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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 Glob 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Putri WCWS, Ulandari LPS, Valerie IC, Prabowo BR, Hardiawan D, Sihaloho ED, Relaksana R, Wardhani BDK, Harjana NPA, Nugrahani NW, Siregar AYM, Januraga PP. Costs and scale-up costs of community-based Oral HIV Self-Testing for female sex workers and men who have sex with men in Jakarta and Bali, Indonesia. BMC Health Serv Res 2024; 24:114. [PMID: 38254186 PMCID: PMC10802071 DOI: 10.1186/s12913-024-10577-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The proportion of individuals who know their HIV status in Indonesia (66% in 2021) still remains far below the first 95% of UNAIDS 2030 target and were much lower in certain Key Populations (KPs) particularly Female Sex Workers (FSW) and Male having Sex with Male (MSM). Indonesia has implemented Oral HIV Self-testing (oral HIVST) through Community-based screening (HIV CBS) in addition to other testing modalities aimed at hard-to-reach KPs, but the implementation cost is still not analysed. This study provides the cost and scale up cost estimation of HIV CBS in Jakarta and Bali, Indonesia. METHODS We estimated the societal cost of HIV CBS that was implemented through NGOs. The HIV CBS's total and unit cost were estimated from HIV CBS outcome, health care system cost and client costs. Cost data were presented by input, KPs and areas. Health care system cost inputs were categorized into capital and recurrent cost both in start-up and implementation phases. Client costs were categorized as direct medical, direct non-medical cost and indirect costs. Sensitivity and scenario analyses for scale up were performed. RESULTS In total, 5350 and 1401 oral HIVST test kits were distributed for HIV CBS in Jakarta and Bali, respectively. Average total client cost for HIV CBS Self testing process ranged from US$1.9 to US$12.2 for 1 day and US$2.02 to US$33.61 for 2 days process. Average total client cost for HIV CBS confirmation test ranged from US$2.83 to US$18.01. From Societal Perspective, the cost per HIVST kit distributed were US$98.59 and US$40.37 for FSW and MSM in Jakarta andUS$35.26 and US$43.31 for FSW and MSM in Bali. CONCLUSIONS CBS using oral HIVST approach varied widely along with characteristics of HIV CBS volume and cost. HIV CBS was most costly among FSW in Jakarta, attributed to the low HIV CBS volume, high personnel salary cost and client cost. Future approaches to minimize cost and/or maximize testing coverage could include unpaid community led distribution to reach end-users, integrating HIVST into routine clinical services via direct or secondary distribution and using social media network.
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Affiliation(s)
- Wayan Citra Wulan Sucipta Putri
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Jl. P. B. Sudirman, Denpasar, Bali, 80232, Indonesia.
| | - Luh Putu Sinthya Ulandari
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Jl. P. B. Sudirman, Denpasar, Bali, 80232, Indonesia
| | - Ivy Cerelia Valerie
- Center for Public Health Innovation (CPHI), Udayana University, Denpasar, Bali, Indonesia
| | | | - Donny Hardiawan
- Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Estro Dariatno Sihaloho
- Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Riki Relaksana
- Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | | | | | - Nur Wulan Nugrahani
- Center for Public Health Innovation (CPHI), Udayana University, Denpasar, Bali, Indonesia
| | - Adiatma Yudistira Manogar Siregar
- Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Pande Putu Januraga
- Center for Public Health Innovation (CPHI), Udayana University, Denpasar, Bali, Indonesia
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Harjana NPA, Nita S, Sebayang M, Mukuan OS, Widihastuti AS, Januraga PP. Intimate partner violence and factors influencing HIV status disclosure among women living with HIV in Indonesia: a cross-sectional study. AIDS Care 2023:1-12. [PMID: 38157374 DOI: 10.1080/09540121.2023.2299746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
The disclosure of HIV status poses challenges, and women living with HIV often face intimate partner violence as a result of revealing their HIV status. This study aims to investigate the prevalence of intimate partner violence and HIV status disclosure among women living with HIV in Indonesia, as well as the factors associated with disclosure. A total of 283 women with HIV participated in an online survey, and descriptive and logistic regression analyses were performed. The findings revealed that women reported experiencing physical (9.54%), sexual (6.01%), mental (23.67%), and economic (14.49%) abuse. HIV status disclosure varied among different individuals, with higher rates observed for partners (71.2%), other family members (65.02%), close friends (37.10%), and lower rates for health workers (1.77%). Factors such as employment status and partner's HIV status influenced disclosure to partners, while the duration of knowing one's HIV status, experiences of intimate partner violence, and perceived barriers influenced disclosure to both family and non-family members. To mitigate the negative consequences of HIV status disclosure, targeted health promotion efforts should prioritize partners, family members, and non-family members, focusing on enhancing knowledge and awareness about HIV, including the impact of violence.
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Affiliation(s)
- Ngakan Putu Anom Harjana
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, Indonesia
| | - Sally Nita
- Jaringan Indonesia Positif, Jakarta, Indonesia
| | | | | | | | - Pande Putu Januraga
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, Indonesia
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Sukmaningrum E, Levy J, Negara MD, N/A D, Wardhani BDK, Wulandari LPL, Januraga PP. Lived Experience, Social Support, and Challenges to Health Service Use during the COVID-19 Pandemic among HIV Key Populations in Indonesia. Res Sq 2023:rs.3.rs-3282353. [PMID: 37720042 PMCID: PMC10503867 DOI: 10.21203/rs.3.rs-3282353/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
The COVID-19 has greatly affected the lives, health and social well-being of people globally including presenting special challenges in low to middle income countries for people living with HIV. This study investigates the pandemic experiences of the four key HIV-positive populations in Indonesia: men who have sex with men, transgender women, female sex workers, and people who use drugs. In-depth interviews were conducted with a convenience sample of 22 key population members recruited through 9 nongovernment HIV agencies in Jakarta and Bali, Indonesia. Indonesia's Large-scale Social Restrictions Policy mandating physical distancing and stay-at-home orders had been in effect for 7-10 months. The interviews were audio-recorded, transcribed, and coded using NVivo™ (R1.7) software A grounded theory approach identified key concepts along with similarities, differences, and reoccurring patterns of COVID-related lived experience among participants. Participants recounted the impact of both the pandemic and the Restriction Policy on their interpersonal, financial, medical, and psychosocial well-being. When in need, they turned to formal and informal sources of financial and social support plus their own resourcefulness. Along with other factors, HIV medication shortages, HIV and COVID-related stigma, and fear of acquiring COVID-19 negatively impacted antiretroviral adherence and the use of health services. The results point to the latent consequences of government attempts to curb a pandemic through public health lockdowns and enforced policies of physical separation. Its findings reveal the importance of ensuring that public safety nets for HIV key populations are available to supplement more informal personal sources of needed support.
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Affiliation(s)
- Evi Sukmaningrum
- Faculty of Psychology, Atma Jaya Catholic University of Indonesia
| | | | - Made Diah Negara
- University Centre of Excellence-AIDS Research Centre Health Policy and Social Innovation, Atma Jaya Catholic University of Indonesia
| | - Devika N/A
- University Centre of Excellence-AIDS Research Centre Health Policy and Social Innovation, Atma Jaya Catholic University of Indonesia
| | | | | | - Pande Putu Januraga
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University
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Harjana NPA, Nita S, Sebayang M, Mukuan OS, Widhiastuti AS, Januraga PP. Factors Associated With Utilization of Cervical Cancer Screening Program Among Women Living With HIV in Indonesia. Asia Pac J Public Health 2023; 35:392-395. [PMID: 37408166 DOI: 10.1177/10105395231185982] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Affiliation(s)
- Ngakan Putu Anom Harjana
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, Indonesia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
| | - Sally Nita
- Positive Indonesia Network, Jakarta, Indonesia
| | | | | | | | - Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, Indonesia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
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Kusumajaya AAN, Mubasyiroh R, Sudikno S, Nainggolan O, Nursanyoto H, Sutiari NK, Adhi KT, Suarjana IM, Januraga PP. Sociodemographic and Healthcare Factors Associated with Stunting in Children Aged 6-59 Months in the Urban Area of Bali Province, Indonesia 2018. Nutrients 2023; 15:nu15020389. [PMID: 36678259 PMCID: PMC9863855 DOI: 10.3390/nu15020389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/24/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023] Open
Abstract
Stunting is a worldwide public health concern, including in Indonesia. Even when living in an urban area with urban characteristics, it is still possible for children to be at risk of stunting. The aim of this study was to determine the sociodemographic and healthcare factors associated with stunting in a province experiencing tourism growth, namely, Bali. Cross-sectional data on Bali Province from the Indonesian Basic Health Research Survey (Riskesdas, 2018) were used as the basis for the research analysis. A total of 846 respondents under five years of age were analyzed, indicating a stunting prevalence of 19.0%. Multivariate logistic regression demonstrated low maternal educational attainment (adjustedOR = 1.92; 95% Confidence Interval = 1.24-2.97), the inadequate consumption of iron tablets during pregnancy (adjustedOR = 1.56; 95% Confidence Interval = 1.08-2.24), and no extended family (adjustedOR = 1.55; 95% Confidence Interval = 1.07-2.26) as being significantly associated with stunting. According to these findings, sociodemographic and healthcare factors are associated with stunting in urban Bali. Improving women's education, ensuring sufficient iron tablets are consumed during pregnancy, and encouraging the involvement of the extended family in childcare are recommended.
