The Impact of Peer Support on Testing, Linkage to and Engagement in HIV Care for People Who Inject Drugs in Indonesia: Qualitative Perspectives From a Community-led Study

Abstract

Introduction: People who inject drugs (PWID) in Indonesia are disproportionately affected by HIV, but tend to be diagnosed at a late stage of infection, delay initiation to and have poor rates of retention in antiretroviral treatment, resulting in high rates of morbidity and mortality. In addition to legal, policy and health system barriers, PWID may be hesitant to engage in HIV, treatment and care due to lack of knowledge, distrust of the health care system, and stigma related to their drug use and HIV status. Implementation of formal peer support initiatives may reduce provider- and PWID LHIV-level barriers and increase testing, linkage to, and engagement in HIV care among PWID.Methods: We conducted a community-led qualitative study to explore the impacts of peer support for PWID on HIV care access and engagement in Indonesia. Semi-structured, in-depth interviews were conducted with 20 participants in Jakarta and Bandung. Thematic analysis was used to explore how PWID living with HIV (PWID LHIV) (n=8), peer support workers (n=6), and service providers (n=6) perceived peer support provision by non-governmental organisations.Results: Participants unanimously described peer support as beneficial. Peer support workers were widely credited with facilitating access to HIV testing, referral to care, uptake of and adherence to antiretroviral treatment, as well as sustaining engagement in care for PWID. Support mechanisms that facilitated positive PWID LHIV experiences included provision of HIV knowledge and awareness, emotional support, help with navigating complex bureaucracy, developing trust in health care services, enhancing confidence and motivation, and supporting peers to navigate a wide range of health and social welfare services beyond HIV-related care.Conclusions: Findings indicate that peer support can enhance access to testing, linkage to, and engagement in HIV care for PWID LHIV in Indonesia. In a context of an ongoing HIV epidemic among people who use drugs, reduced funding and policy attention to HIV and harm reduction, there is an urgent need to prioritize peer support interventions to identify people who use drugs facing health risks and link them to appropriate services.

The HIV pre-exposure prophylaxis continuum of care among women who inject drugs: A systematic review

“…Studies in this review indicated that WWID were very likely to share information on PrEP to other WWID, especially if they were deemed to be at high risk of HIV. This is in line with research on services for PWID which acknowledge the importance of engaging peers (68,72,73). For example, in Indonesia peer support was shown to help with HIV treatment initiation and adherence to HIV care among PWID.…”

“…For example, in Indonesia peer support was shown to help with HIV treatment initiation and adherence to HIV care among PWID. Furthermore, PWID were able to regain trust in the healthcare system and stay motivated to retain in HIV care (73). Similarly, in Senegal, researchers indicated that peer-led outreach among PWID could serve as an important part of harm reduction programs (72), Given their shared lived experiences, and potentially shared social networks, peers can help provide emotional and social support needed to engage with and maintain care.…”

Pay-it-forward to increase testing for hepatitis B and C: a community-led randomized controlled trial in China

“…In addition, a high prevalence of loneliness and social isolation was demonstrated in previous studies among Chinese people who use drugs (31,32). The ndings of our study suggest that the community-led pay-it-forward approach may be particularly effective for marginalized populations, such as people who use drugs.…”