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Wulandari LPL, Lubis DS, Kurniati DPY, Sumintang K, Ardrini DAM, Mariani P, Januraga PP, Camellia A, Laksmi NMDP, Mahmudah L, Ong JJ, Causer L, Liverani M, Guy R, Wiseman V. Challenges to integrating programs for the elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B into antenatal care: Experiences from Indonesia. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002977. [PMID: 38446812 PMCID: PMC10917262 DOI: 10.1371/journal.pgph.0002977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/25/2024] [Indexed: 03/08/2024]
Abstract
The WHO's Asia-Pacific framework for triple elimination recommends that countries evaluate their programs for the elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B (EMTCT), including identifying gaps to improve program planning and the implementation of elimination strategies in antenatal care (ANC) services. In 2022, the Indonesian Ministry of Health reported that only 39% of pregnant women were tested for HIV, 14% for syphilis, and 28% for hepatitis B, respectively. We conducted a qualitative study involving a focus group discussion (FGD) and in-depth interviews with 25 key stakeholders in Bali and West Nusa Tenggara Provinces to identify specific challenges to testing for HIV, syphilis, and hepatitis B in ANC settings. Thematic analysis was used to identify the themes generated from the data. Health system bottlenecks experienced by stakeholders included supply chain management issues involving stock forecasting and stock monitoring, stock-outs of rapid test reagents which were particularly most frequent and for longer durations for syphilis and hepatitis B, high staff turnover, lack of staff training on how to perform the test, the complexity and time needed to record the data on women's characteristics, risk behaviours, and testing in both paper format and into the computer-based surveillance systems, discrepancies in program coverage data from different divisions of the district health office involved in the reporting system, high levels of stigma that prevented women from being followed up, challenges in notifying partners, and inadequate reporting and referral of women from private providers to public ones for testing. Interventions addressing the above challenges are worthy of consideration to improve the health system function and integrate EMTCT into the ANC settings.
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Affiliation(s)
- Luh Putu Lila Wulandari
- The Kirby Institute, University of New South Wales, Sydney, Australia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Dinar Saurmauli Lubis
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Desak Putu Yuli Kurniati
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Karjono Sumintang
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Dewa Ayu Mirah Ardrini
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | | | - Pande Putu Januraga
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Bali, Indonesia
| | | | | | | | - Jason J. Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Louise Causer
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Marco Liverani
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Sydney, Australia
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Subronto YW, Kusmayanti NA, Januraga PP, Dewa Wirawan LN, Wisaksana R, Sukmaningrum E, Kawi NH, Iskandar S, Mulyani T, Sulaiman N, Magnani R, Kaldor J, Law M. Simplified clinical algorithm for immediate antiretroviral therapy initiation: The HATI [HIV awal (early) Test & Treat in Indonesia] implementation research in Indonesia. Indian J Med Res 2022; 156:729-741. [PMID: 37056072 DOI: 10.4103/ijmr.ijmr_239_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
Background & objectives Although the World Health Organization recommends same day or rapid (< seven days) antiretroviral therapy (ART) initiation, delays in ART initiation remain common due to waiting for laboratory test results. This study employed a simplified clinical algorithm the HATI [HIV Awal (Early) Test & Treat Indonesia]-SAI (Simple ART Initiation) aimed to increase the proportion of ART uptake and decrease the time to ART initiation that can be used in various care settings. Methods This study compared the percentage of ART uptake and retention, viral load (VL) suppression and time to ART initiation between the observation and intervention phases among newly diagnosed HIV patients from key populations. As part of the intervention, the newly diagnosed patients underwent screening using a simple form [consisting of data on age, height and weight (for body mass index calculation), questions on the presence of symptoms of HIV stages 1 and 2, tuberculosis, history of diabetes, hypertension and kidney disease], to determine eligibility for immediate ART initiation. Those who met the pre-defined criteria immediately received a combination of tenofovir lamivudine and efavirenz for two weeks. The baseline laboratory examination due to this was moved up to two weeks post ART. Factors significantly associated with ART uptake were also determined and their odds ratios were measured using logistic regression analysis. Results A total of 2173 people newly diagnosed with HIV were recruited, with 1579 and 594 in the observation and intervention phases, respectively. In both phases, the majority were men who have sex with men, who were young (<30 yr old) and employed, with high levels of education. The intervention phase significantly increased the proportion of ART initiation [91%, 95% confidence interval (CI): 89-93% vs. 78%, 95% CI: 76-80%] but did not have any impact on the proportion of six months retention and VL suppression. The intervention also significantly decreased the time to ART initiation from median ± interquartile range: 9±20 days to 2±10 days. Interpretation & conclusions The findings of this study suggest that the HATI-SAI intervention increased the uptake and decreased the time for immediate ART initiation. The HATI-SAI provides a simple and safe clinical approach that can readily be adopted in different settings without a costly investment in technology.