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Affiliation(s)
| | - Rofingatul Mubasyiroh
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta 10340, Indonesia
- Correspondence:
| | - Sudikno Sudikno
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta 10340, Indonesia
| | - Olwin Nainggolan
- Health Development Policy Agency, Ministry of Health, Jakarta 10560, Indonesia
| | | | - Ni Ketut Sutiari
- Department of Public Health and Preventive Medicine, Medical Faculty, Udayana University, Denpasar 80361, Indonesia
| | - Kadek Tresna Adhi
- Department of Public Health and Preventive Medicine, Medical Faculty, Udayana University, Denpasar 80361, Indonesia
| | - I Made Suarjana
- Health Polytechnic, Ministry of Health, Denpasar 80224, Indonesia
| | - Pande Putu Januraga
- Department of Public Health and Preventive Medicine, Medical Faculty, Udayana University, Denpasar 80361, Indonesia
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Webb E, Michelen M, Rigby I, Dagens A, Dahmash D, Cheng V, Joseph R, Lipworth S, Harriss E, Cai E, Nartowski R, Januraga PP, Gedela K, Sukmaningrum E, Cevik M, Groves H, Hart P, Fletcher T, Blumberg L, Horby PW, Jacob ST, Sigfrid L. An evaluation of global Chikungunya clinical management guidelines: A systematic review. EClinicalMedicine 2022; 54:101672. [PMID: 36193172 PMCID: PMC9526181 DOI: 10.1016/j.eclinm.2022.101672] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/02/2022] [Accepted: 09/07/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Chikungunya virus (CHIKV) has expanded its geographical reach in recent decades and is an emerging global health threat. CHIKV can cause significant morbidity and lead to chronic, debilitating arthritis/arthralgia in up to 40% of infected individuals. Prevention, early identification, and clinical management are key for improving outcomes. The aim of this review is to evaluate the quality, availability, inclusivity, and scope of evidence-based clinical management guidelines (CMG) for CHIKV globally. METHODS We conducted a systematic review. Six databases were searched from Jan 1, 1989, to 14 Oct 2021 and grey literature until Sept 16, 2021, for CHIKV guidelines providing supportive care and treatment recommendations. Quality was assessed using the appraisal of Guidelines for Research and Evaluation tool. Findings are presented in a narrative synthesis. PROSPERO registration: CRD42020167361. FINDINGS 28 CMGs were included; 54% (15/28) were produced more than 5 years ago, and most were of low-quality (median score 2 out of 7 (range 1-7)). There were variations in the CMGs' guidance on the management of different at-risk populations, long-term sequelae, and the prevention of disease transmission. While 54% (15/28) of CMGs recommended hospitalisation for severe cases, only 39% (11/28) provided guidance for severe disease management. Further, 46% (13/28) advocated for steroids in the chronic phase, but 18% (5/28) advised against its use. INTERPRETATION There was a lack of high-quality CMGs that provided supportive care and treatment guidance, which may impact patient care and outcomes. It is essential that existing guidelines are updated and adapted to provide detailed evidence-based treatment guidelines for different at-risk populations. This study also highlights a need for more research into the management of the acute and chronic phases of CHIKV infection to inform evidence-based care. FUNDING The UK Foreign, Commonwealth and Development Office, Wellcome Trust [215091/Z/18/Z] and the Bill & Melinda Gates Foundation [OPP1209135].
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Affiliation(s)
- Eika Webb
- Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, UK
| | - Melina Michelen
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Ishmeala Rigby
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Andrew Dagens
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Dania Dahmash
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Vincent Cheng
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Samuel Lipworth
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Erhui Cai
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Robert Nartowski
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | | | | | - Evi Sukmaningrum
- Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
- HIV AIDS Research Centre-HPSI, AJCU, Jakarta, Indonesia
| | - Muge Cevik
- Department of Global Health and Infection Research, School of Medicine, University of St Andrews, Fife, Scotland, UK
| | | | | | - Tom Fletcher
- Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, UK
| | - Lucille Blumberg
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Peter W. Horby
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Shevin T. Jacob
- Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, UK
| | - Louise Sigfrid
- International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Oxford, UK
- Corresponding author.
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Kawi NH, Sihotang EP, Nisa T, Hui B, Causer LM, Januraga PP, Ronoatmodjo S. Incidence and risk factors for syphilis infection among men who have sex with men: A cohort study from an urban sexual health clinic in Jakarta, Indonesia. Int J STD AIDS 2022; 33:1065-1072. [PMID: 36067281 DOI: 10.1177/09564624221125079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Syphilis infection remains a significant health issue among marginalised populations in Indonesia, in particular among men who have sex with men (MSM), in whom there are limited studies from Indonesia exploring risk factors associated with STI acquisition.Our study aimed to identify risk factors of syphilis infection among MSM attending large sexual health clinic in Jakarta. Methods: We conducted a retrospective cohort analysis using patient records (MSM aged 18 years or older) period Jan 2018-Dec 2019. We used Cox regression to identify risk factors associated with syphilis incidence. Results: Study population were 2912 MSM tested for syphilis, 473 (16.2%) were diagnosed with syphilis on their first visit; early syphilis (415; 14%) and latent syphilis (58, 2%). Among the cohort of 2439 MSM who tested negative at baseline, 40 MSM were identified with a new positive syphilis result during 2 years follow up. Risk factors remaining significantly associated with syphilis incidence included having STI symptom at 1st visit (aHR, 2.8; 95% CI, 1.38-5.65), and HIV-infection (aHR 4.53; 95% CI 2.24 - 9.17).Syphilis incidence rate was 8.19 (95% CI 6.01-11.16) per 100 PYFU. Conclusions: Syphilis infection at baseline and incidence was high among MSM attending this large clinic in Jakarta. Integrated and accessible syphilis prevention and detection coupled with HIV services are needed, with a special focus on high-risk individuals.
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Affiliation(s)
- Nurhayati H Kawi
- Public Health, 206718University of Indonesia, Depok (Kota), Indonesia.,Globalindo Clinic, Jakarta Selatan, Indonesia
| | | | - Tiara Nisa
- Globalindo Clinic, Jakarta Selatan, Indonesia
| | - Ben Hui
- UNSW Sydney, 2786Kirby Institute, Sydney, Australia
| | | | - Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, 95340Udayana University, Denpasar, Indonesia
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Wirawan GBS, Gustina NLZ, Januraga PP. Open Communication about Reproductive Health is Associated with Comprehensive HIV Knowledge & Non-stigmatizing Attitude among Indonesian Youth: Cross-sectional Study. J Prev Med Public Health 2022; 55:342-350. [PMID: 35940189 PMCID: PMC9371787 DOI: 10.3961/jpmph.21.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/29/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives Human immunodeficiency virus (HIV) prevention among youth seems under-prioritised compared to other key populations. HIV knowledge and stigma are important parts of HIV prevention. To inform HIV prevention among youths, this study quantitatively analysed the associations between open communication regarding sexuality and sexual health, comprehensive HIV knowledge, and non-stigmatising attitudes in Indonesia. Methods This study used data from the Indonesian Demographic and Health Survey (IDHS) 2017. The analysis included unmarried men and women aged 15–25 years old. Comprehensive HIV knowledge and a stigmatising attitude were defined according to the IDHS 2017. Open communication about sexuality and sexual health was defined as the number of people with whom participants could openly discuss these topics in their direct network of friends, family, and service providers, with a scale ranging from 0 to a maximum of 7. Primary analysis used binomial logistic regression with weighting adjustments. Results The final analysis included 22 864 respondents. Twenty-two percent of youth had no one in their direct network with whom to openly discuss sexual matters, only 14.1% had comprehensive HIV knowledge, and 85.9% showed stigmatising attitudes. Youth mostly discussed sex with their friends (55.2%), and were less likely to discuss it with family members, showing a predominant pattern of peer-to-peer communication. Multivariate analysis showed that having a larger network for communication about sexuality and sexual health was associated with more HIV knowledge and less stigmatising attitudes. Conclusions Having more opportunities for open sex communication in one’s direct social network is associated with more HIV knowledge and less stigmatising attitudes.
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Affiliation(s)
| | | | - Pande Putu Januraga
- Center for Public Health Innovation, Udayana University, Denpasar,
Indonesia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Ward PR, Bissell P, Meyer SB, Gesesew HA, Januraga PP, Chang D, Lombi L. Editorial: COVID-19-Social Science Research During a Pandemic. Front Public Health 2022; 10:923992. [PMID: 35615044 PMCID: PMC9126570 DOI: 10.3389/fpubh.2022.923992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Paul R Ward
- Research Centre for Public Health Policy, Torrens University, Adelaide, SA, Australia
| | - Paul Bissell
- Deputy Vice Chancellor Research, University of Chester, Chester, United Kingdom
| | - Samantha B Meyer
- School of Public Health, University of Waterloo, Waterloo, ON, Canada
| | - Hailay A Gesesew
- Research Centre for Public Health Policy, Torrens University, Adelaide, SA, Australia.,College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Pande Putu Januraga
- Faculty of Medicine, Center for Public Health Innovation, Udayana University Denpasar, Denpasar, Indonesia
| | - Dukjin Chang
- School of Sociology, Seoul National University, Seoul, South Korea
| | - Linda Lombi
- Catholic University of the Sacred Heart, Milan, Italy
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12
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Nopiyani NMS, Januraga PP, Wirawan IMA, Bakta IM. Comprehensive Travel Health Education for Tour Guides: Protocol for an Exploratory Sequential Mixed Methods Research. JMIR Res Protoc 2022; 11:e33840. [PMID: 35604754 PMCID: PMC9171602 DOI: 10.2196/33840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Tourists are at risk of experiencing health problems during their travel. However, even though tour guides have the potential to become travel health promoters, their participation has not been optimal.
Objective
This study aims to develop a comprehensive travel health education model to help tour guides improve health information delivery to tourists.
