The cost of providing hospital-based (early) antiretroviral treatment in Indonesia: what has changed in almost a decade?

17% of all people living with HIV in Indonesia who are in need of antiretroviral treatment (ART) actually receive the treatment. The cost of ART based on three CD4 cell count groups (e.g., 0-200, 201-350, >350 cells/mm3) in a main referral hospital in West Java, Indonesia, in 2011-2016 was compared to the results from a decade earlier in the same setting. Costs were estimated including resources used for opportunistic infection treatment, laboratory tests, and antiretroviral (ARV) drugs. For each group, we divided the costs into several periods: pre-ART, and every 6 months up to 24 months after onset of treatment. Before ART, costs were dominated by laboratory tests (>80%); ARV drugs were the main cost after treatment onset (>92%). Average cost of treatment per year was US$600 across all groups. Moreover, the patient cost to access ART (n = 49 patients) did not exceed 10% of their household monthly expenditures (i.e., 4%). The unit cost of providing ART per patient/year is half the cost under the previous treatment initiation guidelines. A lower ARV drug cost, more patients in higher CD4 cell-count groups, and lower viral load test cost characterize the current cost profile.

Active and latent tuberculosis among HIV-positive injecting drug users in Indonesia.

INTRODUCTION: Injecting drug use (IDU) is associated with tuberculosis but few data are available from low-income settings. We examined IDU in relation to active and latent tuberculosis (LTBI) among HIV-positive individuals in Indonesia, which has a high burden of tuberculosis and a rapidly growing HIV epidemic strongly driven by IDU. METHODS: Active tuberculosis was measured prospectively among 1900 consecutive antiretroviral treatment (ART)-naïve adult patients entering care in a clinic in West Java. Prevalence of LTBI was determined cross-sectionally in a subset of 518 ART-experienced patients using an interferon-gamma release assay. RESULTS: Patients with a history of IDU (53.1%) more often reported a history of tuberculosis treatment (34.8% vs. 21.9%, p < 0.001), more often received tuberculosis treatment during follow-up (adjusted HR = 1.71; 95% CI: 1.25-2.35) and more often had bacteriologically confirmed tuberculosis (OR = 1.67; 95% CI: 0.94-2.96). LTBI was equally prevalent among people with and without a history of IDU (29.1 vs. 30.4%, NS). The risk estimates did not change after adjustment for CD4 cell count or ART. CONCLUSIONS: HIV-positive individuals with a history of IDU in Indonesia have more active tuberculosis, with similar rates of LTBI. Within the HIV clinic, LTBI screening and isoniazid preventive therapy may be prioritized to patients with a history of IDU.

Skin disorders in HIV-infected patients from West Java.

AIM: to describe the spectrum of HIV-related skin disorders as well as their prevalence and relation to CD4-cell counts among HIV-seropositive patients from West Java, Indonesia. METHODS: all HIV-positive patients presenting in 2008 at the HIV-clinic, Hasan Sadikin Hospital, were included in a cross-sectional study. Patients who had a skin complaint were examined by a dermatologist. Skin diseases were classified based on ICD 10. RESULTS: among 843 patients, 121 (14.4%) had a skin complaint, consisting of skin manifestations (73.3%), drug eruptions (30.5%), and sexually transmitted infections (15.7%), some of them had more than one diseases. The most common skin manifestations were drug eruptions, pruritic papular eruptions, seborrhoeic dermatitis, herpes zoster, dermatophytosis, and bacterial skin infections. Among patients who started nevirapine, 6.4% (95%CI: 3.9% - 8.9%) developed any kind of drug eruption, and 1.4% (95%CI 0.2%-2.6%) developed a severe drug eruption. No cases of Kaposi sarcoma, penicilliosis, eosinophilic folliculitis were seen, however one case of histoplasmosis was diagnosed. CONCLUSION: this is the first report describing the prevalence and characteristic of skin manifestation in HIV-positive in Indonesia. Indonesian physicians should be alert about HIV when patient presents with certain skin manifestations. The rate of severe drug eruptions following treatment with nevirapine is a cause of concern that needs further study.