Incorporating acute HIV infection screening, same-day diagnosis and antiretroviral treatment into routine services for key populations at sexual health clinics in Indonesia: a baseline analysis of the INTERACT prospective study

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society Pub Date : 2025-04-28 DOI:10.1002/jia2.26463

Irwanto Irwanto, Nurhayati H. Kawi, Hendry Luis, Dwi P. Rahmawati, Erik P. Sihotang, Pande Putu Januraga, Margareta Oktaviani, Suwarti Suwarti, Gilbert Lazarus, Evi Sukmaningrum, Evy Yunihastuti, Maartje Dijkstra, Eduard J. Sanders, F. Stephen Wignall, Keerti Gedela, Raph L. Hamers, the INTERACT Study Group

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引用次数: 0

Abstract

Introduction

Indonesia has an escalated HIV epidemic concentrated among key populations. To strengthen the care cascade, we implemented a care pathway for the screening of individuals for acute HIV infection (AHI), to achieve prompt diagnosis and antiretroviral treatment (ART) initiation, at three non-governmental sexual health clinics in Jakarta and Bali. We assessed the AHI testing uptake, yield and prevalence, and the care cascade.

Methods

This is a cross-sectional baseline analysis of individuals (≥16 years) who presented for HIV testing and were consecutively enrolled (May 2023−November 2024). We used an AHI risk-score self-assessment and test algorithm comprising a fourth-generation antibody/p24 antigen rapid diagnostic test (4gRDT; Abbott Determine HIV Early Detect) and, if negative/discordant, followed by HIV-PCR (Cepheid Xpert) (either individual or pooled-sample testing). AHI was pragmatically defined as having negative/discordant RDT results with positive HIV-PCR (ISRCTN41396071).

Results

Three thousand seven hundred and ninety-seven (44.0%) of 8665 individuals were screened for study eligibility, and 3689 (97.2%) were enrolled. Median age was 28 years, and 78.2% were male. Men who have sex with men (MSM) accounted for 53.3%, clients of sex workers 19.2%, persons having a sex partner living with HIV 8.9% and sex workers 4.1%. We diagnosed 229 (6.3%; 229/3662) persons with RDT-positive (chronic) HIV, and we additionally identified 13 persons with AHI—that is a diagnostic yield of 5.6% (95% CI 3.1−9.5; 13/229) overall, and 6.1% (95% CI 3.2−10.3; 12/198) among MSM. AHI prevalence was 0.38% (95% CI 0.20−0.65; 13/3429) overall, and 0.72% (95% CI 0.37−1.2; 12/1677) among MSM. The number of persons needed to test to identify one person with AHI was 264 (3429/13) overall and 140 (1677/12) among MSM. The 4gRDT's performance to detect AHI was poor (2/13). Most participants received their HIV-PCR results on the same day (84.8%, 2907/3429) or within 24 hours (92.8%, 3182/3429). Of the 242 newly HIV-diagnosed individuals, 236 (97.5%) started ART, of whom 158 (67.0%) on the same day and 215 (91.1%) within 1 week.

Conclusions

We successfully implemented prompt AHI diagnosis and treatment, and identified a high AHI prevalence among Indonesian MSM. Prioritizing access to AHI testing can create opportunities for enhanced interventions to curb the HIV epidemic among key populations.

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将急性艾滋病毒感染筛查、当日诊断和抗逆转录病毒治疗纳入印度尼西亚性健康诊所对关键人群的常规服务：对INTERACT前瞻性研究的基线分析

印度尼西亚艾滋病毒疫情升级，主要集中在关键人群中。为了加强护理级联，我们在雅加达和巴厘岛的三家非政府性健康诊所实施了筛查急性艾滋病毒感染（AHI）的护理途径，以实现及时诊断和抗逆转录病毒治疗（ART）的开始。我们评估了AHI检测的吸收、产量和患病率以及护理级联。方法：对连续入组（2023年5月至2024年11月）接受HIV检测的个体（≥16岁）进行横断面基线分析。我们使用了AHI风险评分自我评估和测试算法，包括第四代抗体/p24抗原快速诊断试验(4gRDT；雅培确定HIV早期检测)，如果阴性/不一致，然后进行HIV- pcr（造父变星Xpert）（个体或合并样本检测）。AHI被实际定义为RDT结果阴性/与HIV-PCR阳性不一致（ISRCTN41396071）。结果8665名受试者中筛选出33797人（44.0%）符合研究条件，入组3689人（97.2%）。中位年龄28岁，78.2%为男性。男男性行为者（MSM）占53.3%，性工作者嫖客占19.2%，性伴侣感染艾滋病毒者占8.9%，性工作者占4.1%。我们确诊229例(6.3%；229/3662) rdt阳性（慢性）HIV患者，另外我们还鉴定了13例ahi患者，诊断率为5.6% (95% CI 3.1−9.5；13/229)和6.1% (95% CI 3.2−10.3；12/198)。AHI患病率为0.38% (95% CI 0.20 - 0.65；13/3429)，为0.72% (95% CI 0.37−1.2；12/1677)。需要检测以确定一个人患有AHI的总人数为264人（3429/13），在男男性行为者中为140人（1677/12）。4gRDT检测AHI的性能较差（2/13）。大多数参与者在同一天（84.8%,2907/3429）或24小时内（92.8%,3182/3429）获得HIV-PCR结果。在242名新诊断出艾滋病毒的个体中，236人（97.5%）开始接受抗逆转录病毒治疗，其中158人（67.0%）在同一天接受治疗，215人（91.1%）在一周内接受治疗。结论：我们成功地实施了及时的AHI诊断和治疗，并确定了印度尼西亚MSM中AHI的高患病率。优先提供AHI检测可以为加强干预创造机会，以遏制关键人群中的艾滋病毒流行。

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来源期刊

Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES

CiteScore

8.60

自引率

10.00%

发文量

186

审稿时长

>12 weeks

期刊介绍： The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.