Methods
This is an exploratory sequential mixed methods research. The first phase consisted of a qualitative study with an informed grounded theory design. In-depth interviews were carried out with tour guides from all language divisions and policymakers of the Indonesian Tour Guide Association Bali Branch or Himpunan Pramuwisata Indonesia Daerah Bali (HPI Bali). The interview guidelines were developed based on the theory of planned behavior and identity theory. Qualitative data were analyzed thematically. In the interim phase, a travel health education model and questionnaire were developed based on the qualitative findings. The initial model and its instruments were finetuned after consultation with travel medicine and health promotion experts. Furthermore, the validity and reliability of the questionnaire were tested on 30 tour guides. The second phase consisted of a quantitative study with a randomized pretest-posttest control group design. A total of 76 tour guides in the intervention group received comprehensive travel health education, while 76 in the control group received no specific intervention. Outcome variables (ie, attitudes, subjective norms, perceived behavioral control, actual behavioral control, role identity, and behavioral intention) were measured at baseline (T0), after the online training (T1), before information sharing via WhatsApp (T2), a month after the start of the WhatsApp intervention (T3), and at the end of the WhatsApp intervention (T4). The mean difference of each outcome variable before and after the intervention will be compared between the intervention and control groups. Thereafter, the quantitative and qualitative findings will be integrated into a joint display.
Results
The qualitative phase was conducted through in-depth interviews with 21 informants who included tour guides and policymakers from HPI Bali from May to June 2021. The education model, educational materials, and questionnaire were developed based on the qualitative findings and consultation with experts. The education model consists of online training and information sharing through WhatsApp and was trialed with tour guides from November 2021 to February 2022. As of April 2022, this study is in the quantitative data analysis stage.
Conclusions
A travel health education model was developed based on qualitative findings and consultation with experts. The model was tested with tour guides, and a series of self-administered questionnaires were completed. This study is in the quantitative data analysis stage and will continue by integrating qualitative and quantitative findings into a joint display.
Trial Registration
ClinicalTrials.gov NCT04961983; https://clinicaltrials.gov/ct2/show/NCT04961983
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Affiliation(s)
- Ni Made Sri Nopiyani
- Doctoral Program of Medical Sciences, Faculty of Medicine, Udayana University, Denpasar, Indonesia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
| | - Pande Putu Januraga
- Doctoral Program of Medical Sciences, Faculty of Medicine, Udayana University, Denpasar, Indonesia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
| | - I Md Ady Wirawan
- Doctoral Program of Medical Sciences, Faculty of Medicine, Udayana University, Denpasar, Indonesia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
| | - I Made Bakta
- Doctoral Program of Medical Sciences, Faculty of Medicine, Udayana University, Denpasar, Indonesia
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Wirawan GBS, Harjana NPA, Nugrahani NW, Januraga PP. Health Beliefs and Socioeconomic Determinants of COVID-19 Booster Vaccine Acceptance: An Indonesian Cross-Sectional Study. Vaccines (Basel) 2022; 10:724. [PMID: 35632482 PMCID: PMC9146460 DOI: 10.3390/vaccines10050724] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The threat of new SARS-CoV-2 variants indicates the need to implement COVID-19 vaccine booster programs. The aim of this study was to identify the level of booster acceptance and its determinants. METHODS A cross-sectional online survey was conducted in Jakarta and Bali, Indonesia. Booster acceptance was divided into three categories: non-acceptor, planned acceptor, and actual acceptor. The primary independent variables were health beliefs, media influence, and trust in authoritative sources. Other covariates included demographics, socioeconomic status, and COVID-19 history. A primary analysis was conducted through multinomial logistic regression. The effects of the hypothetical situations on booster acceptance were tested using the Wilcoxon signed-rank test. RESULTS The final analysis included 2674 respondents with a booster acceptance rate of 56.3% (41.2% planned acceptors, 15.1% actual acceptors). Health beliefs, social media influence, and trust in authoritative information sources were identified as determinants for planned and actual booster acceptance. Socioeconomic status indicators were also identified as determinants for actual booster acceptance. Booster acceptance was increased in hypothetical scenarios involving booster requirements for work, travel, and accessing public places. CONCLUSIONS Booster acceptance was found to be lower than the predicted primary vaccine acceptance prior to its launch. The acceleration of booster coverage requires strategies that leverage health beliefs and focus on people with a lower socioeconomic status.
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Affiliation(s)
- Gede Benny Setia Wirawan
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar 80232, Indonesia; (G.B.S.W.); (N.P.A.H.); (N.W.N.)
| | - Ngakan Putu Anom Harjana
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar 80232, Indonesia; (G.B.S.W.); (N.P.A.H.); (N.W.N.)
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar 80232, Indonesia
| | - Nur Wulan Nugrahani
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar 80232, Indonesia; (G.B.S.W.); (N.P.A.H.); (N.W.N.)
| | - Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar 80232, Indonesia; (G.B.S.W.); (N.P.A.H.); (N.W.N.)
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar 80232, Indonesia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Magnani RJ, Wirawan DN, Sawitri AAS, Mahendra IGAA, Susanti D, Utami Ds NKAD, Asanab D, Yunus JO, Setiabudi CH, Nugroho A, Widihastuti AS, Mukuan OS, Januraga PP. The short-term effects of COVID-19 on HIV and AIDS control efforts among female sex workers in Indonesia. BMC Womens Health 2022; 22:21. [PMID: 35081950 PMCID: PMC8791089 DOI: 10.1186/s12905-021-01583-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 10/07/2021] [Indexed: 12/21/2022] Open
Abstract
Background The COVID-19 pandemic has raised concerns as to its impact on other health programs. One program that appears particularly vulnerable is HIV and AIDS. We undertook an assessment of COVID-19 impact on HIV control efforts in Indonesia for a sub-population that has received little attention in the global literature—female sex workers (FSW). Methods The study was undertaken in 23 National AIDS program priority districts. Four sources of monthly data during January–July 2020 were considered. COVID-19 infection data were extracted from national and district surveillance systems. Combination prevention program outputs were reported by civil society organizations (CSOs) providing community support services to FSW. These organizations also undertook monthly scans of levels of commercial sex activity and HIV testing availability. We also considered data from an ongoing HIV community screening trial. The primary mode of analysis entailed comparisons of levels and trends of indicators from the four data series. Results Commercial sex activity was severely curtailed in April–May in many districts. While recovering to pre-COVID-19 levels in “Localization” areas, the number of active FSW in July was one-third below that in February. HIV testing service availability declined by 50% at health facilities before recovering slowly, while mobile clinic services largely ceased during April–June. Numbers of FSW reached, condoms distributed, FSW tested for HIV, HIV cases detected, and FSW starting treatment all declined precipitously in April/May but had largely recovered to pre-COVID-19 levels by July. We found only a temporary dip in treatment initiation rates among HIV positive FSW and no discernible impact on treatment retention. The HIV community screening trial data revealed significant demand for HIV testing among FSW that was not being met even before the onset of COVID-19. Conclusions COVID-19 has had at least short-run economic effects on FSW and the national response to HIV and AIDS targeting FSW. However, the effects appear to have been cushioned by community-based services and support in study districts. The findings make a compelling case for the expansion of community-based services irrespective of the future trajectory of COVID-19. As COVID-19 has not yet been contained, the trajectory of economic activity and service delivery is uncertain.
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Affiliation(s)
- Robert J Magnani
- Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
| | - Dewa Nyoman Wirawan
- Kerti Praja Foundation, Denpasar, Bali, Indonesia.,Department of Community and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - Anak Agung Sagung Sawitri
- Kerti Praja Foundation, Denpasar, Bali, Indonesia.,Department of Community and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - I Gusti Agung Agus Mahendra
- Kerti Praja Foundation, Denpasar, Bali, Indonesia.,Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - Dewi Susanti
- Kerti Praja Foundation, Denpasar, Bali, Indonesia
| | | | | | | | | | - Adi Nugroho
- School of Public Health, Faculty of Medicine, University of Lambung Mangkurat, Banjarbaru, South Kalimantan, Indonesia
| | | | | | - Pande Putu Januraga
- Kerti Praja Foundation, Denpasar, Bali, Indonesia. .,Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia.
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Wirawan GBS, Wardhani BDK, Pradnyani PE, Nurhalina A, Sulaiman N, Sukmaningrum E, Wulandari LPL, Januraga PP. Behavioral Changes, Adaptation, and Supports among Indonesian Female Sex Workers Facing Dual Risk of COVID-19 and HIV in a Pandemic. Int J Environ Res Public Health 2022; 19:1361. [PMID: 35162384 PMCID: PMC8835319 DOI: 10.3390/ijerph19031361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 02/01/2023]
Abstract
The objective of this study is to explore the impacts of COVID-19 and changes taking place among the Indonesian female sex worker (FSW) community during the COVID-19 pandemic and the predictors of these changes. We conducted a cross-sectional online survey and selected the participants using a purposive snowball sampling technique. Incentives were provided to participants in the form of a 5 USD e-wallet balance. Variables of interest included adaptation to online sex work, adherence to COVID-19 prevention measures during sex work, number of clients, income reduction, social support, condom access, and condom use frequency. Sociodemographic data and COVID-19 fear index values were also collected. Final analysis included 951 FSWs, of whom 36.4% of had adapted to online sex work and 48.6% had practiced COVID-19 prevention measures. Major reductions in client frequency and income were reported by 67.8% and 71.1% of respondents, respectively. However, only 36.3% of FSWs reported they had ever received any form of social support from any parties, public or private. Meanwhile, 16.7% encountered difficulties in accessing condoms and 12.5% reported less frequent condom use during the pandemic. Easy access to condoms was the main factor influencing the frequency of condom use. As expected, staying in employment protected FSWs from major income loss, while education and younger age predicted adaptive behavioral changes, such as taking up online sex work. The COVID-19 pandemic has disrupted access to socioeconomic support systems and HIV prevention services among FSWs and has further exposed them to the dual jeopardy of HIV and COVID-19 infections.
