In Indonesia and other areas of the Asia Pacific region, the HIV epidemic continues at a fast-growing pace among key population groups: people who inject drugs (PWID), men who have sex with men (MSM), female sex workers, and transgender people. In a commentary appearing online now in The Lancet HIV, University of Massachusetts Amherst School of Public Health and Health Sciences associate professor of community health education Dr. Krishna Poudel and Dr. Masamine Jimba of the University of Tokyo argue that identifying and addressing the gaps in their HIV care continuum is critical to improve their health.
Drs. Poudel and Jimba argue that engagement with HIV-positive individuals at each stage of the HIV care continuum – defined as diagnosis, retention in HIV care, prescription of antiretroviral therapy (ART), and viral suppression – is the key to reducing mortality and morbidity, and preventing further HIV transmission.
In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched the “90-90-90” campaign, a call for 90 percent of people with HIV to know their status, 90 percent of all people diagnosed with HIV to receive antiretroviral therapy, and 90 percent of people on ART to be virally suppressed. Yet, as the authors discuss in their commentary, in a recent prospective investigation conducted among the key population groups in Indonesia, findings revealed that only 85 percent of participants received care, with 73 percent initiating ART and only 35 percent achieving viral suppression within 6 months, far below the UNAIDS target goal.
The results, Dr. Poudel notes, are strikingly low and cause for concern, highlighting the importance of expanding access to ART to primary care facilities where treatment can be offered alongside with testing. He suggests that future studies should also focus on investigating best practices for promoting successful long-term engagement in each stage of the HIV care continuum in specific subgroups of the key populations. Application of the analytical framework of the continuum of HIV prevention and care Dr. Poudel and his colleagues developed earlier might be useful in identifying health-system-related strengths and constraints, the authors write, “thereby improving HIV diagnosis, treatment initiation, and retention in care among key populations.”
“Identifying and addressing these gaps in the HIV care continuum will ultimately increase the proportions of people initiating ART, engaging in sustained care, and achieving viral suppression,” Drs. Poudel and Jimba conclude. “Thus, the health and lifespan of these key populations can be improved, and transmission of HIV in Indonesia and other countries can be reduced.”