Publikasi / Jurnal Internasional

Antiretroviral drug switches to zidovudine-based regimens and loss to follow-up during the first COVID-19 lockdown in Bali, Indonesia

  • 06 April 2022

Keerti Gedela, Ngurah Rajus, Hendry Luis, Wayan Dede Fridayantara, Irwanto, Evi Sukmaningrum, Frank Stephen Wignall.

International lockdowns during the COVID-19 pandemic impacted antiretroviral drug supplies in Indonesia. We assessed the impact of antiretroviral treatment (ART) provision and being lost to follow-up (LTFU) on people living with HIV, attending a key population-focused HIV clinic in Denpasar, Bali. 

We are using retrospective note review of anonymized data from adult Indonesian patients living with HIV. We collected demographic data and information on being LTFU, and assessed the numbers of patients impacted by ART switches from fixed-dose combination (FDC) tenofovir/lamivudine/efavirenz to multi-pill zidovudine-based regimens, during the first international lockdown from March 2020.

Records of 260 Indonesian adult patients registered for HIV care and prescribed ART were reviewed; 240 (92.3%) were men, and 90% were men who have sex with men. Between 13 March and 28 May 2020, 214 (87%) out of 247 patients (previously diagnosed with HIV) had to switch to individual, multi-pill zidovudine-based regimens from their FDC. The switch lasted a mean of 35 days (range 10–85). Twenty-five patients (10%) were LTFU; patients who switched were more likely to remain in care. Data on viral load status and toxicity are lacking as laboratory testing requires self-payment.

The majority of patients living with HIV had no choice but to switch to multi-pill, zidovudine-based regimens. Despite significant efforts to minimize the impact of lockdown on care, 10% of patients were LTFU. Patients switching ART required greater clinic attention and support, improving retention. Complete national data are needed to understand the impact of ART stockouts on virological suppression and drug resistance throughout Indonesia.


Karantina internasional selama pandemi COVID-19 berdampak kepada stok obat antiretroviral di Indonesia. Kami meninjau dampak dari persediaan stok ARV di Indonesia hingga orang dengan HIV yang menunda hingga menghentikan (Lost to follow-up; LTFU) perawatan ARV-nya di Denpasar, Bali, Indonesia.

Kami mengumpulkan data demografis dan informasi mengenai LTFU, dan meninjau jumlah pasien yang terdampak oleh perubahan ART dari campuran tenofovir/lamivudine/efavirenz dengan dosis tetap (fixed-dose combination; FDC) menjadi multi-pill berbasis zidovudine. Data dikumpulkan selama karantina internasional pertama sejak Maret 2020.

Sebanyak 260 pasien dewasa Indonesia teregistrasi untuk perawatan HIV dan diresepkan ART ditinjau; 240 (92.3%) adalah laki-laki, dan 90% adalah lelaki seks dengan lelaki (LSL). Antara 13 Maret dan 28 Mei 2020, sebanyak 214 (87%) dari 247 pasien dengan HIV harus beralih ke multi-pill berbasis zidovudine. Peralihan terjadi selama rata-rata 35 hari (berjarak 10-85 hari). Dua puluh lima pasien adalah LTFU; pasien yang beralih cenderung untuk tetap dalam perawatan HIV. Data mengenai status viral load tidak mencukupi karena biaya tes laboratorium ditanggung individu.

Mayoritas pasien dengan HIV tidak punya pilihan selain beralih ke multi-pill berbasis zidovudine. Meskipun ada upaya signifikan untuk mengurangi dampak dari menunda untuk perawatan sebagaimana 10% pasien adalah LTFU. Pasien yang beralih membutuhkan perhatian dan dukungan klinik yang lebih besar untuk melanjutkan perawatan. Data nasional yang lengkap diperlukan untuk memahami dampak kehabisan ART terhadap penekanan virologi dan resistensi obat di seluruh Indonesia.