The Evaluation of HIV Surveillance System in Pregnant Women in

Badung Regency, Indonesia

I Gusti Ayu Agung Apsari

, Anak Agung Sagung Sawitri

and Ni Putu Eka Purnama Dewi

Field Epidemiology Training Program, Magister of Public Health Science, Udayana University, Indonesia

Badung District Health Office, Indonesia

Keywords: Early Detection, HIV, Surveillance Evaluation.

Abstract: HIV surveillance is very important to support HIV/AIDS treatment in pregnant women to break the chain of

HIV transmission to their children. The objective of this study was to evaluate the HIV surveillance system

in pregnant women in Badung regency. This study used a descriptive observational approach performed using

a questionnaire and checklist. We interviewed 13 HIV health officers from primary healthcare centers in

Badung regency regarding the input, process, and output of the surveillance. This study found that HIV health

officers lacked the ability to detect and map all HIV-confirmed pregnant women early (92.3%) using the web

system. Most HIV health officers did not complete the form records (92.3%), leading to less accurate

information. In addition, most of them faced obstacles in reporting the process to the web system. Lack of

ability to detect and map HIV case in pregnant women needs to be solved by providing technical guidance to

HIV health officers.

1 INTRODUCTION

Mother To Child Transmission (MTCT) is the

transmission of an infection from a mother to her

child. The high rate of MTCT in Indonesia reached

61,000 HIV-positive pregnant women, and only some

(56%) of mothers who gave birth were infected with

HIV and underwent ARV therapy in 2017 (UNAIDS,

2018). Bali province was reported having 160

pregnant women with HIV positive in 2017 (Bali

Provincial Health Office, 2017). Furthermore, 30

HIV-positive cases in pregnant women were found in

Badung regency in 2018. The HIV positive incidence

in pregnant women poses a risk for children to get

infected. Previous research discovered new

HIV/AIDS cases in children aged < 15 years

amounting to 180,000 new HIV-positive cases and

110,000 new AIDS cases worldwide in 2017

(UNAIDS Global Summary, 2017). An increase in

new cases of HIV-positive infection occurred to

children every year in Indonesia from 2010 to 2016

(2,300 new cases; 3,200 new cases, respectively)

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(UNAIDS, 2017). Of 25% of babies born to HIV-

positive mothers in Indonesia, 16.9% of them were

infected by HIV in 2017 (UNAIDS, 2018). MTCT

cases can be seen from the number of new HIV and

AIDS-positive cases in children aged <4 years (1.50%

and 3.27%) and 5-14 years (0.81% and 0.27%) in Bali

in 2017 (Bali Provincial Health Office, 2017).

HIV testing on the Service Providers and

Counseling Initiative (PITC) is one of the programs to

prevent the transmission of HIV/AIDS from a mother

to her baby. PITC is one of the programs in Indonesia

that is run by all districts through the Primary Health

Center. However, a gap was found between the targets

and outcomes of PITC. Data from Badung District

Health Office show that the PITC program had not

reached the target yet from 2020 to 2021. The program

still uncovered 2,991 and 3,219 pregnant women in

2020 and 2021, respectively. Thirteen Health Offices

report their PITC progress monthly to the Badung

District Health Office. Problems were found that the

PITC carried out at private health facilities were not

reported or few pregnant women participated in the

program. According to interviews with HIV/AIDS

Apsari, I., Sawitri, A. and Dewi, N.

The Evaluation of HIV Surveillance System in Pregnant Women in Badung Regency, Indonesia.

DOI: 10.5220/0011939300003576

In Proceedings of the 2nd Bali Biennial International Conference on Health Sciences (Bali BICHS 2022), pages 69-71

ISBN: 978-989-758-625-5

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

program holders of Badung District Health Office,

reporting flow from private health facilities was

unclear enough.

To find gaps in PITC implementation, this study

aimed to evaluate the HIV surveillance system,

especially for pregnant women in Badung regency.

This evaluation can later be used in intervention

planning and formulation of HIV surveillance

systems for pregnant women to control HIV

transmission from mothers to babies

2 SUBJECTS AND METHODS

This study was observational descriptive research

conducted at the Badung District Health Office. The

total sampling was used to select 13 HIV program

holders across all primary healthcare centers of

Badung regency. Data was collected from February

to May 2022 using questionnaires, checklists, and

interviews with the program holders. The components

evaluated included input (man, money, material, and

method), process (early detection, recording,

reporting, accuracy, data analysis, and monitoring),

and output (dissemination). The data collected were

analyzed descriptively using SPSS 25 for Windows to

see the distribution of each variable. All data were

presented in the form of graphs and tables.

