HIVST

1-Policy uptake of WHO recommended HIV testing approaches 

Source: UNAids.org

In general, HIV testing can be accessed in Indonesia through Voluntary Counselling and Testing (VCT) services at community health services, private clinics, or public and private hospitals. As of 2019, at least 6924 VCT services reported testing activity to the Ministry of Health. As per December 2020 data, Indonesia has no HIVST policy though there are plans for updating National HTS policy including HIVST. The country also plans for implementing HIVST.

In Indonesia, the Ministry of Health has responded to the growing HIV epidemic with a continuum of HIV care known as Layanan Komprehensif Berkesinambungan (ie, continuum of care), an approach first adopted in 2012 that aims to integrate prevention, treatment, and care for all populations. This programme authorises doctors to immediately offer patients ART through health clinics after HIV diagnosis; however, coverage of prevention services among key populations is believed to have remained at less than 55%.

As per an 2018 ESCAP report, the Ministry of Health worked to develop the new National Action Plan on HIV in 2018. As part of the process, the Ministry consulted with civil society and development partners where the inputs on the enabling environment focused on policy reforms and strengthening access to justice for key populations and people living with HIV. As per the same report, the National Action Plan was to be used as a reference for the National Mid-Term Development Plan (2020-2024), seeking to shift the current legal paradigm for key populations from being considered passive subjects of rehabilitation to being active citizens, to remove the economic burden of social rehabilitation.

Overall, Indonesia’s national effort is to reach the goal of 90 percent of estimated people living with HIV know their status by 2030. The Indonesian government has also committed to overcome HIV/AIDS epidemic by targeting the achievement of 3 Zeros (Zero new HIV infection, Zero Stigma and Discrimination, Zero Death related to AIDS) and promoting HIV/AIDS prevention Programme. The 2018 AIDS Act in the country is set to expand human rights for people living with HIV. As per the most recent data, the country has partially adopted 2015 WHO guidelines recommendations on HIV testing services.

2-Implementation status

Indonesia is piloting self-testing as well as making rapid HIV testing available at some sites. The country is also assessing HIVST distribution models in STAR III Initiative.

Overall, Indonesia has conducted numerous stakeholder consultations since 2015 to discuss the feasibility of implementing innovations for HIV prevention and treatment including PrEP and self-testing. Studies have been undertaken to assess acceptability of PrEP and self-testing among select communities. Since 2016, the Global Fund has supported a pilot for community-based rapid HIV testing (Oraquick), and an expanded pilot from 2018 to 2020. 

In 2018, ILO and WHO have released a Joint Guideline on HIV self-testing (HIVST) at workplace with an aim to increase HIV awareness and scale up the strategy at workplace that makes HIV testing services more accessible and appealing to those in need.

At present, there is a call to introduce HIV self-tests to improve HIV testing coverage in key populations in the country. Findings from a 2020 study show the potential utility of offering HIV oral fluid self-test kits to scale-up HIV testing in MSM.

Kerti Praja Foundation has been conducting implementation research on self HIV testing  among MSM using oral fluid test. The test is offered to those people who are not able to come to the clinic for blood test. KPF outreach workers provide the test in their home or  work places.  The client with positive result is required visit the clinic for confirmation test.

3-Product Registration and Costing of HIVST Kits 

Indonesia plans to register an HIVST product. Therefore, HIVST products were undergoing evaluations for registration as on December 2020. The country also had a planned WHO Collaborative Registration Procedure workshop. Pilot studies mostly report use oral fluid tests. 

There have been multiple national stakeholder consultations on access to affordable HIV medicines, diagnostics and vaccines in Indonesia. The Government of Indonesia has also conducted reviews of its patent laws and other relevant laws which impact on access to medicines. Indonesia enacted a new patent law in 2016, which incorporate several TRIPS flexibilities that can promote greater access to affordable medicines.

With a program supported by the Bill & Melinda Gates Foundation in 50 low- and middle-income countries, the cost of the OraQuick® HIV self-test is now as low as US$ 2 per test kit. Respondents in a study published in May 2020 report that respondents (men who purchase sex in brothels in Indonesia) preferred the price of HIVST kits to be lower than $3.5.  the costs of self-tests needs to be considered if introducing HIV self-testing in this setting.