Care Disengagement Prevention in PLWH in Indonesia

Care Disengagement Prevention in Treatment Naive Indonesians Living With HIV

This study is being done because the investigators want to learn about how stigma and culture in Indonesia affects how much contact people living with HIV have with the healthcare system and also how it might affect their health status.

Study Overview

• Status: Recruiting
• Conditions: HIV; Stigma; Engagement in HIV Care; Indonesia
• Intervention / Treatment: Behavioral: Stigma reduction

Detailed Description

This project focuses on an innovative evidence-based stigma-reduction intervention that addresses HIV care engagement, which is key for reducing HIV transmission. This work is directly relevant to the U.S., including the Ending the HIV Epidemic (EHE) initiative, as stigma remains a key barrier to care engagement across variable populations. U.S. communities, including faith-based populations, need to strengthen retention across the HIV care continuum to reduce HIV transmission and eventually eradicate HIV infection from the U.S. However, there is a dearth of information related to strategies to reduce HIV stigma among Muslims who are living with HIV in the U.S., who are both widely distributed and in concentrations that make studies impossible to carry out over short time frames. As the world's largest Muslim-majority country, accounting for 13% of the global Muslim population, Indonesia provides a critical context for developing culturally grounded stigma-reduction interventions to improve HIV treatment engagement. In Asia, the population size of people living with HIV (PLH) in Indonesia is second only to that in India and China. According to recent estimates from UNAIDS, while there were an estimated 540,000 PLH in Indonesia in 2022, only 179,659 (33.27%) were reportedly on antiretroviral therapy (ART), 36,821 (6.82%) were regularly tested for viral load, and 33,395 (6.18%) achieved viral suppression. The majority of Indonesian PLHs are lost across the HIV care continuum, even after the government's Strategic Use of Antiretroviral Therapy program launched in 2013. The reasons for this failure to retain PLH in care include insufficient knowledge and limited accessibility and affordability of care, but the most prominent barrier is the fear of stigma. Stigma not only deters PLH from seeking care but also strains patient-provider relationships. Indeed, stigma is considered the greatest barrier to ending HIV in Indonesia whose cultural meanings surrounding HIV are rooted in the local "religious-familial" complex. The scientific premise is that HIV stigma remains rampant in Indonesia, where Islamic doctrine is prominent, with severe negative impacts on treatment engagement. This study addresses the critical need to increase treatment engagement among PLH and retain them in care by addressing the stigma surrounding HIV. Study aims are to adapt an evidence-based stigma reduction intervention and to test the feasibility, acceptability, and preliminary efficacy of the adapted intervention for stigma reduction and care engagement in a Muslim-dominant population. This study will provide transferable insights to inform stigma-reduction strategies and improve HIV care engagement in the U.S. context. The project's key innovations are culturally grounded modules informed by Islamic teachings on justice, compassion, and mindful prayer, while employing a nurse-led, low-intensity, four-session intervention model designed for scalability in resource-poor settings in the U.S. The project findings will advance the understanding of stigma reduction tools used to prevent leakage from the HIV care continuum and ultimately help protect the health of Americans.

• Study Type: Interventional
• Enrollment (Estimated): 110
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Wei-Ti Chen, RN, CNM, Ph.D., FAAN; Phone Number: 310-206-8539; Email: wchen@sonnet.ucla.edu

Study Locations

• Indonesia
  • West Java
    • Depok, West Java, Indonesia, 16424
      • Recruiting
      • University of Indonesia Hospital
      • Contact: Wei-Ti Chen, RN, CNM, PhD, FAAN; Phone Number: 310-206-8539; Email: wchen@sonnet.ucla.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Living with HIV
• Able to give informed consent
• Able to attend study visits

Exclusion Criteria:

• Condition that prevents full participation in the study such as neurological disease, major depression or cardiovascular disease
• Unable to communicate

