Impact of strategic use of antiretroviral therapy intervention to the HIV continuum of care in 13 cities in Indonesia: an interrupted time series analysis

Tarigan Y.N., Woodman R.J., Miller E.R., Wisaksana R., Ward P.R.

Health Sciences Building, College of Medicine and Public Health, Flinders University, Sturt Rd Bedford Park, Adelaide, SA 5042, Australia; Department of Internal Medicine, Hasan Sadikin Hospital, University of Padjajaran, Bandung, Indonesia


Abstract

Background: In 2013 the Indonesian government introduced the strategic use of antiretroviral therapy (SUFA) initiative of expanding access to HIV test and treatment, to help achieve the UNAIDS 90–90–90 targets. However, there has been no comprehensive evaluation of the impact of this intervention in Indonesia. We conducted an interrupted time series (ITS) analysis across 6-years to assess its immediate and medium-term impact. Methods: Monthly aggregated HIV data from all HIV care clinics for persons aged ≥ 15 years were collected from 13 pilot cities. The data period encompassed 3-years prior to SUFA (26 Dec 2010–25 Dec 2013) and 3-years post-SUFA (26 Dec 2013–25 Dec 2016). The ITS was performed using a multilevel negative binomial regression model to assess the immediate and trend changes in each stage of the HIV continuum of care. Results: In the pre-SUFA period, the overall coverage in the respective risk populations for HIV tests, cases, enrolments, eligible cases and ARV initiation were 1.0%, 8.6%, 98.9%, 76.9% and 75.8% respectively. In the post-SUFA period coverage was 3%, 3.8%, 98.6%, 90.3% and 81.2% respectively—with a significant increase in the median number of HIV tests, HIV cases, those eligible for ARV treatment and treatment initiation (p < 0.05 for each). The ITS analysis demonstrated immediate increases in HIV tests (IRR = 1.41, 95% CI 1.25, 1.59; p < 0.001) and an immediate decrease in detected HIV cases per person tested (IRR = 0.77, 95% CI 0.69–0.86; p < 0.001) in the month following commencement of SUFA. There was also a 3% decline in the monthly trend for HIV tests performed (IRR = 0.97; 95% CI 0.97–0.98, p < 0.001), a 1% increase for detected cases (IRR = 1.01, 95% CI 1.0–1.02, p < 0.001), and a 1% decline for treatment initiation (IRR = 0.99,95% CI 0.99–1.0 p < 0.05). Conclusions: SUFA was associated with an immediate and sustained increase in the absolute number of HIV tests performed, detected HIV cases, and close to complete coverage of detected cases that were enrolled to care and defined as eligible for treatment. However, treatment initiation remained sub-optimal. The findings of this study provide valuable information on the real-world effect of accelerating ARV utilizing Treatment as Prevention for the full HIV continuum of care in limited resource countries. © 2021, The Author(s). Continuum of care; HIV; Indonesia; Interrupted time series; TasP


Journal

AIDS Research and Therapy

Publisher: BioMed Central Ltd

Volume 18, Issue 1, Art No 22, Page – , Page Count


Journal Link: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85104856722&doi=10.1186%2fs12981-021-00340-4&partnerID=40&md5=afd158d7045319a4c6a1ad7bfd93ef2e

doi: 10.1186/s12981-021-00340-4

Issn: 17426405

Type: All Open Access, Gold, Green


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