HATI – HIV Awal (Early) Testing and Treatment Indonesia
The 90-90-90 narrative on HIV treatment states that 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy will have viral suppression by 2020. Regardless of the newly ambitious and final narrative, Indonesia still reports new high cases of HIV per year and the cascade of HIV testing and treatment uptake is low.
Study on HIV Awal (Early) Test and Treat Indonesia–known as HATI Study–is a collaborative initiative between research centers, government, NGOs and stakeholders that seek solutions regarding the HIV care of cascade in Indonesia. The research was conducted in 2015 – 2020 and took place in multiple cities like Jakarta, Bandung, Yogyakarta, and Denpasar.
Yanri Wijayanti Subronto
It is important to determine the right key population that is going to partake in this study, hence we grouped our study participants into four main categories. Study participants were predominantly men who have sex with men, female sex workers, followed by transgenders (waria), and people who inject drugs.
Our Five Interventions
One of the interventions aimed to cover MSM-targeted screening by oral fluid testing (OFT) in Denpasar, Bali. HATI distributed the testing kit in in 2018 to 813 MSM and among confirmed positives were enrolled in HATI cohort study and started treatment. At six months follow up, 64% of those initiating treatment were still on treatment and all had suppressed viral load. There was an increase in the mean number of MSM tested for HIV by HATI study in Bali per month, these findings show the potential utility of offering HIV oral fluid self-testing kit to scale up HIV testing in MSM key population.
This study also tried to simplify ARV initiation so that newly diagnosed patients were able to receive fixed-dose-combination regimen upon knowing their status. Simplified Antiretroviral Initiation (SAI) model in Bandung, Yogyakarta, dan Denpasar was proved to be feasible and effective to increase uptake of antiretroviral therapy initiation after HIV diagnosis.
Community-Based Organisation to Reach Further
Primary health care services join in collaboration with local NGOs like Vesta, Kebaya, and Pasar Kembang brothels in Yogyakarta to further their outreach with community-based intervention in which the HIV testing and antiretroviral initiation were conducted simultaneously at community level. This improved coverage and even raised awareness among the general population on knowing their HIV status. Likewise this intervention proved to shorten the testing and treatment time gap significantly.
Community-based intervention increased coverage of people who started therapy and shortened the time between testing and treatment.
The sex workers community of Pasar Kembang were trained on the risk and screening of non-communicable diseases alongside with the HIV and other STIs testing. Most participants were screened positive for non-communicable disease risks like unhealthy diet, smoking, alcohol consumption, and lack of physical activity.
To learn further about the progress and the result of this research project, please refer to this provided information listed below.
Januraga, P., Reekie, J., Mulyani, T., Lestari, B., Iskandar, S., Wisaksana, R., Kusmayanti, N., Subronto, Y., Widyanthini, D., Wirawan, D., Wongso, L., Sudewo, A., Sukmaningrum, E., Nisa, T., Prabowo, B., Law, M., Cooper, D. and Kaldor, J., 2018. The cascade of HIV care among key populations in Indonesia: a prospective cohort study. The Lancet HIV, 5(10), pp.e560-e568.
Lazuardi, E., Newman, C., Anintya, I., Rowe, E., Wirawan, D., Wisaksana, R., Subronto, Y., Kusmayanti, N., Iskandar, S., Kaldor, J. and Bell, S., 2019. Increasing HIV treatment access, uptake and use among men who have sex with men in urban Indonesia: evidence from a qualitative study in three cities. Health Policy and Planning: The Journal on Health Policy and System Research, vol. 35(1), pp 16-25
Lazuardi, E., Newman, C., Tasya, I., Rowe, E., Wirawan, D., Wisaksana, R., Subronto, Y., Kaldor, J., Kusmayanti, N., Iskandar, S. and Bell, S., 2019. Understanding the Social Influences on Engaging Key Populations With HIV Prevention: A Qualitative Study With Men Who Have Sex With Men in Three Indonesian Cities. AIDS Education and Prevention, 31(3), pp.206-223.
Mitchell, E., Lazuardi, E., Rowe, E., Anintya, I., Wirawan, D., Wisaksana, R., Subronto, Y., Prameswari, H., Kaldor, J. and Bell, S., 2019. Barriers and Enablers to HIV Care Among Waria (Transgender Women) in Indonesia: A Qualitative Study. AIDS Education and Prevention, 31(6), pp.538-552.
Widyanthini, D., Januraga, P., Wisaksana, R., Subronto, Y., Sukmaningrum, E., Kusmayanti, N., Dewi, H., Law, M., Kaldor, J. and Wirawan, D., 2021. HIV self-testing for men who have sex with men: an implementation trial in Indonesia. AIDS Care, pp.1-8.