 Tanza - The cascade of PMTCT services in Tanzania starts nia Service Provision Assessment (TSPA) survey. TSPA with provider-initiated HIV testing and counseling was designed to assess all health facilities in Tanzania (PITC) during antenatal care (ANC) attendance [17]. [24]. The survey provides information on the availabil - Through PITC all pregnant women at the first-visit of ity of basic and essential health care services and service Bin tabara et al. AIDS Res Ther (2021) 18:38 Page 3 of 11 readiness. One of the issues the survey assessed is the meet these criteria were excluded from the study (seven presence and functions of components essential for high- refused to participate, four were closed on the day of quality service delivery for antenatal care services includ- the interview, one could not be reached, 157 did not ing HIV counseling and testing services as a package of provide ANC services, 216 were not selected for ANC PMTCT. observation, 167 did not have first ANC visit observa - tions). Therefore, after excluding all facilities that did Study sample and sampling procedure not meet the inclusion criteria, a total of 648 health A list of all the formal sector health facilities such as facilities in which 1853 first-visit ANC consultations hospitals, health centres, dispensaries, and clinics pro- were performed were included for this analysis (Fig. 1). vided by the Ministry of Health and Social Welfare During data collection, the interviewers used the (MoHSW) in Tanzania Mainland and the Ministry Observation Questionnaire to assess whether the pro- of Health (MOH) in Zanzibar was used as a sampling cesses followed in observed client-provider consulta- frame in which a sample of 1200 facilities was selected tions met standards for acceptable content and quality to participate in the survey. More details about TSPA during service delivery. In this case, the interviewers survey sampling procedures are available online [24]. acting as observers sat in on consultations for ANC ser- Based on the objectives of this research, the current vices. They recorded the information shared between analysis was restricted to health facilities with at least client and provider and the processes the provider one observed first-visit ANC consultation. Hence, facil - followed when assessing the client, conducting pro- ities that reported providing ANC services, selected to cedures, and providing treatment. In our analysis, we participate for ANC observation, were open on the day focused only on the provision of PITC related services of the interview, and agreed to participate were eligible for the PMTCT. and were selected in this study. Facilities that did not Fig. 1 Selection procedure of the health facilities and ANC visits included in this analysis Bintabara et al. AIDS Res Ther (2021) 18:38 Page 4 of 11 Measurement of variables those without were categorized as "No." The fourth Outcome variable domain was medicine and commodities which has three “Provision of high-quality of PITC,” was a composite indicators, i.e., the availabilities of Zidovudine syrup, score created by using the responses observed by inter- Nevirapine syrup, and Maternal Antiretroviral (ARV) viewers if the provider performed the following five prophylaxis (either Option A: AZT, NVP, and 3TC or important services of PITC to the pregnant women dur- Option B: AZT + 3TC + LPV or AZT + 3TC + ABC or ing first-visit ANC consultations. These included (i) AZT + 3TC + EFV or TDF + 3TC (or FTC) + EF V ). Each establishing client’s HIV status, (ii) provide or refer for of the medicine indicators was categorized as “Yes” for counseling related to HIV test, (iii) perform or refer for the facilities reported the availability of that medicine(s) HIV test, (iv) provided post-test counseling and v) dis- and otherwise was categorized as “No.” For details see cussed partner testing. Each of these services scored Additional file 1: Table S1. “1” if the provider was observed to perform it, other- The PMTCT service readiness index was then totaled wise scored “0.” The composite score ranges from 0 to 5. by adding the presence of each indicator, with equal The higher scores regarded as provision of high-quality weight given to each of the domains and each of the of PITC during first-visit consultation compared to the indicators within the domains. As the target was 100%, lower scores. each domain accounted for 25% (100%/4) of the