Dona Arlinda, Evy Yunihastuti, Agnes Rengga Indrati, Tuti Parwati Merati, Emmanuelle Papot, Deborah Cromer, Aly Diana, Adhella Menur Naysilla, Riza Danu Dewantara, Nugroho Harry Susanto, Nurhayati Lukman, Wayan Adi Pranata, Herman Kosasih, Dewi Lokida, Muhammad Karyana, Teguh Sarry Hartono, Gede Rai Kosa, Deborah Theresia, Dwiana Savitri, Dwi Kurniawan Nugroho, Eppy Eppy, Made Susila Utama, Kurnia Fitri Jamil, Ivan Lumban Toruan, Nelly Elfrida Samosir, Sudirman Katu, Nur Farhanah, Sri Wahyunie, Musofa Rusli, Widya Amalia Swastika, Willy Anthony Ignatius Wullur, Yanri Wijayanti Subronto, C. Jason Liang, Renee Ridzon, Ray Y. Chen, Aaron T. Neal, Rudi Wisaksana, Anggraini Alam, Syndi Nurmawati, Nurul Hidayah Chairunnisa, Octavia Kartika Dwi, Hofiya Djauhari, Sigit Sunarko, Tuti Parwati Merati, Ketut Agus Somia, Made Susila Utama, Ni Made Dewi Dian Sukmawati, Anak Agung Yuli Gayatri, Ketut Dewi Kumara Wati, Anak Agung Wiradewi Lestari, Ni Nengah Dwi Fatmawati, Ni Luh Putu Ariastuti, Ni Putu Satriawati, Ni Ketut Lestari, Ni Wayan Desi Jumanti, Ni Nyoman Setiani, Gede Purinawa, Desak Putra Artini, Ni Nyoman Seri Sutarni, Nia Kurniati, July Kumalawati, Fadlika Harinda, Tiara Kumala Putri, Madyaningati, Wusthi Ali Chasanah, Desrinawati Muhammad Amin, Adria Rusli, Nisrina Fatin Mardiyah, Ayu Reskianingsih, Evi Hindawati, Fitriani, Ninny Meutia Pelupessy, Munawir, Asvin Nurulita, Dhiny Reskita Ayu, Rizky Auliah Bakri, Muhammad Fiqhi Hardiansyah, Dewi Sriyanti, Kartini, Nasruh Nurdin, Andi Tessyoja, Muchlis Achsan Udji Sofro, Nahwa Arkhaesi, Muji Rahayu, Rohedy Adlina, Erni, Trie Wahyuningtias, Bayu Sampurmantoro Kusumo, Ngatno, Usman Hadi, Dwiyanti Puspitasari, Munawaroh Fitriah, Muhammad Vitanata Arfijanto, Bramantono, Musofa Rusli, Myrna Evanda Adeline, Rifaaah Rosyiidah, Misutarno, Yuanita Bahar, Diah Wahyuni, Hera Nirwati, Ida Safitri Laksanawati, Umi Solekhah Intansari, Vitia Ajeng Nur Linda, Diajeng Gayatri Kusumaningtyas, Siti Binzanah, Linda Oktabriana, Heidy Agustin, Fauzi Mahfuzh, Dewi Yennita Sari, Titin Dani Martiwi, Putri Permata Sari, Ariesta Putra Indoin, Susetianingsih, Tri Mulyani, Tambar Kembaren, Rita Evalina, Cicimei Putri Siregar, Iramaya Oktariana Harahap, Junita Siahaan, Ennyke Karolina Ginting, Melpinna Fretty Marpaung, Gede Rai Kosa, Chakrawati Hayuningsih, Arif Budiman, Cintya Naya Danastri, Ivana Yulian Hendarsin, Husnul Chotimah, Evi Herawati, Suyono, Wiwit Agung Sri Nur Cahyawati, Rahmawati, Priyanti Kisworini, Regina Septiana, Rizka Dwi Puteri, Lutfia Rahimah, Silvia Rahmi Astuti, Irma Meilyana Fajar Utami, Setiawati, Emon Winardi Danudirgo, Elizabeth Yohmi, Janice Tandraeliene, Cicilia Ina Prihsetyati, Lili, Danang Legowo Norosingomurti, Willy Anthony Iqnatius Wullur, Nisa Trini Asnil, Francisca Lianiwati Tanzil, Glegery Putri Hardoni, Winny Wangun Lestari Wullur, Mutamimah, Diana Sulastri, Friska Sitorus, Carta A. Gunawan, Sunarto Ang, Hendra, Andini Agustyana, Edwin