HIV testing experience of drug users in Bali, Indonesia

The effect of electronic and printed module about drug abuse prevention on teachers' beliefs in Indonesia

Background: Drug abuse is a serious global health problem. Globally, 269 million people or 5.3 percent of the population aged 15‒64 years used drugs in 2018. Evidence shows that most drug addicts start using drugs in adolescence (<15-years-old). Adolescents need role models who are able to guide them; teachers have important roles as they are primary role models for students. Therefore, teachers should have positive beliefs to guide students effectively, i.e. they should have good awareness about the threat of drug abuse and high confidence to implement required prevention. This research developed an alternative electronic delivery method of learning material to empower teachers in preventing drug abuse. This study aimed to compare the effect of the electronic and a printed teaching module on teachers' beliefs about drug abuse prevention. Methods: 260 junior high school teachers were selected randomly. These teachers were split into two groups. Before intervention, a questionnaire was completed by both groups. The teachers then completed the learning material: electronic module in the first group and printed module in the second group. One month later, data was collected from both groups using the same questionnaire to assess the beliefs of the teachers Results: There was significant positive effect on teachers' beliefs, both in electronic module and printed module groups. All categories of beliefs at one month after intervention were significantly higher than those at baseline (P<0.001). Based on between group comparison analysis of mean changes, perceived susceptibility in electronic module group was significantly higher than printed module group (P<0.001), while perceived severity, benefits, barriers and efficacy were not significantly different (P>0.05). Conclusions: Electronic and printed module intervention significantly increased teachers' beliefs in drug abuse prevention. The printed module was still effective to be used as learning media, while the electronic module was an alternative with some advantages.

Understanding the challenges faced in community-based outreach programs aimed at men who have sex with men in urban Indonesia

Background Community-based outreach programs play an important role in the provision of HIV testing, treatment and health care for men who have sex with men (MSM) in Indonesia. However, qualitative studies of community-based HIV programs have mostly focused on clients rather than on outreach workers (OW). The experiences of MSM peer OW provide insights into how to extend and improve community involvement in HIV programs in Indonesia.

METHODS

This is a qualitative study based on focus group discussions, which brought together MSM OW (n = 14) and healthcare workers (n = 12). This approach facilitated documentation of the challenges associated with community-based outreach programs in Indonesia through a participatory focus group discussion between OW and healthcare workers.

RESULTS

Findings are reported in relation to challenges experienced in the context of community outreach, and solutions to the challenges faced by OW. It was found that awareness of a shared commitment to delivering HIV programs can facilitate good relationships between OW and healthcare workers.

CONCLUSION

Future efforts should consider the role of OW within broader relationships, especially with healthcare workers, when developing community-based responses to HIV testing and treatment. Documenting the role of OW can help contribute to an understanding of ways to adapt HIV programs to reduce barriers to access both for those identified as MSM and others who are ambiguously placed in relation to the programmatic use of such categories.

A 'scoping review' of qualitative literature about engagement with HIV care in Indonesia

Background The Indonesian response to HIV has been informed largely by quantitative evidence. This review examines what is known about the Indonesian HIV care cascade from published qualitative research.

METHODS

A 'scoping review' method was used to synthesise and interpret the findings of 17 eligible peer-reviewed publications.

RESULTS

Qualitative findings are reported in relation to two themes. Factors influencing successful engagement include a lack of HIV-related knowledge among clients, fear of stigma or lack of privacy/confidentiality at services, limited accessibility and affordability, and poor linkages between services. Factors affecting the broader response include a failure to adapt programs to specific socio-cultural settings, political issues in the distribution of donor funding, distrust and poor communication between service users and providers, the need for cultural privacy in particular community settings, and systemic experiences of gendered stigmatisation.

CONCLUSIONS

Enhancing understanding of the Indonesian context would benefit from future qualitative research on HIV care in urban settings, describing the experiences of the most at-risk populations, and examining the role of clinics and providers in delivering HIV care in an increasingly decentralised health system.

Molecular Antiretroviral Resistance Markers of Human Immunodeficiency Virus-1 of CRF01_AE Subtype in Bali, Indonesia

Background:

Molecular epidemiological study of human immunodeficiency virus drug-resistant (HIVDR) markers is challenging in areas where the dominant subtype is non-B.