index. The percentage for each indicator within the domain was Key independent variable equal to 25% divided by the number of indicators in that Facility readiness; in this study was measured based on domain. The PMTCT service readiness index for each the score of PMTCT specific services readiness index. facility was then calculated by summing the percentages. This score was determined using a WHO approach, while The facility with less or more score in PMTCT readiness the PMTCT readiness indicators were identified accord - index were considered to have lower or higher readiness ing to WHO Service Availability and Readiness Assess- respectively. ment (WHO-SARA) reference manual [25]. Using this approach, the PMTCT service readiness index was cat- Controlling (adjusting) factors egorized into four domains. The first domain was “staff These included facilities, provider and client level vari - and guidelines,” which had four indicators, i.e., guide- ables. The facility variables were: facility location cat - lines for PMTCT, guidelines for infant and young child egorized as “urban” and “rural;”managing authorityas feeding counseling, staff trained in PMTCT, and staff “public” and “private;” facility type categorized as “hospi- trained in infant and young child feeding. The facilities tal,” “health center,” and “dispensary;”quality assurance as that reported having guidelines for PMTCT or guide- “performed” and “not performed;” and routine manage- lines for PMTCT and infant and young child feeding ment meeting as “performed” and “not performed.”The counseling was categorized as “Yes,” while those without provider variables were sex coded as “male” and “female;” such guidelines were categorized as “No.” Also, facili- cadre coded as “clinician” and “nurses;” working experi- ties with at least one staff member that had received ence coded as “ ≤ 5  years” and “ > 5  years.” Client vari- refresher training in PMTCT and infant and young child ableswere: age coded as “ < 20,” “20–34,” and “ ≥ 35;” and feeding counseling within two years before the interview level of formal education coded as “primary,” “secondary,” was categorized as “Yes,” while those without such staff and “tertiary.” members were categorized as “No.” The second domain was equipment, which had one indicator, i.e., the pres- Statistical analysis ence of visual and auditory privacy. Facilities with the During descriptive analyses, all categorical variables private room or screened off area for PMTCT that a nor - were summarized using frequencies and percentages mal conversation can be held without being overheard, and then presented in either tables or graphs. The series and without the client being observed were categorized of Poisson regression models were fitted to estimate the as “Yes,” while those without were categorized as “No.” effect of key independent variable (facility readiness) The third domain was diagnostics, which had two indi - on the outcome variable (Provision of high-quality of cators, i.e., HIV diagnostic capacity for adults and HIV PITC). The Poisson regression models were preferred diagnostic capacity for infant/ young child. Facilities than the others such as zero inflated and negative bino - with HIV Rapid Diagnostic Test (RDT) or ELISA for HIV mial models because the response variable did not have testing of adults were categorized as “Yes,” while those excessive number of zeros and did not show over-dis- without were categorized as “No.” in addition, facilities persion respectively. Moreover, the Poisson model uses with Dried Blood Spot (DBS) filter paper for diagnos - the log link function that allows all of the predicted ing HIV in newborns were categorized as "Yes," while values of the outcome variable being non-negative. Bin tabara et al. AIDS Res Ther (2021) 18:38 Page 5 of 11 Initially, unadjusted Poisson regression model (model PITC to pregnant women during the first-visit ANC 1) was fitted to identify controlling (adjusting) vari - consultations. Although the performance of all five ables that would be included for multivariable analysis. PITC services was relatively low (35.8%), there was a All variables with P < 0.05 were selected and included in satisfactory proportion of high-quality in some sepa- the multiple Poisson regression model (model 2) using a rate individual components such as counseling on HIV criterion based procedure known as Akaike’s Informa- tests (77.2%) and