National Consultant – HIV Clinical Guidelines (PNPK) and Permenkes Writer

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Background

Indonesia remains one of the countries in the Asia-Pacific region with a significant HIV burden. Ensuring that clinical management of HIV and opportunistic infections (OIs) is guided by evidence-based, up-to-date national standards is critical to achieving the 95-95-95 UNAIDS targets, improving patient outcomes, and rationalizing health system expenditures.

Two key policy instruments govern HIV clinical management in Indonesia:

· The National Clinical Practice Guideline for HIV and Opportunistic Infections (Pedoman Nasional Pelayanan Kedokteran / PNPK HIV-IO), issued by the Indonesian Medical Council (KKI) and endorsed by the Ministry of Health (Kemenkes RI). This document sets the clinical standard of care binding for all physicians treating HIV patients nationwide.

· Ministerial Regulation No. 23 of 2022 on HIV Prevention and Control (Peraturan Menteri Kesehatan / Permenkes No. 23/2022). This regulation provides the legal framework for HIV service delivery, including treatment protocols.

Both documents are currently in need of revision due to:

1. Publication of the WHO Consolidated Guidelines on HIV (2025 edition), which serves as the primary international reference for this revision. The 2025 WHO guidelines introduce updated recommendations on ART regimens, advanced HIV disease (AHD) screening and management, viral load monitoring strategies, and differentiated service delivery, and must now be reflected in Indonesia's national standards.

2. Significant advances in antiretroviral therapy (ART), including updated first-line and second-line regimens (Dolutegravir-based preferred), availability of long-acting injectable ART, and management of treatment failure and resistance.

3. Updated evidence on management of key opportunistic infections including tuberculosis co-infection, cryptococcal meningitis, Pneumocystis jirovecii pneumonia (PJP), toxoplasmosis, cytomegalovirus (CMV) disease, and others.

4. Evolving standards for special populations: pediatric HIV (in collaboration with pediatric specialists), pregnant women living with HIV (in collaboration with Obstetrics and Gynecology / ObGyn specialists), and key populations including people who inject drugs (PWID), men who have sex with men (MSM), and transgender women.

5. Introduction of triple combination Rapid Diagnostic Tests (triple combo RDT) for HIV diagnosis, particularly for pregnant women and key populations, enabling simultaneous detection of HIV, syphilis, and hepatitis B at point of care – a critical tool for both PMTCT programs and key population services that requires explicit clinical guidance.

6. Updated approaches to Early Infant Diagnosis (EID): the revised PNPK must address both the use of HIV Viral Load (VL) testing and conventional EID platforms (PCR-based) for infant diagnosis, with clear algorithms specifying appropriate use by setting and age.

7. The critical role of PNPK and Permenkes as the basis for BPJS Kesehatan (National Health Insurance) reimbursement decisions. Any clinical service, drug, or diagnostic not reflected in these documents risks being excluded from BPJS coverage for both outpatient (rawat jalan) and inpatient (rawat inap) HIV and sexually transmitted infections (STI/IMS) services. Alignment is therefore not only a clinical priority but a health financing imperative.

8. Post-pandemic reconfiguration of HIV services requiring updated guidance on decentralization of care to primary health centers (Puskesmas), task-shifting including HIV testing by trained community health cadres in geographically isolated areas, telemedicine integration, and community-based ART delivery.

WHO Indonesia will support Kemenkes RI in this revision process by engaging one qualified Individual Consultant from an academic background to serve as Lead Writer and overall technical coordinator of the drafting process. The consultant will work under the technical supervision of WHO and in close collaboration with Kemenkes RI and a multi-specialty expert panel.

Deliverables

Document 1: Revision of PNPK HIV and Opportunistic Infections

The Lead Writer shall be responsible for producing a comprehensive, fully revised PNPK document covering the following thematic areas (non-exhaustive):

· Adult HIV Management

· Opportunistic Infections

· Pediatric HIV (to be developed in coordination with Pediatric Specialist)

· HIV in Pregnant Women (to be developed in coordination with ObGyn Specialist)

· Key Populations

· HIV and STI/IMS Integration

· Service Delivery and Health Systems

Document 2: Revision of Permenkes No. 23/2022

The Lead Writer shall draft proposed amendments to Permenkes No. 23/2022 to:

1. Align the legal/regulatory text with the updated clinical standards reflected in the revised PNPK, including reference to the WHO Consolidated HIV Guidelines 2025 as the international evidence base.

2. Update the list of ARV drugs and diagnostics covered under BPJS schemes to reflect current formularies and global availability, including the inclusion of triple combo RDT and POCT-VL (Point-of-Care Viral Load testing) within the covered diagnostic framework.