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Affiliation(s)
- Yanri Wijayanti Subronto
- Center for Tropical Medicine; Department of Internal Medicine, Division of Tropical Medicine & Infectious Diseases, Faculty of Medicine, Public Health, & Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | | | - Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Bandung, Indonesia
| | | | - Rudi Wisaksana
- Research Center for Care and Control of Infectious Disease, Faculty of Medicine, Padjajaran University, Bandung, Indonesia
| | - Evi Sukmaningrum
- Department of Psychology; Centre of Excellence Health Policy and HIV-AIDS, Jakarta, Indonesia
| | | | - Shelly Iskandar
- Research Center for Care and Control of Infectious Disease, Faculty of Medicine, Padjajaran University, Bandung, Indonesia
| | - Tri Mulyani
- Research Center for Care and Control of Infectious Disease, Faculty of Medicine, Padjajaran University, Bandung, Indonesia
| | - Nurjannah Sulaiman
- Indonesia Ministry of Health, Directorate Communicable Disease Control, Sydney, New South Wales, Australia
| | - Robert Magnani
- HIV-AIDS Research Centre, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Law
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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Widyanthini DN, Januraga PP, Wisaksana R, Subronto YW, Sukmaningrum E, Kusmayanti NA, Dewi H, Law M, Kaldor JM, Wirawan DN. HIV self-testing for men who have sex with men: an implementation trial in Indonesia. AIDS Care 2022; 34:527-534. [PMID: 33550846 DOI: 10.1080/09540121.2021.1883509] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
We investigated oral fluid testing (OFT) among men who have sex with men (MSM) to increase HIV testing in Bali, Indonesia. We distributed OFT in January-December 2018 to 813 MSM in Bali. Supervised testing was offered first, and unsupervised was only offered to an individual who declined supervised testing. Included participants were MSM who did not have a HIV test result in the last 6 months and declined referral to facility-based testing. Of 813 participants, 93% (765/813) chose supervised testing and 7% (57/813) unsupervised. The OFT result was reactive for 83 (10%), of whom 52/83 (63%) underwent confirmatory testing with 47/52 (90%) found HIV positive. Among confirmed positives, 43/47 (92%) were enrolled in HATI study cohort, of whom 39 (91%) started treatment. At six months follow up, 25/39 (64%) of those initiating treatment were still receiving it, and all had a suppressed viral load. There was an increase in the mean number of MSM tested for HIV by HATI study Bali sites per month, from 100 (95%CI: 85-112) before the intervention to 152 (95% CI: 130-172) during the intervention. Our findings show the potential utility of offering HIV oral fluid self-test kits to scale-up HIV testing in MSM.Trial registration: ClinicalTrials.gov identifier: NCT03429842.
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Affiliation(s)
- Desak Nyoman Widyanthini
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Bali, Indonesia
- Discipline of Public Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Rudi Wisaksana
- Faculty of Medicine, Padjajaran University, West Java, Indonesia
| | - Yanri Wijayanti Subronto
- Center for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Evi Sukmaningrum
- AIDS Research Center, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Nur Aini Kusmayanti
- Center for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Helen Dewi
- Ministry of Health of Indonesia, Jakarta, Indonesia
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Septarini NW, Hendriks J, Maycock B, Burns S. Methodologies of Stigma-Related Research Amongst Men Who Have Sex With Men (MSM) and Transgender People in Asia and the Pacific Low/Middle Income Countries (LMICs): A Scoping Review. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:688568. [PMID: 36304052 PMCID: PMC9580832 DOI: 10.3389/frph.2021.688568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022] Open
Abstract
Much stigma-related research focuses on marginalized populations, including men who have sex with men (MSM) and transgender people. The importance of research in this area is widely recognized, however methodologies and measures vary between studies. This scoping review will collate existing information about how stigma-related research has been conducted in low/middle income countries (LMICs) within the Asia Pacific region, and will compare research designs, sampling frameworks, and measures. Strengths and limitations of these studies will inform recommendations for future stigma-related health research. A methodological framework for scoping studies was applied. Searches of Psych INFO, Scopus, ProQuest, Global Health and PubMed were used to identify articles. Stigma-related research amongst MSM and transgender communities, published between 2010 and 2019 in LMICs within the Asia Pacific region were included. A total of 129 articles based on 123 different studies were included. Of the 129 articles 51.19% (n = 66) were quantitative; 44.96% (n = 57) were qualitative and 3.88% (n = 5) were mixed methods studies. The majority of studies (n = 57; 86.36%) implemented a cross sectional survey. In-depth interviews (n = 20, 34.48%) were also common. Only 3.88% of studies utilized mixed-methods design. Non-probabilistic and probabilistic sampling methods were employed in 99.22 and 0.78% of studies respectively. The most common measures used in quantitative studies were the Center for Epidemiological Study on Depression (CES-D) (n = 18) and the Self Stigma Scale (SSS) (n = 6). Strengths and limitations proposed by researchers included in this review are summarized as lesson learnt and best practices in stigma-related research.
