Recruitment of participants

Pregnant women aged 15–49 years who received antenatal care services during the study period were included. Those who were critically ill, unable to hear, or with other disabilities such as impaired communication ability, and those who had already received HIV testing during current pregnancy were excluded.

PITC service was provided with informed consent to all pregnant women attending antenatal care facilities per national guidelines.9,20 All the health sectors providing qualified PMTCT service in Adama were included in the study. The institutions included 4 governmental health centers, 2 private clinics, 1 private hospital, and 1 governmental hospital. The stratified sampling technique was used to select the study units in each health sector. Based on the number of pregnant women who visited each health sector 10 months before this survey, the total sample size was calculated with a single proportion formula to get the required number of pregnant women from each health sector. Pregnant women were recruited on working days (from Monday to Friday) over a 4-week period.