In 2015, there were an estimated 690,000 people living with HIV in Indonesia, including 17,000 children, and there were 35,000 AIDS-related deaths.1 The country’s HIV epidemic, one of the largest in the Asia-Pacific region, is concentrated in urban settings and in key populations—people who inject drugs, sex workers and their clients, men who have sex with men (MSM), and transgender people.
Dr. Evy Yunihastuti
Situated in the capital city of Jakarta, Cipto Mangunkusumo General Hospital has been at the forefront of the country’s HIV epidemic since the mid-1980s. “It was in 1986 that Cipto established its Working Group on AIDS, around the time the first case of HIV was identified in Indonesia,” said Evy Yunihastuti, M.D., Ph.D., who directs adult HIV services at Cipto. “Since then, our program has expanded to encompass an extensive clinical and research agenda with the capacity to address the evolving needs of our population.”
In the heart of a province that now has one of the highest numbers of new HIV infections in Indonesia, Cipto’s expanded clinical and research program provides adult and pediatric care, including hotline services, HIV counseling, testing, treatment, and referrals. It also has an extensive health education and training program for “frontline” clinicians and healthcare workers caring for patients with HIV, and its faculty conduct extensive research on HIV disease and treatment outcomes, adherence, opportunistic infections, coinfections, cancers, psychosocial support, and medical problems of children with HIV/AIDS.
Dr. Nia KurniatiDr. Yunihastuti has led Cipto’s involvement in the TREAT Asia HIV Observational Database (TAHOD) since 2009, supporting its regional analysis of long-term HIV disease and treatment outcomes. As signs of an epidemic of HIV among MSM in Jakarta and Indonesia emerged, Dr. Yunihastuti led a number of initiatives to better understand and address this epidemic. These included research on multidisciplinary services to enhance HIV testing and linkage to care for MSM, as well as a collaboration with TREAT Asia and the Indonesian Medical Association to organize MSM gender sensitivity trainings for healthcare professionals.
Since 2010, Cipto has also participated in several TREAT Asia-supported multisite research projects. The Anal Neoplasia Study in the Asia Pacific (ANSAP) focused on the treatment of MSM with HPV-associated pre-cancerous lesions. The Effectiveness and Tolerability of HCV Treatment in HIV Co-infected Patients study integrated hepatitis C treatment within routine HIV care, providing intensive patient education, treatment preparedness, and adherence support. The TREAT Asia Studies to Evaluate Resistance 2 (TASER-2), which begins enrollment in August 2016, will assess resistance to second-line antiretroviral therapy in HIV-infected adults.
To care for the perinatally infected children and other children living with HIV in Indonesia, Cipto has expanded the clinical and research programs of its Department of Child Health, directed by Nia Kurniati, M.D. Dr. Kurniati has led Cipto’s involvement in the TREAT Asia Pediatric HIV Observational Database (TApHOD) since 2008, and its participation in the TREAT Asia Studies to Evaluate Resistance, Pediatrics (TASER-P), a regional multicenter study of second-line antiretroviral therapy failure and resistance in children.
Dr. Kurniati notes that an important issue facing adolescents with HIV in the region is disclosure and the many complications that arise with knowing their HIV status. “Once we understand that, we can offer better services for them at this difficult stage of their development and, we hope, make life easier for them,” she says.
“The HIV clinical and support teams at Cipto Mangunkusumo Hospital are committed to responding to the emerging needs of people living with HIV in Indonesia,” says Annette Sohn, M.D., director of TREAT Asia. “We especially commend their willingness to step forward to address the epidemic among key populations and those most at risk in their communities.”
1 UNAIDS Indonesia estimates 2015 http://www.unaids.org/en/regionscountries/countries/indonesia/