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Affiliation(s)
- Ni Wayan Septarini
- School of Population Health, Curtin University, Perth, WA, Australia
- Department of Community and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
- *Correspondence: Ni Wayan Septarini ;
| | - Jacqueline Hendriks
- School of Population Health, Curtin University, Perth, WA, Australia
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth, WA, Australia
| | - Bruce Maycock
- European Center for Environmental and Human Health, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Sharyn Burns
- School of Population Health, Curtin University, Perth, WA, Australia
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Whitford K, Mitchell E, Lazuardi E, Rowe E, Tasya IA, Wirawan DN, Wisaksana R, Subronto YW, Prameswari HD, Kaldor JM, Bell S. A strengths-based analysis of social influences that enhance HIV testing among female sex workers in urban Indonesia. Sex Health 2021; 18:77-83. [PMID: 33588987 DOI: 10.1071/sh20085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/07/2020] [Indexed: 11/23/2022]
Abstract
Background HIV prevalence among female sex workers in Indonesia remains high and large proportions of female sex workers have never been tested for HIV. International research highlights the importance of community-led strategies to increase HIV testing in this population. Little qualitative research has been conducted to address these issues in Indonesia or other Asia-Pacific countries. This paper documents social influences that enhance HIV testing among female sex workers in urban Indonesia. METHODS This was an interpretive qualitative study in Yogyakarta, Denpasar and Bandung. In total, 57 female sex workers participated in 11 focus group discussions, and four participated in individual semi-structured interviews. Deductive and inductive thematic analysis techniques were used to identify narratives of strengths pertaining to uptake of HIV testing. RESULTS Participants described supportive relationships with peers, community-based organisations and 'bosses'. Participants reported trusted networks with peers within which to share information about HIV testing and receive emotional support. Relationships with community outreach workers facilitated HIV testing through reminders, accompanied visits, and emotional/informational support. Community-based organisations worked with health services to facilitate mobile, community-based testing to overcome employment- and family-related constraints that inhibited women's clinic attendance. 'Bosses' employed a variety of practices to encourage HIV testing among their workers. CONCLUSIONS Relationships, practices and action in community- and workplace-based settings outside formal health service spaces enhanced HIV testing among female sex workers. Community- or workplace-based HIV testing with outreach support from health services, peer-led HIV testing within existing social and work-based networks, and working with bosses to implement HIV prevention strategies can address low HIV testing rates in this key population.
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Affiliation(s)
- Kate Whitford
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; and Corresponding author.
