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HIV/AIDS Update 2019

HOSPITAL BASED HIV AIDS SERVICES IN PAPUA
PARTICULARY IN RSUD JAYAPURA TO ENDING AIDS

ONE STOP SERVICE

Samuel Maripadang Baso

Samuel M Baso
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Ditjen P2P Indonesia Feb 2018 = 330.152 ; Estimated PLWH 630.000 , ART = 91.400 (14%)
Papua 1April 2019 = 40.805 (70%); Estimated 72.000, ART = 6492 (16%) Supression = 1.051 (16%)

Papua Land Prevalence 2.3%

Indonesia Prevalence 0.4%
Word Prevalence : 0.8 %
Indonesian in General : Concentric Epidemi . Papua Land: Generalized epidemic

Sumber : Laporan Estimasi 2012, Ditjen PPPL

 HIV AIDS SITUATION IN PAPUA PARTICULARY IN RSUD
JAYAPURA 4
HIV/AIDS BIG PROBLEMS (EPIDEMIC) IN PAPUA
POPITICAL WILL VERY IMPORTANT

TOTAL CUMULATIVE CASE APRil 31 2019 = 40.805 CASES
 EPIDEMIOLOGI SURVEY 2013: 2.3%, DOWN 0.1% COMPARED TO THIS LAST 6 YEARS
 ESTIMATED HIV / AIDS CASE IN PAPUA AROUND 72.000 CASES
 PROVINCE DATA GETS ARV OTI COVERED 33%
 RSUD DOK II 5-10 NEW CASE OF AIDS / MONTH
 CUMULATIVE AMOUNT UNTIL JUNE 2019: 3171 CASES
 70% PRODUCTIVE AGE ( AGE 20-40 )
 TREND START FLAT EVEN DOWN (DECREASE)
 EVER GET ARV 1653 ( VCT DOK II)
 UNTIL TODAY PATIENT HAVE GOT ARV : 761 (23.4 %)
 PMTCT 182 PREGNANT WOMAN
 MANY EFFORTS / STEPS ARE DONE, RESULTS ARE NOT MAXIMAL
 VCT AND AIDS WORKGROUP (AIDS HOSPITAL WORKGROUP ) SINCE JUNE 2004
 ALMOST % CAME IN STADIUM III AND IV
 ALL DISTRICT HAS HAD VCT AND AIDS WORKGROUP
 ARV IN ALL SELECTED DISTRICT AND HEALTH CENTER HAVE START INITIATION
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PrePrevalence
va le nc e HIV
HIV in
in Papua
Pa p ua La nd
Land (%)(%)
ST BP 2006
STBP 2006 && STBP
STBP 2013
2013

kepercayaan 95%.
Grafik menunjukkan estimasi titik & selang kepercayaan 95%.
kedua survei
Prevalensi HIV di tahun 2006 & 2013 tidak dapat dibandingkan secara langsung karena kedua survei
menggunakan metode pemeriksaan & reagent yg berbeda
90-90-90 and Continuum of Care Targets

90 % 90 % 90 %

Know status On treatment Virally suppressed

PAPUA
70% 20% 20%
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TARGET AND RESULT IN 90-90-90 PAPUA
80,000
72,000
70,000
64,000
60,000 58,320
52,480
50,000

40,000 40.805(56.6%)

30,000

20756
20,000

10,000 6492 (16%)

1531 1051(16.1%)
0
ESTIMASI ODHA TARGET ODHA ODHA TARGET ODHA ODHA ART ODHA ON ART RARGET ODHA JUMLAH ODHA JUMLAH ODHA
TERDIAGNOSIS TERDIAGNOSIS ON TREATMENT JUMLAH VIRUS YANG YANG JUMLAH
TIDAK DIPERIKSA VIRUS TDK
TERDETEKSI TERDETEKSI
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PREGNANT WOMEN TESTING HIV, PW HIV POSITIF
AND POSITIVE RATE
30,000 3.0%
2.8% 27,364 26,805

25,000 2.5%

2.1% 20,505
2.1%
20,000 2.0%
17,296 1.8%

15,000 1.5%
13,281
1.3%

10,000 1.0%

5,000 0.5%

364 371 570 477 263

- 0.0%
2014 2015 2016 2017 43374

Bumil Tes HIV HIV+ Positif Rate

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PMTCT CASCADE
Chart Title
300
253
250 231

200 195

156
150
109
98
100
73
50
50 28
11 5
0 0 2 0
0
JUMLAH BAYI LAHIR DARI JUMLAH BAYI LAHIR DARI JUMLAH BAYI DITES PCR JUMLAH BAYI DITES PCR HIV
IBU HIV POSITIF IBU HIV POSTIF POSITIF
MENDAPATKAN PROFILAKSIS
4.76%
2014 2015 2016 2017 Okt-18
TOTAL 36.4 million
 Global HIV Trends
Twelve countries with highest
HIV burden and new HIV
infection trends . ASIAN PASIFIC

HIV in Asia and the Pacific. UNAIDS Report 2013.