3 RESULTS

3.1 Input Evaluation

Table 1: Distribution of human resources at Badung district

health office in 2022

Aspects of Human Resources F (%)

N = 13

Gender

Female

Male

12 (92.3%)

1 (7.7%)

Last Education

Diploma

D4/S1

7 (53.8%)

5 (38.5%)

1 (7.7%)

Epidemiology Education Background

Yes

2 (15.4%)

11 (84.6%)

HIV Surveillance Training

Yes

6 (46.2%)

(

53.8%

)

Total Workload

1 program

rams

2 (15.4%)

(

61.5%

)

More than 2 programs 3 (23.1%)

Length of work as HIV surveillance

≤ 5 years

> 5

ears

8 (61.5%)

(

38.5%

)

Table 1 describes that most of the program holders

are women (92.3%) and mostly hold diploma

education (53.8%). Most of them did not have a

history of previous epidemiology education (84.6%)

and did not receive training (53.8%). In addition,

most program holders were responsible for two

programs (61.5%). Most of the program holders had

a history of working in surveillance for five years

(61.5%). The complexity of the program management

was that 13 offices had standard operating procedures

of HIV surveillance in their workplaces (61.5%).

Most of the offices had good facilities and

infrastructure although some had problems with

internet connection, computer, and printers

3.2 Process Evaluation

3.2.1 Early Detection

Early detection of HIV in pregnant women can be

done through the PITC program which can

incorporate screening for HIV and sexually

transmitted diseases. However, data show that the

offices in Badung regency had not achieved the

predetermined targets well due to the absence of HIV

case mapping (92.3%). Meanwhile, mapping is

prominent to see the distribution of pregnant women

and infections in the work areas of district health

offices that perform Antenatal Care (ANC). Without

this strategy, it will be difficult to identify HIV cases

early.

3.2.2 Recording and Reporting

Most of the offices did not record HIV cases on the

KT form (92.3%). They also slowly reported the case

to the WA group which was available 1 x 24 hours

(53.8%). Some problems causing poor reporting are

poor internet connection, interference with the SIHA

application, slow computers, and untransferred

reporting which was only done in Ms. Excel not to

SIHA.

3.2.3 Completeness

Most of the offices understood the KT form and

operations of SIHA program. However, the program

was not used optimally because patients forgot to

bring their identity card.

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3.2.4 Data Analysis

Most of the HIV program holders in Badung regency

understood how to analyze data and make data

analysis.

3.2.5 Monitoring

Most of the offices were monitored by district and

provincial officers. The offices conducted planning,

preparation, implementation, and evaluation of the

surveillance program every three months.

3.3 Output Evaluation

Table 2: Output evaluation.

Out

ut Evaluation Yes/no %

The results of surveillance

analysis are disseminated to the

public as a guide to early HIV

detection

Yes

38.5

61.5

Conducted a management

review to discuss the trend of

HIV cases in pregnant women

at the Health Center Office

Yes

69.2

30.8

There is feedback or evaluation

from superiors or tiered

feedback on the re

orts

iven

Yes

92.3

7.7

Information related to HIV surveillance was not

distributed to the society (61.5%). Hence, awareness

of sexual health, especially HIV in pregnant women,

is hard to achieve.

3.4 Attribute Surveillance

3.4.1 Simplicity

The representation of HIV report is considered

important by considering the objectives of HIV

surveillance system. Five reports came from the

primary healthcare centers, hospitals, district/city

health offices and provincial health offices. The

report format was simple and easy to understand

because communication was provided on WhatsApp

to provide fast and effective information

3.4.2 Flexibility

The HIV surveillance system for pregnant women

was flexible. It requires pregnant women to take a

laboratory test which result finished in 15-30 minutes.

Standardized reporting has also been carried out

through the SIHA system.

3.4.3 Acceptability

Based on the results of observations, most of the KT

forms were incomplete. By involving private

practice, the health offices could have more support

for case reporting.

3.4.4 Sensitivity

The HIV surveillance system was conducted using

the 2013 reporting technical manual from the

Indonesian Ministry of Health. Blood samples of

pregnant women were examined in each primary

healthcare center.

3.4.5 Representativeness

A surveillance system was considered representative

because all health offices performed PITC for early

detection and reporting of HIV cases in pregnant

women every month.

3.4.6 Timeliness

The interview and tracing results mention that every

case report was reported on time from the 26th to the

31st each month.

4 CONCLUSIONS

This study confirms that the HIV surveillance system

was still poorly run for the pregnant women

population. Beside the problem, the program holders

lack the ability to map HIV risk in pregnant women

and received double workload. Also, they did not

complete KT form fully and did not disseminate

information related to HIV surveillance to the society,

leading to poor awareness of early HIV detection.

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Yayasan

The Evaluation of HIV Surveillance System in Pregnant Women in Badung Regency, Indonesia