Implementing a clinical pathway for diagnosing and treating acute HIV infection among key populations attending sexual health clinics in Indonesia: cohort profile of the INTERACT study

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ABSTRACT Background To reduce the high HIV incidence among key populations in Indonesia, we implemented a clinical pathway for screening, diagnosis and treatment of acute HIV infection (AHI) in sexual health clinics in Jakarta and Bali. This paper presents a cohort profile and analysis of baseline data on the study uptake, diagnostic yield, and estimated AHI prevalence and screening cascade outcomes. Methods We performed a baseline analysis of 1879 individuals who underwent AHI screening at three sexual health clinics in Jakarta and Bali between May and December 2023, comprising a risk-score assessment, fourth-generation antibody/p24 antigen-based rapid diagnostic test (RDT; Abbott Determine HIV Early Detect) and HIV-PCR (Xpert) testing. Results Median age was 27 years (IQR24-31), and 75.4% were male. Men who have sex with men (MSM) accounted for 50.4%, clients of sex workers 20.1%, and sex workers 5.2%. Of 1866 participants tested at study enrolment, 113 (6.1% [113/1866]) had chronic HIV (antibody-positive) and 6 (0.34% [6/1748]) had AEHI. HIV-PCR testing led to a 5.3% (95%CI1.9-11.2) increase in confirmed HIV diagnoses. The number needed to test to detect one AEHI case was 291 (1748/6) overall and 169 (842/5) among MSM. Overall HIV and AHI prevalence was 6.4% (95%CI 5.3-7.6; 119/1866) and 0.34% (95%CI0.12-0.74; 6/1748) overall; and 10.8% (95%CI8.9-13.0; 102/940) and 0.53% (95%CI 0.17-1.2; 5/940) among MSM. The Abbott Determine HIV Early Detect RDT only detected 2 (18.2%) of 11 AEHI cases. 113 (95.0%) newly diagnosed individuals were linked to care and started ART, of whom 75 (66.4%) on the same day and 104 (92.0%) within a week (median 0 days, range 0-93). Conclusion AHI screening, diagnosis and prompt treatment is feasible among high-risk urban MSM in Indonesia. Further evaluations are needed to estimate clinical impact and cost-effectiveness of AHI screening in this setting. The study continues accrual and follow-up, and provides a platform for future immuno-virological, social science, and intervention studies in Indonesia.

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