In addition to the preparation of PROACTIVE primary and additional manuscripts previously mentioned, we are also conducting a scoping review on HIV research in Indonesia since the first HIV case was reported in the country in 1987. The goal is to comprehensively understand HIV research in Indonesia and identify gaps where further research is needed. This activity involves INA-RESPOND Secretariat staff and Warm-based Research Assistants from all sites. We found around 1,500 international publications covering all aspects of HIV, from epidemiology and laboratory to clinical and socio-behavioral studies. Our first scoping review project focuses on research concerning children living with HIV in Indonesia. The articles involving pediatric patients were screened, categorized, and later selected for discussion. This review will support the preparation of a PROACTIVE manuscript on pediatric subjects.

INA-RESPOND Secretariat Staff, along with Research Assistants (RAs), have established an “HIV Journal Club.” This club meets online every two weeks to discuss selected HIV articles conducted in Indonesia to keep abreast of current knowledge, learn to critique and appraise research and enrich references for manuscript writing. Site investigators, Secretariat staff, and RAs attend the meetings. RAs, in turn, present the articles and lead the ensuing discussion.

The background of this study highlights the critical need to maintain effective antiretroviral therapy (ART) and its association with an adequate virological response. Managing children and adolescents living with HIV presents substantial challenges, notably in sustaining effective ART. Significant threats to this endeavor include poor treatment adherence and drug resistance. HIV viral load testing is the preferred method for monitoring the response to ART and serves as an essential tool for identifying issues with treatment adherence and drug resistance. Currently, virologic failure has been reported in 25–34% of children and adolescents receiving ART. A better understanding of virologic failure in pediatric populations is crucial as it will guide the development and implementation of interventions, thereby optimizing the durability of ART regimens, improving HIV outcomes, and aiding in achieving the UNAIDS target of viral suppression.

The study aimed to describe the incidence of virologic failure and identify its associated factors within the TREAT Asia pediatric HIV Observational Database (TApHOD) cohort, a regional study in South and Southeast Asia. Virologic failure is defined as at least one HIV viral load of ≥1,000 copies/mL following virologic suppression, achieved after receiving six months of continuous combination ART (cART) in conjunction with a documented HIV viral load of <400 copies/mL 5–12 months after beginning continuous cART. Conducted in an Asian cohort across 16 pediatric HIV services in six countries (Cambodia, India, Indonesia, Malaysia, Thailand, and Vietnam) from 2005 to 2014, the study analyzed patients under 20 years who achieved virologic suppression and underwent subsequent viral load testing. It presented participants’ characteristics at the initiation of cART and upon virologic suppression, the cumulative incidence of virologic failure, and the factors at virologic suppression associated with early and late virologic failure. Early virologic failure is defined as occurring ≤12 months from the initial virologic suppression, while late virologic failure occurs >12 months after.

Among the 1,105 individuals analyzed, 182 (17.9%) experienced virologic failure. The median age at virologic suppression was 6.9 years, and the median time to virologic failure was 24.6 months post-suppression. The incidence rate for a first virologic failure event was 3.3 per 100 person-years. Factors associated with late virologic failure at the time of virologic suppression included older age, treatment in predominantly rural clinic settings, a his-tory of tuberculosis (TB), the use of protease inhibitor (PI)-based regimens, and previous early virologic failure. No risk factors were pinpointed for early virologic failure. Approximately one in five children and adolescents in the cohort experienced virologic failure at a median time of 2 years after achieving virologic suppression. Factors such as older age at the initiation of cART, a history of TB co-infection, the use of PI-based regimens, treatment in rural clinic settings, and a history of early virologic failure were linked with long-term virologic failure. To meet the UNAIDS target, there is a necessity to improve the capacity for early HIV diagnosis and the initiation of cART in HIV-exposed infants and children, conduct regular HIV viral load testing, and implement targeted interventions to manage complex treatment scenarios, including those involving adolescents, TB co-infection, and cases of poor virologic control.

As of February 12, 2024, all 700 participants (100%) who enrolled in the study have completed their participation. The study was conducted at three different sites: Site 01 com-pleted Visit 5 on January 24, 2024; Site 02 (TC Hillers Hospital) completed Visit 5 on November 16, 2023; and Site 03 (Dr. Ansari Saleh Hospital) completed Visit 5 on January 4, 2024. The details of the visits for each site are listed in Table 1.

Out of the 700 participants who ended their participation, 639 (91.29%) completed the study, while 44 (6.29%) withdrew. Reasons for withdrawal included decisions by participants, personal reasons, or loss of interest. Additionally, three (0.43%) participants were excluded from the study because they did not receive the complete vaccine regimen within 12 months of enrollment. Two (0.29%) participants were not allowed to continue as it was not in their best interest, and one (0.14%) participant was non-compliant with study procedures. Regrettably, one (0.14%) participant passed away during the study, and ten (1.43%) participants had other reasons for ending their participation.

The study has also been monitoring symptomatic visits among participants. Table 2 provides details of these visits as of February 12, 2024. It is important to emphasize that while some participants have experienced symptoms of COVID-19, this does not necessarily indicate that they have contracted the virus.

As of January 25, 2024, the Material Transfer Agreement has been approved by Kepala Badan Kebijakan Pembangunan Kesehatan (BKPK) / Health Policy Agency. INA-RESPOND and NIAID are currently discussing preparations for shipping specimens from the Reference Laboratory to the Central Laboratory.

Table 1. Details of Visits per site per Feb 12, 2024

Table 2. Symptomatic Visit Details per Feb 12, 2024