Increasing Access to HIV treatment/ART through ART Scaling Up in West Java

The number of HIV cases in Indonesia rose rapidly, increasing the need for antiretroviral treatment (ART). However, the public health expenditure on HIV/AIDS is relatively low, and ART are undersupplied and has limited fund. Strategies are required to increase the uptake of ART within limited resource. We simulate the increase of ART uptake as the result of scaling up ART in hospital or community level and use it to forecast the costs and implications on HIV epidemic in West Java by employing HIV in Indonesia Model (HIM). We collect data from both research sites and literatures. Benefit Incidence Analysis (BIA) is used to observe distribution pattern of access to HIV care among HIV patients. If by 2020 additional 20,000 PLHIV are treated with ART, the epidemic may decrease by roughly 1% in 2020 and around 6% (±2,100) of HIV infection would be averted. If around additional 45,000 PLHIV are treated in 2020, it may decrease the epidemic by approximately 4% in 2020 and around 18% (±6,000) of HIV infection would be averted. This requires 6 to 13 additional hospitals (costing US$1.3 mln to US$2.9 mln) or around 714 to 11,400 puskesmas (costing of US$1.1 mln to US$17.2 mln) distributing ART. The BIA analysis shows that the HIV patients’ access to the hospital seemed equally distributed. First, puskesmas better acts as a support to the already established hospital-based HIV service. Second, the specific demand and need for ART in puskesmas in separate region should be acknowledged before upscale ART through puskesmas. Third, ART upscale should be led by main referral hospitals, supported by satellite hospitals and puskesmas.