Objective:

Here we provide molecular data for HIVDR in the CRF01_AE subtype in Bali, Indonesia.

Method:

Seventy patients were enrolled in this study and grouped into treatment failure and treatment naïve groups. The full-length pol gene was amplified using nested reverse transcriptase polymerase chain reaction and the product was then sequenced. The readable sequence was then subjected to Stan-ford HIV Drug Resistance Database genotyping.

Results:

We found that clinical classification was in accordance with the presence of HIVDR markers in the pol gene. Independent of therapy history, the treatment failure group showed resistance markers against nucleoside reverse transcriptase inhibitors (NRTI) and non-nucleoside reverse transcriptase in-hibitors (NNRTI), ranging from 72%–100% of patients. Only a small proportion of naïve patients harbored HIV with drug resistance markers to NNRTI. No protease inhibitor-resistant marker was found in either patient group. Molecular marker mutations, which were found in more than 50% of treatment failure patients, were M184V (100%), T215A/Y/F (88.2%), D67N/G (76.5%), and M41L (58.8%).

Conclusion:

The protocol used in this study to determine genetic markers of HIVDR based on sub-type B can be applied for the rapid determination of resistance of the CRF01_AE subtype. All patients with progressive clinical signs and increased viral load should be recommended to undergo second-line treatment of the ARV regimen.

CRF01_AE dominates the HIV-1 epidemic in Indonesia

BACKGROUND

The HIV epidemic in Indonesia remains concentrated in vulnerable populations, namely injecting drug users (IDUs), commercial sex workers (CSWs) and men who have sex with men (MSM). We aimed to determine the HIV-1 subtypes present in Indonesia and to establish the extent of the viral overlap between individuals with different risk factors.

METHODS

Venous blood samples were collected from HIV-positive individuals primarily from sexually transmissible infection clinics and drug rehabilitation centres in Bali and Jakarta, and applied to filter paper. A polymerase chain reaction-based assay designed to amplify a 330-bp region of the HIV-1 envelope was used to determine HIV-1 subtype result and to perform phylogenetic analysis.

RESULTS

Of the 175 individuals recruited to the study, a subtype result was obtained for 108 (62%). Four subtypes were found to exist in the population, CRF01_AE (n=96, 88.9%), B (n=10, 9.3%), C (n=1, 0.9%) and G (n=1, 0.9%). Of these 108 individuals, 65 (60%) were IDUs, and the remaining 40% were CSWs, MSM, transgender individuals, people with multiple sexual partners or those with no obvious risk factor. CRF01_AE was found to be more common among IDUs with 100% of individuals infected with this subtype. Subtype B was more common among MSM and CSWs (P=<0.001). Phylogenetic analysis revealed a lack of viral segregation between risk groups.

CONCLUSIONS

In Indonesia, CRF01_AE continues to dominate the HIV epidemic, although HIV subtype B is responsible for a significant number of sexually acquired infections.

Barriers for introducing HIV testing among tuberculosis patients in Jogjakarta, Indonesia: a qualitative study

Background

HIV and HIV-TB co-infection are slowly increasing in Indonesia. WHO recommends HIV testing among TB patients as a key response to the dual HIV-TB epidemic. Concerns over potential negative impacts to TB control and lack of operational clarity have hindered progress. We investigated the barriers and opportunities for introducing HIV testing perceived by TB patients and providers in Jogjakarta, Indonesia.

Methods

We offered Voluntary Counselling and Testing (VCT) to TB patients in parallel to a HIV prevalence survey. We conducted in-depth interviews with 33 TB patients, 3 specialist physicians and 3 disease control managers. We also conducted 4 Focus Group Discussions (FGDs) with nurses. All interviews and FGDs were recorded and data analysis was supported by the QSR N6^® software.

Results

Patients' and providers' knowledge regarding HIV was poor. The main barriers perceived by patients were: burden for accessing VCT and fear of knowing the test results. Stigma caused concerns among providers, but did not play much role in patients' attitude towards VCT. The main barriers perceived by providers were communication, patients feeling offended, stigmatization and additional burden.

Conclusion

Introduction of HIV testing among TB patients in Indonesia should be accompanied by patient and provider education as well as providing conditions for effective communication.