| | - Elke Mitchell
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Elan Lazuardi
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; and Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Emily Rowe
- Kerti Praja Foundation, Denpasar, Indonesia
| | - Irma Anintya Tasya
- Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
| | - Dewa N Wirawan
- Kerti Praja Foundation, Denpasar, Indonesia; and Department of Public Health and Preventive Medicine, Faculty of Medicine, Universities Udayana, Denpasar, Indonesia
| | - Rudi Wisaksana
- Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia; and Department of Internal Medicine, Hasan Sadikin Hospital, Bandung, Indonesia
| | - Yanri W Subronto
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; and Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Hellen D Prameswari
- HIV AIDS and STI Sub-directorate, Directorate of Communicable Disease Prevention and Control, Directorate General of Disease Prevention and Control, Ministry of Health of Indonesia, Jakarta, Indonesia
| | - John M Kaldor
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Stephen Bell
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; and Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia; and Kirby Institute, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW, Australia
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Yuvaraj A, Mahendra VS, Chakrapani V, Yunihastuti E, Santella AJ, Ranauta A, Doughty J. HIV and stigma in the healthcare setting. Oral Dis 2020; 26 Suppl 1:103-111. [PMID: 32862542 DOI: 10.1111/odi.13585] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
People living with HIV (PLHIV) continue to endure stigma and discrimination in the context of health care despite global improvements in health outcomes. HIV stigma persists within healthcare settings, including dental settings, manifesting itself in myriad, intersecting ways, and has been shown to be damaging in the healthcare setting. Stigmatising practices may include excessive personal protective equipment, delaying the provision of care or unnecessary referral of PLHIV to specialist services in order to access care. The workshop entitled "HIV and Stigma in the Healthcare Setting" provided an overview of the concept and manifestation of HIV stigma and explored the disproportionate burden it places on groups that face additional disadvantages in accessing care. The final part of the workshop concluded with a review of institutional and community-based interventions that worked to reduce HIV stigma and group discussion of the ways in which these strategies might be adapted to the dental workforce.
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Affiliation(s)
- Anandi Yuvaraj
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | | | - Evy Yunihastuti
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Indonesia
| | | | - Amitha Ranauta
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India.,DBT/Wellcome Trust India Alliance, The Humsafar Trust, Mumbai, India
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Lazuardi E, Newman CE, Anintya I, Rowe E, Wirawan DN, Wisaksana R, Subronto YW, Kusmayanti NA, Iskandar S, Kaldor J, Bell S. Increasing HIV treatment access, uptake and use among men who have sex with men in urban Indonesia: evidence from a qualitative study in three cities. Health Policy Plan 2020; 35:16-25. [PMID: 31625559 DOI: 10.1093/heapol/czz128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2019] [Indexed: 11/12/2022] Open
Abstract
Men who have sex with men make up one of four key populations identified as critical to a successful HIV response in Indonesia. Despite international policies supporting HIV treatment in low- and middle-income countries, Indonesia is one of the few countries experiencing low coverage of HIV treatment and little decrease in HIV incidence. There is poor retention in care and low viral suppression rates among key populations such as men who have sex with men. The national government has committed to increasing treatment access and uptake for people with HIV but little is known about how these men themselves view, use and experience these medications. Drawing on qualitative data collected in 2015-16 from 24 HIV-positive men who have sex with men living in three Indonesian cities, we observed multiple intersecting social and contextual factors that can influence effective HIV treatment use. Although shared stories of strong side effects and fear of unwanted disclosure inhibited treatment uptake, social support from 'buddies' helped to navigate healthcare systems and sharing medication among peers enabled adherence. In order to improve treatment uptake and adherence among Indonesian men who have sex with men living with HIV, these divergent effects of the social meanings and practices associated with HIV treatments in Indonesia must be better acknowledged. A more comprehensive understanding of social and community practices within key populations can strengthen national efforts to improve treatment access and increase adherence. Ongoing decentralization of healthcare in Indonesia, and differentiated care models that enable initiation of treatment in community settings and involve non-medical, community-based organizations in the provision of treatment services have the potential to address the needs of individuals who fall into a key population category such as men who have sex with men.
