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Antiretroviral therapy suppresses HIV replication, prevent mobility and mortality. Treatment adherence is needed to achieve therapeutic success, prevent antiretroviral drug resistance and the risk of HIV transmission in the community. This study aims to determine the factors that associated with the adherent of antiretroviral drug treatment of HIV / AIDS patients in four hospitals in Jakarta in 2018-2019. This study was an observational study with a cross sectional design from the baseline data of INAPROACTIVE study (secondary data) from 666 people living with HIV. Treatment compliance was measured by self-report. Data were analyzed using cox proportional hazard regression with STATA12 software. The results showed the proportion of nonadherent by 17.9%, Analysis of determinant factors for compliance with treatment in this study using multivariate cox regression analysis and the magnitude of the effect was expressed in the prevalence ratio (PR) with 95% confidence interval (CI). Our study showed a proportion of ARV treatment adherence ≥ 95% showed 82.1%. This study showed that the socio-demographic factors associated with ARV treatment adherence among people living with HIV who received ARV therapy were gender, age, marital status and HIV transmission route. Clinical factors that have a relationship with adherence of ARV were the variable history of opportunistic infection syphilis and CD4 value. Treatment factors that have a relationship with adherence of ARV were the variable type of ARV regiment and duration of ARV treatment. All these variables were not statistially significant effect with p value > 0.05.
ABSTRAK Nama : Ikke Yuniherlina NPM : 1506704434 Program Studi : Epidemiologi Komunitas Judul : Faktor-faktor yang berhubungan dengan keparahan DBD pada pasien studi demam akut di delapan rumah sakit di Indonesia Manifestasi klinis demam berdarah dengue (DBD) masih menjadi permasalahan dalam kesehatan masyarakat di Indonesia. Berdasarkan derajat keparahan DBD menurut kritera WHO 2011 terbagi atas DBD derajat I, DBD derajat II, DBD derajat III, dan DBD derajat IV. Di Indonesia insiden DBD meningkat walaupun angka kematiannya menurun, untuk itu penelitian ini bertujuan meneliti faktor-faktor yang berhubungan dengan keparahan DBD, dimana DBD derajat II, III, dan IV dikategorikan sebagai DBD parah. Penelitian cross-sectional yang menggunakan data sekunder dari studi etiologi demam akut dari delapan rumah sakit di Indonesia, didapatkan proporsi keparahan DBD sebesar 43,3%. Faktor-faktor yang berhubungan dengan keparahan DBD didapatkan faktor jenis serotipe virus DENV-2 (OR = 3,06 95%CI 1,43 – 6,55), DENV-3 (OR = 2,62 95% CI 1,33 – 5,15), faktor lama demam (OR = 1,91 95%CI 1,09 – 3,35), dan faktor jumlah leukosit (OR = 1,79 95%CI 1,02 – 3,16). Skoring didapatkan sebesar 67% kemampuan untuk memprediksi keparahan. Kata kunci: keparahan, demam berdarah dengue, faktor-faktor
ABSTRACT Name : Ikke Yuniherlina NPM : 1506704434 Study Program : Epidemiology Title : Prognostic factors associated with dengue hemorrhagic fever severity of the acute fibril illness study patients in eight hospitals in Indonesia Dengue hemorrhagic fever (DHF) as a clinical manifestasion of dengue infection remains a public health problem in Indonesia. According to WHO, DHF severity grade was divided into DHF I, DHF II, DHF III and DHF IV. In Indonesia, the incidence of DHF increased eventhough the mortality rate decreased. Therefore, the study aims to examine prognostic factors related to the severity of DHF, with the category of severe DHF is including DHF II, DHF III and DHF IV. This cross-sectional study using secondary data from the Acute Febrile Illness Etiology Study of eight Hospitals in Indonesia. The result as follow, the proportion of severe DHF category is 43.3%, the prognostic factors associated with DHF severity are DENV serotype (DENV-2, OR = 3.06 95% CI 1.43 - 6.55; DENV-3, OR = 2.62 95% CI 1.33 - 5.15), day of illness (OR = 1.91 95% CI 1.09 - 3.35), and leucocyte count (OR = 1.79 95% CI 1.02 - 3.16). The scoring with contributing of DENV serotype, day of illness, and leucocyte count as prognostic factors, has only 67% ability to predict DHF severity. Keywords: severity, dengue hemorrhagic fever, prognostic factors
Latar Belakang Indonesia merupakan daerah hyper-endemic dengue dengan siklus epidemik yang rutin terjadi. Kriteria klasifikasi WHO tahun 2009 mendefinisikan kumpulan gejala, tanda dan hasil laboratorium yang dapat mendeteksi mayoritas kasus dengue namun untuk konfirmasinya membutuhkan tambahan pemeriksaan laboratorium seperti pemeriksaan NS1 maupun Immunoglobulin M.
