Challenges in delivering HIV-care in Indonesia: experience from a referral hospital.

HIV in Indonesia is strongly associated with injecting drug use (IDU), and surrounding stigma and lack of knowledge reduce accessibility of services. Uptake of HIV-testing is low and many patients present with advanced AIDS. A comprehensive evaluation was made of HIV-services provided between 2006 and 2008 in a referral hospital in West-Java, the province with the highest burden of HIV in Indonesia. A total of 826 HIV-positive patients, mostly infected through IDU (73.9%), presented between 2006 - 2008. Targeted screening and provider-initiated testing and counseling (PITC) led to earlier HIV-diagnosis. Operational research helped optimize diagnosis and treatment of important disease complications. Systematic monitoring of treatment response, and collaboration with other providers, methadone maintenance program and prison help improve treatment outcome. Over the last three years, the number of individuals tested and treated for HIV increased approximately two-fold and six-month mortality decreased from 13.6% to 7.5%. Loss to follow-up was 12.2% at six months. Significant progress has been made in delivering HIV-care in West-Java through operational research, systematic treatment monitoring, and the use of simple indicators to evaluate the quantity and quality of care.