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Dr. Siti Nadia Tarmizi M Epid National AIDS Program Manager Ministry of Health Indonesia

Introduction of The Strategic Use of ARVs For Treatment & Prevention in Indonesia: From Policy Development to Implementation. Dr. Siti Nadia Tarmizi M Epid National AIDS Program Manager Ministry of Health Indonesia. Outline. Epidemiological situation and P rogramme Progress

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Dr. Siti Nadia Tarmizi M Epid National AIDS Program Manager Ministry of Health Indonesia

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  1. Introduction of The Strategic Use of ARVs For Treatment & Prevention inIndonesia:From Policy Development to Implementation Dr. Siti Nadia Tarmizi M Epid National AIDS Program Manager Ministry of Health Indonesia

  2. Outline • Epidemiological situation and Programme Progress • Prevention outcomes • Treatment outcomes • Rational for Policy Formulation • Policy Implementation • Programmatic Questions and Challenges

  3. 1. Epidemioliogical Background Concentrated epidemic in most of country, but low-level generalized epidemic in Papua Source: Estimates & Projection of HIV/AIDS 2011-2016, MoH 2012

  4. Estimated Number of New Infections by Population Sub-Groups From Driven By Injection To Predominantly Sexual Transmission Source: Estimates & Projection of HIV/AIDS 2011-2016, MoH 2012

  5. Programme ProgressHIV Prevalence by Population Sub-group Challenges remaining in controlling sexual transmission IDFSW HRM DFSW TG MSM IDU Inmates Source: IBBS 2007 – 2011 and 2009 -2013 at the same location, MoH

  6. Remaining Sexual Risk Behaviors Condom Use at last sex TG Always Condom Use Source: IBBS 2007 & 2011 and IBBS 2009 & 2013, MoH

  7. Prevention Efforts PWIDs • Perilaku penggunaan kondom konsisten masih rendah (STBP 2009: 31%, 2013:46%). Source: Rapid Behavior Survey 2010 & 2013, NAC

  8. Great variability in access to ART in Asia ART coverage in selected Asian countries, 2012 Coverage: number of people receiving ART in 2012 / number of individuals eligible for ART in 2012 according to 2010 guidelines Source: WHO SEARO, 2013

  9. Annual ART Scale Up Source : MoH Indonesia, 2013

  10. Still too many people are lost from ART: Retention at 12, 24 and 60 months Retention rates for ART at 12, 24 and 60 months in selected countries, 2011 % Source: WHO/UNAIDS

  11. Retention rates for ART at 6 & 12months in Indonesia, 2004-2012 Source: MoH 2013

  12. HIV Treatment Cascade NA NA Source: MoH 2014

  13. 2. Rationale for Policy Formulation • Evidence of further reducing new HIV infections through “Test and Treat” or SUFA and global move towards earlier treatment • Implementing SUFA will help accelerating coverage of ART for those most in need • Joint rapid assessment early 2013 in collaboration among MoH, NAC, WHO, UNAIDS and UNICEF • to obtain information for developing a roadmap to accelerate expansion of ARVs for HIV treatment and prevention in Indonesia • To assess barriers to diagnosis and treatment • to review and learn current existing good practices • to find opportunities to further accelerate expansion and coverage of ART • Mathematical modelling to look at the impact and effectiveness of program that is expected from rapidly scaling-up ART in Indonesia • Followed by national consultation meeting in March 2013

  14. Mathematical Modeling on Impact of ART coverage on numbers of new HIV infection The impact on numbers of new HIV infection would be modest at current levels of ART coverage (the dark blue, red lines and purple) Impact will be significantly observed by increasing coverage of those treatment-eligible persons of 80%. (The green and light blue lines )

  15. 3. Policy ImplementationContinuum of Comprehensive HIV Services Framework (LKB) Indonesia is intensifying the response by strengthening the continuum of HIV-STI comprehensive care, a service delivery model was on going Addressing the prevention, care and treatment comprehensively by increased participation of all related stakeholders especially the community members at district level & HIV service available at PHC

  16. Introduction of Strategic Use of ARVs (SUFA) through “LKB” • Objectives: • To significantly increase HIV testing and ART coverage • To optimize the prevention impact of ARVs by offering ART regardless of CD4 level to key affected populations and sero-discordant couples • To strengthen the involvement and ownership by CSO groups. • Strategies • 1. Expanding HIV diagnosis • 2. Effective enrollment and retention in HIV care • 3. Build on effective efforts that already exist, including the LKB (CoC)

  17. Phased Approach • Roadmap of “Rapid Scale Up of ART and Strategic Use of ARVs (SUFA) through LKB” • 75 priority districts • phased implementation and scale-up approach • started in 13 districts (3 from Tanah Papua and 8 from the remainder of Indonesia) in October 2013. • rolled-out in 63 additional districts during April till December 2014. • Minister of Health Regulation No. 21/2013 • PITC approach to increase HIV test and counseling • ART regardless CD4 count to KAPs (CSW, MSM, transgender IDUs), TB-HIV patients, Hep-HIV patients, and HIV infected pregnant women

  18. Accelerating getting to Zero New Infections (and reduce mortality) Initiate ART when the CD4 under 350 Start ART regardless of the CD4 Key Affected Populations: IDU, MSM, TG, SW Prisoners

  19. Increasing HIV test coverage Source : MoH Indonesia, 2013

  20. 4. Programmatic Questions - Challenges • For T&T as part of LKB/SUFA to have an impact in Indonesia it would need to be accessible/acceptable and reach all key affected groups. • T&T/SUFA as in the Permenkes 21 raises programmatic questions specially about how to improve the HIV treatment cascade: • How best to control STI ? • How best to expand HIV testing and reach those KAPs? • How bes decentralization of HIV services implemented • How best to retain them on treatment • How SUFA will affect adherence and risk behaviors? • Effective community-based interventions involving KAPs are fundamentalin the success of LKB/SUFA • In a decentralized context local ownership by policy/decision makers is key for adoption of policy and financial sustainability

  21. Acknowledgments MsWenita I – NAC Indonesia Dr Oscar Barreneche – WHO Indonesia Mr Cho Kah Sin – UNAIDS Indonesia Dr Sri Pandam – WHO Indonesia DrJantoLingga –WHO Indonesia MsFettyWijayanti –WHO Indonesia Mr Daniel – Spiritia Foundation USAID, DFAT, FHI 360, CHAI

  22. TERIMA KASIH THANK YOU

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