Determinants of Community-Based HIV Prevention Effectiveness through Multi-Stakeholder Collaboration

Abstract

Community-based HIV prevention effectiveness is associated with workforce capability, social conditions, behavior, infrastructure, and stakeholder collaboration. This study examined the direct effects of health worker competence, supportive infrastructure, social factors, and behavioral factors on community-based HIV prevention effectiveness in Kendari City, Indonesia. A mixed-methods sequential explanatory design was employed. The quantitative phase involved a census of 131 beneficiaries/community members, outreach workers, and volunteers, with data analyzed using PLS-SEM in SmartPLS 4. The qualitative phase used in-depth interviews and thematic analysis within a Pentahelix perspective involving government, academia, business/non-governmental organizations, communities, and media. Social factors were the strongest determinant of program effectiveness (β=0.563; p<0.001), followed by health worker competence (β=0.218; p=0.049) and behavioral factors (β=0.181; p=0.002). Supportive infrastructure had a positive but non-significant effect (β=0.084; p=0.384). The model explained 82.1% of program effectiveness variance (R²=0.821) with strong predictive relevance (Q²=0.705). Qualitative findings revealed persistent stigma, uneven social support, gradual behavioral change, and underutilized infrastructure. The findings demonstrate that effective HIV prevention depends primarily on social conditions, competent health workers, and preventive behavior, supported by coordinated stakeholder action and effective infrastructure utilization.