Arlinda, Dona and Yunihastuti, Evy and Indrati, Agnes Rengga and Merati, Tuti Parwati and Papot, Emmanuelle and Cromer, Deborah and Diana, Aly and Naysilla, Adhella Menur and Dewantara, Riza Danu and Susanto, Nugroho Harry and Lukman, Nurhayati and Pranata, Wayan Adi and Kosasih, Herman and Lokida, Dewi and Karyana, Muhammad and Hartono, Teguh Sarry and Kosa, Gede Rai and Theresia, Deborah and Savitri, Dwiana and Nugroho, Dwi Kurniawan and Eppy, Eppy and Utama, Made Susila and Jamil, Kurnia Fitri and Toruan, Ivan Lumban and Samosir, Nelly Elfrida and Katu, Sudirman and Farhanah, Nur and Wahyunie, Sri and Rusli, Musofa and Swastika, Widya Amalia and Wullur, Willy Anthony Ignatius and Subronto, Yanri Wijayanti and Jason Liang, C. and Ridzon, Renee and Chen, Ray Y. and Neal, Aaron T. and Wisaksana, Rudi and Alam, Anggraini and Nurmawati, Syndi and Chairunnisa, Nurul Hidayah and Dwi, Octavia Kartika and Djauhari, Hofiya and Sunarko, Sigit and Merati, Tuti Parwati and Somia, Ketut Agus and Utama, Made Susila and Dian Sukmawati, Ni Made Dewi and Gayatri, Anak Agung Yuli and Wati, Ketut Dewi Kumara and Lestari, Anak Agung Wiradewi and Fatmawati, Ni Nengah Dwi and Ariastuti, Ni Luh Putu and Satriawati, Ni Putu and Lestari, Ni Ketut and Jumanti, Ni Wayan Desi and Setiani, Ni Nyoman and Purinawa, Gede and Artini, Desak Putra and Sutarni, Ni Nyoman Seri and Kurniati, Nia and Kumalawati, July and Harinda, Fadlika and Putri, Tiara Kumala and Madyaningati and Chasanah, Wusthi Ali and Amin, Desrinawati Muhammad and Rusli, Adria and Mardiyah, Nisrina Fatin and Reskianingsih, Ayu and Hindawati, Evi and Fitriani and Pelupessy, Ninny Meutia and Munawir and Nurulita, Asvin and Ayu, Dhiny Reskita and Bakri, Rizky Auliah and Hardiansyah, Muhammad Fiqhi and Sriyanti, Dewi and Kartini and Nurdin, Nasruh and Tessyoja, Andi and Sofro, Muchlis Achsan Udji and Arkhaesi, Nahwa and Rahayu, Muji and Adlina, Rohedy and Erni and Wahyuningtias, Trie and Kusumo, Bayu Sampurmantoro and Ngatno and Hadi, Usman and Puspitasari, Dwiyanti and Fitriah, Munawaroh and Arfijanto, Muhammad Vitanata and Bramantono and Rusli, Musofa and Adeline, Myrna Evanda and Rosyiidah, Rifaaah and Misutarno and Bahar, Yuanita and Wahyuni, Diah and Nirwati, Hera and Laksanawati, Ida Safitri and Intansari, Umi Solekhah and Linda, Vitia Ajeng Nur and Kusumaningtyas, Diajeng Gayatri and Binzanah, Siti and Oktabriana, Linda and Agustin, Heidy and Mahfuzh, Fauzi and Sari, Dewi Yennita and Martiwi, Titin Dani and Sari, Putri Permata and Indoin, Ariesta Putra and Susetianingsih and Mulyani, Tri and Kembaren, Tambar and Evalina, Rita and Siregar, Cicimei Putri and Harahap, Iramaya Oktariana and Siahaan, Junita and Ginting, Ennyke Karolina and Marpaung, Melpinna Fretty and Kosa, Gede Rai and Hayuningsih, Chakrawati and Budiman, Arif and Danastri, Cintya Naya and Hendarsin, Ivana Yulian and Chotimah, Husnul and Herawati, Evi and Suyono and Nur Cahyawati, Wiwit Agung Sri and Rahmawati and Kisworini, Priyanti and Septiana, Regina and Puteri, Rizka Dwi and Rahimah, Lutfia and Astuti, Silvia Rahmi and Utami, Irma Meilyana Fajar and Setiawati and Danudirgo, Emon Winardi and Yohmi, Elizabeth and Tandraeliene, Janice and Prihsetyati, Cicilia Ina and Lili and Norosingomurti, Danang Legowo and Wullur, Willy Anthony Iqnatius and Asnil, Nisa Trini and Tanzil, Francisca Lianiwati and Hardoni, Glegery Putri and Wullur, Winny Wangun Lestari and Mutamimah and Sulastri, Diana and Sitorus, Friska and Gunawan, Carta A. and Ang, Sunarto and Hendra and Agustyana, Andini and Prasetya, Edwin and Palondongan, Monika Lestari and Heniastuti and Mukano, Nursiah and Achmaddany, Ady and Jamil, Kurnia Fitri and Safri, Mulya and Mutiawati, Vivi Keumala and Azhar, Muhammad Abrar and Novita, Ika and Muslim and Husna, Nurul and Firbria, Ella and Arfajah and Nugroho, Muchamad Budi and Halim, Handoko and Susanti, Wiwi Endang and Vebrina, Redha and Rahmawati, Ike and Herlina and Sudaryanto and Suyanti, Emy and Darmaja, Made Gede and Purwaningsih, Immaculata and Sembiring, Justina and Yanti, Nur and Emma, Nani and Sunarti and Ayer, Martha Magdalena and Purnama, Asep and Nara, Mario Bernardinus Realino and Nugroho, Dwi Kurniawan and Sari, Putri Nur Indah and Riawan, Ulul Azmiyah and Mathilde, Fransiska and Koli, Kurniawati Handayani and Tolok, Stefani Marwah and Yuanti, Maria Yupina and Kosasih, Herman and Diana, Aly and Anwary Junior, Chandra Ilham El and Butarbutar, Deni Pepy Rentina and Rusman, Eka Windari and Bang, Lois Eirene and Siahaan, Meity and Setiyaningrum, Melinda and Ariqa, Nada and Susanto, Nugroho Harry and Hanum, Nur Latifah and Lukman, Nurhayati and Mukti, Restu Amalia and Sari, Rizki Amalia and Saraswati, Tiya and Agusta, Virtania Meirina and Wulan, Wahyu Nawang and Chen, Ray Y. and Neal, Aaron T. and Ridzon, Renee and Lau, Chuen-Yen and Grue, Louis and Perodin, Jacqueline and Watkins, Katie (2026) Annual trends and risk factors of late presentation of HIV at 19 referral hospitals in Indonesia: findings from the INA-PROACTIVE cohort. The Lancet Regional Health - Southeast Asia, 46.

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Abstract

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 (83·3â-89·8). Characteristics associated with late presentation included age 30 39 (aOR = 1·47, 95 CI: 1·15â 1·90) or age â ¥40 (aOR = 1·71, 95 CI: 1·21â-2·46) vs. age 18â-29; male sex (aOR = 2·93, 95 CI: 2·07â-4·24); diagnosis in â-¤2015 (aOR = 1·45, 95 CI: 1·12â-1·89); and diagnosis through Provider-Initiated Testing and Counseling (aOR = 2·38, 95 CI: 1·86â-3·04) vs. Voluntary Counseling and Testing (VCT). Suspected MSM transmission was associated with lower odds of late presentation (aOR = 0·57, 95 CI: 0·39â-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).

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