RESUMO
OBJECTIVES: International lockdowns during the COVID-19 pandemic impacted antiretroviral drug supplies in Indonesia. We assessed the impact of antiretroviral treatment (ART) provision and being lost to follow-up (LTFU) on people living with HIV, attending a key population-focused HIV clinic in Denpasar, Bali. METHODS: This was a retrospective note review of anonymized data from adult Indonesian patients living with HIV. We collected demographic data and information on being LTFU, and assessed the numbers of patients impacted by ART switches from fixed-dose combination (FDC) tenofovir/lamivudine/efavirenz to multi-pill zidovudine-based regimens, during the first international lockdown from March 2020. RESULTS: Records of 260 Indonesian adult patients registered for HIV care and prescribed ART were reviewed; 240 (92.3%) were men, and 90% were men who have sex with men. Between 13 March and 28 May 2020, 214 (87%) out of 247 patients (previously diagnosed with HIV) had to switch to individual, multi-pill zidovudine-based regimens from their FDC. The switch lasted a mean of 35 days (range 10-85). Twenty-five patients (10%) were LTFU; patients who switched were more likely to remain in care. Data on viral load status and toxicity are lacking as laboratory testing requires self-payment. CONCLUSIONS: The majority of patients living with HIV had no choice but to switch to multi-pill, zidovudine-based regimens. Despite significant efforts to minimize the impact of lockdown on care, 10% of patients were LTFU. Patients switching ART required greater clinic attention and support, improving retention. Complete national data are needed to understand the impact of ART stockouts on virological suppression and drug resistance throughout Indonesia.
Assuntos
Fármacos Anti-HIV , COVID-19 , Infecções por HIV , Minorias Sexuais e de Gênero , Adulto , Fármacos Anti-HIV/uso terapêutico , Antirretrovirais/uso terapêutico , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Feminino , Seguimentos , Infecções por HIV/tratamento farmacológico , Homossexualidade Masculina , Humanos , Indonésia/epidemiologia , Masculino , Pandemias , Estudos Retrospectivos , Carga Viral , Zidovudina/uso terapêuticoRESUMO
Indonesia has one of the fastest growing HIV epidemics in the world. AIDS related deaths in Indonesia have not fallen and have increased significantly since 2010. HIV infection rates remain high and rising in key affected populations. We provide an on the ground, evidence-based perspective of the challenges Indonesia faces. We discuss what is required to adopt tailored public health approaches that address context specific challenges, confront structural barriers and the heterogeneity of the current evolving HIV epidemic.
Assuntos
Epidemias/prevenção & controle , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Acessibilidade aos Serviços de Saúde , Humanos , Indonésia/epidemiologia , Política , Assunção de Riscos , Comportamento SexualAssuntos
Discriminação Psicológica , Infecções por HIV/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Adulto , Epidemias , Homossexualidade Masculina/psicologia , Humanos , Indonésia/epidemiologia , Masculino , Vigilância da População , Fatores de Risco , Assunção de Riscos , Meio Social , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaRESUMO
Globally, one in four people living with HIV are unaware of their status. Current HIV testing services' strategies are falling short of reaching all, and thus, HIV testing should be offered in more decentralized and non-traditional settings such as the dental and community settings. The workshop titled "HIV Testing: What, Where, and How?" provided an overview of concepts and advances in HIV point of care and self-testing diagnostics and a discussion on the implementation of HIV self-test interventions in different healthcare settings and its impact thereof. We also described how to build layperson capacity to deliver HIV testing in community settings. Additionally, we discussed what we have learned from expanding HIV testing beyond the specialist setting. We also noted considerations (i.e. provider willingness, test selection, training and preparing testing environment) dentists and other non-specialist providers need to account for if they are planning to conduct HIV testing. Finally, we highlighted facilitators and barriers to implementing HIV testing in the dental setting on a global scale. These considerations are critical to meeting the UNAIDS 90-90-90 target to help end the HIV/AIDS epidemic.