HIV incidence and adherence after pre-exposure prophylaxis initiation in key populations in Indonesia: Findings from a real-world pilot program 2021-2023

IF 1.5 Q4 INFECTIOUS DISEASES

IJID regions Pub Date : 2025-01-19 DOI:10.1016/j.ijregi.2025.100573

Nadia Hanum , Miasari Handayani , Armina Padmasawitri , Zulfan Zazuli , Kusnandar Anggadiredja , Mawar N. Pohan , Tarinanda A. Putri , Fani F. Rakhmat , Dwi S. Anggiani , Nurhalina Afriana , Endang Lukitosari , Bagus R. Prabowo , Rudi Wisaksana

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Abstract

Objectives

To provide important data for the national rollout, Indonesia launched a pre-exposure prophylaxis (PrEP) pilot program. In this study, we determined the HIV incidence and adherence among key populations, PrEP initiation, sexually transmitted infection incidence, and changes in sexual behaviors.

Methods

The Indonesian PrEP pilot program (December 2021 to December 2023, rolled out in 21 districts in 10 provinces) was a longitudinal, non-randomized implementation study among men who have sex with men, female sex workers, transgender women, people who inject drugs, and serodiscordant partners of people with HIV. Eligible participants were offered same-day oral PrEP and completed the baseline, 1-monthly, and 3-monthly follow-up visits.

Results

A total of 9124 individuals initiated PrEP between December 2021 and December 2023; 4220 had at least one follow-up visit. Of the 4220, 31 seroconverted over 2817.5 person-years; overall incidence rate (IR) 1.10 (95% confidence interval 0.75-1.56) per 100 person-years. All seroconversions occurred during poor adherence or PrEP discontinuation (IR 7.8; 5.34-11.16 vs 0; 0-0.4 for adequate adherence). Event-driven PrEP users showed poorer adherence than daily PrEP users (P <0.001). In men who have sex with men, HIV incidence was higher in those who lived outside Java and Bali (adjusted IR ratio 5.56; 1.68-18.38, P = 0.005).

Conclusion

Insufficient adherence leads to decreased efficacy of PrEP. Improving adherence and access to PrEP is a public health priority in Indonesia.

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印度尼西亚关键人群开始接触前预防后的艾滋病毒发病率和依从性：2021-2023年现实世界试点项目的结果

目的印度尼西亚启动了暴露前预防（PrEP）试点项目，为全国推广提供重要数据。在这项研究中，我们确定了重点人群的HIV感染率和依从性，PrEP的开始，性传播感染的发病率和性行为的变化。方法印度尼西亚PrEP试点项目（2021年12月至2023年12月，在10个省的21个区开展）是一项纵向、非随机实施研究，在男男性行为者、女性性工作者、变性妇女、注射吸毒者和艾滋病毒感染者的血清不一致伴侣中开展。符合条件的参与者当天接受口服PrEP，并完成基线、1个月和3个月的随访。结果2021年12月至2023年12月，共有9124人开始使用PrEP；4220人至少进行了一次随访。在4220例中，31例血清转化超过2817.5人年；总发病率（IR） 1.10(95%可信区间0.75-1.56)/ 100人年。所有血清转换均发生在依从性差或停用PrEP期间(IR 7.8；5.34-11.16 vs 0；0-0.4表示充分遵守)。事件驱动PrEP使用者的依从性比每日PrEP使用者差（P <0.001）。在男男性行为者中，居住在爪哇和巴厘岛以外地区的男性艾滋病毒感染率较高(调整后的IR比5.56；1.68-18.38, p = 0.005)。结论PrEP依从性不足导致PrEP疗效下降，提高PrEP的依从性和可及性是印度尼西亚公共卫生的重点。

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