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Affiliation(s)
- Gede Benny Setia Wirawan
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar 80113, Indonesia; (G.B.S.W.); (B.D.K.W.); (P.E.P.)
| | - Brigitta Dhyah K. Wardhani
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar 80113, Indonesia; (G.B.S.W.); (B.D.K.W.); (P.E.P.)
| | - Putu Erma Pradnyani
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar 80113, Indonesia; (G.B.S.W.); (B.D.K.W.); (P.E.P.)
| | | | | | - Evi Sukmaningrum
- Faculty of Psychology, Atma Jaya Catholic University of Indonesia, Jakarta 12930, Indonesia;
| | - Luh Putu Lila Wulandari
- Kirby Institute, University of New South Wales, Sydney 2033, Australia;
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar 80113, Indonesia
| | - Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar 80113, Indonesia; (G.B.S.W.); (B.D.K.W.); (P.E.P.)
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar 80113, Indonesia
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Parwati NM, Bakta IM, Januraga PP, Wirawan IMA. A Health Belief Model-Based Motivational Interviewing for Medication Adherence and Treatment Success in Pulmonary Tuberculosis Patients. Int J Environ Res Public Health 2021; 18:ijerph182413238. [PMID: 34948846 PMCID: PMC8701142 DOI: 10.3390/ijerph182413238] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 11/16/2022]
Abstract
Medication adherence behavior plays a central role in the success of tuberculosis (TB) treatment. Conventional motivation is not optimal in strengthening long-term medication adherence. A motivational interviewing (MI) communication motivation model based on the Health Belief Model (HBM) was designed with the main objective of improving medication adherence and treatment success. This study used an experimental design with a randomized posttest-only control group design. The intervention and control groups consisted of 107 TB patients each, who were selected by random cluster sampling. The study was conducted from November 2020 to June 2021 at 38 public health centers in Bali Province. The HBM-based MI model intervention was given in seven counseling sessions, pill count percentages were used to measure medication adherence, and treatment success was based on sputum examination results. Logistic regression was used to assess the effect of the intervention on medication adherence and treatment success. Logistic regression analysis showed that MI-based HBM and knowledge were the most influential variables for increasing medication adherence and treatment success. Medication adherence was 4.5 times greater (ARR = 4.51, p = 0.018) and treatment success was 3.8 times greater (ARR = 3.81, p < 0.038) in the intervention group compared to the control group, while the secondary outcome of knowledge of other factors together influenced medication adherence and treatment success. The conclusion is that the HBM-based MI communication motivation model creates a patient-centered relationship by overcoming the triggers of treatment barriers originating from the HBM construct, effectively increasing medication adherence and treatment success for TB patients, and it needs further development by involving families in counseling for consistent self-efficacy of patients in long-term treatment.
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Affiliation(s)
- Ni Made Parwati
- Doctoral Study Program, Medical Faculty, Udayana University, Denpasar 80361, Indonesia
- Correspondence:
| | - I Made Bakta
- Department of Internal Medicine, Medical Faculty, Udayana University, Denpasar 80234, Indonesia;
| | - Pande Putu Januraga
- School of Public Health, Udayana University, Denpasar 80234, Indonesia; (P.P.J.); (I.M.A.W.)
| | - I Made Ady Wirawan
- School of Public Health, Udayana University, Denpasar 80234, Indonesia; (P.P.J.); (I.M.A.W.)
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Yunus JO, Sawitri AAS, Wirawan DN, Mahendra IGAA, Susanti D, Utami Ds NKAD, Asanab D, Narayani IA, Mukuan OS, Widihastuti A, Magnani R, Januraga PP. Web-Based Multifaceted Approach for Community-Based HIV Self-Testing Among Female Sex Workers in Indonesia: Protocol for a Randomized Community Trial. JMIR Res Protoc 2021; 10:e27168. [PMID: 34287217 PMCID: PMC8339988 DOI: 10.2196/27168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND New HIV infections in Indonesia continue to be concentrated among key populations, including female sex workers (FSWs). However, increasing HIV testing among this subpopulation remains a challenge, necessitating exploration into alternative testing modalities. OBJECTIVE This study aims to assess whether the addition of an oral fluid testing option in community settings would increase the rate of HIV case identification among FSWs. Because the study was implemented early in the outbreak of COVID-19 in Indonesia, a secondary objective is to assess approaches and tools for implementing both community outreach and community HIV screening for FSWs during pandemic conditions. METHODS We undertook a community-based randomized trial in 23 national priority districts in which community outreach services were being provided. Community-based screening using an oral fluid-based rapid test was added to the community outreach standard of care in intervention districts with clients having the option of performing the test themselves or being assisted by outreach workers. A web-based system was created to screen for eligibility and collect participant data and test results, facilitating the process for both unassisted and assisted participants. Participants with reactive screening results were encouraged to undergo HIV testing at a health facility to confirm their diagnosis and initiate antiretroviral treatment as needed. Multiple means of recruitment were deployed including through outreach workers and social media campaigns. RESULTS Of the 1907 FSWs who registered, met the eligibility criteria, and gave consent to participate, 1545 undertook community oral fluid test (OFT) screening. Most (1516/1545, 98.1%) opted for assisted screening. Recruitment via social media fell far short of expectations as many who registered independently for the OFT because of the social media campaign did not identify as FSWs. They were eventually not eligible to participate, but their interest points to the possibility of implementing HIV self-testing in the general population. The successful recruitment through outreach workers, facilitated by social media, indicates that their roles remain crucial in accessing FSW networks and improving HIV testing uptake. CONCLUSIONS The addition of HIV self-testing to the standard of care supported by a web-based data collection system was able to increase HIV case identification among FSWs in intervention districts. The high satisfaction of OFT users and the interest of the general population toward this alternative testing modality are promising for scaling up community HIV screening nationally. TRIAL REGISTRATION ClinicalTrials.gov NCT04578145; https://clinicaltrials.gov/ct2/show/NCT04578145. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/27168.
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Affiliation(s)
| | - Anak Agung Sagung Sawitri
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar Bali, Indonesia
| | - Dewa Nyoman Wirawan
- Kerti Praja Foundation, Denpasar Bali, Indonesia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar Bali, Indonesia
| | | | - Dewi Susanti
- Kerti Praja Foundation, Denpasar Bali, Indonesia
| | | | | | | | | | | | - Robert Magnani
- Faculty of Public Health, University of Indonesia, Depok, Indonesia
| | - Pande Putu Januraga
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar Bali, Indonesia
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19
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Sitanggang FP, Wirawan GBS, Wirawan IMA, Lesmana CBJ, Januraga PP. Determinants of Mental Health and Practice Behaviors of General Practitioners During COVID-19 Pandemic in Bali, Indonesia: A Cross-sectional Study. Risk Manag Healthc Policy 2021; 14:2055-2064. [PMID: 34040468 PMCID: PMC8141387 DOI: 10.2147/rmhp.s305373] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/29/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE We aim to study the level of mental health distress and COVID-19 prevention in practice behaviors among general practitioners (GPs) in Bali, Indonesia, as well as their determinants. METHODS We conducted a cross-sectional online survey. Survey recruitment material was disseminated by purposive snowballing through regional professional association as well as research team's personal acquaintances. The survey measured mental health status by DASS-21 questionnaire and practice behavior by a questionnaire based on WHO recommendations for hand hygiene and PPE use during the COVID-19 pandemic. We conducted multivariate analyses to identify independent determinants for mental health and practice behavior. RESULTS Analyses included 635 (41.75%) of GPs in Bali. Mental health status was relatively good with prevalence of depression, anxiety, and stress of 13.2%, 19.7%, and 11% respectively, lower than previous studies in Indonesia and elsewhere. Practice behavior, however, was not considerably lower with only 65.4% and 32.1% reported consistent hand hygiene and recommended PPE use respectively. Routine optional PPE use was reported by 23.6% of respondents. Long working hours and fear of COVID-19 was identified as detrimental to mental health while consistent hand hygiene improved it. Meanwhile, workplace, work setting, and fear of COVID-19, were identified as determinants for PPE use. GPs working in primary health centers and private hospitals were also found to have less adherence to hand hygiene protocols. CONCLUSION Our results showed relatively good mental health status along with inadequate infection prevention in practice behavior of GPs in Bali, Indonesia. Intervention should be made to improve practice behavior. Determinants of practice behavior identified in this study could help to pinpoint intervention targets.
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Affiliation(s)
- Firman Parulian Sitanggang
- Department of Radiology, Faculty of Medicine, Udayana University/Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - Gede Benny Setia Wirawan
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - I Md Ady Wirawan
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - Cokorda Bagus Jaya Lesmana
- Department of Psychiatry, Faculty of Medicine, Udayana University/Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
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20
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Wirawan GBS, Mahardani PNTY, Cahyani MRK, Laksmi NLPSP, Januraga PP. Conspiracy beliefs and trust as determinants of COVID-19 vaccine acceptance in Bali, Indonesia: Cross-sectional study. Pers Individ Dif 2021; 180:110995. [PMID: 34007092 PMCID: PMC8118669 DOI: 10.1016/j.paid.2021.110995] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/30/2022]
Abstract
Objective This study aimed to investigate association between conspiracy beliefs, trusts in media and authoritative information sources, with COVID-19 vaccine acceptance. Methods We conducted online survey on adult resident of Bali Province, Indonesia in September 14th to October 31st 2020 collecting data on demographics, impacts of the pandemic, conspiracy beliefs, trusts in conventional media and authoritative sources, as well as vaccine acceptance. We conducted bivariate and multivariate analysis for determinants of vaccine acceptance with SPSS 23.0. Results We recruited 779 respondents with 38.9% male and median age of 24 years old (IQR 20 – 26). The result showed vaccine acceptance of 60.8%. Vaccine acceptance was correlated with conspiracy beliefs, trusts in conventional media and authoritative sources with Spearman's rho of −0.350, 0.269, and 0.287 respectively. Controlling for demographics and impacts of pandemic, showed strong conspiracy beliefs and trust in conventional media as the only independent determinants with OR of 0.33 (CI95% 0.20–0.54) and 1.91 (CI95% 1.37–2.65) respectively. Conclusion The results indicated considerable impacts of infodemic, represented by conspiracy beliefs, trust in media, and in authoritative sources, toward COVID-19 vaccine acceptance. Effective public health messaging should be conducted concurrent with vaccine rollout to improve acceptance and achieve herd immunity.
