HIV Awal (Early) Testing & Treatment Indonesia Project Implementing 'Test and Treat' Strategies for HIV Treatment and Prevention in Key Populations in Indonesia: a Prospective Implementation Research Study (Intervention Phase)

Description of the Each Proposed Interventions After the qualitative research, literature reviews, thorough discussions, and based on practical/ logistic considerations, there are five specific interventions that have been chosen. Each of the intervention will be presented here in the same format, i.e. rationale of the intervention, aims of the intervention, study site and key population, description of the intervention, and evaluation of the intervention.

1. ORAL FLUID BASED TESTING (SELF-TESTING) AS A STRATEGY TO OVERCOME BARRIERS OF TESTING AMONG MSM IN BALI, INDONESIA While in Indonesia facility-based HIV testing and counselling (HTC) has been available widely, studies including the HATI qualitative research found that people still worry about stigma, visibility, and social discrimination. Also some reports mentioned lack of privacy and lengthy waiting time for the result impede people to access facility based testing. Public health effort to increase testing coverage and treatment uptakes is urgently needed. Home based testing kit including oral saliva test for HIV has been available in the international market that could bring more control to the communities in finding out their HIV status. A number of studies have reported that the self-testing strategy is accepted and in many cases preferred, however there is still limited study to evaluate its effectiveness in increasing HTC and treatment uptake.

The aim of intervention : To test whether oral fluid self-testing will increase the uptake HTC in MSM and increase the number of HIV+ve MSM who are aware of their status in Bali, Indonesia Description of intervention The current HIV testing practices in Indonesia is happen in two major settings: VCT clinic settingand Mobile testing; both procedure need the health provider team in minimum consist of a doctor, a nurse, a lab technician/analyst and outreach staffs.

The intervention will be different to above practices as it will add or introduce a new option of HIV diagnosis using oral fluids rapid test that could be conducted by the clients themselves (self-testing).

1. The second year intervention will introduce provider supervised and unsupervised self-testing as an option for early HIV diagnosis among MSM community in Denpasar Bali Indonesia.
2. The intervention will be delivered by outreach workers of Kerti Praja Foundation (YKP) in Denpasar Bali. Currently there are 8 outreach workers for MSM in Denpasar. The main task of the outreach staff would be delivering health communication and education around self-testing procedures, distribute the kits to participants who received the test, supervised the test when participants choose to have supervised test, collect the used kits, conduct follow up counselling procedure of the test results including for participants who choose to have unsupervised or home-based test, and conduct referral of reactive result participants to the VCT clinics for confirmatory test and ART services.
3. Potential subjects will be approached in the outreach setting conducted by outreach workers during a standard outreach works. Every MSM will be offered HTC at VCT clinics or mobile VCT available near to their living or working areas. If the client refuse, outreach worker will offer self-testing option.
4. Steps that will take place if potential subject received the intervention i. Subjects will be given detailed information on how to use the test kit in a standardised information (brochure or video) and counselling session for the use of self-testing kit.