Abstract
BackgroundLittle is known about HIV treatment outcomes in Indonesia, which has one of the most rapidly growing HIV epidemics worldwide.MethodsWe examined possible differences in loss to follow-up (LTFU) and survival between HIV-infected females and males over a 7-year period in an HIV clinic in Bandung, West Java. Data imputation was performed on missing covariates and a multi-state Cox regression was used to investigate the effects of sex and other covariates on patient transitions among four states: (1) clinic enrollment with HIV, (2) initiation/continuation/re-initiation of antiretroviral therapy (ART), (3) LTFU, and (4) death.ResultsWe followed 3215 patients (33% females), for a total of 8430 person-years. ART was used by 59% of patients at some point. One-year retention was 73% for females and 77% for males (p = 0.06). One-year survival was 98% for both females and males (p = 0.15). Females experienced a higher relative hazard to transition from HIV to LTFU (adjusted hazard ratio 1.21; 95% confidence interval 1.00–1.45), but this decreased after adjustments for clinical variables (aHR 0.94; 95% CI 0.79–1.11). Similarly, a lower relative hazard in females to transition from ART to death (aHR 0.59; 95% CI 0.35–0.99) decreased after adjustments for demographic variables.ConclusionThis Indonesian cohort has low ART uptake and poor overall pre- and post-ART retention. Female-male differences in survival and retention were gone after adjusting for clinical and sociodemographic factors such as CD4 count and education level. Efforts should be made to improve retention among patients with lower education.
Highlights
Indonesia has one of the most rapidly growing HIV epidemics in Southeast Asia with an estimated 690,000 people living with HIV in 2015 [1], mainly in Jakarta, East Java, and West Java [2]
Data imputation was performed on missing covariates and a multi-state Cox regression was used to investigate the effects of sex and other covariates on patient transitions among four states: (1) clinic enrollment with HIV, (2) initiation/continuation/re-initiation of antiretroviral therapy (ART), (3) loss to follow-up (LTFU), and (4) death
Females experienced a higher relative hazard to transition from HIV to LTFU, but this decreased after adjustments for clinical variables
Summary
Indonesia has one of the most rapidly growing HIV epidemics in Southeast Asia with an estimated 690,000 people living with HIV in 2015 [1], mainly in Jakarta, East Java, and West Java [2]. Crucial for HIV treatment success [16], remains a major challenge globally Both worldwide and in Asia about 50% of HIV-infected people received sustained ART in 2016 [17], while Indonesia has a much lower proportion of 14% in 2017 [18]. A recent study found only 76% of HIV-infected key populations who received ART in four cities in Indonesia retained in treatment [19]. Little is known about HIV treatment outcomes in Indonesia, which has one of the most rapidly growing HIV epidemics worldwide.
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