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Affiliation(s)
| | | | | | | | - Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Bali, Indonesia.,Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
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21
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Harjana NPA, Januraga PP, Indrayathi PA, Gesesew HA, Ward PR. Prevalence of Depression, Anxiety, and Stress Among Repatriated Indonesian Migrant Workers During the COVID-19 Pandemic. Front Public Health 2021; 9:630295. [PMID: 34026709 PMCID: PMC8131639 DOI: 10.3389/fpubh.2021.630295] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/30/2021] [Indexed: 01/10/2023] Open
Abstract
Introduction: Repatriated Indonesian migrant workers are vulnerable to developing serious mental health problems during the COVID-19 pandemic. This study aimed to assess the prevalence and associated factors of depression, anxiety, and stress among these populations during the COVID-19 pandemic. Methods: Guided by the health belief model, a cross-sectional study design was employed among 335 participants, and primary data were collected through an online survey. Measured using DASS-21, anxiety, depression, and stress were the dependent variables. We performed descriptive and inferential statistical analyses—logistic regression was used to predict independently associated variables. STATA was used to execute all data analyses. Results: The prevalence of depression, anxiety, and stress among repatriated Indonesian migrant workers were 10.15, 9.25, and 2.39%, respectively. The risk of anxiety and depression was low among those aged 21–30 years old, who had completed a university degree, were married, and had quarantined for 14 days. Conversely, the risk of anxiety and depression was high among those who had bad perceived health status, high perceived susceptibility, and negative stigma perception. Conclusion: The prevalence of depression, anxiety, and stress among repatriated Indonesian migrant workers was relatively low compared to the general population. The risk of anxiety and depression was low among young people, educated people, and those under effective quarantine, but the risk was high among those who had negative perceptions about their health, stigma, and susceptibility to the disease.
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Affiliation(s)
- Ngakan Putu Anom Harjana
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, Indonesia.,Institute for Population and Social Research, Mahidol University, Nakhon Pathom, Thailand
| | - Pande Putu Januraga
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia.,Discipline of Public Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Putu Ayu Indrayathi
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, Indonesia.,Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
| | - Hailay Abrha Gesesew
- Discipline of Public Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Epidemiology, School of Health Sciences, Mekelle University, Mek'ele, Ethiopia
| | - Paul Russell Ward
- Discipline of Public Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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22
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Indrayathi PA, Januraga PP, Pradnyani PE, Gesesew HA, Ward PR. Perceived Social Norms as Determinants of Adherence to Public Health Measures Related to COVID-19 in Bali, Indonesia. Front Public Health 2021; 9:646764. [PMID: 33996723 PMCID: PMC8119776 DOI: 10.3389/fpubh.2021.646764] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/04/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction: Before the widespread availability of an effective COVID-19 vaccine, it is crucial to control the rate of transmission by ensuring adherence to behavioral modifications, such as wearing masks, physical distancing, and washing hands, all of which can be implemented as public health measures. Focusing on the conditions in Bali, this study explored the level of compliance to public health measures targeted at COVID-19 and identified the determinants of compliance via the values, rules, and knowledge approach. Materials and Methods: This cross-sectional study conducted an online survey using the Google Form application from June 29 to July 5, 2020. The minimum required sample size was 664. Inclusion criteria were set as follows: 18 years of age or older and residing in Bali during the data collection period. Adherence was measured based on nine protocol indicators that were rated using a four-point Likert scale. A multiple linear regression analysis was then conducted to determine the associated factors of adherence to public health measures. Results: Of the 954 survey respondents, data from 743 were included for analysis. The average level of adherence to public health measures was 32.59 (range of 20-36). The linear regression analysis showed that perceived health benefits from public health measures, being female, and having COVID-19 test histories were significantly associated with adherence to public health measures. Conclusions: For public health measures targeted at COVID-19, adherence was strongly associated with perceived social norms, in which individuals played social community roles by adapting to standardized public health measures. It is thus imperative for governments to support and monitor public health measures during the COVID-19 pandemic.
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Affiliation(s)
- Putu Ayu Indrayathi
- 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
| | - 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
| | - Putu Erma Pradnyani
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Hailay Abrha Gesesew
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia.,Epidemiology, School of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Paul Russel Ward
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
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23
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Januraga PP, Frisdiantiny E, Crosita Y, Hakim W, Izwardy D, Sutrisna A. Involvement of Civil Society Organization in Facilitating the Implementation of Ten Steps for Successful Breastfeeding: Analysis of Health Care Workers' Perspectives? J Nutr Sci Vitaminol (Tokyo) 2021; 66:S436-S442. [PMID: 33612638 DOI: 10.3177/jnsv.66.s436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Despite the present of national policy support, the prevalence of early breastfeeding initiation in Indonesia are still low. Research has shown that health care workers are the most reliable source for breastfeeding advice, but sadly they were often lacking in capacity. The aim of the study to assess the involvement of civil society organization (CSO) and its associated factors in facilitating the implementation of Ten Steps for Successful Breastfeeding (TSSB) based on health care workers' perspectives in Malang and Sidoarjo districts, East Java Province, Indonesia. We used qualitative approach to in-depth interview 117 participants and conducted 14 FGDs in Sidoarjo and Malang East Java. the PARiHS framework was used to identify the role of CSO in facilitating the BFHI implementation from the health workers perspective to offer insight on the facilitation process and development of future recommendations. The study found that the health care workers' have good knowledge on the benefits of breastfeeding with significant portion of the knowledge that they hold are coming from trainings provided by the CSO. There was cultural context barriers within the community, where grandmothers are considered as an important influence factor esspecially for working mothers. The implementation of training by the CSO was considered appropriate due to its ability to address some pressing structural obstacles and provide not only training to improve evidence but also help in addressing other contextual barriers. The CSO has offered opportunities not only for dissemination of evidence-based intervention but also to close gaps on resources provision to attend courses.
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Affiliation(s)
- Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, Udayana University
| | | | - Yessi Crosita
- Center for Public Health Innovation, Faculty of Medicine, Udayana University
| | | | - Doddy Izwardy
- Direktorat Gizi Masyarakat, Kementerian Kesehatan Republik Indonesia
| | - Aang Sutrisna
- Consultant for the Global Alliance for Improved Nutrition (GAIN)
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24
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Wirawan GBS, Januraga PP. Correlation of Demographics, Healthcare Availability, and COVID-19 Outcome: Indonesian Ecological Study. Front Public Health 2021; 9:605290. [PMID: 33598443 PMCID: PMC7882903 DOI: 10.3389/fpubh.2021.605290] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/05/2021] [Indexed: 01/19/2023] Open
Abstract
Objective: To analyze the correlation between demographic and healthcare availability indicators with COVID-19 outcome among Indonesian provinces. Methods: We employed an ecological study design to study the correlation between demographics, healthcare availability, and COVID-19 indicators. Demographic and healthcare indicators were obtained from the Indonesian Health Profile of 2019 by the Ministry of Health while COVID-19 indicators were obtained from the Indonesian COVID-19 website in August 31st 2020. Non-parametric correlation and multivariate regression analyses were conducted with IBM SPSS 23.0. Results: We found the number of confirmed cases and case growth to be significantly correlated with demographic indicators, especially with distribution of age groups. Confirmed cases and case growth was significantly correlated (p < 0.05) with population density (correlation coefficient of 0.461 and 0.491) and proportion of young people (-0.377; -0.394). Incidence and incidence growth were correlated with ratios of GPs (0.426; 0.534), hospitals (0.376; 0.431), primary care clinics (0.423; 0.424), and hospital beds (0.472; 0.599) per capita. For mortality, case fatality rate (CFR) was correlated with population density (0.390) whereas mortality rate was correlated with ratio of hospital beds (0.387). Multivariate analyses found confirmed case independently associated with population density (β of 0.638) and demographic structure (-0.289). Case growth was independently associated with density (0.763). Incidence growth was independently associated with hospital bed ratio (0.486). Conclusion: Pre-existing inequality of healthcare availability correlates with current reported incidence and mortality rate of COVID-19. Lack of healthcare availability in some provinces may have resulted in artificially low numbers of cases being diagnosed, lower demands for COVID-19 tests, and eventually lower case-findings.
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Affiliation(s)
| | - 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, SA, Australia
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25
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Wirawan GBS, Januraga PP, Mahendra IGAA, Harjana NPA, Mahatmi T, Luhukay L, Rewari BB, Johnson C, Katz DA. Perspectives on voluntary assisted partner notification among providers, people with HIV and the general population in Indonesia: a formative qualitative study. BMC Public Health 2021; 21:254. [PMID: 33516201 PMCID: PMC7847236 DOI: 10.1186/s12889-021-10332-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Voluntary assisted partner notification (aPN) services are effective in increasing access to and uptake of HIV testing among partners of people with HIV. Following recommendations by the World Health Organization in 2016, Indonesia evaluated various approaches to aPN. We present the lessons learned from formative operational research undertaken to understand provider and patient perspectives on aPN from three demonstration sites in cities with a high HIV burden. METHODS We conducted a formative qualitative study in three cities: Jakarta, Semarang, and Denpasar between September and October 2019. We conducted six focus group discussions (FGDs) (n = 44 participants) among health-care providers, people living with HIV and the general population. We explored participant preferences and concerns about how aPN should be delivered, including the methods of and messaging for contacting partners. All FGDs were conducted in the Indonesian language. Qualitative data were analysed using thematic analysis. RESULTS aPN was acceptable across different participant populations, although with caveats. Some differences were observed between the general population, providers and people living with HIV. People living with HIV were mainly concerned with confidentiality of the procedure and preferred the use of telecommunication and messages that avoid explicit mention of HIV exposure. Providers preferred similar approaches but for different reasons, being concerned mainly with self-efficacy and security. There was consensus regarding dual referral models. The use of phone calls and short messages were preferred as these are perceived to minimize negative reactions and stigma, protect client confidentiality and are suitable in the current legal situation. The general population was mainly concerned with effectiveness and prefer direct provider-led approaches, such as preferring in-person meeting with explicit notification of potential HIV exposure. CONCLUSIONS We found consensus among stakeholders on acceptance of aPN, especially dual referral methods. Development and implementation of aPN protocols should also consider clients' individual situations and concerns regarding safeguarding of confidentiality, and offer a range of options to accommodate all stakeholders involved.