 Fast-Track Treatment to Reach 90–90–90 by 2020

P e o p le re c e iv in g A R T
Fast-Track Target
People receiving ART in Asia and the Pacific 2020:
4.2 million
5,100,000 people on ART
At current pace:

2017 estimate:
3.4 million
people on ART
2.7 million
by 2020

14% annual
increase
between 2013 and 2017

0
0

People receiving ART

Trend to Fast-Track target People receiving ART by 2020 (at current pace)

Source: Prepared by www.aidsdatahub.org based on UNAIDS 2018 HIV Estimates; Global AIDS Monitoring (GAM) 2018
 Regional overview: 90-90-90 target and gaps
Gap Progress (%) Target
100
% HIV testing and treatment cascade, Asia and the Pacific, 2017
90
80 0.8 million 81
73
74% 1.5 million
60 1.4 million

53%
40 45%

20
3.8 2.7 2.3
million million million
0
PLHIV who know their PLHIV on PLHIV who are
status treatment virally suppressed

ACHIEVED
Singapore; Thailand
NOT ON-TRACK (<50%)
Bangladesh; Indonesia;
Mongolia; Pakistan
Prepared by www.aidsdatahub.org
based on UNAIDS special analysis
DATA NOT AVAILABLE
2018; UNAIDS 2018 estimates and
Global AIDS Monitoring 2018 Afghanistan; Australia; China;
Japan; Myanmar; New Zealand;
PNG; Viet Nam
ACHIEVED
Cambodia
NOT ON-TRACK (<30%)
Bangladesh; Indonesia;
Mongolia; Pakistan
DATA NOT AVAILABLE
Afghanistan; China; Japan; New
Zealand; PNG
ACHIEVED
Cambodia
NOT ON-TRACK (<30%)
Pakistan
DATA NOT AVAILABLE
Afghanistan; Australia; Bangladesh;
China; Indonesia; Japan; Mongolia;
Myanmar; New Zealand; PNG; Philippines
 Towards 90-90-90 Fast-Track
treatment targets
Treatment cascade, 2017

N u m b er o f p eo p le
5.2 M
74%

71%
Asia - Pacific 5.2 M

Cascade 0
3.8 M
2.7 M
85%

PLHIV Tested
0.41 M 0.39 M
Estimated People on Suppressed
know their for viral
PLHIV ART viral load
status load*

Countries with CD4 threshold policy for treatment initiation

2016 2018
15 30 treat all regardless of CD4
* China and India do not
CD4 ≤ 500 but treat all key report viral load testing
6 0 populations regardless of CD4 data in 2018 GAM
reporting. Estimated 55%
9 2 CD4 ≤ 500 of PLHIV who are on
treatment in 13 reported
CD4 ≤ 350 but treat all key
2 0 populations regardless of CD4
countries had tested for
viral load in the past 12
countries have national policy on routine viral load months.
25 monitoring for antiretroviral therapy

Prepared by www.aidsdatahub.org based on Global AIDS Monitoring 2018 Reporting and UNAIDS 2018 HIV Estimates
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Sumber : Laporan Triwulanan Des 2013, Kemkes
GLOBAL TB
PROGRAMME
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HIV/AIDS and Infection Opportunistic
in RSUD Dok II Jayapura

 TB-HIV 29.2 % ; TBHIV (20.4%) ; MDRTB DM (8.8%)

 IPT = 23
 PCP 20 %
 OC 15 %
 Diare kronik 15 %
 Toxoplasmosis 8 %
 Criptococcocus 0.5%
 Sarcoma Kaposi. 3 cases
 PPE. 7%
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COINFECTION HIV/AIDS

TB-HIV : 29.2 %
HEPATITS B – HIV : 18%
HEPATITIS C – HIV : ?
SYPHILIS – HIV : 15%
 % Pasien TB HIV Mendapatkan PPK dan ART
Jan – Jun 2017
100% 100% 100% 100% 100% 100% 100%
100%

90% 88%
80%
80%

70% 67%
63%
60% 55%
50%

40%

30%

20%
Jan Feb Mar Apr MayJun
10%
TBHI
0%
Jan Feb Mar Apr May Jun
V 8 8 5 7 6 11
PPK 8 8 5 7 6 11
ART 5 7 4 7 4 6
% PPK % ART

Sumber : SITT Online per 30 Agt 2017

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Distribusi Prevalensi HIV di Kelompok WPSL
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Distribusi Prevalensi HIV di Kelompok WPSTL 23
 Prevalensi HIV 9 Kota di Indonesia
Populasi Kunci

1. Penasun 39,5% (2013) dan 27% (2009),

2. LSL 12,8% (2013) dan 7%(2009),
3. Waria 7,4% (2013) dan 9.2% (2009),
4. WPSL 7,2% (2013) dan 8% (2009),
5. WPSTL 1,6% (2013) dan 2,6% (2009),
6. WBP 1,2 % (2013),
7. Pria Risti 0,2% (2013) dan 0,4% (2009).
STBP 2013 | Survei Terpadu Biologis Perilaku
 GUIDELINES