Metode Penelitian Penelitian cross-sectional dengan data sekunder dari pasien demam akut di tiga lokasi Kabupaten Tangerang yaitu RSUD Kabupaten Tangerang, Puskesmas Kelapa Dua dan Puskesmas Bojong Nangka. Reference test berupa pemeriksaan RT-PCR, sedangkan index test adalah kriteria klasifikasi WHO tahun 2009 dan pemeriksaan RDT NS1. Analisis data dilakukan dengan uji diagnostik berupa uji reabilitas dan validitas.
Hasil Penelitian Kekuatan tingkat kesepakatan pada kriteria klasifikasi WHO tahun 2009 terhadap pemeriksaan RT-PCR maupun RDT NS1 adalah fair sedangkan pemeriksaan RDT NS1 terhadap RT-PCR didapatkan tingkat kesepakatan substantial. Sensitivitas kriteria klasifikasi WHO tahun 2009 didapatkan sebesar 72% (95%CI 65-78.2) lebih tinggi daripada pemeriksaan RDT NS1 65.6% (95%CI 58.4-72.4), namun spesifisitasnya sangat rendah (52.4% vs 97.6%). Kombinasi kriteria klasifikasi WHO tahun 2009 dan RDT NS1 secara serial memiliki sensitivitas 50.8% dan spesifisitas 98.1% dibandingkan kombinasi paralel menunjukkan hasil sensitivitas 86.8% dan spesifisitas 51.9%.
Kesimpulan Berdasarkan uji reabilitas hanya pemeriksaan RDT NS1 yang memiliki tingkat kesepakatan substantial. Berdasarkan uji validitas sensitivitas kriteria klasifikasi WHO tahun 2009 tidak cukup baik dalam skrining kasus dengue sehingga penggunaannya sebaiknya digantikan kombinasi paralel agar kasus dengue yang tidak terdiagnosis dapat berkurang.
Background Dengue is hyperendemic with frequent epidemic cycles in Indonesia. Tangerang district is among the regions with a high dengue burden. The 2009 WHO dengue case classification has a set of symptoms, signs, and laboratory findings that can identify most dengue cases; however, dengue cases need to be confirmed by additional laboratory diagnostic tests, such as NS1 and Immunoglobulin M testing. Method A cross-sectional study using secondary data from acute fever patients in three different locations in Tangerang District: Bojong Nangka PHC, Kelapa Dua PHC, and Tangerang District Hospital. The 2009 WHO dengue case classification and the NS1 RDT as index test, whereas the reference test is RT-PCR. Validity and reliability tests are used to analyze data. Results The observed agreement on the 2009 WHO dengue case classification for RT-PCR and NS1 RDT examinations was fair, although among NS1 RDT and RT-PCR was substantial. The sensitivity of the 2009 WHO dengue case classification was 72% (95%CI 65-78.2) higher than the NS1 RDT 65.6% (95%CI 58.4-72.4), but the specificity was considerably lower (52.4% vs 97.6%). The serial combination of the 2009 WHO dengue case classification and NS1 RDT in this study had a sensitivity of 50.8% and a specificity of 98.1%, while the parallel combination showed a sensitivity of 86.8% and a specificity of 51.9%. Conclusion Based on the reliability test, only the NS1 RDT has a substantial level of agreement. Based on the validity test, the sensitivity of the 2009 WHO dengue case classification is insufficient for screening dengue cases; therefore, a parallel combination can be used instead to lower the number of undiagnosed dengue cases.