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Affiliation(s)
- Gede Benny Setia Wirawan
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Bali, Denpasar, Indonesia
| | - Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Bali, Denpasar, Indonesia.
| | | | - Ngakan Putu Anom Harjana
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Bali, Denpasar, Indonesia
| | - Tiara Mahatmi
- World Health Organization Indonesia, Jakarta, Indonesia
| | | | | | - Cheryl Johnson
- Global HIV, Hepatitis and STI Programme, World Health Organization, Geneva, Switzerland
| | - David A Katz
- Department of Global Health, University of Washington, Seattle, USA
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26
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Januraga PP, Harjana NPA. Improving Public Access to COVID-19 Pandemic Data in Indonesia for Better Public Health Response. Front Public Health 2020; 8:563150. [PMID: 33330311 PMCID: PMC7732417 DOI: 10.3389/fpubh.2020.563150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Pande Putu Januraga
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia.,Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, Indonesia
| | - Ngakan Putu Anom Harjana
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, Indonesia
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27
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Gedela K, Januraga PP, Luis H, Wignall FS, Irwanto I. COVID-19 Lockdown in Indonesia: Greater Investment Will Be Needed to Mitigate the Impact on People Living With HIV. Asia Pac J Public Health 2020; 32:461-462. [DOI: 10.1177/1010539520962611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Keerti Gedela
- Chelsea & Westminster NHS Foundation Trust, London, UK
| | | | - Hendry Luis
- Yayasan Bali Peduli HIV/Sexual Health Clinic, Kota Denpasar, Bali, Indonesia
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Abstract
The situation of low women empowerment in household settings might influence women's attitude and ability to negotiate for protected sex in their marital relationship. This study aimed to investigate the association between women empowerment factors and the attitude for safer sex negotiation among Indonesian married women. The secondary data of 28,934 individual records of married women retrieved from the 2017 Indonesia Demographic and Health Survey (IDHS) was used. The dependent variable was the attitude for safer sex negotiation measured by women's acceptance toward a justification to ask her husband to use a condom if her husband has a sexually transmitted disease. Multivariate logistic regression analysis accounting for the complex survey design was performed. The results showed that women empowerment factors, that include higher level of education and participation in household decision-making had a positive effect on women's attitude for protected sex. Those women with higher levels of HIV knowledge and whoever talked about HIV with their husbands were also more likely to justify for protected sex. Therefore, women empowerment through education, improving socioeconomic conditions, and increasing HIV-related knowledge can help develop a positive attitude and enable women to negotiate for safer sex with their partners.
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Affiliation(s)
- I Gusti Ngurah Edi Putra
- School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong , Wollongong, Australia
| | - Tashi Dendup
- School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong , Wollongong, Australia
| | - Pande Putu Januraga
- Center for Public Health Innovation (CPHI), Faculty of Medicine, Udayana University , Bali, Indonesia.,College of Medicine and Public Health, Flinders University , Adelaide, Australia
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29
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Edi Putra IGN, Januraga PP. Social Capital and HIV Testing Uptake among Indirect Female Sex Workers in Bali, Indonesia. Trop Med Infect Dis 2020; 5:tropicalmed5020073. [PMID: 32392824 PMCID: PMC7345714 DOI: 10.3390/tropicalmed5020073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/23/2020] [Accepted: 05/06/2020] [Indexed: 01/20/2023] Open
Abstract
Indirect female sex workers (FSWs), a type of FSW working under the cover of entertainment enterprises (e.g., karaoke lounge, bar, etc.), remain as an important key population for HIV transmission, signaling the need of appropriate interventions targeting HIV-related behaviors. This study aimed to investigate the association between social capital and HIV testing uptake. A cross-sectional study was conducted among 200 indirect FSWs in Denpasar, Bali. The dependent variable was HIV testing uptake in the last six months preceding the survey. The main independent variables were social capital constructs: social cohesion (perceived peer support and trust) and social participation. Variables of socio-demographic characteristics were controlled in this study to adjust the influence of social capital. Binary logistic regression was performed. The prevalence of HIV testing in the last six months was 72.50%. The multivariate analysis showed that only peer support from the social capital constructs was associated with HIV testing uptake. Indirect FSWs who perceived a high level of support within FSWs networks were 2.98-times (95% CI = 1.43–6.24) more likely to report for HIV testing. Meanwhile, perceived trust and social participation did not show significant associations in relation to HIV testing uptake. As social cohesion (support) within FSWs’ relationships can play an important role in HIV testing uptake, existing HIV prevention programs should consider support enhancement to develop a sense of belonging and solidarity.
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Affiliation(s)
- I Gusti Ngurah Edi Putra
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, Bali 80361, Indonesia
- Correspondence: ; Tel.: +6281246180389
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30
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Wirawan IMA, Januraga PP. Forecasting COVID-19 Transmission and Healthcare Capacity in Bali, Indonesia. J Prev Med Public Health 2020; 53:158-163. [PMID: 32498137 PMCID: PMC7280815 DOI: 10.3961/jpmph.20.152] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES In the current early phase of the coronavirus disease 2019 (COVID-19) outbreak, Bali needs to prepare to face the escalation of cases, with a particular focus on the readiness of healthcare services. We simulated the future trajectory of the epidemic under current conditions, projected the impact of policy interventions, and analyzed the implications for healthcare capacity. METHODS Our study was based on the first month of publicly accessible data on new confirmed daily cases. A susceptible, exposed, infected, recovered (SEIR) model for COVID-19 was employed to compare the current dynamics of the disease with those predicted under various scenarios. RESULTS The fitted model for the cumulative number of confirmed cases in Bali indicated an effective reproduction number of 1.4. Interventions have decreased the possible maximum number of cases from 71 125 on day 86 to 22 340 on day 119, and have prolonged the doubling time from about 9 days to 21 days. This corresponds to an approximately 30% reduction in transmissions from cases of mild infections. There will be 2780 available hospital beds, and at the peak (on day 132), the number of severe cases is estimated to be roughly 6105. Of these cases, 1831 will need intensive care unit (ICU) beds, whereas the number of currently available ICU beds is roughly 446. CONCLUSIONS The healthcare system in Bali is in danger of collapse; thus, serious efforts are needed to improve COVID-19 interventions and to prepare the healthcare system in Bali to the greatest extent possible.
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Affiliation(s)
- I Md Ady Wirawan
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia.,Travel Medicine Research Group, Health Research Centre, Institute for Research and Community Services, 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
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31
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Januraga PP, Mooney-Somers J, Gesesew HA, Ward PR. The Logic of Condom Use in Female Sex Workers in Bali, Indonesia. Int J Environ Res Public Health 2020; 17:E1627. [PMID: 32138336 PMCID: PMC7084507 DOI: 10.3390/ijerph17051627] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 11/23/2022]
Abstract
Studies on human immunodeficiency virus (HIV) prevention practices of female sex workers often examine the use of condom as a single behaviour: using or not using condom. This study explores typologies of the logic of condom use as part of exercising meaningful identities from female sex workers' perspectives. We employed in-depth interviews with a purposely selected 35 female sex workers in Bali, Indonesia. Information from the in-depth interviews was analysed using thematic framework analysis to develop typologies of female sex workers' experiences on the logic of condom use and its relation to the construction of identity. We identified two main logics for not using condom: the prioritising of financial stability and romantic relationships over condom use. The main logic for using condom was to protect their health in order to improve their future economic security. Embedded within these logics, women chose to practise agency and negotiate meaningful identities consistent with their ideals of being responsible mothers, successful migrant workers and loyal partners. Our study concluded that female sex workers had clear logics for both the use and non-use of condom with their clients, highlighting the rational nature of female sex workers decision making.
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Affiliation(s)
- Pande Putu Januraga
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali 80232, Indonesia
- Discipline of Public Health, College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia
| | - Julie Mooney-Somers
- School of Public Health, Faculty of Medicine, University of Sydney, Sydney 2006, Australia
| | - Hailay Abrha Gesesew
- Discipline of Public Health, College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia
- Epidemiology, College of Health Sciences, Mekelle University, Mekelle 1871, Ethiopia
| | - Paul R Ward
- Discipline of Public Health, College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia
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32
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Putra IGNE, Phuengsamran D, Jampaklay A, Thammawijaya P, Januraga PP. Psychological factors associated with protected sex among indirect female sex workers in Denpasar, Bali, Indonesia. AIDS Care 2019; 32:749-757. [PMID: 31288546 DOI: 10.1080/09540121.2019.1640851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A cross-sectional study was conducted among indirect FSWs (a type of FSWs who provide sex services under the cover of entertainment or recreational enterprises) in Denpasar, Bali from August to October 2017 to investigate factors associated with protected sex with clients using the Health Belief Model (HBM) framework. The protected sex as a dependent variable was identified through self-reported consistency in using condoms with clients in the last month. Independent variables consisted of six HBM constructs and three main groups of modifying factors (personal, sex work, and interventional factors). Binary logistic regression was employed to identify the determinants. The prevalence of protected sex with clients in last month was 50.17% (95%CI = 41.50-80.83). Indirect FSWs were more likely to use condoms consistently if they completed senior high school or higher. Meanwhile, those working in a karaoke lounge, bar, or café were less likely to have protected sex than those in a massage parlour, spa, or beauty salon. Based on HBM, an increase of one-score of these following constructs increased likelihood of protected sex: perceived susceptibility, self-efficacy, and cues to action. Low protected sex among indirect FSWs indicates the need for public health interventions at individual, interpersonal, and institutional level.
