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