TY - JOUR
T1 - Changes in the HIV continuum of care following expanded access to HIV testing and treatment in Indonesia
T2 - A retrospective population-based cohort study
AU - Tarigan, Yane N.
AU - Woodman, Richard J.
AU - Miller, Emma R.
AU - Wisaksana, Rudi
AU - Wignall, F. Stephen
AU - Ward, Paul R.
N1 - Funding Information:
1. YNT received a scholarship award for pursuing a Doctor of Public Health at Flinders University of South Australia. 2. The work funding was supported by College of Medicine and Public Health Flinders University Adelaide South Australia (https://www.flinders.edu.au/college-medicinepublic-health) and the Australian Government, Department of Foreign Affairs and Trade, Australia Awards Scholarship (https://www.dfat.gov.au/ people-to-people/australia-awards/Pages/australiaawards) 3. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors acknowledge contribution of the Indonesian MOH particularly Dr Wiendra Waworuntu, M.Kes Director of Prevention and Control of Direct Disease Transmission, Dr Sedya Wisangka Head of Sub Directorate HIV AIDS and STI for their strong support in enabling the study to be conducted within a limited study time period, providing the data and internal policy documents. The authors also acknowledge contribution of Dr Sri Pandam Pulungsih M.Sc (SUFA Consultant) for her guidance to the authors in conceiving the study, support in data collection, support in understanding Indonesian HIV program implementation particularly at the time of SUFA policy development, launching and expansion.
Publisher Copyright:
© 2020 Tarigan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2020/9
Y1 - 2020/9
N2 - Background In 2013, the Indonesian government launched the strategic use of antiretroviral therapy (SUFA) initiative with an aim to move closer to achieving the UNAIDS 90-90-90 target. This study assessed the impact of SUFA on the cascade of HIV care. Methods We performed a two-year retrospective population-based cohort study of all HIV positive individuals aged ≥ 18 years residing in two cities where SUFA was operational using data from HIV clinics. We analysed data for one-year pre- and one-year post-SUFA implementation. We assessed the rates of enrolment in care, assessment for eligibility for antiretroviral therapy (ART), treatment initiation, loss to follow-up (LTFU) and mortality. Multivariate Cox regression was used to determine the pre-to-post-SUFA hazard ratio. Results A total of 2,292 HIV positive individuals (1,085 and 1,207 pre and post-SUFA respectively) were followed through their cascade of care. In the pre-SUFA period, 811 (74.6%) were enrolled in care, 702 (86.6%) were found eligible for ART, 485 (69.1%) initiated treatment, 102 (21%) were LTFU and 117 (10.8%) died. In the post-SUFA period, 930 (77%) were enrolled in care, 896 (96.3%) were found eligible for ART, 627 (70%) initiated treatment, 100 (16%) were LTFU and 148 (12.3%) dead. There was an 11% increase in the rate of HIV linkage to care (HR = 1.11; 95% CI 1.001, 1.22 p<0.05), a 13% increase in the rate of eligibility for ART (HR = 1.13, 95% CI 1.02,1.25, p<0.01) and a 27% reduction in LTFU (HR = 0.73, 95%CI 0.55, 0.97, p<0.05). Rates of ART initiation and mortality did not change. Conclusion SUFA was effective in improving HIV care in relation to linkage to care, eligibility and ART retention. Therefore, the scale up across the whole of Indonesia of the SUFA currently in the form of a test and treat policy, with improvement in testing and treatment strategies is justified.
AB - Background In 2013, the Indonesian government launched the strategic use of antiretroviral therapy (SUFA) initiative with an aim to move closer to achieving the UNAIDS 90-90-90 target. This study assessed the impact of SUFA on the cascade of HIV care. Methods We performed a two-year retrospective population-based cohort study of all HIV positive individuals aged ≥ 18 years residing in two cities where SUFA was operational using data from HIV clinics. We analysed data for one-year pre- and one-year post-SUFA implementation. We assessed the rates of enrolment in care, assessment for eligibility for antiretroviral therapy (ART), treatment initiation, loss to follow-up (LTFU) and mortality. Multivariate Cox regression was used to determine the pre-to-post-SUFA hazard ratio. Results A total of 2,292 HIV positive individuals (1,085 and 1,207 pre and post-SUFA respectively) were followed through their cascade of care. In the pre-SUFA period, 811 (74.6%) were enrolled in care, 702 (86.6%) were found eligible for ART, 485 (69.1%) initiated treatment, 102 (21%) were LTFU and 117 (10.8%) died. In the post-SUFA period, 930 (77%) were enrolled in care, 896 (96.3%) were found eligible for ART, 627 (70%) initiated treatment, 100 (16%) were LTFU and 148 (12.3%) dead. There was an 11% increase in the rate of HIV linkage to care (HR = 1.11; 95% CI 1.001, 1.22 p<0.05), a 13% increase in the rate of eligibility for ART (HR = 1.13, 95% CI 1.02,1.25, p<0.01) and a 27% reduction in LTFU (HR = 0.73, 95%CI 0.55, 0.97, p<0.05). Rates of ART initiation and mortality did not change. Conclusion SUFA was effective in improving HIV care in relation to linkage to care, eligibility and ART retention. Therefore, the scale up across the whole of Indonesia of the SUFA currently in the form of a test and treat policy, with improvement in testing and treatment strategies is justified.
UR - http://www.scopus.com/inward/record.url?scp=85090837861&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0239041
DO - 10.1371/journal.pone.0239041
M3 - Article
C2 - 32915923
AN - SCOPUS:85090837861
VL - 15
JO - PLoS ONE
JF - PLoS ONE
SN - 1932-6203
IS - 9 September
M1 - e0239041
ER -