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Affiliation(s)
- I Gusti Ngurah Edi Putra
- Institute for Population and Social Research, Mahidol University, Nakorn Pathom, Thailand.,Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, Indonesia
| | - Dusita Phuengsamran
- Institute for Population and Social Research, Mahidol University, Nakorn Pathom, Thailand
| | - Aree Jampaklay
- Institute for Population and Social Research, Mahidol University, Nakorn Pathom, Thailand
| | - Panithee Thammawijaya
- Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Bangkok, Thailand
| | - Pande Putu Januraga
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Utami NWA, Agustina KK, Atema KN, Bagus GN, Girardi J, Harfoot M, Haryono Y, Hiby L, Irawan H, Januraga PP, Kalalo L, Purnama SG, Subrata IM, Swacita IBN, Swarayana IMI, Wirawan DN, Hiby E. Evaluation of Community-Based Dog Welfare and Rabies Project in Sanur, a Sub-district of the Indonesian Island Province of Bali. Front Vet Sci 2019; 6:193. [PMID: 31338368 PMCID: PMC6629783 DOI: 10.3389/fvets.2019.00193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/31/2019] [Indexed: 12/25/2022] Open
Abstract
The Indonesian island province of Bali experienced its first rabies incursion in 2008. Mass vaccination of the dog population has proven effective and rabies cases in dogs and people have decreased, however the virus is still circulating among the dog population. Vaccination coverage must be maintained until rabies elimination. Increasing efficiency and effectiveness of vaccination campaigns is therefore desired. Community engagement leading to preventative health actions by community members can reduce disease incidence and costs of control. Here we evaluate 2 years of a novel community-based dog welfare and rabies control project (Program Dharma) in the Sanur sub-district. The project engaged the services of people living in the project area with an interest or experience in dogs or community health services. These people spoke with owners within their own community about dog welfare and health, monitored owned and unowned dogs and increased owner and carer efforts to access vaccination and further veterinary services. The evaluation focused on a sample of dogs whose owners had been regularly engaged with project. Vaccination coverage was increased and there were no dog or human rabies cases reported in the project area; the percentage of the dogs that had never been vaccinated was reduced by an average 28.3% (baseline unvaccinated 41–49%, post-project unvaccinated 11–19%). The welfare of dogs improved from an average of 20.7% of dogs with visible welfare problems at baseline to 2.7% after project implementation. Roaming dog density observed on street surveys also decreased in all project areas (24–47% reduction dependent on desa). A participatory evaluation event with a sample of Program Dharma community-based agents highlighted several additional successes, including that the community appeared to welcome and value their services and were beginning to support the cost of project activities. Conversely, challenges included identifying dogs in the database during revisits, sustaining the costs of community member time spent working on Program Dharma activities and the costs of veterinary care, whilst avoiding dependency of owners on free veterinary services. The benefits revealed by the evaluation were judged to be sufficient to extend Program Dharma to new areas, whilst evolving activities to resolve challenges.
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Affiliation(s)
- Ni Wayan Arya Utami
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
| | - Kadek Karang Agustina
- Department of Veterinary Public Health, Faculty of Veterinary Medicine, Udayana University, Denpasar, Indonesia
| | | | | | | | - Mike Harfoot
- Independent Researcher, Cambridge, United Kingdom
| | | | - Lex Hiby
- Conservation Research Ltd., Cambridge, United Kingdom
| | - Hendra Irawan
- Bali Animal Welfare Association (BAWA), Ubud, Indonesia
| | - Pande Putu Januraga
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
| | - Levin Kalalo
- Bali Animal Welfare Association (BAWA), Ubud, Indonesia
| | - Sang Gede Purnama
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
| | - I Made Subrata
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
| | - Ida Bagus Ngurah Swacita
- Department of Veterinary Public Health, Faculty of Veterinary Medicine, Udayana University, Denpasar, Indonesia
| | | | - Dewa Nyoman Wirawan
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
| | - Elly Hiby
- International Fund for Animal Welfare, Yarmouth Port, MA, United States
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Januraga PP, Reekie J, Mulyani T, Lestari BW, Iskandar S, Wisaksana R, Kusmayanti NA, Subronto YW, Widyanthini DN, Wirawan DN, Wongso LV, Sudewo AG, Sukmaningrum E, Nisa T, Prabowo BR, Law M, Cooper DA, Kaldor JM. The cascade of HIV care among key populations in Indonesia: a prospective cohort study. Lancet HIV 2018; 5:e560-e568. [PMID: 30143455 DOI: 10.1016/s2352-3018(18)30148-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/05/2018] [Accepted: 06/19/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Indonesia has had low uptake of HIV testing and treatment. We did a study to estimate the cascade of HIV care in key populations and identify predictors of outcomes at key cascade steps. METHODS We used an observational cohort study design to recruit and follow up men who have sex with men (MSM), female sex workers, transgender women (known as waria in Indonesia), and people who inject drugs (PWID) diagnosed with HIV in four locations in Indonesia: Bali, Bandung, Jakarta, and Yogyakarta. Recruitment, baseline, and follow-up visits were done at collaborating clinical services, including both primary care sites and hospitals. Inclusion criteria for participants included identifying as a member of a key population, age 16 years or older, not previously tested positive for HIV, and HIV positivity at baseline. All participants were offered treatment as per national guidelines, with the addition of viral load testing and completion of study-specific forms. Estimates were calculated of proportions of participants linked to care, commencing treatment, adherent to treatment, and who achieved virological suppression. We used logistic regression to investigate characteristics associated with antiretroviral therapy (ART) initiation and viral suppression and Cox regression to identify factors associated with loss to follow-up. This study is registered with ClinicalTrials.gov, NCT03429842. FINDINGS Between Sept 15, 2015, and Sept 30, 2016, 831 individuals were enrolled in the study, comprising 637 (77%) MSM, 116 (14%) female sex workers, 27 (3%) waria, and 51 (6%) PWID. Of those enrolled, 703 (84·6%, 95% CI 82·1-87·1) were linked to HIV care and 606 (86·2%, 83·7-88·8) who were linked with care started ART. Among participants who started treatment, 457 (75·4%, 71·8-78·9) were retained in care, of whom 325 (71·1%, 66·7-75·2) had a viral load test about 6 months after enrolment, with 294 (90·5%, 86·7-93·4) of those tested (294 [35%, 32·1-38·7] of the original cohort) virally suppressed. 146 (24%) of 606 who started treatment were lost to follow-up. People who enrolled at sites that offered both testing and treatment had a higher likelihood of treatment initiation than those who enrolled at sites offering testing only (p<0·0001 by multivariate analysis), and participants who had been linked to care and had a high school or university education were significantly more likely to achieve viral suppression than those with a primary school or lower level of education (p≤0·029 by mulivariate analysis). INTERPRETATION HIV cascade data among key populations in Indonesia show very poor rates of retention in treatment and viral suppression. Site and individual characteristics associated with initiating and continuing treatment suggest an urgent need to develop and implement effective interventions to support patients in achieving viral suppression among all people with HIV. FUNDING Australian Government Department of Foreign Affairs and Trade, WHO, and Indonesian Government.
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Affiliation(s)
- Pande Putu Januraga
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Bali, Indonesia.
| | | | - Tri Mulyani
- Faculty of Medicine, Padjajaran University, West Java, Indonesia
| | | | - Shelly Iskandar
- Faculty of Medicine, Padjajaran University, West Java, Indonesia
| | - Rudi Wisaksana
- Faculty of Medicine, Padjajaran University, West Java, Indonesia
| | - Nur Aini Kusmayanti
- Center for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yanri Wijayanti Subronto
- Center for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | | | - Lydia Verina Wongso
- AIDS Research Center, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | | | - Evi Sukmaningrum
- AIDS Research Center, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Tiara Nisa
- WHO Country Office of Indonesia, Jakarta, Indonesia
| | | | - Matthew Law
- Kirby Institute, UNSW, Sydney, NSW, Australia
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Dewi Satiawati KDK, Januraga PP. Attitudes toward Supplemental Nutrition Assistance Programs in Caregivers of Children with Moderate-Acute Malnutrition Younger than 5 Years in Denpasar, Bali: A Qualitative Study. Food Nutr Bull 2018; 39:465-474. [PMID: 30037275 DOI: 10.1177/0379572118788663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Providing additional nutriment represents one strategy for overcoming moderate-acute malnutrition (MAM) in children younger than 5 years. However, it is important to examine how well received such Supplemental Nutrition Assistance Programs (SNAP) are by caregivers in order to ensure optimal results. OBJECTIVE This study explores SNAP's reception by caregivers of MAM children younger than 5 years. METHODS Qualitative research was conducted through semi-structured, in-depth interviews with 16 selected caregivers and 5 Nutritional Executives from October to November, 2016 at 4 health centers in Denpasar, Bali, Indonesia. The results are presented to highlight the underlying patterns of SNAP's acceptance. RESULTS Overall, the informants responded negatively to SNAP, reporting that it was of limited usefulness. The results show 4 main themes relating to the receipt of SNAP. The first relates to the caregiver's preferences in terms of the types of supplementary food on offer. Second, caregiver's perceptions that the child was not, in fact, in a state of illness or disease due to a medical issue. Third, that the caregiver does not require supplementary food as they maintain that they are able to buy it independently. Fourth, factors related to the lack of support for health-care workers working with malnourished children. CONCLUSION The study finds that strengthening the role of health workers in terms of enabling them to effectively communicate the benefits of supplementary food to caregivers as well as adjusting the range of foods available according to the recipient's preferences is critical in overcoming malnutrition in children younger than 5 years.