performing or referring to HIV tests tion Criterion (AIC). Despite AIC use similar approach (71.2%). like backward elimination method, it tends to retain some important variables that needed to be included Availability of PMTCT service readiness indicators in the final model. Similar approach was used to per - Table  2 presents the distribution of PMTCT services form a sensitivity analysis of each domain of the facility readiness indicator. About 80% of the facilities had readiness score (staff and guidelines, equipment, diag - “PMTCT guidelines” and “visual and auditory pri- nostics, and medicine and commodities), to see which vacy” area for PMTCT. More than half of the facilities domain(s) were most strongly associated with provi- had observed not having HIV diagnostic capacity for sion of high-quality PITC. A Pearson’s chi-square (χ ) adults. Majority of the facilities had maternal Antiret- test and its corresponding P < 0.05 was considered sta- roviral (76.2%) and Nevirapine syrup (69.1%) while tistically significant. The generalized variance inflation few had Zidovudine syrup (3.7%). The mean percent - factor (VIF) was performed to test for multicollinear- age of PMTCT readiness score were relatively low 63.96 ity, which usually should not exceed 5. In this analysis [61.32–66.59]%. each variable presented with VIF < 2.0, suggesting the absence of multicollinearity in the fitted models. All sta - Association between facility readiness and provision tistical analyses were performed using STATA 15 (Stata- of high‑quality of PITC Corp, College Station, TX). All estimates were weighted Table  3 presents the results of unadjusted (model 1) and to correct for non- responses and disproportionate sam- adjusted (model 2 models that examine the association pling. We properly adjusted for clustering observed at between facility readiness and provision of high-qual- provider level by using survey method (“svy” command ity of PITC. The results of the adjusted Poisson model in STATA) to correct the standard errors for design (model 2) shows that, given the other variables are held effect. constant in the model, the provision of high-quality PITC was expected to increase by 7.5% more for each per- Sensitivity analysis centage increase of facility readiness score ( β = 0.075, We disaggregated the key independent variable (facility P = 0.00). readiness) into four predetermined domains (staff and guidelines, equipment, diagnostics, and medicine and Results of sensitivity analysis commodities) and performed the sensitivity analysis to Table  4 presents the summary of sensitivity analysis, identify which domain had stronger association with pro- which indicates that the provision of high-quality of vision of high-quality PITC. PITC were expected to increase more for each percent- age increase of score in domain of equipment, diagnos- Results tics, and medicines and commodities. In addition, in Baseline characteristics of the observed firstvisit ANC ‑ module 5 and 6 the provision of high-quality of PITC consultations tend to decrease by 17.5% in private compared to public Table  1 presents a summary of the baseline characteris- facilities. tics of the observed first-visit ANC consultations accord - ing to the health facilities, health providers, and clients’ Discussion characteristics. Out of 1853 included first-visit ANC This study was conducted to examine whether the facility consultations, about 82% were observed in publicly readiness to provide PMTCT services promotes the pro- owned facilities and 68% were observed in lower-level vision of high-quality PITC to pregnant women during facilities (dispensary or clinics). Less than one-fifth of the the first-visit ANC. The findings presented in this study observed consultations included clients with secondary indicated moderate average score of facilities readiness to or above education level. provide PMTCT services and the high-quality of PITC to pregnant women during the first-visit ANC. In addition, Provision of high‑quality of PITC services the study indicated that the provision of high-quality of Figure  2 shows the percentages of the five compo- PITC to the pregnant women was expected to increase nents used to assess the provision of high-quality of Bintabara et al. AIDS Res Ther (2021) 18:38 Page 6 of 11 Table 1 Baseline characteristics of first-visit ANC consultations, Tanzania SPA 2014–2015 (n = 1853) Variable n(%) Managing