Prasetya, Monika Lestari Palondongan, Heniastuti, Nursiah Mukano, Ady Achmaddany, Kurnia Fitri Jamil, Mulya Safri, Vivi Keumala Mutiawati, Muhammad Abrar Azhar, Ika Novita, Muslim, Nurul Husna, Ella Firbria, Arfajah, Muchamad Budi Nugroho, Handoko Halim, Wiwi Endang Susanti, Redha Vebrina, Ike Rahmawati, Herlina, Sudaryanto, Emy Suyanti, Made Gede Darmaja, Immaculata Purwaningsih, Justina Sembiring, Nur Yanti, Nani Emma, Sunarti, Martha Magdalena Ayer, Asep Purnama, Mario Bernardinus Realino Nara, Dwi Kurniawan Nugroho, Putri Nur Indah Sari, Ulul Azmiyah Riawan, Fransiska Mathilde, Kurniawati Handayani Koli, Stefani Marwah Tolok, Maria Yupina Yuanti, Herman Kosasih, Aly Diana, Chandra Ilham El Anwary Junior, Deni Pepy Rentina Butarbutar, Eka Windari Rusman, Lois Eirene Bang, Meity Siahaan, Melinda Setiyaningrum, Nada Ariqa, Nugroho Harry Susanto, Nur Latifah Hanum, Nurhayati Lukman, Restu Amalia Mukti, Rizki Amalia Sari, Tiya Saraswati, Virtania Meirina Agusta, Wahyu Nawang Wulan, Ray Y. Chen, Aaron T. Neal, Renee Ridzon, Chuen-Yen Lau, Louis Grue, Jacqueline Perodin, Katie Watkins
Background People living with HIV (PLWH) presenting with advanced HIV have worse outcomes than those diagnosed earlier. The proportion of PLWH in Indonesia who are late presenters is unknown but likely high. Identifying factors associated with late presentation is key to earlier diagnosis and intervention. Methods Adult PLWH were enrolled at 19 centers across Indonesia (2018–2020) in the INA-PROACTIVE observational cohort study. Late presentation was defined as having a CD4+ count <350 cells/μl within 3 months of diagnosis. Risk factors were assessed using multivariable logistic regression. Findings Among 3201 eligible participants, 2790 (87·2%) were late presenters. High proportion of late presenters was observed from 2015 to 2019 (83·3%–89·8%). Characteristics associated with late presentation included age 30–39 (aOR = 1·47, 95% CI: 1·15–1·90) or age ≥40 (aOR = 1·71, 95% CI: 1·21–2·46) vs. age 18–29; male sex (aOR = 2·93, 95% CI: 2·07–4·24); diagnosis in ≤2015 (aOR = 1·45, 95% CI: 1·12–1·89); and diagnosis through Provider-Initiated Testing and Counseling (aOR = 2·38, 95% CI: 1·86–3·04) vs. Voluntary Counseling and Testing (VCT). Suspected MSM transmission was associated with lower odds of late presentation (aOR = 0·57, 95% CI: 0·39–0·82) compared to heterosexual transmission. Interpretation Late presentation remains highly prevalent in Indonesia. Expanded efforts are needed to promote testing among those at risk. Targeted interventions for older adults, men, and non-MSM populations, alongside VCT and MSM-focused programs, may help reduce late HIV diagnosis and improve early management. Funding This project has been funded in whole or in part with Federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health , under contract No. 75N91019D00024 Task orders 75N91020F00004, 75N91020F000012. © 2026 The Author(s).
Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Jl. Percetakan Negara No.29, Kec. Johar Baru, Kota Jakarta Pusat, Daerah Khusus Ibukota Johar Baru, Jakarta, Indonesia; Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Kenari, Kec. Senen, Daerah Khusus Ibukota Kota Jakarta Pusat, Jakarta, Indonesia; Faculty of Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Jl. Pasteur No.38, Bandung, Indonesia; Department of Internal Medicine, Faculty of Medicine, Udayana University, Jl. P.B Sudirman, Bali, Denpasar, Indonesia; The Kirby Institute, University of New South Wales, Sydney, Australia; Sulianti Saroso Infectious Disease Hospital, Jalan Baru Sunter Permai Raya, Tanjung Priok, Jakarta Utara, Indonesia; Tangerang District Hospital, Jalan Ahmad Yani No.9, Tangerang, Indonesia; St. Carolus Hospital, Jl. Salemba Raya No 41, Central Jakarta, Indonesia; Dr. Moch. Ansari Saleh Hospital, Jl. Brigjend H.Hasan Basri no. 1, Banjarmasin, Indonesia; Dr. T. C. Hillers Public Hospital, JI. Wairklau No.1, Kota Uneng, Kec. Alok, Kabupaten Sikka, Nusa Tenggara Timur, Indonesia; Persahabatan Central General Hospital, Jalan Persahabatan Raya No. 1, Rawamangun, Pulo Gadung, Daerah Khusus Ibukota Kota Jakarta Timur, Jakarta, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Udayana, Jl. Diponegoro, Denpasar, Indonesia; Dr. Zainoel Abidin Hospital/Faculty of Medicine, Universitas Syiah Kuala, Jl. Tgk. Daud Beureueh No. 108, Bandar Baru, Kuta Alam, Kota, Banda Aceh, Indonesia; Soedarso General Hospital, Jl. Dr. Soedarso No. 1, Pontianak Tenggara, Kalimantan Barat, Kota Pontianak, Indonesia; Adam Malik Hospital, Jl. Bunga Lau No. 17, Kemenangan Tani, Medan Tuntungan, Medan, Indonesia; Wahidin Sudirohusodo General Hospital, Faculty of Medicine, Hasanuddin University, Jalan Perintis Kemerdekaan No.Km.11, South Sulawesi, Makassar, Indonesia; Department of Internal Medicine, Universitas Diponegoro/Dr, Kariadi Hospital, Jalan Dr Sutomo No. 16-18, Jawa Tengah, Semarang, Indonesia; Faculty of Medicine, Abdoel Wahab Sjahranie General Hospital, Universitas Mulawarman, Jl. Palang Merah Indonesia No 1, Samarinda, Indonesia; Department of Internal Medicine, Universitas Airlangga/Dr, Soetomo General Academic Hospital, Jalan. Prof. Mayjend. Dr. Moestopo 6 – 8, Surabaya, Indonesia; Abepura Regional General Hospital, JI. Kesehatan No.1, Abepura, Jayapura, Indonesia; Budi Kemuliaan Hospital, JI. Budi Kemuliaan No.1 Kel. Kp. Seraya, Kee. Batu Ampar, Batam, Indonesia; Department of Internal Medicine/Magister of Tropical Medicine Study Program, Universitas Gadjah Mada, Dr Sardjito General Hospital, JI. Farmako Sekip Utara, Radioputro Building 3rd Floor, Sleman, Yogyakarta, Indonesia; National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5601 Fishers Lane, Rockville, MD, United States; Dr. Hasan Sadikin General Hospital/Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia; Ngoerah Hospital/Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia; Cipto Mangunkusumo Hospital/Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia; Prof. Dr. Sulianti Saroso Infectious Disease Hospital,, North Jakarta, Indonesia; Faculty of Medicine, Universitas Hasanuddin/Dr, Wahidin Sudirohusodo Hospital, Makassar, Indonesia; Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia; Faculty of Medicine, Universitas Diponegoro/Dr. Kariadi Hospital, Semarang, Indonesia; Dr. Kariadi Hospital, Semarang, Indonesia; Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Faculty of Medicine, Universitas Gadjah Mada/Dr, Sardjito General Hospital, Yogyakarta, Indonesia; Persahabatan Central General Hospital, East Jakarta, Indonesia; Adam Malik Hospital, Medan, Indonesia; District Hospital, Tangerang, Indonesia; Dr. Moch. Ansari Saleh Hospital, Banjarmasin, Indonesia; St. Carolus Hospital, Central Jakarta, Indonesia; Budi Kemuliaan Hospital, Batam, Indonesia; Abdoel Wahab Sjahranie General Hospital, Faculty of Medicine, Universitas Mulawarman, Samarinda, Indonesia; Abdoel Wahab Sjahranie General Hospital, Samarinda, Indonesia; Dr. Zainoel Abidin Hospital/Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Dr. Soedarso General Hospital, Pontianak, Indonesia; Abepura Regional General Hospital, Papua, Jayapura, Indonesia; Dr. T. C. Hillers Public Hospital, Maumere, Indonesia; Health Policy Agency, Ministry of Health, Central Jakarta, Indonesia; Indonesia Research Partnership on Infectious Diseases (INARESPOND), Central Jakarta, Indonesia; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States; Leidos Biomedical Research, Inc, MD, United States
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