National roll out of HIV community based screening (HIV CBS) among key populations in Indonesia: assessment of early results

Background: Although progress has been made, Indonesia remains far from achieving the first “95” of the UNAIDS95-95-95 framework with only an estimated 43% of PLHIVknowing their HIV status in 2019. In response, the Indonesian Ministry of Health has revised its HIV testing guidelines to permit community-based HIV screening/self-testing using oral fluid rapid tests. National roll out of the newstrategy began in late 2021.This study assesses the early results in terms of community response, impact on HIV testing coverage, and linkage with treatment. Methods: Test kits distribution and outcome data, including linkage with confirmatory testing and as needed withtreatment, were compiled from four MoH implementing partners covering the October 2021 – March 2022 period.Distribution data were analyzed in terms of distributionmodels and modalities, as well as in terms of the characteristics of persons engaging in community screening. Testing-to-treatment initiation cascades were constructed both in the aggregate and for key population subgroups. Results: A total of 34,981 valid community screening testshad been performed by April 2022. Hotspot distribution oftest kits for assisted screening was the most common distribution mechanism (76.7% of all test kits distributed) followed by workplace distribution with assisted screening(8.4%). 95.2% of persons undergoing community screening were male, reflecting a late start in distribution tofemale sex workers. Of the persons screened, 75.8% wereMSM, 14.3% were male employees of strategically chosencompanies, 3.9% were transgendered females, 4.7% person who inject drugs, 0.9% female sex workers, and 0.3%others. 98.7% were first-time HIV testers. The HIV positivityrate in community screening was 3.6% (5.1% among transgendered females). Among persons with reactive community screening tests, 42.4% had received a confirmatory test at a health facility, and among those with reactive confirmatory tests 50% had initiated ART. The rates ofboth confirmatory testing and treatment initiation wereespecially low among FSW and male PWID. Conclusions: Community-based HIV screening is reachingpreviously under-served segments of HIV key populationsas evidenced by the high first-time tester rates. However,linkage with confirmatory HIV testing is low, as is linkagebetween confirmatory testing and treatment initiation.