authority Public 1519 (81.98) Private 334 (18.02) Facility location Rural 1383 (74.64) Urban 470 (25.36) Facility type Clinic and dispensary 1253 (67.62) Health center 336 (18.13) Hospital 264 (14.25) Quality assurance Not Performed < 1 year 1375 (74.20) Per formed < 1 year 478 (25.80) Routine management meeting 404 (62.4) Not Performed 348 (18.78) Performed 1505 (81.22) Provider’s sex (Female) Male 309 (16.68) Female 1544 (88.32) Cadre 782 (95.1) Nurses 1744 (94.12) Clinicians 109 (5.88) Working experience 392 (47.7) < 5 years 1057 (57.04) ≥ 5 years 796 (42.96) Maternal age < 20 years 351 (18.94) 20–35 years 1229 (66.34) > 35 years 273 (14.73) Maternal education level None 430 (23.21) Primary 1145 (61.79) Secondary and above 278 (15.00) more for each percentage increase of facility readiness Similar to an earlier study conducted in Tanzania score. [29], more than two-thirds of the observed consulta- The unsatisfactory facility readiness to provide PMTCT tions in this study providers performed HIV tests to services reported in this study indicates the existing chal- the pregnant women. However, the Tanzanian national lenges to Tanzanian health systems which limit the real- guideline for PMTCT recommends that every preg- life effectiveness of PMTCT interventions [16], such as nant woman during first-visit ANC should receive all shortage of human resources, diagnostic tools, and medi- five components of PITC. In this study, only about one- cines [26, 27]. This situation hinders the progress towards third of pregnant women received all five components the EMTCT target across the Global Plan priority coun- required for PITC. This low provision of high-quality tries (22 countries that accounted for 90% of pregnant of PITC indicates that the majority of pregnant women women living with HIV worldwide) that including Tan- are not receiving the full package of PITC components. zania [28]. This might compromise the acceptance, adherence, Bin tabara et al. AIDS Res Ther (2021) 18:38 Page 7 of 11 Fig. 2 Overall and specific service of PITC during observed first ANC visit, TSPA 2014–2015 (n = 1853) providers to consider the comprehensive provision of Table 2 Distribution of PMTCT service readiness indicators, TSPA high-quality of PITC to pregnant women. The provision 2014–2015 (n = 648) of inadequate quality of PITC was reported in studies Variable n (%) conducted in Ethiopia and Nepal [34, 35]. Staff and training Provision of PMTCT services can be broadly com Presence of guidelines for PMTCT 513 (79.17) promised by health systems factors. Therefore, for the Availability of trained staff 385 (59.41) health provider to deliver the high-quality PMTCT Equipment services that are accessible, equitable, safe, and respon Presence of visual and auditory privacy 533 (82.25) sive to the patients, the high readiness of the facilities Diagnostics is required [36, 37]. This argument is supported by the HIV diagnostic capacity for adults 300 (46.30) findings of the current study which indicated a strong HIV diagnostic capacity for infants 407 (62.81) association between the facilities with high readiness to provide PMTCT and provision of high-quality of PITC Medicines and commodities during first-visit ANC in Tanzania. The observed asso Zidovudine syrup 24 (3.70) - Nevirapine syrup 448 (69.14) ciation may be because facility with high readiness is more likely to be committed to providing all PMTTCT Maternal Antiretroviral 494 (76.23) services including provision of high-quality PITC ser The mean PMTCT readiness score Mean [95% CI] - Facility readiness 63.96 [61.32–66.59] vices to identify pregnant women with HIV at the early gestational period. Therefore, these facilities tend to Total 648 have all diagnostic tools, equipment, and medical sup plies related to PMTCT and PITC services. In contrast, facilities with low readiness are usually facing inade and retention rates for PMTCT interventions because quate access to important equipment, medical supplies, women receive inadequate PITC services during ANC. and trained staff to provide PMTCT and PITC services [30, 31] Previous studies conducted in Tanzania showed [27, 38]. that adherence to ART and retention are poorly asso- The current study had some limitations including ciated with the readiness indicators listed above which the inability to provide a causal connection due to the might be expected to work primarily on detection study