Online Mental Health Survey for Addressing Psychosocial Condition During the COVID-19 Pandemic in Indonesia: Instrument Evaluation.

BACKGROUND: Regular monitoring of the pandemic's psychosocial impact could be conducted among the community but is limited through online media. This study aims to evaluate the self-rating questionnaire commonly used for online monitoring of the psychosocial implications of the coronavirus disease 2019 (COVID-19) pandemic. METHODS: The data were taken from the online assessment results of two groups, with a total of 765 participants. The instruments studied were Self-Rating Questionnaire (SRQ-20), post-traumatic stress disorder (PTSD), and Center for Epidemiological Studies Depression Scale-10 (CESD-10), used in the online assessment. Data analysis used Rasch modeling and Winsteps applications. Validity and reliability were tested, and data were fit with the model, rating scale, and item fit analysis. RESULTS: All the scales for outfit mean square (MnSq) were very close to the ideal value of 1.0, and the Chi-square test was significant. Item reliability was greater than 0.67, item separation was greater than 3, and Cronbach's alpha was greater than 0.60; all the instruments were considered very good. The raw variance explained by measures for the SRQ-20, PTSD, and CESD-10 was 30.7%, 41.6%, and 47.6%, respectively. The unexplained eigenvalue variances in the first contrast were 2.3, 1.6, and 2.0 for the SRQ-20, PTSD, and CESD-10, respectively. All items had positive point-measure correlations. CONCLUSION: The internal consistency of all the instruments was reliable. Data were fit to the model as the items were productive for measurement and had a reasonable prediction. All the scales are functionally one-dimensional.

Severity of psychiatric and physical problems is associated with lower quality of life in methadone patients in Indonesia.

BACKGROUND AND OBJECTIVES: The goal of methadone maintenance treatment (MMT) is to reduce the harm and to improve patients' quality of life (Qol). However, the Qol is also influenced by other co-occurring disorders. Data regarding the Qol and the co-occurrence of these disorders is lacking in low-middle income countries. We therefore describe the prevalence of physical, psychiatric, and drug abuse co-occurring disorders among MMT patients in Indonesia and determine the association between the severity of the co-occurring disorders and the Qol. METHODS: Data were collected in 112 injection drug abusers (IDUs) attending a MMT program in West Java, Indonesia, using validated questionnaires, medical records and laboratory testing. For comparison, 154 IDUs not enrolled in MMT were recruited by respondent driven sampling. RESULTS: The most frequent co-occurring disorders were hepatitis C (92%), HIV (77%), benzodiazepine abuse (56%), and anxiety disorders (32%). IDUs in MMT had one (26%), two (47%), or three (27%) co-occurring disorders. Higher severity in psychiatric and physical problems was associated with poorer Qol. IDUs not enrolled in MMT had similar co-occurring problems. CONCLUSIONS: The prevalence of co-occurring disorders in IDUs in Indonesia is high and they influence their Qol. SCIENTIFIC SIGNIFICANCE: Therefore, comprehensive treatment, especially focusing on the common co-occurring disorders should be provided in MMT to improve the Qol.

Excellent reliability of the Hamilton Depression Rating Scale (HDRS-21) in Indonesia after training.

INTRODUCTION: The Hamilton Depression Rating Scale (HDRS) is the most widely used depression rating scale worldwide. Reliability of HDRS has been reported mainly from Western countries. The current study tested the reliability of HDRS ratings among psychiatric residents in Indonesia, before and after HDRS training. The hypotheses were that: (i) prior to the training reliability of HDRS ratings is poor; and (ii) HDRS training can improve reliability of HDRS ratings to excellent levels. Furthermore, we explored cultural validity at item level. METHODS: Videotaped HDRS interviews were rated by 30 psychiatric residents before and after 1 day of HDRS training. Based on a gold standard rating, percentage correct ratings and deviation from the standard were calculated. RESULTS: Correct ratings increased from 83% to 99% at item level and from 70% to 100% for the total rating. The average deviation from the gold standard rating improved from 0.07 to 0.02 at item level and from 2.97 to 0.46 for the total rating. DISCUSSION: HDRS assessment by psychiatric trainees in Indonesia without prior training is unreliable. A short, evidence-based HDRS training improves reliability to near perfect levels. The outlined training program could serve as a template for HDRS trainings. HDRS items that may be less valid for assessment of depression severity in Indonesia are discussed.

Cost-effectiveness of methadone maintenance therapy as HIV prevention in an Indonesian high-prevalence setting: a mathematical modeling study.

BACKGROUND: Indonesia faces an HIV epidemic that is in rapid transition. Injecting drug users (IDUs) are among the most heavily affected risk populations, with estimated prevalence of HIV reaching 50% or more in most parts of the country. Although Indonesia started opening methadone clinics in 2003, coverage remains low. METHODS: We used the Asian Epidemic Model and Resource Needs Model to evaluate the long-term population-level preventive impact of expanding Methadone Maintenance Therapy (MMT) in West Java (43 million people). We compared intervention costs and the number of incident HIV cases in the intervention scenario with current practice to establish the cost per infection averted by expanding MMT. An extensive sensitivity analysis was performed on costs and epidemiological input, as well as on the cost-effectiveness calculation itself. RESULTS: Our analysis shows that expanding MMT from 5% coverage now to 40% coverage in 2019 would avert approximately 2400 HIV infections, at a cost of approximately US$7000 per HIV infection averted. Sensitivity analyses demonstrate that the use of alternative assumptions does not change the study conclusions. CONCLUSION: Our analyses suggest that expanding MMT is cost-effective, and support government policies to make MMT widely available as an integrated component of HIV/AIDS control in West Java.

