Policy options to integrate HIV services into Social Health Insurance (JKN) in Indonesia

Latar belakang: Setelah sekian tahun bergantung pada sumber pendaaan luar negeri, pembiayaan Program HIV AIDS di Indonesia diharapkan menggunakan sumber pendanaan dalam negeri. Skema Jaminan Kesehatan Semesta atau Jaminan Kesehatan Nasional (JKN) yang dimulai tahun 2014 menanggung pengobatan termasuk infeksi oportunistik. Pertanyaan penelitian apakah paket manfaatnya dapat mencakup intervensi kesehatan masyarakat seperti HIV tanpa menghambat penyediaan pelayanan? Implementasi untuk Program HIV yang selama ini disubsidi Pemerintah memerlukan kehati-hatian. Studi ini bertujuan untuk menganalisis skenario terkait biaya dan utilisasi pada pelayanan HIV guna mendukung kebijakan yang potensial untuk mengintegrasikan intervensi HIV ke dalam paket manfaat JKN. Metode: Penelitian ini menganalisis paket manfaat dan mekanisme pembiayaan terkait pelayanan HIV, keanggotaan JKN, target populasi kunci, serta estimasi premi untuk pelayanan HIV hingga tahun 2019. Studi observasional ini menghasilkan data biaya dan utilisasi dari tingkat nasional dan daerah sebagai data dasar. Peneliti membangun model dan menganalisis skenario proyeksi biaya dan utilisasi dari beragam program aktivitas HIV serta konsekuensinya. Hasil: Skenario dikembangkan berdasarkan kelengkapan paket manfaat dan komponen mana yang bisa dijamin dalam JKN.Pelayanan yang terkait HIV saat ini sebagian besar dijamin oleh pemerintah mulai dari Konseling dan Tes HIV Sukarela (KTS) hingga pengobatan Infeksi Oportunistik. Pengobatan dan perawatan kemungkinan dapat dijamin oleh JKN, dengan bantuan pemerintah untuk pencegahan dan pelayanan ART. Kesimpulan: Skenario dengan paket manfaat dasar akan membutuhkan biaya medis yang rasional per pasien per bulan, tergantung pada kelengkapan paket manfaat. Sebuah peta jalan yang jelas perlu disusun untuk memastikan seluruh pelayanan terjangkau dan berkualitas baik.  Kata kunci: Jaminan kesehatan semesta, pelayanan HIV, dan Opsi Kebijakan   Abstract   Background: HIV and AIDS program in Indonesia is planned to be financed by domestic sources after depending on external sources for many years. Indonesia has started its Social Health Insurance scheme so called Jaminan Kesehatan Nasional (JKN) program in 2014, that covers HIV treatment including opportunistic infection. Research question is whether JKN could expand its benefit package to public health interventions without hampering service provision. Converting HIV program that has been subsidizied by the Government needs careful considerations. The study aimed to assess scenarios on cost and utilization to support decision on integration of HIV interventions into the JKN benefit package. Methods: The study assessed the current coverage and funding mechanisms for HIV-related services, JKN membership, key target populations, and estimated premium for HIV services up to 2019. We captured cost and utilization from national and subnational levels as the baseline through an observational study. Researchers developed model and scenarios on the projection of cost and utilization of various HIV program activities and its consequences. Results: We developed scnearios based on benefit covered by JKN. current services mostly covered by government. The Care and treatment could be possibly covered by the JKN, with support from government for prevention and ART. Conclusion: The scenarios show that provision of HIV services within the basic benefits package of JKN would require a reasonable cost per member per month, depending on the comprehensiveness of the benefit. A clear roadmap should be developed to ensure all services provided are affordable and in good quality.  Keywords: Universal Health Coverage, HIV AIDS, Policy Optio

Impacts of COVID-19-related service disruptions on TB incidence and deaths in Indonesia, Kyrgyzstan, Malawi, Mozambique, and Peru: Implications for national TB responses.

Initial global-level estimates reported in June 2020 by the World Health Organization suggested that levels of disruption to TB service delivery could be as high as 25%-50% and result in an additional 6·3 million cases of tuberculosis (TB) and an additional 1·4 million TB-related deaths attributable to COVID-19 between 2020 and 2025. Quarterly epidemiological estimates and programmatic TB data capturing disruption levels to each TB service were collected by National TB Programmes in Indonesia, Kyrgyzstan, Malawi, Mozambique, and Peru. Data from 2019, for a pre-COVID-19 baseline, and throughout 2020, together with the NTP's COVID-19 response plans, were used within Optima TB models to project TB incidence and deaths over five years because of COVID-19-related disruptions, and the extent to which those impacts may be mitigated through proposed catch-up strategies in each country. Countries reported disruptions of up to 64% to demand-driven TB diagnosis. However, TB service availability disruptions were shorter and less severe, with TB treatment experiencing levels of disruption of up to 21%. We predicted that under the worse-case scenario cumulative new latent TB infections, new active TB infections, and TB-related deaths could increase by up to 23%, 11%, and 20%, respectively, by 2024. However, three of the five countries were on track to mitigate these increases to 3% or less by maintaining TB services in 2021 and 2022 and by implementing proposed catch-up strategies. Indonesia was already experiencing the worse-case scenario, which could lead to 270,000 additional active TB infections and 36,000 additional TB-related deaths by the end of 2024. The COVID-19 pandemic is projected to negatively affect progress towards 2035 End TB targets, especially in countries already off-track. Findings highlight both successful TB service delivery adaptions in 2020 and the need to proactively maintain TB service availability despite potential future waves of more transmissible COVID-19 variants