Nugroho Adi, Erasmus Vicki, Coulter Robert W S, Koirala Sushil, Nampaisan Oranuch, Pamungkas Wirastra, Richardus Jan Hendrik
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
School of Public Health, Medical Faculty, Lambung Mangkurat University, Banjarbaru, Indonesia.
PLoS One. 2018 Jan 17;13(1):e0191255. doi: 10.1371/journal.pone.0191255. eCollection 2018.
Little is known about the prevalence of and factors that influence retention in HIV-related care among Indonesian men who have sex with men (MSM) and transgender women (transwomen, or waria in Indonesian term). Therefore, we explored the driving factors of retention in care among HIV-positive MSM and waria in Indonesia. This cross-sectional study involved 298 self-reported HIV-positive MSM (n = 165) and waria (n = 133). Participants were recruited using targeted sampling and interviewed using a structured questionnaire. We applied a four-step model building process using multivariable logistic regression to examine how sociodemographic, predisposing, enabling, and reinforcing factors were associated with retention in care. Overall, 78.5% of participants were linked to HIV care within 3 months after diagnosis or earlier, and 66.4% were adequately retained in care (at least one health care visit every three months once a person is diagnosed with HIV). Being on antiretroviral therapy (adjusted odds ratio [AOR] = 6.00; 95% confidence interval [CI]: 2.93-12.3), using the Internet to find HIV-related information (AOR = 2.15; 95% CI: 1.00-4.59), and having medical insurance (AOR = 2.84; 95% CI: 1.27-6.34) were associated with adequate retention in care. Involvement with an HIV-related organization was associated negatively with retention in care (AOR = 0.47; 95% CI: 0.24-0.95). Future interventions should increase health insurance coverage and utilize the Internet to help MSM and waria to remain in HIV-related care, thereby assisting them in achieving viral suppression.
对于印度尼西亚男男性行为者（MSM）和变性女性（变性女性，印度尼西亚语称“瓦里亚”）中与艾滋病相关护理的留存率及影响留存的因素，人们了解甚少。因此，我们探讨了印度尼西亚艾滋病毒阳性的男男性行为者和瓦里亚人群护理留存的驱动因素。这项横断面研究涉及298名自我报告为艾滋病毒阳性的男男性行为者（n = 165）和瓦里亚（n = 133）。通过目标抽样招募参与者，并使用结构化问卷进行访谈。我们采用多变量逻辑回归的四步模型构建过程，来研究社会人口学因素、诱发因素、促成因素和强化因素如何与护理留存相关。总体而言，78.5%的参与者在诊断后3个月内或更早与艾滋病护理建立联系，66.4%的参与者得到了充分的护理留存（一旦被诊断为艾滋病毒感染，每三个月至少进行一次医疗保健就诊）。接受抗逆转录病毒治疗（调整后的优势比[AOR] = 6.00；95%置信区间[CI]：2.93 - 12.3）、使用互联网查找与艾滋病相关的信息（AOR = 2.15；95%CI：1.00 - 4.59）以及拥有医疗保险（AOR = 2.84；95%CI：1.27 - 6.34）与充分的护理留存相关。参与艾滋病相关组织与护理留存呈负相关（AOR = 0.47；95%CI：0.24 - 0.95）。未来的干预措施应提高医疗保险覆盖率，并利用互联网帮助男男性行为者和瓦里亚人群继续接受与艾滋病相关的护理，从而帮助他们实现病毒抑制。
