Background

There is an uncontrolled HIV epidemic among key populations at highest risk of HIV infection in Indonesia, including men who have sex with men (MSM), transgender people and sex workers. Innovative, context-specific interventions are urgently needed to break HIV transmission.

Multi-component intervention models based on detection of individuals with acute HIV infection (AHI), using symptom and behaviour risk scores and point-of-care HIV viral load diagnostic testing, have been successful in curbing local HIV epidemics in several cities in high-income countries, by enabling direct linkage to care and immediate initiation of antiretroviral therapy (ART) as well as enhanced HIV testing of their sexual partners.

There is thus a strong impetus to tailor those successful models to explosive epidemics in low- and middle-income countries (LMIC) such as in Indonesia.

Aims

Addressing an unmet need of high priority, the principal overarching research question of the INTERACT project is to evaluate whether implementing a patient-centered AHI clinical pathway, coupled with a digital behavioral intervention reaching out to the wider target community, can curb the rapidly growing HIV epidemic among key populations in Jakarta and Bali.

The aim of this implementation study is to demonstrate the proof-of-concept that context-specific implementation of AHI diagnostic screening, as part of a clinical pathway for same-day diagnosis and treatment of AHI, can optimize current HIV care delivery and strengthen the HIV care cascade, and thereby curb the explosive HIV epidemic in key populations in Jakarta and Bali, Indonesia.

Implemented at three high-volume sexual health clinics, INTERACT will assess the effectiveness/yield, uptake/adoption, acceptance, feasibility, and cost-effectiveness, and estimate its potential for impact at scale, of the intervention. The INTERACT project will strengthen local capacities to adopt implementation science approaches to improve HIV service delivery, reduce new HIV infections, death and health costs, and provide critical evidence to health policymakers in Indonesia, and in other LMIC.