Introducing and optimizing safe and voluntary partner notification services in Indonesia

BACKGROUND: With funding from the PEPFAR and USAID, the Linkages across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) and the Meeting Targets and Maintaining Epidemic Control (EpiC) projects have helped the Government of Indonesia establish and implement guidelines for the introduction of voluntary partner-notification services for people living with HIV (PLHIV). They do this using routine program data to identify opportunities for further improvement.
DESCRIPTION: In 2019, team members helped adapt the 2016 World Health Organization index testing guidelines into standard operating procedures relevant to the local Indonesian context. They emphasized key-population-friendly services, given the concentration of HIV infections in these groups, and incorporated strategies that could be implemented through a mix of community- and facility-based service providers. LINKAGES and EpiC supported implementation in Jakarta beginning in October 2019. They collected and analyzed routine program data on PLHIV participation in voluntary partner-notification services, assessing rates of acceptance, contact referrals, successful linkage of contacts to HIV testing services, and new HIV case-finding rates by population, service setting, and geography.
LESSONS LEARNED: From October 2019 through September 2021, 13,710 offers of partner-notification services were accepted among a total of 22,323 PLHIV. PLHIV who accepted partner-notification services referred 18,899 contacts, of whom 9,121 (48.3%) were reached and 5,702 (30.2%) received HIV testing. Among the contacts tested, 978 (17.2%) received positive results. Community-based services contributed to case-finding rates 4.7 times higher than those in facility-based settings (11.1% vs. 2.4%) among PLHIV who had been offered partner notification. In community settings, PLHIV who identified as men who have sex with men were significantly less likely (aOR=0.29, [95% CI: 0.25-0.33]) than clients of other categories to accept partner notification, but those who did accept were significantly more likely (aOR=5.3 [3.76-7.45]) than clients of other categories to refer HIV-positive contacts.
CONCLUSIONS: Project team members are working with national HIV program partners to mainstream offers of partner notification into PLHIV community support services and expand online and anonymous contact referral options to improve participation among men who have sex with men.