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Publications

Journal Article Epublish

PubMed: 41808690 DOI: 10.1016/j.lansea.2026.100742

Annual trends and risk factors of late presentation of HIV at 19 referral hospitals in Indonesia: findings from the INA-PROACTIVE cohort.

Lancet Reg Health Southeast Asia 46:100742

Authors: Dona Arlinda, Evy Yunihastuti, Agnes Rengga Indrati, Tuti Parwati Merati, Emmanuelle Papot, Deborah Cromer, Aly Diana, Adhella Menur Naysilla, Riza Danu Dewantara, Nugroho Harry Susanto, Nurhayati Lukman, I Wayan Adi Pranata, Herman Kosasih, Dewi Lokida, Muhammad Karyana, Teguh Sarry Hartono, I Gede Rai Kosa, Deborah Theresia, Dwiana Savitri, Dwi Kurniawan Nugroho, Eppy Eppy, I Made Susila Utama, Kurnia Fitri Jamil, Ivan Lumban Toruan, Nelly Elfrida Samosir, Sudirman Katu, Nur Farhanah, Sri Wahyunie, Musofa Rusli, Widya Amalia Swastika, Willy Anthony Ignatius Wullur, Yanri Wijayanti Subronto, C Jason Liang, Renee Ridzon, Ray Y Chen, Aaron T Neal

Affiliations

  • Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Jl. Percetakan Negara No.29, Johar Baru, Kec. Johar Baru, Kota Jakarta Pusat, Daerah Khusus Ibukota Jakarta, Indonesia.
  • Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Kenari, Kec. Senen, Kota Jakarta Pusat, Daerah Khusus Ibukota Jakarta, Indonesia.
  • Faculty of Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Jl. Pasteur No.38, Bandung, Indonesia.
  • Department of Internal Medicine, Faculty of Medicine, Udayana University, Jl. P.B Sudirman, Denpasar, Bali, Indonesia.
  • The Kirby Institute, University of New South Wales, Sydney, Australia.
  • Prof. Dr. Sulianti Saroso Infectious Disease Hospital, Jalan Baru Sunter Permai Raya, Tanjung Priok, Jakarta Utara, Indonesia.
  • Tangerang District Hospital, Jalan Ahmad Yani No.9, Tangerang, Indonesia.
  • St. Carolus Hospital, Jl. Salemba Raya No 41, Central Jakarta, Indonesia.
  • Dr. Moch. Ansari Saleh Hospital, Jl. Brigjend H.Hasan Basri no. 1 Banjarmasin, Indonesia.
  • Dr. T. C. Hillers Public Hospital, JI. Wairklau No.1, Kota Uneng, Kec. Alok, Kabupaten Sikka, Nusa Tenggara Timur, Indonesia.
  • Persahabatan Central General Hospital, Jalan Persahabatan Raya No. 1, Rawamangun, Pulo Gadung, Kota Jakarta Timur, Daerah Khusus Ibukota Jakarta, Indonesia.
  • Department of Internal Medicine, Faculty of Medicine, Ngoerah Hospital, Universitas Udayana, Jl. Diponegoro, Denpasar, Indonesia.
  • Dr. Zainoel Abidin Hospital/Faculty of Medicine, Universitas Syiah Kuala, Jl. Tgk. Daud Beureueh No. 108, Bandar Baru, Kuta Alam, Kota Banda Aceh, Indonesia.
  • Soedarso General Hospital, Jl. Dr. Soedarso No. 1, Pontianak Tenggara, Kota Pontianak, Kalimantan Barat, Indonesia.
  • Adam Malik Hospital, Jl. Bunga Lau No. 17, Kemenangan Tani, Medan Tuntungan, Medan, Indonesia.
  • Wahidin Sudirohusodo General Hospital, Faculty of Medicine, Hasanuddin University, Jalan Perintis Kemerdekaan No.Km.11, Makassar, South Sulawesi, Indonesia.
  • Department of Internal Medicine, Faculty of Medicine, Universitas Diponegoro/Dr, Kariadi Hospital, Jalan Dr Sutomo No. 16-18, Semarang, Jawa Tengah, Indonesia.
  • Faculty of Medicine, Abdoel Wahab Sjahranie General Hospital, Universitas Mulawarman, Jl. Palang Merah Indonesia No 1, Samarinda, Indonesia.
  • Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga/Dr, Soetomo General Academic Hospital, Jalan. Prof. Mayjend. Dr. Moestopo 6 - 8, Surabaya, Indonesia.
  • Abepura Regional General Hospital, JI. Kesehatan No.1, Abepura, Jayapura, Papua, Indonesia.
  • Budi Kemuliaan Hospital, JI. Budi Kemuliaan No.1 Kel. Kp. Seraya, Kee. Batu Ampar, Batam, Indonesia.
  • Department of Internal Medicine/Magister of Tropical Medicine Study Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito General Hospital, JI. Farmako Sekip Utara, Radioputro Building 3rd Floor, Sleman, Yogyakarta, Indonesia.
  • National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5601 Fishers Lane, Rockville, MD, USA.

Abstract

BACKGROUND

People living with HIV (PLWH) presenting with advanced HIV have worse outcomes than those diagnosed earlier. The proportion of PLWH in Indonesia who are late presenters is unknown but likely high. Identifying factors associated with late presentation is key to earlier diagnosis and intervention.

METHODS

Adult PLWH were enrolled at 19 centers across Indonesia (2018-2020) in the INA-PROACTIVE observational cohort study. Late presentation was defined as having a CD4+ count <350 cells/μl within 3 months of diagnosis. Risk factors were assessed using multivariable logistic regression.

FINDINGS

Among 3201 eligible participants, 2790 (87·2%) were late presenters. High proportion of late presenters was observed from 2015 to 2019 (83·3%-89·8%). Characteristics associated with late presentation included age 30-39 (aOR = 1·47, 95% CI: 1·15-1·90) or age ≥40 (aOR = 1·71, 95% CI: 1·21-2·46) vs. age 18-29; male sex (aOR = 2·93, 95% CI: 2·07-4·24); diagnosis in ≤2015 (aOR = 1·45, 95% CI: 1·12-1·89); and diagnosis through Provider-Initiated Testing and Counseling (aOR = 2·38, 95% CI: 1·86-3·04) vs. Voluntary Counseling and Testing (VCT). Suspected MSM transmission was associated with lower odds of late presentation (aOR = 0·57, 95% CI: 0·39-0·82) compared to heterosexual transmission.

INTERPRETATION

Late presentation remains highly prevalent in Indonesia. Expanded efforts are needed to promote testing among those at risk. Targeted interventions for older adults, men, and non-MSM populations, alongside VCT and MSM-focused programs, may help reduce late HIV diagnosis and improve early management.

FUNDING

This project has been funded in whole or in part with Federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health, under contract No. 75N91019D00024 Task orders 75N91020F00004, 75N91020F000012.

MeSH

Cd4 Lymphocyte Count, Sex, Risk Factors, Diagnosis