3. Clarify eligibility criteria for ART initiation and monitoring to remove ambiguities in BPJS reimbursement claims (outpatient and inpatient).

4. Mandate and operationalize Viral Load (VL) testing at Puskesmas level using Point-of-Care Testing (POCT) platforms: the Permenkes shall include a provision explicitly permitting and enabling Puskesmas to conduct VL monitoring using validated POCT-VL devices, specifying the minimum technical and quality assurance requirements. This is intended to support decentralized care and reduce barriers to viral load monitoring for stable patients managed at Puskesmas.

5. Establish the regulatory basis for HIV testing by trained community health cadres (kader kesehatan) in geographically isolated, frontier, and outermost areas (Daerah Terpencil, Perbatasan, dan Kepulauan / DTPK): the Permenkes shall specify the conditions, training requirements, supervision protocols, and quality assurance mechanisms under which cadres may conduct rapid HIV testing, as a task-shifting measure to expand access in areas with geographic difficulty.

6. Define PrEP financing policy: the Permenkes shall state that PrEP services are currently provided through donor support (to be specified) and shall include a regulatory framework and transition roadmap for the planned shift toward non-donor financing, which may include out-of-pocket payment, JKN/BPJS coverage, or alternative domestic financing mechanisms. The Permenkes shall specify the transition timeline and responsible implementing parties.

7. Update provisions on service delivery mechanisms including formalization of Puskesmas as the primary care site for stable PLHIV, multi-month dispensing, community-based ART delivery, and differentiated service delivery models.

8. Incorporate special provisions for pediatric and obstetric HIV care consistent with the revised PNPK, including regulatory recognition of triple combo RDT use in ANC settings.

9. Ensure terminological and structural consistency with other relevant Permenkes and BPJS regulatory frameworks including INA-CBG coding for HIV services.

Timeline

Phase 1 (30%) – Month 1–2

Deliverables:

· Inception report (workplan, methodology, engagement plan, and schedule).

· Literature review and gap analysis of PNPK HIV-IO and Permenkes No. 23/2022.

· Draft outline of revised PNPK HIV-IO and proposed Permenkes amendments.

· First stakeholder coordination meeting and meeting documentation.

Phase 2 (60%) – Month 3–5

Deliverables:

· First drafts of the revised PNPK HIV-IO and Permenkes amendments.

· Consolidation of specialist inputs and expert consultations.

· Revised drafts incorporating feedback from WHO and Kementerian Kesehatan RI.

· Coordination meetings and validation workshop (if required), with supporting documentation.

Phase 3 (10%) – Month 6

Deliverables:

· Final revised PNPK HIV-IO and Permenkes amendment drafts ready for official review.

· Final report summarizing the revision process, key updates, and recommendations.

· Submission of all final documents and supporting materials to WHO Indonesia.

Full Terms of Reference are available here.

Qualifications, experience, skills and languages

Educational Qualifications

Essential: Medical Doctor (MD/dr.) with postgraduate qualification; Specialist or sub-specialist in Infectious Diseases, Internal Medicine, or directly relevant clinical HIV diseases

Desirable: N/A

Experience

Essential:

• Active affiliation with an accredited Indonesian university or academic medical center at the time of application

• Demonstrated expertise in HIV clinical management, with a minimum of 10 (Ten) years of relevant clinical and/or research experience in the field

• Prior direct engagement with MoH in a guideline development or policy advisory capacity

• Proven track record in producing clinical guidelines, policy documents, or peer-reviewed scientific publications related to HIV/AIDS or infectious diseases

• Strong knowledge of Indonesian health system structures, including Kemenkes regulatory frameworks and BPJS Kesehatan mechanisms

• Ability to work independently under tight deadlines and manage a multi-stakeholder coordination process

Desirable:

• Prior experience in national guideline development processes in Indonesia (PNPK or equivalent)

• Prior collaboration with or consultancy for WHO, other UN agencies, or international health organizations

• Understanding with BPJS Kesehatan or knowledge of INA-CBG coding systems for HIV services

• Knowledge of WHO global HIV treatment guidelines and UNAIDS frameworks

• Existing professional networks with pediatric HIV and ObGyn specialists in Indonesia

Languages and Level Required

Fluency in Bahasa Indonesia (required for document drafting) and working proficiency in English (required for WHO coordination and reference to international literature)

Location

Remote / Home-based (Indonesia) with limited on-site meetings.

Travel

The consultant is expected to travel for coordination meetings with the Ministry of Health and university-based specialists. Approximately 18 travel days are anticipated.

Remuneration and budget

IDR 26,760,000 per month, excluding travel costs. Payments will be made in instalments upon satisfactory completion of the agreed deliverables at Months 2, 4, and 6.

Currency: Rupiah

Additional Information

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