Friday, May 16, 2025
5/16/2025
Prison-Based HIV Partner Notification in Indonesia - Abstract This R01 application responds to PAR-23-062: Innovations to Optimize HIV Prevention and Care Continuum Outcomes. In Indonesia, an estimated 33% of people with HIV (PWH) are undiagnosed. Interventions are needed to increase timely HIV testing and diagnosis among people who have come into contact with the virus. Assisted partner notification (APN) is a voluntary process that utilizes health workers to encourage and assist people diagnosed with HIV to inform their former sex and drug use partners about possible shared exposure to HIV. When carried out in community care settings, APN increases partner notification and HIV testing with safety and effectiveness. Our research will demonstrate APN”s benefits among people in prison care settings, who face additional barriers to informing their numerous at-risk and mostly female partners in the community. A hybrid type I effectiveness-implementation design will be used to evaluate Impart, a prison-based APN model that we developed and successfully pilot-tested in Indonesia to encourage and assist IPWH to inform their former sex and drug-injecting partners in the community about possible exposure to HIV. With Impart, community health workers are trained to work in prisons as APN Counselors to coach inmates to self-notify partners, or, if inmates prefer, APN Notifiers will notify partners anonymously (without identifying the index) and offer them HIV testing and treatment referrals. In our pilot study, APN was preferred by inmate participants to notify partners and also proved the more successful in generating new HIV testing and in identifying and referring partners with previously undiagnosed HIV. The proposed research will introduce Impart at 8 Indonesia correctional facilities to evaluate its effectiveness to increase partner notification and HIV testing (Aim 1), while also evaluating Impart's reach and organizational sustainability across a range of prison contexts (Aim 2). A randomized trial with 216 incarcerated PWH and up to 450 sex and drug-injecting partners will compare our Impart model (choice of APN or self-tell for each partner) with a self-tell notification only condition that is aligned with international guidelines. As outcomes, we will compare the number of partners who are HIV tested, newly diagnosed, and linked to HIV care within 6 weeks. We will train and mentor 12 community health workers as APN Counselors and Notifiers to deliver Impart during the study's randomized trial phase. As indicators of implementation success, we will examine Impart's reach, fidelity, and sustained implementation by Impart service providers and clinic staff at each prison facility for one year after the randomized trial phase ends. Qualitative interviews and other data collected at each implementation phase will be used to evaluate prison-based contextual factors associated with varying levels of implementation success. This study will yield a prison-based APN model for adoption in prison settings in Indonesia and possibly elsewhere to increase HIV testing and earlier diagnosis among at-risk partners of inmates. The study addresses priority areas within the NIH Office of AIDS Research and the NIMH Strategic Plans for HIV-related Research and also the trans-NIH plan to Advance Science for the Health of Women (2019-2023).
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