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Affiliation(s)
- Elan Lazuardi
- The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia.,Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl. Medika, Kabupaten Sleman, Daerah Istimewa Yogyakarta 55281, Indonesia
| | - Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Irma Anintya
- Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjajaran, Jl. Eijkman No. 38, Kota Bandung, West Java 40161, Indonesia
| | - Emily Rowe
- Kerti Praja Foundation, Jl. Raya Sesetan No. 270, Kota Denpasar, Bali 80223, Indonesia
| | - Dewa N Wirawan
- Kerti Praja Foundation, Jl. Raya Sesetan No. 270, Kota Denpasar, Bali 80223, Indonesia.,Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Udayana, Jl. P.B. Sudirman, Kota Denpasar, Bali 80232, Indonesia
| | - Rudi Wisaksana
- Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjajaran, Jl. Eijkman No. 38, Kota Bandung, West Java 40161, Indonesia.,Department of Internal Medicine, Hasan Sadikin Hospital, Bandung, Jl. Pasteur No. 38, Kota Bandung, West Java 40161, Indonesia
| | - Yanri W Subronto
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl. Medika, Kabupaten Sleman, Daerah Istimewa Yogyakarta 55281, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl. Farmako, Kabupaten Sleman, Daerah Istimewa Yogyakarta 55281, Indonesia
| | - Nur Aini Kusmayanti
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl. Medika, Kabupaten Sleman, Daerah Istimewa Yogyakarta 55281, Indonesia
| | - Shelly Iskandar
- Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjajaran, Jl. Eijkman No. 38, Kota Bandung, West Java 40161, Indonesia
| | - John Kaldor
- The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Stephen Bell
- The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia.,Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2052, Australia
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Tumwine C, Aggleton P, Bell S. Accessing HIV treatment and care services in fishing communities around Lake Victoria in Uganda: mobility and transport challenges. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2019; 18:205-214. [PMID: 31575339 DOI: 10.2989/16085906.2019.1648306] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Qualitative research exploring the influence of community-level factors on access to and use of HIV treatment and care services among people living in fishing communities is limited, especially with respect to those already in receipt of HIV care and on treatment. To enhance understanding of these issues, semi-structured in-depth interviews were conducted with 42 HIV-positive fisherfolk and 15 health care providers from two HIV clinics located in two fishing communities in Uganda. Fisherfolk's mobility and poor transport systems were significant barriers to access to and use of HIV treatment and care. Mobility, which involved regular movement between communities, sometimes led to fisherfolk's inability to access HIV treatment and care. A poor transport system in fishing communities - characterised by irregular transport services and boats in a poor condition - was reported to force both fisherfolk and health care providers sometimes to cancel journeys to centres providing treatment and support. Community-level factors such as these, which relate to the organisation and provision of transport in local community settings, are significant influences on access to HIV treatment and care. Interventions that address these challenges are needed to improve access to and use of HIV treatment and care in fishing communities.
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Affiliation(s)
- Christopher Tumwine
- Centre for Social Research in Health , UNSW Sydney , Australia.,Department of Sociology and Social Administration, Kyambogo University , Kampala , Uganda
| | - Peter Aggleton
- Centre for Social Research in Health , UNSW Sydney , Australia.,School of Sociology, The Australian National University , Canberra , Australia.,Centre for Gender and Global Health, UCL , London , United Kingdom
| | - Stephen Bell
- Centre for Social Research in Health , UNSW Sydney , Australia.,Kirby Institute for Infection and Immunity in Society , UNSW Sydney , Australia
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Mitchell E, Lazuardi E, Rowe E, Anintya I, Wirawan DN, Wisaksana R, Subronto YW, Prameswari HD, Kaldor J, Bell S. Barriers and Enablers to HIV Care Among Waria (Transgender Women) in Indonesia: A Qualitative Study. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:538-552. [PMID: 31815531 DOI: 10.1521/aeap.2019.31.6.538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Transgender women (waria) in Indonesia have high rates of HIV and experience barriers accessing HIV services. This qualitative research explored barriers and facilitators to HIV care among waria in Indonesia. Between 2015 and 2016, 42 participants were involved in focus group discussions and in-depth interviews across three urban sites in Indonesia to examine participants' experiences and views on HIV prevention, testing, treatment initiation, and treatment adherence. Data were analyzed thematically. Barriers to accessing HIV care services included perceptions of health and HIV treatment, confidentiality and stigma concerns, and poor access to health insurance. Facilitators to HIV care included recognition of health and perceived susceptibility, perceptions of treatment benefits and consequences of non-adherence, access to social support, and patient-friendly services. Research findings highlight the importance of improving HIV treatment literacy, safeguarding community responses to addressing HIV vulnerability, addressing confidentiality and stigma issues, ensuring services are transgender-friendly, and increasing health insurance coverage.
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Affiliation(s)
| | - Elan Lazuardi
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Emily Rowe
- Kerti Praja Foundation, Denpasar, Indonesia
| | - Irma Anintya
- Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
| | - Dewa N Wirawan
- Kerti Praja Foundation, Denpasar, Indonesia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
| | - Rudi Wisaksana
- Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
- Department of Internal Medicine, Hasan Sadikin Hospital, Bandung, Indonesia
| | - Yanri W Subronto
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Hellen Dewi Prameswari
- HIV AIDS and STI Subdirectorate, Directorate of Communicable Disease Prevention and Control, Directorate General of Disease Prevention and Control, Ministry of Health of Indonesia, Jakarta, Indonesia
| | - John Kaldor
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Stephen Bell
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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