design. What has been presented are only asso and treatment initiation [32, 33]. Despite the reported ciations and should be presented with this word of shortage of human resources in Tanzanian health sys- caution. As the study restricted to the first-visit ANC, tems, the emphases should be made to ANC health Bintabara et al. AIDS Res Ther (2021) 18:38 Page 8 of 11 Table 3 Poisson regression analyses for provision of high-quality of PITC and facility readiness unadjusted (Model 1) and adjusted by the selected factors (model 2) Variable Model 1 Model 2 β (Robust SE) β (Robust SE) Facility readiness score Score 0.069 (0.016)** 0.075 (0.017)** Managing authority (ref. Public) Private − 0.129 (0.082)* − 0.123 (0.070)* Facility location (ref. Rural) Urban − 0.022 (0.060) Facility type (ref. Clinic/dispensary) Health centre 0.068 (0.054)* − 0.083 (0.062)* Hospital 0.053 (0.055)* − 0.069 (0.073)* Quality assurance (ref. Not performed < 1 year) Per formed < 1 year 0.068 (0.055)* − 0.015 (0.068) Routine management meeting (ref. Not performed) Performed 0.088 (0.099) Provider’s sex (ref. Male) Female − 0.034 (0.070) Cadre (ref. Nurses) Clinicians 0.239 (0.144)* 0.179 (0.114)* Working experience (ref. < 5 years) ≥ 5 years 0.026 (0.054) Age (ref. < 20 years) 20–35 years 0.061 (0.052)* 0.059 (0.047)* > 35 years 0.042 (0.066)* 0.055 (0.062)* Education level (ref. None) Primary 0.005 (0.049) Secondary and above 0.047 (0.062) the findings may have limited generalizability to all current situation about PMTCT and quality of PITC in other ANC visits. Although the use of direct observa- Tanzanian health systems. tion is regarded as the gold standard, this approach is susceptible to observation biases as well as the Haw- thorne effect “the alteration of behaviour by the partici - Conclusion pants of a study as a result of their awareness of being In summary, even though the majority of pregnant observed” [39]. Despite the limitations, this is the first women in Tanzania receives HIV tests during first-visit study to show the association of PMTCT facility readi- ANC, only a few of them receives high-quality of PITC ness and provision of high-quality of PITC to preg- services as recommended by WHO. In order to increase nant women attending the first-visit ANC in Tanzania. high-quality of PITC, efforts should be made to improve Also, the study used a nationally-representative sample the PMTCT facility readiness by increasing availability of with a high response rate and robust sampling proce- trained staffs, diagnostic tools, and ARTs among health dure, which suggest our findings accurately reflect the facilities in Tanzania. Bin tabara et al. AIDS Res Ther (2021) 18:38 Page 9 of 11 Table 4 Adjusted Poisson regression analyses for provision of high-quality of PITC and domain-specific of facility readiness (Model 3, 4, 5, and 6) Variable Model 3 Model 4 Model 5 Model 6 β (Robust SE) β (Robust SE) β (Robust SE) β (Robust SE) Facility readiness score Score 0.080 (0.041)* 0.165 (0.041)** 0.104 (0.040)** 0.168 (0.048)** Managing authority (ref. Public) Private − 0.144 (0.081)* − 0.097 (0.072)* − 0.175 (0.083)** − 0.175 (0.084)** Facility type (ref. Clinic/dispensary) Health center 0.020 (0.058) 0.032 (0.054) − 0.041 (0.063) 0.030 (0.058) Hospital 0.038 (0.072) 0.068 (0.071) − 0.035 (0.077) 0.023 (0.075) Quality assurance (ref. Not performed < 1 year) Per formed < 1 year 0.033 (0.066) 0.027 (0.064) 0.012 (0.069) 0.027 (0.064) Cadre (ref. Nurses) Clinicians 0.212 (0.131)* 0.200 (0.121)* 0.181 (0.134)* 0.238 (0.128)* Age (ref. < 20 years) 20–35 years 0.053 (0.051)* 0.053 (0.050)* 0.064 (0.050)* 0.059 (0.048)* > 35 years 0.049 (0.063)* 0.055 (0.062)* 0.059 (0.062)* 0.043 (0.062)* Model 3 for the domain of “Staff and training” Model 4 for the domain of “Equipment” Model 6 for the domain of “Diagnostics” Model 5 for the domain of “Medicines and commodities” = p < 0.2, ** = p < 0.05 Abbreviations Availability of data and materials AIDS: Acquired immunodeficiency syndrome; ANC: Antenatal; HIV: Human The dataset used for this secondary analysis was generated from the original immunodeficiency virus; MoHCDGEC: Ministry of health, community develop - Tanzanian SPA datasets available in the DHS Program repository: http:// dhspr ment, gender, elderly, and children; MTCT : Mother-to-child transmission; PITC: ogram. com/ data/ avail able- datas ets. cfm. The generated dataset is currently Provider-initiated HIV testing and counseling; PMTCT : Prevention of mother- stored and accessible by the first author. However, it is available upon request to-child transmission; SE: Standard error; SPA: Service provision assessment; to the first author at the contact address provided in this article. SSA: Sub-Saharan Africa; WHO: World Health Organization. Declarations Supplementary Information Ethics approval and consent to participate The online version contains supplementary material available at https:// doi. This study was based on analysis of existing public domain survey data sets org/ 10. 