Muslim doctor touching the belly of a pregnant Muslim woman. Credit: AdobeStock

The MENJAGA (“Protection”) Study

An implementation trial of continuous quality improvement for antenatal syphilis and HIV detection and treatment in Indonesia

The challenge

Screening for HIV and syphilis among pregnant women is an essential element of antenatal care (ANC) and is prioritised globally. Indonesia, the fourth most populous country in the world with over 270 million people, has high coverage rates of antenatal care (i.e., >95%) but low rates of antenatal screening and treatment for HIV/syphilis. This is recognised as one of the most significant gaps in antenatal care in Indonesia. A range of context-specific factors impede the delivery of ANC and specifically, the diagnosis and treatment of HIV/syphilis. This study will use a continuous quality improvement (CQI) approach to identify and implement local solutions to address implementation barriers to the scale-up of HIV/syphilis testing in Indonesia.

The project

We will evaluate a low-cost and locally-driven intervention based on the principles of continuous quality improvement (CQI) to strengthen antenatal care and improve screening for HIV and syphilis. This intervention has the potential to improve maternal and child health in Indonesia and may be adaptable to other health systems in the region where syphilis and HIV screening among pregnant women remains unacceptably low.
Specific objectives are to:

  1. Evaluate the effectiveness of a multi-faceted CQI intervention;
  2. Determine the cost-effectiveness of the intervention;
  3. Evaluate the uptake and implementation of the intervention;
  4. Use published frameworks, to assess the scalability of the intervention.
The method

Using a cluster-randomised design, we will evaluate the effectiveness, cost-effectiveness, acceptability, fidelity and reach of a multi-faceted CQI intervention to improve antenatal testing and treatment of HIV/syphilis in ANC clinics in 6 districts across 3 Provinces (West Java, South Sumatra and South Kalimantan). This 3-year multi-disciplinary trial will involve clinicians, epidemiologists, economists, social scientists, health services researchers and policy-makers from the London School of Hygiene & Tropical Medicine, Universitas Gadjah Mada, Universitas Sebelas Maret, the Indonesian Ministry of Health, World Health Organization and the Kirby Institute.

The results

Formative research is currently underway to inform intervention design.

The impact

To our knowledge, this will be the first cluster-randomised trial with process and economic evaluations to evaluate a multi-faceted CQI intervention to improve antenatal testing and treatment of HIV/syphilis among public and private providers in Indonesia and Southeast Asia more broadly. This intervention has the potential to contribute significantly to improved maternal and child health in Indonesia while also strengthening the underlying health system.

Project collaborators

The London School of Hygiene and Tropical Medicine; Universitas Gadjah Mada; Universitas Sebelas Maret.


MENJAGA collaborator logos


Project funding

Medical Research Council (MRC) Global Maternal and Neonatal Health Shared Grant.