Implementation acceptability, perceived feasibility and protocol fidelity of DELI-MEDAN, a digitally supported PMTCT education and service- navigation model in Medan, Indonesia: a mixed-methods implementation study
This mixed-methods implementation study in Medan, Indonesia, found that the DELI-MEDAN model, a blended digital and facilitated education system for preventing mother-to-child HIV transmission, demonstrated high acceptability, perceived feasibility, and protocol fidelity among pregnant women and healthcare providers, though it did not evaluate clinical or behavioral outcomes.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Every year, millions of pregnant women around the world face a terrifying possibility: passing the human immunodeficiency virus, or HIV, to their unborn children. While modern medicine has made it possible to stop this transmission almost entirely, the solution requires a chain of actions that must happen perfectly. A woman needs to know she is at risk, agree to a test, receive the results without fear of judgment, start medication if needed, and stay in contact with doctors throughout her pregnancy. In many places, this chain breaks not because the medicine is missing, but because the path to get it is confusing, the information is too technical, or the fear of stigma keeps women silent. The gap between having a life-saving policy and actually using it is a problem of human connection, not just biology.
In a recent study conducted in Medan, Indonesia, researchers tested a new way to bridge that gap. They created a program called DELI-MEDAN, which blends digital tools with human conversation to guide pregnant women through the process of preventing HIV transmission. The goal was not to measure whether the program cured anyone or changed their medical status, but to see if the system itself worked. Could the women understand the information? Could they use the tools provided? Did the healthcare workers deliver the program as planned? By focusing on these practical questions, the team wanted to know if this specific mix of technology and human care was ready to be used in the real world.
The researchers worked with two local health centers and their network of midwives. They invited 300 pregnant women to participate in a two-week journey. On the first day, each woman met with a trained midwife for a private session. During this meeting, she received a small printed booklet and was shown how to use a web application on her phone called Prevent-Mom. The app and the booklet contained clear, simple information about HIV, why testing matters, and how the process works. Crucially, the midwife did not just hand over the materials; she sat down to explain them, answer questions, and help the woman decide if she wanted to involve her partner or family. The program respected the woman's choice to keep the matter private or to share it with loved ones.
Over the next two weeks, the women received follow-up contacts. These were short check-ins, either in person, by phone, or through a messaging app, designed to remind them of the next steps and offer support if they had trouble using the app or needed more counseling. The researchers tracked every step of this process. They counted how many women finished the two-week program, how many found the materials easy to understand, and how many felt the process was manageable in their daily lives. They also checked the midwives' records to see if the core parts of the program were delivered correctly, ensuring that no woman was left without a clear explanation or a path to testing.
The results showed that the system worked very well in this setting. Nearly all the women who started the program finished it. When asked, the vast majority said they liked the program and found it easy to use. Specifically, 91 percent of the women who completed the follow-up said the educational materials were easy to understand, and 87 percent said the web application was easy to navigate. The midwives also delivered the program with high accuracy, following the planned steps in more than 90 percent of the cases. The women reported that the program felt acceptable and feasible, meaning they felt it was a good fit for their needs and that they could actually do it.
However, the study also revealed important details that numbers alone could not show. While most women had their own smartphones, some did not, and for those who did, having a device did not always mean they could use it privately or confidently. The researchers found that the printed booklet and the help of the midwife were essential. Without these human and low-tech supports, the digital app would not have worked for everyone. The women also emphasized that the tone of the conversation mattered deeply. They needed to feel that their privacy was protected and that they would not be judged. If the conversation felt cold or stigmatizing, the technology would not have been enough to keep them engaged.
The study also highlighted the role of family. While having a supportive partner or family member could help a woman stay on track, forcing her to involve them could be dangerous or counterproductive. The program succeeded because it gave the woman full control over whether to bring others into the process. This choice was a central part of the design, ensuring that the woman remained the decision-maker. The researchers also noted that for the program to work in the long run, the health centers needed to be clear about who was responsible for what. If a woman was referred to a different clinic for testing, that clinic needed to know she had been sent there, and the original midwife needed to know the result. Without this clear coordination, the chain of care could still break, even if the education was perfect.
It is important to understand what this study did not prove. The researchers did not measure whether the women learned more about HIV, whether they were more likely to get tested, or whether the program reduced the number of babies born with the virus. Those are questions for a different kind of study. This report only looked at whether the delivery system itself was understandable, workable, and delivered correctly. The findings suggest that the DELI-MEDAN model is a strong candidate for wider use, but it is not a guarantee of medical success on its own.
The study concludes that for a program like this to succeed, it cannot rely on technology alone. The digital app was useful, but it worked best when paired with a human who could explain things, protect privacy, and offer a printed alternative for those who needed it. The success of the program depended on the trust between the woman and the midwife, the clarity of the information, and the ability of the health system to keep the woman moving forward without losing her along the way. The researchers found that when these human elements were present, the women were willing and able to engage with the program. This suggests that the path to stopping mother-to-child transmission is not just about having the right drugs or tests, but about building a system that respects the woman's dignity, her choices, and her need for clear, kind guidance.
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