TB/HIV:

Public-Private Partnership for

MARGs in Jakarta, Indonesia
Dr Flora Tanujaya, MSc
Senior Clinical Officer, FHI Indonesia

Dr Halim Danusantoso*, Dr Wia Melia*, Dr Janto G Lingga **,

Dr Chawalit Natpratan***, Robert J Magnani***, Julietty Leksono***,
Kekek Apriana***

* Indonesian Tuberculosis Control Association, Jakarta Branch, Indonesia

** Dr Sulianti Saroso Infectious Disease Hospital, Jakarta, Indonesia
*** Family Health International – Indonesia, Aksi Stop AIDS Program
Outline of Presentation

• Context
• Partners
• Background
• Program
• Outcome
• Recommendation
Context
• Indonesia: 3rd world rank re TB incidence

• HIV epidemic: concentrated in MARGs

• TB is observed: most common OI/co-infection reported in Indonesia

(MoH), cause of 40% death among PLHA

• Routine TB screening among PLHA has not been emphasized in

National CST Guideline. But more often done

• National TB-HIV coordination is stronger since 2007

Partners

• Indonesian Tuberculosis Control Association

(PPTI) – private non profit. TB clinic serving
urban poor; popular among MARGs

• Dr Sulianti Saroso Infectious Diseases

Hospital (RSPI), Public Hospital in North
Jakarta

• FHI and donors (governmental, personal,

private company, community associations)
Background
• PPTI saw increasing non-specific PTB &
EPTB and wondered ‘Could it be HIV?’

• 2003: 10 TB-HIV (self reported by patients)

• Early ‘04: capacity building efforts (FHI-

USAID, IHPCP-AusAID)

• 1 Sept 04: VCT service started at TB clinic,

supported by FHI-USAID
Program – The 1st of its kind in Indonesia
New TB patients

Pre test
HIV Education Session counseling

TB screening HIV test

Follow up interventions:

- TB DOTS & nutrition support at PPTI Post test

- HIV psychosocial support at PPTI counseling
- HIV care & treatment referred / at PPTI
- Follow up for HIV (-) with HIV prevention referred
Program (2)
All TB-HIV cases:
1. Pay ID card 0.5 USD + Chest X-Ray 3 USD (can be waived)
2. Food supplement from WFP
3. Free DOTS for 6 months from NTP.
4. Free additional 3 months OAT (personal donors / adopters)
5. Case management service (psychosocial support, home visit)
6. Mobile DOTS dispensing (radius 70 km)
7. Care & Treatment for HIV referred to nearby hospitals 2004.
Starting February 2005, provided at PPTI
8. Secondary prophylaxis

One-stop TB-HIV services for urban poor MARGs

 Outcome
VCT at PPTI Jakarta, Sept-Dec 2004

New Patient 1371

Challenges:
HIV Education Session 749
1. Limited availability of
HIV education
Pre Test Counseling 206 session
(daily: 8-9 and 9-10
am)
Tested 196
2. Selective referral to
VCT, based on
Post Test Counseling 196 clinical criteria
3. No CST follow up on
Reactive Result 39
site, referral only

0 200 400 600 800 1000 1200 1400 1600

 Program Modification & Outcome (1)
VCT at PPTI Jakarta, Jan-Dec 2005
Modification 1:
New Patient 4106
1. “Opt in” strategy
applied
HIV Education Session 2177
2. HIV care and
treatment provided
Pre Test Counseling 692
at PPTI as RSPI’s
“satellite”
Tested 681

Challenge: Post Test Counseling 640

1. Limited availability of
HIV education session Reactive Result 168

2. Is it time for “opt out”?

0 500 1000 1500 2000 2500 3000 3500 4000 4500
Program Modification & Outcome (2)
VCT at PPTI Jakarta, Jan-Dec 2006
Modification 2:
Ne w Pa tie nt 4658

HIV education session

using audiovisual HIV Ed uca tio n Se ssio n 4658

tools (donation from

private for profit Pre T e st Co unse ling 1431

company), more
availability T e ste d 1401

Free ketoconazole Po st T e st Co unse ling 1332

donation from a
women’s association Re a ctive Re sult 245

0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000
 Outcome (3)
VCT at PPTI Jakarta, Jan-May 2007
Proportion of Female
New Patient 1826 PLHA:

2004: 8%
HIV Education
1826
Session

2005: 16%
Pre Test Counseling 755
2006: 20%
2007: 20%
Tested 747

Proportion of Female New

Post Test Counseling 675
Patients
2006: 39%
Reactive Result 143
2007: 42%
0 200 400 600 800 1000 1200 1400 1600 1800 2000
 What’s next?
• National Policy, Framework, and Guidelines are
needed.
• This model can become learning site for decision
makers as well as other service providers
• It is time for “opt out” strategy at PPTI and others of its
kind
• The model service should be brought to scale: serving
patients’ best interest, comprehensiveness,
responsiveness, multi-party collaboration under one
roof and coordination mechanism