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Affiliation(s)
| | - Pande Putu Januraga
- 1 Center for Public Health Innovation (CPHI), Faculty of Medicine, Udayana University, Bali, Indonesia.,2 Discipline of Public Health, Flinders University, Adelaide, South Australia, Australia
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Hiby E, Agustina KK, Nattras Atema K, Bagus GN, Girardi J, Harfoot M, Haryono Y, Hiby L, Irawan H, Kalalo L, Purnama SG, Subrata IM, Swacita IBN, Utami NWA, Januraga PP, Wirawan DN. Dog Ecology and Rabies Knowledge of Owners and Non-Owners in Sanur, A Sub-District of the Indonesian Island Province of Bali. Animals (Basel) 2018; 8:ani8070112. [PMID: 29976915 PMCID: PMC6070915 DOI: 10.3390/ani8070112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 11/16/2022] Open
Abstract
This study gained an understanding of dog demographics, owner behaviour, and knowledge, attitudes and practices relating to rabies in three villages in Sanur, Bali, providing insights for an intervention to improve responsible dog ownership. A combination of a census of all dogs, street surveys of roaming dogs, and a Knowledge, Attitude and Practices (KAP) survey was used to study both dogs and people. A total of 6009 dogs were recorded, of which only 3.3% appeared to be unowned; unowned dogs had poorer welfare and were more likely to be wary of attempted approaches by people. The source of dogs, method of confinement used by owners, and whether dogs were sterilised differed between three breed types; purebred dogs, mixed breed, and Bali dogs (native breed). Three variables were found to have significant effects on the chances of not being vaccinated: age, dog type, and confinement. A mean of 3.81 roaming dogs per km of street surveyed was recorded along 28 sub-village routes. Responses to attitude statements showed that most people had a positive attitude towards dogs and vaccination and did not agree with culling. Knowledge of appropriate bite treatment and symptoms of rabies in dogs was good.
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Affiliation(s)
| | - Kadek Karang Agustina
- Department of Veterinary Public Health, Faculty of Veterinary Medicine, Udayana University, Jln. PB Sudirman, Denpasar, Bali 80232, Indonesia.
| | | | - Gusti Ngurah Bagus
- BAWA, Jl. Anak Agung Gede Rai no. 550, Br. Kertha Wangsa, Lodtunduh, Ubud, Gianyar, Bali 80232, Indonesia.
| | - Janice Girardi
- BAWA, Jl. Anak Agung Gede Rai no. 550, Br. Kertha Wangsa, Lodtunduh, Ubud, Gianyar, Bali 80232, Indonesia.
| | - Mike Harfoot
- UNEP-WCMC, 219 Huntingdon Rd, Cambridge, CB3 0DL, UK.
| | - Yacinta Haryono
- BAWA, Jl. Anak Agung Gede Rai no. 550, Br. Kertha Wangsa, Lodtunduh, Ubud, Gianyar, Bali 80232, Indonesia.
| | - Lex Hiby
- Conservation Research Ltd., Cambridge, CB22 5AL, UK, .
| | - Hendra Irawan
- BAWA, Jl. Anak Agung Gede Rai no. 550, Br. Kertha Wangsa, Lodtunduh, Ubud, Gianyar, Bali 80232, Indonesia.
| | - Levin Kalalo
- BAWA, Jl. Anak Agung Gede Rai no. 550, Br. Kertha Wangsa, Lodtunduh, Ubud, Gianyar, Bali 80232, Indonesia.
| | - Sang Gede Purnama
- Public Health Department, Faculty of Medicine, Udayana University, Jln. PB Sudirman, Denpasar, Bali 80232, Indonesia.
| | - I Made Subrata
- Public Health Department, Faculty of Medicine, Udayana University, Jln. PB Sudirman, Denpasar, Bali 80232, Indonesia.
| | - Ida Bagus Ngurah Swacita
- Department of Veterinary Public Health, Faculty of Veterinary Medicine, Udayana University, Jln. PB Sudirman, Denpasar, Bali 80232, Indonesia.
| | - Ni Wayan Arya Utami
- Public Health Department, Faculty of Medicine, Udayana University, Jln. PB Sudirman, Denpasar, Bali 80232, Indonesia.
| | - Pande Putu Januraga
- Public Health Department, Faculty of Medicine, Udayana University, Jln. PB Sudirman, Denpasar, Bali 80232, Indonesia.
| | - Dewa Nyoman Wirawan
- Public Health Department, Faculty of Medicine, Udayana University, Jln. PB Sudirman, Denpasar, Bali 80232, Indonesia.
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Abstract
Men who purchase sex (MWPS) have long been considered as one of the population groups at risk of HIV transmission. However, while HIV-related interventions have been targeted towards this group, few studies have directly recruited MWPS to measure the impact of such interventions. This study aimed to fill the gap for Indonesia by identifying the level and predictors of condom use and HIV testing among MWPS, to inform prevention strategies. A cross-sectional study was conducted by surveying 200 MWPS in Bali, Indonesia in 2015. A structured questionnaire was administered to collect the data. Self-reported condom use on the occasion of last paid sex was very high (88.5%), while a history of HIV testing was low (8.1%). None of the variables identified in this study were associated with condom use at last paid sex. Men were more likely to report a history of HIV testing if they: perceived themselves to be at high risk of HIV, had a higher level of HIV-related knowledge, reported a history of genital ulcers or urethral discharge in the past 12 months, or were aware that confidential HIV testing was available. Implications and limitations of this study are discussed.
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Affiliation(s)
- Luh Putu Lila Wulandari
- a Department of Public Health and Preventive Medicine, Faculty of Medicine , Udayana University , Bali , Indonesia.,b The Kirby Institute, University of New South Wales , Sydney , Australia
| | - John Kaldor
- b The Kirby Institute, University of New South Wales , Sydney , Australia
| | - Pande Putu Januraga
- a Department of Public Health and Preventive Medicine, Faculty of Medicine , Udayana University , Bali , Indonesia.,c Discipline of Public Health , Flinders University , Adelaide , Australia
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Januraga PP, Mooney-Somers J, Ward PR. Newcomers in a hazardous environment: a qualitative inquiry into sex worker vulnerability to HIV in Bali, Indonesia. BMC Public Health 2014; 14:832. [PMID: 25113395 PMCID: PMC4141952 DOI: 10.1186/1471-2458-14-832] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 07/29/2014] [Indexed: 11/10/2022] Open
Abstract
Background Women new to sex work and those with a greater degree of mobility have higher risk of HIV infection. Using social capital as a theoretical framework, we argue that better understanding of the interactions of micro-level structural factors can be valuable in reshaping and restructuring health promotion programmes in Bali to be more responsive to the concerns and needs of newcomer and mobile female sex workers (FSWs). Methods We conducted interviews with 11 newcomer FSWs (worked < six months), 9 mobile FSWs (experienced but worked at the current brothel < six months), and 14 senior FSWs (experienced and worked at current brothel > six months). The interviews explored women’s experience of sex work including how and why they came to sex work, relationships with other FSWs and their HIV prevention practices. Results A thematic framework analysis revealed newcomer FSWs faced multiple levels of vulnerability that contributed to increased HIV risk. First, a lack of knowledge and self-efficacy about HIV prevention practices was related to their younger age and low exposure to sexual education. Second, on entering sex work, they experienced intensely competitive working environments fuelled by economic competition. This competition reduced opportunities for positive social networks and social learning about HIV prevention. Finally, the lack of social networks and social capital between FSWs undermined peer trust and solidarity, both of which are essential to promote consistent condom use. For example, newcomer FSWs did not trust that if they refused to have sex without a condom, their peers would also refuse; this increased their likelihood of accepting unprotected sex, thereby increasing HIV risk. Conclusions Public health and social welfare interventions and programmes need to build social networks, social support and solidarity within FSW communities, and provide health education and HIV prevention resources much earlier in women’s sex work careers.
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Affiliation(s)
- Pande Putu Januraga
- School of Public Health, Udayana University, Gedung PSIKM FK Universitas Udayana, Jl, PB Sudirman, Denpasar, Bali 50232, Indonesia.
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Januraga PP, Wulandari LPL, Muliawan P, Sawitri S, Causer L, Wirawan DN, Kaldor JM. Sharply rising prevalence of HIV infection in Bali: a critical assessment of the surveillance data. Int J STD AIDS 2013; 24:633-7. [DOI: 10.1177/0956462413477556] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Summary This study critically examines serological survey data for HIV infection in selected populations in Bali, Indonesia. Sero-survey data reported by the Bali Health Office between 2000 and 2010 were collated, and provincial health staff were interviewed to gain a detailed understanding of survey methods. Analysis of time series restricted to districts that have used the same sampling methods and sites each year indicates that there has been a steady decline in HIV prevalence among prisoners, from 18.7% in 2000 to 4.3% in 2010. In contrast, HIV prevalence among women engaged in sex work increased sharply: from 0.62% in 2000 to 20.2% in 2010 (brothel based), and from 0% in 2000 to 7.2% in 2010 (non-brothel based). The highest prevalence was recorded among people who injected drugs. Recent surveys of gay men and transvestites also found high prevalences, at 18.7% and 40.9%, respectively. Review of the methodology used in the surveys identified inconsistencies in the sampling technique, sample numbers and sites over time, and incomplete recording of individual information about survey participants. Attention to methodological aspects and incorporation of additional information on behavioural factors will ensure that the surveillance system is in the best position to support prevention activities.
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Affiliation(s)
| | | | | | - S Sawitri
- Department of Community Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - L Causer
- Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - D N Wirawan
- Department of Community Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - J M Kaldor
- Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia
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