The cascade of HIV care among key populations in Indonesia: a prospective cohort study

Januraga, Pande Putu; Reekie, Joanne; Mulyani, Tri; Lestari, Bony Wiem; Iskandar, Shelly; Wisaksana, Rudi; Kusmayanti, Nur Aini; Subronto, Yanri Wijayanti; Widyanthini, Desak Nyoman; Wirawan, Dewa Nyoman; Wongso, Lydia Verina; Sudewo, Anindita Gabriella; Sukmaningrum, Evi; Nisa, Tiara; Prabowo, Bagus Rahmat; Law, Matthew; Cooper, David A.; Kaldor, John

doi:10.1016/s2352-3018(18)30148-6

Cited by 86 publications

(110 citation statements)

References 23 publications

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“…Findings of this study are suggestive of a significant relationship between PLHIV who belonged to key populations (PWIDs, TGs and sex workers) and LTFU as a treatment outcome. This finding is consistent with studies that have identified key populations as a risk factor to LTFU (21,22).…”

Section: Discussionsupporting

confidence: 92%

The extent of loss to follow among patients initiated on antiretroviral treatment, Pakistan 2017-2018: a retrospective cross-sectional study

Paracha¹,

Hafeez²,

Habib³

et al. 2019

Preprint

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Background The HIV epidemic in Pakistan is concentrated in key populations and is one of the fastest growing epidemics in South Asia. Over the years the number of people infected with the human immunodeficiency virus initiated on antiretroviral therapy has gradually increased. The effectiveness of the treatment programmes depends on retention in care and treatment adherence. The aim of the study is to the explore the sociodemographic characteristics and magnitude of loss to follow-up in patients initiated on ART in three provinces of Pakistan.Methods A retrospective cross-sectional study was conducted in the National AIDS Control Programme. Case-based data (n=5,215) of 16 treatment centres for all patients initiated on anti-retroviral therapy from 1 st January 2017 to 31 st December 2018 was extracted from the national management information system. Loss to follow-up was defined as a patient who has not visited/attended the ART clinic for >180 days (6 months) and has not been reported dead or transferred out to another ART clinic. Descriptive statistics were applied to study the sociodemographic characteristics and level of lost to follow up in patients initiated on treatment.Results Of the 5,215 patients, 3,097 (59.4%) were aged between 15-49 years. About 4,069 (78%) were male. Around 1,686 (34.3%) of the patients on ART were defined as lost to follow up. Age, gender, and patients with undisclosed identity were identified as the key characteristics of patients lost to follow-up. A greater proportion of the patients were lost to follow-up within the first year of initiation of treatment.Conclusions The loss to follow in the study is high. Efforts need to be focussed on linking people infected with human immunodeficiency virus to treatment, retaining them in care, and increasing patient time on treatment. Patient tracing mechanisms should be strengthened.

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Section: Discussionsupporting

confidence: 92%

The extent of loss to follow among patients initiated on antiretroviral treatment, Pakistan 2017-2018: a retrospective cross-sectional study

Paracha¹,

Hafeez²,

Habib³

et al. 2019

Preprint

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“…The current study had lower uptake of routine VL testing compared with those seen in Swaziland (87%), Rwanda (93.2%) and Indonesia (71.1%) 21–23. As routine VL testing was introduced recently in 2017, the early implementation challenges and barriers such as the need for repeated visits only for VL sample collection would have led to lower uptake of VL testing.…”

Section: Discussionmentioning

confidence: 62%

Uptake of routine viral load testing among people living with HIV and its implementation challenges in Yangon region of Myanmar: a mixed-methods study

Thinn

Thekkur

Kyaw³

et al. 2019

BMJ Open

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ObjectivesIn 2017, Myanmar implemented routine viral load (VL) monitoring for assessing the response to antiretroviral therapy (ART) among people living with HIV (PLHIV). The performance of routine VL testing and implementation challenges has not yet assessed. We aimed to determine the uptake of VL testing and factors associated with it among PLHIV initiated on ART during 2017 in ART clinics of Yangon region and to explore the implementation challenges as perceived by the healthcare providers.DesignAn explanatory mixed-methods study was conducted. The quantitative component was a cohort study, and the qualitative part was a descriptive study with in-depth interviews.SettingSix ART clinics operated by AIDS/sexually transmitted infection teams under the National AIDS Programme.Primary outcome measures(1) The proportion who underwent VL testing by 30 March 2019 and the proportion with virological suppression (plasma VL <1000 copies/mL); (2) association between patient characteristics and ‘not tested’ was assessed using log binomial regression and (3) qualitative codes on implementation challenges.ResultsOf the 567 PLHIV started on ART, 498 (87.8%) retained in care for more than 6 months and were eligible for VL testing. 288 (57.8%, 95% CI: 53.3% to 62.2%) PLHIV underwent VL testing, of which 263 (91.3%, 95% CI: 87.1% to 94.4%) had virological suppression. PLHIV with WHO clinical stage 4 had significantly higher rates of ‘not being tested’ for VL. Collection of sample for VL testing only twice a month, difficulties in sample collection and transportation, limited trained workforce, wage loss and out-of-pocket expenditure for patients due to added visits were major implementation challenges.ConclusionsThe VL test uptake was low, with only six out of ten PLHIV tested. The VL testing uptake needs to be improved by strengthening sample collection and transportation, adopting point-of-care VL tests, increasing trained workforce, providing compensation to patients for wage loss and travel costs for additional visits.