PERMENKES 90 TAHUN 2019

PEDOMAN NASIONAL PELAYANAN
KEDOKTERAN
TATA LAKSANA HIV
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CARE, SUPPORT AND TREATMENT FOR PLWA
Treaatment, Care and Support will Comprehensive, Continuous and Lifelong
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HIV / AIDS CAN BE TREATED TO BE HEALTHY

SUPPORTIVE TREATMENT :
 NUTRITION, FLUID AND ELECTROLYTE
 HOME CARE, UP, SHELTER CARE
 MAINTAIN CLEANLINESS (HYGYNE) 
 PSYCHOSOCIAL SUPPORT
 RELIGIOUS, SOCIAL ECONOMIC SUPPORT  
 FAMILY SUPPORT  
 ASSISTANCE (NGOs, GOVERMENT)  
 PEER GROUP OF SUPPORTS
 HUMAN RIGHTS AND LAW SUPPORT
SPECIAL TREATMENT:
 TREATMENT AND PREVENTION OF OPORTUNISTIC INFECTION (PCP, TB, TOXOPLASMA)
 ANTIRETROVIRAL TREATMENT
 CANCER TREATMENT (KAPOSI, LIMFOMA, CERVIX ETC)
 OTHER INFECTIONS (MALARIA, PMS)
 IPT (ISONIAZID PREVENTION AND TREATMENT)
Cummulative ART AND ADHERENCE 29
in Jayapura Hospital

ART Amount %
FDC ARV (First Line) 744 (97.4%)
TDF+3TC+EFV
TDF+FTC+ALUVIA 17 (2.6%)
(Second Line)
AMOUNT OF ADHERENCE PATIENT IN JUNE 2019 761
LESS THAN 3 DOSE FOR 30 DAYS (>95%) 678
3– 12 DOSE 80-95% 33
>12 DOSE FOR 30 DAYS (80%) 50
PATIENTS GOT ART WHO CHECKED THEIR VIRAL LOAD 30
In Dok II JAYAPURA GENERAL HOSPITAL

Viral Load
Age Amount

Undetected Detected

ADULT 340(61.4%) 65(38.6%) 405

CHILD 29(49.2%) 30(41.8%) 59

Note : Undetected if Viral Load check <40 copy

 WHO Guidelines (2016)
WHO definitions of clinical, immunological and virological failure
for the decision to switch ART regimens

Failure Definition

New or recurrent clinical event indicating severe

Clinical failure immunodeficiency (WHO clinical stage 4 condition)
after 6 months of effective treatment

CD4 count at or below 250 cells/mm3 following

Immunological failure clinical failure or persistent CD4 levels below 100
cells/mm3

Viral load above 1000 copies/mL based on two

Virological failure consecutive viral load measurements in 3 months,
with adherence support following the first viral
load test
Adapted from WHO Consolidated Guidelines On The Use Of Antiretroviral Drugs For Treating And Preventing
HIV Infection, Recommendations For a Public Health Approach, 2 nd Edition 2016
 Rationale: for VL
Targeted viral load monitoring Routine viral load monitoring
(suspected clinical or (early detection of
immunological failure) virological failure)

Test viral load

Viral load >1000

copies/ml

Evaluate for adherence

concerns

Repeat viral load testing

after 3–6 months

Viral load ≤1000 copies/ml Viral load >1000 copies/ml

Switch to second-line
Maintain first-line therapy
therapy
 ART LINI III

Sudah beberapa pasien di Indonesia :

Papua belum ada

Regimen : Integrase + Second line NRTI + PI

terdiri dari : Danuravir +Ritonavir + Raltegavir

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FIVE PREVENTION PILLARS
 UNITAID PSI
HIV SELF-TESTING AFRICA
Improving linkage to treatment and prevention after (self)-testing
among male partners of antenatal care attendees: a multi-arm
adaptive cluster randomised trial in Malawi
 36
WHO and UNAIDS 2012

1. Zero New HIV Infections

2. Zero Discrimination
3. Zero AIDS-Related Deaths
THE FINAL CHAPTER OF THE AIDS EPIDEMIC
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PAPUA
Triple 90 : 90 Testing 60 %
90 Theraphy. 20%
90 Supression 20%
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 Paediatric antiretroviral coverage also varies by region

59%
Eastern Europe
Central Asia
34% 6% 28%
Caribbean
Asia and Pacific
Middle East

71% 24%

Latin America Sub-Saharan

Africa

Source: UNAIDS estimates 2014

Antiretroviral treatment coverage varies between regions
 Global ART coverage

37%

Adults and children

Source: UNAIDS 2014

The result

72
3%
of all people living with HIV
will be virally suppressed

= a three-fold increase
over current estimates
HIV treatment: Critical to ending AIDS and making HIV
transmission rare
Partnering for success

Normative/
Financing
Technical

R&D
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