Successful testing and treating of HIV/AIDS in Indonesia depends on the addiction treatment modality.

BACKGROUND: In many settings, people who inject drugs (PWID) have limited access to human immunodeficiency virus (HIV) care which is provided in several hospitals and primary health centers in big cities. Substance abuse treatment (SAT) can be used as the entry-point to HIV programs. The aim of this study is to describe the characteristics of the PWID who had accessed SAT and determine which SAT modality associates significantly with HIV programs. METHODS: PWID were recruited by respondent-driven sampling in an urban setting in Java, Indonesia and interviewed with the Addiction Severity Index (ASI), Blood-Borne Virus Transmission Risk Assessment Questionnaires, and Knowledge Questionnaire on HIV/AIDS. The information regarding the use of substance abuse treatment and HIV program were based on questions in ASI. RESULTS: Seventy-seven percent of 210 PWID had accessed SAT at least once. PWID who had accessed a SAT modality reported more severe drug problems. The most widely used SAT were opioid substitution (57%) and traditional/faith-based treatment (56%). Accessing substitution treatment (adjusted odds ratio [OR] = 5.8; 95% confidence interval [CI]: 2.5-13.9) or residential drug-free treatment (adjusted OR = 3.7; 95% CI: 1.4-9.7) was significantly associated with HIV testing, whereas accessing substitution treatment (adjusted OR = 3.8; 95% CI: 1.9-7.5) or other medical services (adjusted OR = 3.1; 95% CI: 1.1-8.7) was significantly associated with HIV treatment. There was no significant association between accessing traditional/faith-based treatment and HIV testing and treatment. CONCLUSION: Efforts should be made to link HIV services with traditional/faith-based treatment to increase the coverage of HIV programs.

High risk behavior for HIV transmission among former injecting drug users: a survey from Indonesia.

BACKGROUND: Injecting drug use is an increasingly important cause of HIV transmission in most countries worldwide, especially in eastern Europe, South America, and east and southeast Asia. Among people actively injecting drugs, provision of clean needles and opioid substitution reduce HIV-transmission. However, former injecting drug users (fIDUs) are often overlooked as a high risk group for HIV transmission. We compared HIV risk behavior among current and former injecting drug users (IDUs) in Indonesia, which has a rapidly growing HIV-epidemic largely driven by injecting drug use. METHODS: Current and former IDUs were recruited by respondent driven sampling in an urban setting in Java, and interviewed regarding drug use and HIV risk behavior using the European Addiction Severity Index and the Blood Borne Virus Transmission Questionnaire. Drug use and HIV transmission risk behavior were compared between current IDUs and former IDUs, using the Mann-Whitney and Pearson Chi-square test. RESULTS: Ninety-two out of 210 participants (44%) were self reported former IDUs. Risk behavior related to sex, tattooing or piercing was common among current as well as former IDUs, 13% of former IDUs were still exposed to contaminated injecting equipment. HIV-infection was high among former (66%) and current (60%) IDUs. CONCLUSION: Former IDUs may contribute significantly to the HIV-epidemic in Indonesia, and HIV-prevention should therefore also target this group, addressing sexual and other risk behavior.

Costs of hospital-based methadone maintenance treatment in HIV/AIDS control among injecting drug users in Indonesia.

OBJECTIVE: To assess the cost of hospital-based methadone maintenance treatment (MMT) for injecting drug users (IDUs) in Bandung, Indonesia; to address concerns of financial sustainability at the hospital level and financial accessibility and economic attractiveness at the health care policy level. METHODS: In a 1 year observation period in 2006-2007, MMT service delivery costs were estimated on the basis of a micro-costing approach. Patient costs were estimated on the basis of a survey among 48 methadone clients. RESULTS: A total number of 129 clients attended the MMT clinic, resulting in a total of 16,335 client visits. Total annual societal costs of running the MMT clinic equalled Rp 1130 mln (US$123,672), or Rp 69,206 (US$7.57) per client visit. Of total costs, patient costs established the largest share (65%), followed by that of central government (20%), and the hospital (15%). Present consultation tariffs already cover hospital costs and the patient costs of accessing MMT services constitute almost 70% of their income. CONCLUSION: Under current circumstances, MMT services are financially sustainable to the hospital. MMT services are subsidized by the central government, and this is warranted considering the important role of the program in HIV/AIDS among IDUs. Still, the present user fee seems a barrier to utilization, and a higher level of subsidy might be justified to reduce the cost to the patient.

Integration of methadone maintenance treatment and HIV care for injecting drug users: a cohort study in Bandung, Indonesia.

AIM: to know the effectiveness of antiretroviral treatment (ART) among methadone clients and patients who started ART outside the methadone program during the same period. METHODS: uptake of HIV testing and treatment were evaluated in a cohort of IDUs starting MMT. Effectiveness of anti-retroviral treatment (ART) was compared with matched 175 HIV-patients with a history of IDU outside MMT. RESULTS: overall, 223 patients were enrolled in MMT between May 2006 and January 2009, of whom 44% were tested for HIV, with an HIV prevalence of 73%. Screening of MMT clients was responsible for diagnosing HIV and starting ART in 31.9%, respectively 45.7%. Two year retention (100% vs 97.1%; p=0.23) and survival (93.9% vs 92.3%; p=0.76) during ART were not significantly different for 35 patients who combined ART with methadone, and the control group (n=175). Virological failure was found in one patient (3.7%) in MMT compared to 10.5% of the control group. CONCLUSION: providing HIV testing and treatment is a feasible and effective way to increase detection and treatment of HIV among clients enrolled in MMT. HIV- treatment integrated with methadone maintenance can be very effective. These results support wider application of integrated HIV care and opioid substitution.