1186/ s12981- 021- 00362-y. that are freely available online with all identifier information detached. The original survey was approved by the Ethics Committee of the ICF Macro at Calverton in the USA and by the National Institute of Medical Research Ethics Additional file1: Table S1. Summary of the measurement procedure of Committee in Tanzania. Therefore, the ethical approval for the current analysis key independent variable “Facility readiness.” was automatically deemed unnecessary; however, permission to access the Tanzania SPA dataset was requested and granted by ICF Institutional Review Acknowledgements Board through DHS program. We would like to acknowledge ICF International, Rockville, Maryland, USA, through DHS program for permitting us to Access the Tanzania SPA 2014-2015 Consent for publication dataset. Not applicable. Authors’ contributions Competing interests DB originated the design of the study; DB and BCT performed statistical The authors have no commercial or other associations that might pose a analysis and interpretation of data; DB, AL, SJ, MMN, and BCT drafted the conflict of interest. manuscript and critically revised the drafted manuscript. All authors read and approved the final manuscript. Author details Department of Community Medicine, The University of Dodoma, Dodoma, Funding Tanzania. Department of Obstetrics and Gynecology, The University There was no funding associated with this study. of Dodoma, Dodoma, Tanzania. Department of Pediatrics and Child Health, Bintabara et al. AIDS Res Ther (2021) 18:38 Page 10 of 11 The University of Dodoma, Dodoma, Tanzania. Department of Obstetrics 17. Gourlay A, Wringe A, Todd J, et al. Uptake of services for prevention of and Gynecology, Dodoma Regional Referral Hospital, Dodoma, Tanzania. mother-to-child transmission of HIV in a community cohort in rural Department of Internal Medicine, The University of Dodoma, Dodoma, Tanzania from 2005 to 2012. BMC Health Serv Res. 2015;16:4. https:// doi. Tanzania. org/ 10. 1186/ s12913- 015- 1249-6. 18. Ministry of Health, Community Development, Gender, Elderly and Received: 5 March 2020 Accepted: 26 June 2021 Children (MoHCDGEC). National Guidelines for Comprehensive Care of Prevention of Mother-to-Child Transmission of HIV and Keeping Mothers Alive. Dar es Salaam, Tanzania: 2013. http:// ihi. eprin ts. org/ 3335/1/ tz_ guide lines_ ccs_ optio nb_ all. pdf Accessed 5 Dec 2019. 19. Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) [ Tanzania Mainland], Ministry of Health (MoH) References [Zanzibar], National Bureau of Statistics (NBS), Office of the Chief Govern- 1. Kharsany ABM, Karim QA. HIV infection and AIDS in Sub-Saharan Africa: ment Statistician (OCGS), and ICF. 2016. Tanzania Demographic and current status challenges and opportunities. Open AIDS J. 2016;10:34–48. Health Survey and Malaria Indicator Survey ( TDHSMIS) 2015–16. Dar es https:// doi. org/ 10. 2174/ 18746 13601 61001 0034. Salaam, Tanzania, and Rockville, Maryland, USA: MoHCDGEC, MoH, NBS, 2. Ramjee G, Daniels B. Women and HIV in Sub-Saharan Africa. AIDS Res OCGS, and ICF. 2016. https:// dhspr ogram. com/ pubs/ pdf/ FR321/ FR321. Ther. 2013;10:30. https:// doi. org/ 10. 1186/ 1742- 6405- 10- 30. pdf Accessed 5 Dec 2019. 3. UNAIDS. The Gap Report. 2014. http:// www. unaids. org/ sites/ defau lt/ files/ 20. Gourlay A, Birdthistle I, Mburu G, et al. Barriers and facilitating factors media_ asset/ UNAIDS_ Gap_ report_ en. pdf Accessed 5 Dec 2019. to the uptake of antiretroviral drugs for prevention of mother-to-child 4. Kuhn L, Aldrovandi GM, Sinkala M, et al. Eec ff ts of early, abrupt weaning transmission of HIV in sub-Saharan Africa: a systematic review. J Int AIDS on HIV-free survival of children in Zambia. N Engl J Med. 2008;359:130– Soc. 2013;16:18588. https:// doi. org/ 10. 7448/ IAS. 16.1. 18588. 41. https:// doi. org/ 10. 