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Stigma reduction; Participants receive a stigma-reduction intervention that has been adapted for use in the target population.	Behavioral: Stigma reduction; The study intervention was adapted for stigma reduction and care engagement in a Muslim-dominant population.
No Intervention: Treatment as Usual; Participants receive typical services including care co-ordination and linkage to public health nurses in local communities.
No Intervention: Interview group; With the goal of culturally adapting an existing intervention for use among people living with HIV from Indonesia, in-depth interviews are conducted with Indonesians living with HIV. Participants in the interview group are not followed for outcomes or AEs.
No Intervention: Focus Group; Focus groups made up of Indonesians living with HIV are presented the adapted intervention. Feasibility, acceptability, and appropriateness are assessed that inform the final version of the adapted intervention for use in the target population. Participants in the focus group are not followed for outcomes or AEs.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Perceived Stigma Score From Baseline to End of Intervention	The Perceived Stigma Scale (PSS) of the HIV Stigma Scale will be used to measure perceived stigma. Each item is measured using a 4-point Likert scale and the scale contains four factors: personalized stigma (18 items, subscore total 18-72), disclosure concerns (12 items, subscore total 12-48), negative self-image (9 items, subscore total 9-36), and concern with public attitudes about people with HIV (12 items, subscore total 12-48). Each factor is scored separately, with total score is computed by summing all 40 items, with a minimum total PSS score of 40 and a maximum possible score of 160. Raw PSS scores were transformed into Stigma scores 1-4. Higher scores reflect higher levels of perceived stigma.	Baseline to 26 weeks
Change in Adherence From Baseline to End of Intervention	A one-item visual analog scale assesses 30-day HIV medication adherence, reported separately for each drug, along a continuum of "none of the doses" to "every dose." The maximum possible score for an individual drug item is 100 (representing 100% adherence, or "every dose"). Each drug is scored separately, with total score computed by summing all items, with a minimum total score of 0 (no medications taken) and a maximum possible score depending on the total number of medications in the participant's specific HIV regimen. Higher scores reflect higher levels of HIV medication adherence.	Baseline to 26 weeks
Level of Healthcare Engagement From Baseline to End of Intervention as Measured by Missed or Delayed Clinic Visits	Proportions of missed or delayed clinic visits for HIV care will be calculated for each participant. Minimum scores are 0 (missed or delayed zero scheduled appointments) and maximum score is 1 (missed or delayed every single scheduled appointment). The score is derived by dividing the number of missed/delayed visits by the total number of scheduled visits for that specific participant. Higher scores indicate lower levels of HIV healthcare engagement.	Baseline to 26 weeks
Changes in Patient Activation from Baseline to End of Intervention	The Patient Activation Measure-Short Form will be used to measure knowledge, skill, and confidence managing health. Statements are rated on a 4-point scale from "strongly disagree" to "strongly agree". Scores range from 0 to 100, which corresponds to one of four activation levels: Level 1 (0-47.0), Level 2 (47.1-55.1), Level 3 (55.2-72.4) and Level 4 (72.5-100). Higher levels means greater patient activation.	Baseline to 26 weeks
Change in Internal Stigma Score From Baseline to End of Intervention	Negative Image subscale of the HIV Stigma Scale will be used to detect internal stigma. The negative self-image subscale assesses an individual's negative feelings towards oneself due to HIV. The subscale uses a 4-point Likert scale that consists of items that ask respondents to rate their level of agreement (from strongly disagree to strongly agree) with statements related to self-worth. Total maximum score of the scale is 52 and minimum score is 13. Lower scores reflect better self-image.	Baseline to 26 weeks

Collaborators and Investigators

• Sponsor: University of California, Los Angeles
• Collaborators: Fogarty International Center of the National Institute of Health; Rumah Sakit Universitas Indonesia; Jaringan Indonesia Positif

Study record dates

Study Major Dates

• Study Start (Actual): February 11, 2026
• Primary Completion (Estimated): January 31, 2028
• Study Completion (Estimated): January 31, 2028

Study Registration Dates

• First Submitted: July 11, 2026
• First Submitted That Met QC Criteria: July 11, 2026
• First Posted (Actual): July 16, 2026

Study Record Updates

• Last Update Posted (Actual): July 17, 2026
• Last Update Submitted That Met QC Criteria: July 15, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: HIV; Stigma reduction
• Additional Relevant MeSH Terms: Behavior; Social Behavior; Social Stigma
• Other Study ID Numbers: IRB-25-1193; 1R01TW013110 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: Data available upon reasonable request.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No