From Integration to Impact: Immediate Policy Actions to Accelerate HIV Control within Indonesia’s Primary Health Care Reform

Abstract

Background: Indonesia has reduced new HIV infections by nearly half since 2010, yet AIDS-related mortality continues to rise. This paradox reflects persistent gaps in early diagnosis, treatment initiation, retention, and strategic targeting, occurring amid Indonesia’s major Primary Health Care (PHC) reform, which involves integrated primary health care or Integrasi Pelayanan Kesehatan Primer (ILP). Evidence: Joint HIV Programme Review (JPR) 2023–2025 data show strong treatment quality once patients are retained (≈95% viral suppression among those tested), but weak cascade performance overall: only ~64% of people living with HIV (PLHIV) know their status, <50% are on antiretroviral therapy (ART), and fewer than one-third are virally suppressed. The epidemic remains concentrated among key populations nationally, while Tanah Papua exhibits a mixed-to-generalized epidemic with severe service access constraints. Policy Options: Options include maintaining vertical optimization, full facility-based integration under ILP, or a hybrid model that integrates services while preserving community-led delivery and differentiated care (preferred option). Recommendations: We propose an immediate, operational package centered on (1) a prevention shift plus retention fix; (2) accelerated ILP integration with explicit safeguards for key populations; (3) rapid ART decentralization with multi-month dispensing (MMD); (4) strategic information integration for decision intelligence; and (5) a differentiated, community-centered strategy for Tanah Papua. Implications: Acting now can bend both incidence and mortality curves, safeguard reform momentum, and align HIV control with Universal Health Coverage (UHC) goals.