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Community Discussion Regarding Access to Hepatitis Services and Co-infection

18 September 2021

On September 18, 2021, a discussion was held between Yayasan Peduli Hati Bangsa and other community service communities through Zoom application with the theme “How to access Hepatitis and co-infection services in Indonesia”.

The discussion participants are representatives of the community related to public health services in Indonesia, including:

  1. Claudius. N. Mone Iye (Peduli Hati Bangsa)
  2. Caroline Thomas (Peduli Hati Bangsa)
  3. Jamal (Pontianak Plus-Kalimantan Barat)
  4. Bonny Sofianto (Persaudaraan Korban Napza Bogor)
  5. Radhitya Kusuma (Jakarta)
  6. Rosma (Aksi Keadilan-Bogor)
  7. Deni (Jakarta)
  8. Putri Tanjung (Bekasi)
  9. Joni Wuisan (Komisi Penanggulangan AIDS Sulawesi Utara, Batamang Plus dan Persaudaraan Korban Napza Bogor Sulut)
  10. Ewin (Medan Plus)
  11. Rian (AKSI NTB)
  12. Riezal (Aceh)
  13. Toar Kumontoy (Persaudaraan Korban Napza Bogor Sulut)

The general description discussed include:

  • On average, HIV tests are available at all Puskesmas for free. However, not all Puskesmas (Public Health Centre) that have HIV testing services, have ARV treatment services.
  • NTB: The NTB Health Office has started to initiate a one stop service test for HIV, Hepatitis B (HBsAG) and HCV but is still having problems with PPKM (Community Activities Restrictions Enforcement)
  • Manado: Not all PKMs (Public Health Centre) have Hepatitis C and B services. Only 5 PKMs (Tikala Baru, Bahu, Teling Atas, Sario, Tuminting) provide hepatitis-related testing services.
  • Colleagues from Medan Plus and Galatea who also provide HIV mentoring and outreach in the Aceh region, which has just developed the Hepatitis program, also suggested that key population friends should be tested for Hepatitis when testing for HIV.
  • Not all services related to Hepatitis C are open every day. So you have to call first to confirm the doctor’s schedule to be able to make an appointment.
  • Not all Hepatitis referral hospitals have HCV viral load testing services, in Medan for example, of the 3 Referral Hospitals (Bhayangkara, Adam Malik, Pringadi), only Adam Malik Hospital has a machine for HCV viral load testing.
  • Some services related to HCV are already patient-friendly, including doctors who provide cellphone numbers for community friends to call (eg Aceh, West Kalimantan, Jakarta), and those who object to doctor fees (especially for the South Jakarta area), can discuss again with the doctor so that fee waiver granted.

In accessing Hepatitis and co-infection services in Indonesia, it turns out that there are many obstacles, some of which are the problem of price and availability of drugs. More about the constraints discussed:

  • NTB Provincial Hospital: The VL machine is broken and the number of patients with access is still small
  • NTB Provincial Hospital: BPJS from Health Facility I to Provincial Hospital: code does not appear for Hep C treatment and so people who need a referral for Hepatitis C treatment from Health Facility I to the next level Health Facility are referred to the VCT Poly (HIV)
  • Manado: On average, IDU friends don’t have BPJS
    Manado: People who use drugs cannot use opioid substitution therapy, especially Methadone because it is not available. For friends who use drugs finally use Buprenorphone. Depending on the user of Buprenorphine, some use up to 8mg per week. Buprenorphone price for 8mg is Rp. 800,000. There are also drug users who use Alprazolam and depending on the user, there are those who use 4 strips per week at a price of Rp. 400,000. With a doctor’s fee of Rp. 150,000 per week (RS Bhayangkara), the total expenditure per week is around RP. 1,350,000 per week or Rp. 5,400,000 per month, making it difficult for people to access other services (including Hep C services) apart from drug services.
  • Bogor Hospital: it’s a free service but now it’s a Covid referral center
  • West Kalimantan: HCV PCR machine is being used for Covid PCR
  • Medan: HIV outreach and mentoring is recommended for HCV testing, but there are problems if community members don’t have BPJS, especially drug users and transgender people. In addition, some also do not have ID cards.
  • Medan: 30 people who were tested and treated, there were some who did not finish, 1 months or 2 month later the drugs were already out of stock. People are afraid to start over (fear of stock out and there is no cost to do VL HCV before re-treatment).
  • NTB Provincial Hospital: In July 2021: NTB Health Office initiated a mobile service for testing for HIV, HBsAG and Anti HCV. The challenge is PPKM starting July 2021.

As a further reference, here is a price list of services, related to Hepatitis which is collected through the existing community

Non BPJS registration price for Hepatitis related services:

  • Pengayoman Hospital (Jakarta): Rp. 8,000 (require photocopy of ID card at the beginning)
  • NTB Provincial Hospital: new patient registration Rp. 45,000. Current patient Rp. 30,000. You must make an appointment for Hepatitis C service.
  • Kandou Hospital Manado: Rp. 180,000 per month (Gastro Poly)
  • Soedarso Hospital Pontianak: Registration fee Rp. 50,000 (Internal Medicine Poly)
  • Medan: Administration: Rp. 70,000
  • Fatmawati: Rp. 300,000 (doctor registration, if you have difficulty with funding and do not have BPJS, you can discuss with the doctor)

Prices for hepatitis C therapy support tests (non BPJS):

  • Pengayoman Hospital: APRI/USG/FibroScan price (if there is an IO): Rp. 8,000 (price for FIbroScan is being discussed again)
  • NTB Provincial Hospital: VL: 1.3 million (private lab). Additional out of pocket lab tests (complete blood count, kidney function, etc.)-Rp, 550,000
  • Kandou Hospital Manado: HCV RNA: Rp. 680,000 (Gastro Clinic)
    Labkesda Manado: LFT (Labkesda): SGOT, SGPT, Gamma Rp. 65,000 (Kandou) Rp.120,000
  • Bogor Hospital: Registration, consul, lab tests: Rp. 200,000
    RSUD Soedarso: Anti HCV test, HCV VL, liver function, complete blood count: Rp. 1,800,000
  • Medan: VL: Rp. 1,800,000 (price between government and private hospitals is the same)

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