1056/ NEJMo a0737 88. 21. Gourlay A, Wringe A, Todd J, et al. Factors associated with uptake of 5. Chersich MF, Rees HV. Vulnerability of women in southern Africa to infec- services to prevent mother-to-child transmission of HIV in a community tion with HIV: biological determinants and priority health sector interven- cohort in rural Tanzania. Sex Transm Infect. 2015;91:520–7. https:// doi. tions. AIDS. 2008;22:S27-40. https:// doi. org/ 10. 1097/ 01. aids. 00003 41775. org/ 10. 1136/ sextr ans- 2014- 051907. 94123. 75. 22. Dussault G, Dubois CA. Human resources for health policies: a critical 6. Torrone EA, Morrison CS, Chen P-L, et al. Prevalence of sexually transmit- component in health policies. Hum Resour Health. 2003. https:// doi. org/ ted infections and bacterial vaginosis among women in sub-Saharan 10. 1186/ 1478- 4491-1-1. Africa: an individual participant data meta-analysis of 18 HIV prevention 23. Bintabara D, Nakamura K, Seino K. Determinants of facility readiness for studies. PLOS Med. 2018;15:e1002511. https:// doi. org/ 10. 1371/ journ al. integration of family planning with HIV testing and counseling services: pmed. 10025 11. evidence from the Tanzania service provision assessment survey, 7. World Health Organization ( WHO). Global Update on the Health Sector 2014–2015. BMC Health Serv Res. 2017;17:844. https:// doi. org/ 10. 1186/ Response to HIV, 2014. s12913- 017- 2809-8. 8. Mutabazi JC, Zarowsky C, Trottier H. The impact of programs for preven- 24. Ministry of Health and Social Welfare (MoHSW ) [ Tanzania Mainland], tion of mother-to-child transmission of HIV on health care services and Ministry of Health (MoH) [Zanzibar], National Bureau of Statistics (NBS), systems in sub-Saharan Africa—a review. Public Health Rev. 2017;38:28. Office of the Chief Government Statistician (OCGS), and ICF International https:// doi. org/ 10. 1186/ s40985- 017- 0072-5. 2015. Tanzania Service Provision Assessment. 2015. https:// dhspr ogram. 9. Hampanda K. Vertical transmission of HIV in Sub-Saharan Africa: applying com/ pubs/ pdf/ SPA22/ SPA22. pdf Accessed 5 Dec 2019. theoretical frameworks to understand social barriers to PMTCT. ISRN 25. Health Statistics and Information Systems, World Health Organization Infect Dis. 2013;2013:1–5. https:// doi. org/ 10. 5402/ 2013/ 420361. ( WHO). Service Availability and Readiness Assessment (SARA): an annual 10. UNICEF. Elimination of mother-to-child transmission of HIV (eMTCT ). monitoring system for service delivery: Reference Manual, Version 2.2. 2010. https:// www. unicef. org/ tanza nia/ 6912_ 10623. html Accessed 5 Dec 2015. http:// www. who. int/ healt hinfo/ syste ms/ sara_ refer ence_ manual/ en/ Accessed 5 Dec 2019. 11. World Health Organization ( WHO). Guidance on Global Scale-Up of the 26. Naburi H, Ekström AM, Mujinja P, et al. The potential of task-shifting in Prevention of Mother-Child Transmission of HIV: Towards universal access scaling up services for prevention of mother-to-child transmission of HIV: for women, infants and young children and eliminating HIV and AIDS a time and motion study in Dar es Salaam Tanzania. Hum Resour Health. among children. 2007. http:// www. who. int/ hiv/ pub/ toolk its/ PMTCT 2017;15:35. https:// doi. org/ 10. 1186/ s12960- 017- 0207-2. 97892 41596 015_ eng. pdf Accessed 5 Dec 2019. 27. An SJ, George AS, LeFevre AE, et al. Supply-side dimensions and dynam- 12. Ministry of Health Community Development Gender Elderly and Children ics of integrating HIV testing and counselling into routine antenatal care: (MOHCDGEC). Tanzania elimination of Mother to Child Transmission of a facility assessment from Morogoro Region, Tanzania. BMC Health Serv HIV plan, 2012–2015. 2012. https:// www. healt hprom otion tanza nia. org/ Res. 2015;15:451. https:// doi. org/ 10. 1186/ s12913- 015- 1111-x. index. php/ en/ libra ry122/ doc_ view/ 152- costed- emtct- plan- final- 16- may- 28. UNAIDS. 2015 Progress Report on the Global Plan towards elimination 2. html Accessed 5 Dec 2019. of new HIV infections among children and keeping their mothers alive. 13. Isangula KG, Holmes A, Brownie S. HIV Testing for PMTCT in Tanzania: Time 2015. http:// www. unaids. org/ sites/ defau lt/ files/ media_ asset/ JC2774_ to move from ‘Voluntary’ to ‘Mandatory’? Adv Soc Sci Res J. 2015;2:131–8. 2015P rogre ssRep ort_ Globa lPlan_ en. pdf Accessed 5 Dec 2019. https:// doi. org/ 10. 14738/ assrj. 22. 895. 