Incorporating acute HIV infection screening, same‐day diagnosis and antiretroviral treatment into routine services for key populations at sexual health clinics in Indonesia: a baseline analysis of the INTERACT prospective study

Introduction: Indonesia has an escalated HIV epidemic concentrated among key populations. To strengthen the care cascade, we implemented a care pathway for the screening of individuals for acute HIV infection (AHI), to achieve prompt diagnosis and antiretroviral treatment (ART) initiation, at three non‐governmental sexual health clinics in Jakarta and Bali. We assessed the AHI testing uptake, yield and prevalence, and the care cascade. Methods: This is a cross‐sectional baseline analysis of individuals (≥16 years) who presented for HIV testing and were consecutively enrolled (May 2023−November 2024). We used an AHI risk‐score self‐assessment and test algorithm comprising a fourth‐generation antibody/p24 antigen rapid diagnostic test (4gRDT; Abbott Determine HIV Early Detect) and, if negative/discordant, followed by HIV‐PCR (Cepheid Xpert) (either individual or pooled‐sample testing). AHI was pragmatically defined as having negative/discordant RDT results with positive HIV‐PCR (ISRCTN41396071). Results: Three thousand seven hundred and ninety‐seven (44.0%) of 8665 individuals were screened for study eligibility, and 3689 (97.2%) were enrolled. Median age was 28 years, and 78.2% were male. Men who have sex with men (MSM) accounted for 53.3%, clients of sex workers 19.2%, persons having a sex partner living with HIV 8.9% and sex workers 4.1%. We diagnosed 229 (6.3%; 229/3662) persons with RDT‐positive (chronic) HIV, and we additionally identified 13 persons with AHI—that is a diagnostic yield of 5.6% (95% CI 3.1−9.5; 13/229) overall, and 6.1% (95% CI 3.2−10.3; 12/198) among MSM. AHI prevalence was 0.38% (95% CI 0.20−0.65; 13/3429) overall, and 0.72% (95% CI 0.37−1.2; 12/1677) among MSM. The number of persons needed to test to identify one person with AHI was 264 (3429/13) overall and 140 (1677/12) among MSM. The 4gRDT's performance to detect AHI was poor (2/13). Most participants received their HIV‐PCR results on the same day (84.8%, 2907/3429) or within 24 hours (92.8%, 3182/3429). Of the 242 newly HIV‐diagnosed individuals, 236 (97.5%) started ART, of whom 158 (67.0%) on the same day and 215 (91.1%) within 1 week. Conclusions: We successfully implemented prompt AHI diagnosis and treatment, and identified a high AHI prevalence among Indonesian MSM. Prioritizing access to AHI testing can create opportunities for enhanced interventions to curb the HIV epidemic among key populations.