03 January 2020
Indonesia continues its progress towards malaria elimination, the majority of the country having officially been declared malaria-free. There has been a 50% reduction in confirmed cases and a 66% reduction in malaria-related deaths. The country’s case notification outcomes for presumptive TB increased by 24% between 2017 and 2018, and the number of key affected populations tested for HIV is steadily increasing. Indonesia however remains far from reaching the UNAIDS 90-90-90 target.
Improvements are needed in grant design if HIV and TB program targets for 2020 are to be achieved. The HIV grants are yet to include a plan to increase the number of facilities conducting both testing and treatment, a critical component of rolling out the ‘test and treat’ policy to improve treatment rates. Grant interventions to scale up viral load coverage have been developed, but are yet to be implemented. Referral systems and information sharing between public sector facilities and civil society organizations are weak for HIV, TB and HIV/TB collaboration activities. The TB grants do not adequately address the scale-up of the public/private mix and treatment of MDR-TB patients.
There are inefficiencies in programmatic implementation. For HIV, there are delays in rolling out innovative outreach and prevention activities. The test and treat policy is not fully implemented, and monitoring of patients on treatment is not effective, resulting in high treatment drop-out. There is a need to improve TB contact tracing activities to increase case finding, treatment initiation (especially for MDR-TB), and to improve utilization of GeneXpert diagnostics to leverage the technology for HIV viral load testing. Weaknesses were noted in Principal Recipient supervision of sub- and sub-sub-recipients.
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