HIV Pre-Exposure Prophylaxis Service Cascade and Risk Factors Associated with Loss to Follow-Up Among Key Populations...

Area of Science:

• Public Health
• Epidemiology
• HIV Prevention

Background:

• The pre-exposure prophylaxis (PrEP) care cascade is crucial for HIV prevention but lacks systematic evaluation in Indonesia.
• Key populations in Indonesia, including men who have sex with men (MSM), female sex workers (FSW), people who inject drugs (PWID), transgender women (TGW), and serodiscordant partners of people living with HIV (SD-PLHIV), are prioritized for PrEP.
• Understanding factors influencing PrEP initiation, continuation, and loss to follow-up (LTFU) is vital for program optimization.

Purpose of the Study:

• To evaluate the PrEP care cascade in Indonesia.
• To identify baseline factors associated with PrEP initiation.
• To determine longitudinal risk factors for LTFU within the Indonesia PrEP Pilot Program.

Main Methods:

• Analysis of data from the large-scale Indonesia PrEP Pilot Program.
• Examination of 16,469 eligible individuals for PrEP initiation.
• Longitudinal assessment of factors contributing to LTFU over 12 months.

Main Results:

• Over 55% of eligible individuals initiated PrEP, with higher initiation rates among older individuals, women, FSW, and TGW, but lower rates among PWID and SD-PLHIV.
• PrEP continuation rates at 1 and 3 months were notably low for FSW (37% and 34%).
• The cumulative 12-month LTFU rate was 41.9%, predicted by younger age, female sex, FSW status, specific geographic locations, lack of STI diagnosis, consistent condom use, and high adherence.

Conclusions:

• Significant gaps exist in PrEP initiation, continuation, and LTFU among key populations in Indonesia.
• Targeted interventions are necessary to improve engagement for individuals at risk of LTFU and for underserved populations.
• Addressing these gaps is essential to enhance PrEP program effectiveness in Indonesia.