HIV and AIDS control activities in Bali Province are vertically organised, lack integration at point of delivery and are heavily reliant on funding from donor agencies. Bali Province is currently developing an ‘exit strategy’ from donor funding, with strong emphasis on integration policy to maximise program efficiency and sustainability. This study explored barriers to implementing integration of HIV and AIDS services into community health centres (Puskesmas) and potential solutions.
Methods: A policy analysis was completed using a qualitative design. Policy documents were analysed to identify components of current overarching frameworks relevant to integration. In-depth interviews were conducted with 10 respondents to explore the perspectives of policy makers and other stakeholders. Data were analysed using a thematic method and presented using a narrative approach. results: Barriers to integration included lack of infrastructure and funding arrangements, lack of program linkages at Puskesmas, lack of inter-sectoral linkages, high turnover and rotation of staff, lack of skills and training, lack of incentives program for increased workload and lack of community awareness about HIV services availability at Puskesmas. Several steps need to be taken to enable implementation of integration. HIV-AIDS funding should be pooled at Bali Province Department of Health and distributed based on Puskesmas capacity and need. Training should be conducted with Puskesmas staff to promote HIV-AIDS services as core business and encourage program cross-linking. Partnerships should be formed between Puskesmas and lay counsellors to raise awareness of Puskesmas services.
Conclusion: The findings of this study can be used to inform implementation of a health system strengthening approach for HIV-AIDS control measures in Bali Province. Puskesmas integration should also be considered as a policy option by other provinces in Indonesia where HIV prevalence is high and the main route of transmission is heterosexual contact.
REACH was a collaborative research and practice initiative to develop evidence building frameworks, capacity, tools and resources with the Victorian HIV community partnership.
HIV disease is associated with chronic inflammation and activation of the innate immune system. This state, as measured using plasma markers of inflammation, persists following suppression of HIV viremia using antiretroviral therapy, and may increase risk of non-AIDS co-morbidities. The causes of innate immune activation in the setting of virological suppression are unclear. Natural killer (NK) cells are innate immune cells that kill virus-infected and transformed cells without prior sensitization. We have shown that NK cells are activated both phenotypically (elevated expression of HLA-DR) and functionally (increased spontaneous degranulation measured by CD107a surface expression) in virologically suppressed (VS) HIV+ individuals. NK cells also lose expression of CD16, the receptor which mediates antibody-dependent cellular cytotoxicity.
Regular HIV testing is recommended in men who take sexual risks. We assessed the relationship between perceived barriers to HIV testing, and frequency of testing among men who engaged in unprotected anal intercourse with casual partners (UAIC), to inform HIV testing strategies.
The majority of HIV diagnoses including delayed diagnoses in Australia occur among men who report homosexual contact – hereafter called gay and bisexual men (GBM). Delayed diagnosis is strongly associated with increased HIV-related mortality and morbidity. People who are unaware of their HIV-positive status may also be unwittingly transmitting HIV. We assessed trends in delayed HIV diagnoses among GBM in Australia.
HIV-associated leishmaniasis, endemic in the Mediterranean basin is a growing problem in India, Brazil and East Africa. Despite surviving for than 20 years, the clinical course of our visceral-leishmania (VL)-HIV co-infected patient illustrates several management challenges including diagnosis, speciation and drug resistance; monitoring burden of disease; access to and use of VL-treatments; end-organ toxicity and the combined immunosuppressive effects of HIV-VL.
Adherence to combination antiretroviral therapy (cART ) plays an important role on treatment outcomes. The TREAT Asia Studies to Evaluate Resistance – Monitoring Cohort Study (TASER-M) collects patients’ adherence based on a Visual Analogue Scale. The aim of this analysis was to assess the rates of, and factors associated with, suboptimal adherence in the first 24 months of initial cART in Asian patients.
Early first sexual intercourse has been proposed as an important marker of later sexual and reproductive health. Discussions of what constitutes early sexual debut in this context, however, have been limited.