29. Balira R, Mabey D, Weiss H, et al. The need for further integration of 14. World Health Organisation ( WHO). PMTCT strategic vision 2010–2015 : services to prevent mother-to-child transmission of HIV and syphilis in preventing mother-to-child transmission of HIV to reach the UNGASS Mwanza City, Tanzania. Int J Gynecol Obstet. 2015;130:S51–7. https:// doi. and Millennium Development Goals. 2015. org/ 10. 1016/j. ijgo. 2015. 04. 016. 15. Joint United Nations Programme on HIV/AIDS (UNAIDS). On the fast-track 30. Gruskin S, Ahmed S, Ferguson L. Provider-initiated HIV testing and to an AIDS-free generation; the incredible journey of the global plan counseling in health facilities—what does this mean for the health and towards the elimination of new HIV infections among children by 2015 human rights of pregnant women? Dev World Bioeth. 2008;8:23–32. and keeping their mothers alive. 2016. http:// www. unaids. org/ sites/ defau https:// doi. org/ 10. 1111/j. 1471- 8847. 2007. 00222.x. lt/ files/ media_ asset/ Globa lPlan 2016_ en. pdf Accessed 5 Dec 2019. 31. Kennedy CE, Fonner VA, Sweat MD, et al. Provider-initiated HIV testing 16. Joint United Nations Programme on HIV/AIDS (UNAIDS). Prevention gap and counseling in low- and middle-income countries: a system- report Geneva, Switzeland. 2016. http:// www. unaids. org/ sites/ defau lt/ atic review. AIDS Behav. 2013;17:1571–90. https:// doi. org/ 10. 1007/ files/ media_ asset/ 2016- preve ntion- gap- report_ en. pdf Accessed 5 Dec s10461- 012- 0241-y. 2019. Bin tabara et al. AIDS Res Ther (2021) 18:38 Page 11 of 11 32. Ngarina M, Kilewo C, Karlsson K, et al. Virologic and immunologic failure, 36. Gunn JKL, Asaolu IO, Center KE, et al. Antenatal care and uptake of HIV drug resistance and mortality during the first 24 months postpartum testing among pregnant women in sub-Saharan Africa: a cross-sectional among HIV-infected women initiated on antiretroviral therapy for life in study. J Int AIDS Soc. 2016;19:20605. the Mitra plus Study, Dar es Salaam Tanzania. BMC Infect Dis. 2015;15:175. 37. World Health Organization ( WHO). Everybody’s business: strengthening https:// doi. org/ 10. 1186/ s12879- 015- 0914-z. health systems to improve health outcomes: WHO’s framework for action. 33. Gamell A, Luwanda LB, Kalinjuma AV, et al. Prevention of mother-to-child 2007. transmission of HIV Option B+ cascade in rural Tanzania: The One Stop 38. Ministry of Health and Social Welfare (MoHSW ). Tanzania Service Avail- Clinic model. PLoS ONE. 2017;12:e0181096. https:// doi. org/ 10. 1371/ journ ability and Readiness Assessment (SARA) 2012.https:// ihi. eprin ts. org/ al. pone. 01810 96.2448/1/ SARA_ 2012_ Report. pdf Accessed 5 Dec 2019. 34. Gebremedhin KB, Tian B, Tang C, et al. Factors associated with acceptance 39. Leonard K, Masatu MC. Outpatient process quality evaluation and the of provider-initiated HIV testing and counseling among pregnant women Hawthorne Eec ff t. Soc Sci Med. 2006;63:2330–40. https:// doi. org/ 10. in Ethiopia. Patient Prefer Adherence. 2018;12:183–91. https:// doi. org/ 10. 1016/j. socsc imed. 2006. 06. 003. 2147/ PPA. S1486 87. 35. Kumar R, Probandari A, Ojha B, et al. Implementation fidelity of provider- Publisher’s Note initiated HIV testing and counseling of tuberculosis patients under the Springer Nature remains neutral with regard to jurisdictional claims in pub- National Tuberculosis Control Program in Kathmandu District of Nepal: an lished maps and institutional affiliations. implementation research. BMC Health Serv Res. 2019;19:543. https:// doi. org/ 10. 1186/ s12913- 019- 4343-3. Re Read ady y to to submit y submit your our re researc search h ? Choose BMC and benefit fr ? Choose BMC and benefit from om: : fast, convenient online submission thorough peer review by experienced researchers in your field rapid publication on acceptance support for research data, including large and complex data types • gold Open Access which fosters wider collaboration and increased citations maximum visibility for your research: over 100M website views per year At BMC, research is always in progress. Learn more biomedcentral.com/submissions

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AIDS Research and Therapy – Springer Journals

Published: Jul 3, 2021

Keywords: Facility readiness; High-quality; Antenatal care; Provider-initiated HIV testing and counseling; PMTCT; Tanzania

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