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“…In 2015 Indonesia became a "Fast-Track" country, aiming to make rapid, efficient, innovative investments to reach HIV prevention and treatment targets, notably in Jakarta (IAPAC, n.d.). However, PLHIV retention on treatment remains low, especially among key populations (Januraga et al 2018).…”

Section: Introductionmentioning

confidence: 99%

Health Workforce Assessment in Jakarta for Effective HIV Policy Implementation: Challenges and Opportunities toward Epidemic Control

Deussom¹,

Rottach

Prabawanti³

et al. 2019

jurnaleki

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Strategic efforts are needed in Indonesia to implement the recently released human immunodeficiency virus (HIV) Test and Treat policy which promotes increased treatment uptake, known to have important economic benefits. Of Indonesia’s estimated 631,635 people living with HIV (PLHIV) in 2018, only 12% are on treatment. The USAID- and PEPFAR-funded Human Resources for Health in 2030 (HRH2030) Program undertook policy analysis and assessed the available health workforce and service delivery at select sites in Jakarta to identify and anticipate Test and Treat implementation gaps. A mixed methods concurrent triangulation design was used, including policy analysis, key informant interviews, and site-level tools to capture workforce availability, skills, quality, and performance. Results indicate priorities to: define and implement HIV standards of practice for the Test and Treat policy; improve relevance and coordination of pre-service and in-service training programs; and support managers to optimize task and workforce allocation, including allocating lower-skilled workers to routine testing. Additional site-level data are needed from rural and remote sites in Indonesia, where fewer health workers are distributed. Efficiencies can help sustain HIV programs and contribute to epidemic control.Abstrak Upaya strategis dibutuhkan Indonesia untuk implementasi kebijakan Pemeriksaan dan Pengobatan (Test and Treat) HIV, seperti yang diterbitkan oleh USAID dan PEPFAR. Kebijakan ini mendorong peningkatan cakupan pengobatan yangd diyakini penting secara ekonomi. Diperkirakan pada tahun 2018 terdapat 631,635 ODHA di Indonesia dan hanya 12% yang menjalani pengobatan. Program HRH2030 yang didanai oleh USAID dan PEPFAR melakukan analisis kebijakan dan penilaian ketersediaan tenaga kesehatan dan pelayanan HIV di beberapa unit layanan di Jakarta, untuk mengidentifikasi dan mengantisipasi kesenjangan implementasi kebijakan. Kajian menggunakan metode campuran dengan melakukan analisis kebijakan, wawancara informan kunci, dan serangkaian alat asesmen tingkat unit layanan untuk menangkap informasi terkait ketersediaan, keterampilan, kualitas, dan kinerja tenaga kesehatan. Hasil kajian ini memprioritaskan adanya penetapan dan penerapan standar praktik layanan HIV yang sesuai dengan kebijakan Pemeriksaan dan Pengobatan. Peningkatan koordinasi program pendidikan pra-layanan dan pelatihan dalam jabatan dan dukungan kepada manajer unit layanan untuk mengoptimalkan alokasi tugas dan tenaga kesehatan menjadi hal yang penting. Pendekatan ini diharapkan dapat meningkatkan efisiensi layanan dan keberlanjutan program HIV. Data dan informasi tingkat unit layanan dibutuhkan, khususnya dari wilayah pedesaan dan terpencil.

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The cascade of HIV care among key populations in Indonesia: a prospective cohort study

Abstract: Australian Government Department of Foreign Affairs and Trade, WHO, and Indonesian Government.

Cited by 86 publications

References 23 publications

The extent of loss to follow among patients initiated on antiretroviral treatment, Pakistan 2017-2018: a retrospective cross-sectional study

The extent of loss to follow among patients initiated on antiretroviral treatment, Pakistan 2017-2018: a retrospective cross-sectional study

Uptake of routine viral load testing among people living with HIV and its implementation challenges in Yangon region of Myanmar: a mixed-methods study

Health Workforce Assessment in Jakarta for Effective HIV Policy Implementation: Challenges and Opportunities toward Epidemic Control

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