Résumé

<p>Background: Prevention of Mother-to-Child HIV Transmission (PMTCT) coverage has been low in Ethiopia and the</p><p>service has been implemented in a fragmented manner. Solutions to this problem have mainly been sought on the</p><p>supply-side in the form of improved management and allocation of limited resources. However, this approach</p><p>largely ignores the demand-side factors associated with low PMTCT coverage in the country. The study assesses the</p><p>factors associated with the utilization of PMTCT services taking into consideration counts of visits to antenatal care</p><p>(ANC) services in urban high-HIV prevalence and rural low-HIV prevalence settings in Ethiopia.</p><p>Methods: A multivariate regression model was employed to identify significant factors associated with PMTCT</p><p>service utilization. Poisson and negative binomial regression models were applied, considering the number of ANC</p><p>visits as a dependent variable. The explanatory variables were age; educational status; type of occupation; decisionmaking</p><p>power in the household; living in proximity to educated people; a neighborhood with good welfare</p><p>services; location (urban high-HIV prevalence and rural low-HIV prevalence); transportation accessibility; walking</p><p>distance (in minutes); and household income status. The alpha dispersion test (a) was performed to measure the</p><p>goodness-of-fit of the model. Significant results were reported at p-values of &lt; 0.05 and &lt; 0.001.</p><p>Results: Household income, socio-economic setting (urban high-HIV prevalence and rural low-HIV prevalence) and</p><p>walking distance (in minutes) had a statistically significant relationship with the number of ANC visits by pregnant</p><p>women (p &lt; 0.05). A pregnant woman from an urban high-HIV prevalence setting would be expected to make 34%</p><p>more ANC visits (counts) than her rural low-HIV prevalence counterparts (p &lt; 0.05). Holding other variables constant,</p><p>a unit increase in household income would increase the expected ANC visits by 0.004%. An increase in walking</p><p>distance by a unit (a minute) would decrease the number of ANC visits by 0.001(p &lt; 0.001).</p><p>Conclusion: Long walking distance, low household income and living in a rural setting are the significant factors</p><p>associated with low PMTCT service utilization. The primary strategies for a holistic policy to improve ANC/PMTCT</p><p>utilization should thus include improving the geographical accessibility of ANC/PMTCT services, expanding</p><p>household welfare and paying more attention to remote rural areas.</p><p>Keywords: PMTCT service, Ethiopia, Urban-rural settings, Count regression, Utilization analysis</p>