Implementasi Kebijakan Tatalaksana HIV di Puskesmas Kabupaten Sleman

SERUNI ANGRENI S, dr. Yanri Wijayanti Subronto, Ph.D, SpPD-KPTI; dr. Tiara Marthias, MPH, Ph.D

2022 | Tesis | MAGISTER ILMU KESEHATAN MASYARAKAT

HIV AIDS masih menjadi tantangan global dan nasional. Pemerintah berupaya melakukan pengendalian dengan memperluas akses pengobatan HIV di Puskesmas, termasuk 4 Puskesmas di Kabupaten Sleman. Upaya memperluas akses pengobatan belum diikuti dengan pencapaian target 95% ODHIV yang mendapatkan ART, 95% ODHIV yang tersupresi viral load, serta inisiasi segera terapi ARV dan pemberikan obat untuk Terapi Pencegahan Tuberculosis. Terdapat berbagai faktor yang mempengaruhi implementasi pedoman Tatalaksana HIV di puskesmas, antara lain faktor tenaga Kesehatan dan fasilitas layanan Kesehatan. Penelitian ini dilakukan untuk mengevaluasi implementasi serta faktor pendukung dan hambatan dalam implementasi kebijakan tatalaksana HIV di Puskesmas. Penelitian ini merupakan penelitian mixed method di 4 puskesmas yang telah menyelenggarakan Program layanan Perawatan Dukungan Pengobatan HIV di Kabupaten Sleman. Pengambilan data dilaksanakan di bulan Mei - Juni 2022. Data penelitian kuantitatif adalah data sekunder kasus orang dengan HIV yang mengakses layanan PDP yang teregistrasi pada Puskesmas periode 2019 - 2021, sedangkan data kualitatif diambil kepada 9 responden melalui wawancara mendalam. Hasil penelitian menunjukkan didapatkan kesenjangan kesesuian tatalaksana di puskesmas dengan standar tatalaksana sesuai regulasi, serta rendahnya ODHIV yang terpantau supresi viral load. Faktor penghambat implementasi tatalaksana HIV di Puskesmas adalah sikap petugas kesehatan menunda tatalaksana terkait persepsi kebijakan tatalaksana HIV belum tersosialisasi dengan baik, belum semua petugas pemberi layanan terlatih, kurangnya sarana tes viral load di RS Daerah, sistem pencatatan tatalaksana HIV yang kurang efisien, serta adanya stigma. Faktor pendukung implementasi PDP HIV adalah sikap kesediaan petugas kesehatan untuk memberikan tatalaksana terkait persepsi dukungan pendamping sebaya, adanya petugas yang terlatih konseling serta dukungan logistik obat. Kesimpulan didapatkan bahwa 4 puskesmas tersebut belum mencapai target program tatalaksana HIV dan perlu dilakukan intervensi untuk meningkatkan kinerja HIV puskesmas.

HIV AIDS is still a global and national challenge. The government is trying to control it by expanding access to HIV treatment at the Puskesmas, including 4 Puskesmas in Sleman Regency. However, efforts to expand access to treatment have not yet reached the target of 95% of people living with HIV who are receiving ART and 95% of people living with HIV who are viral load suppressed. WHO in 2017 recommended the immediate initiation of diagnosed HIV-positive people regardless of CD4 cell count, and this was followed by changes in the national HIV management policy through a fast track strategy in 2018 to provide immediate initiation of ARVs, provision of Tuberculosis Preventive Therapy, and viral load monitoring. The rapid change in HIV management strategies raises the question of whether the Puskesmas in Sleman Regency is able to carry out HIV management according to the latest policy recommendations, in achieving the target of 90% of people living with HIV who are suppressed by viral load. The purpose of this study was to measure the suitability of the implementation of HIV management in health centers based on regulations and to determine the supporting factors and obstacles in the implementation of HIV management in health centers. This research is a mixed method research with sequential explanatory method. The location of the research was carried out in 4 health centers in Sleman Regency which had organized the HIV Treatment Support Care Service Program, data collection was carried out in May - June 2022. Quantitative research data was secondary data on cases of people with HIV who accessed PDP services registered at the Puskesmas for the period 2019 - July 2021, while qualitative data were taken to 9 respondents through in-depth interviews. Quantitative sampling method uses non-probability sampling method and for qualitative data collection is selected by purposive sampling method. The results of the study showed that there was a gap in the suitability of treatment at the puskesmas with standard management according to regulations, as well as low levels of HIV positive people who were monitored for viral load suppression. The inhibiting factors for the implementation of HIV treatment at the Puskesmas are the attitude of health workers delaying treatment related to the perception that HIV management policies have not been properly socialized, not all service providers are trained, lack of viral load testing facilities at Regional Hospitals, inefficient HIV treatment recording systems, and stigma. . Supporting factors for the implementation of PDP HIV are the attitude of the willingness of health workers to provide treatment related to perceptions of peer support, the presence of trained officers in counseling and logistical support for drugs. The conclusion was that not all people living with HIV who were treated at the Puskesmas received treatment according to regulations until viral load suppression was monitored. For this reason, it is necessary to increase the capacity of HIV counseling and management for all health workers involved in providing PDP services, adding viral load testing facilities at regional hospitals, and providing HIV stigma prevention programs for people living with HIV, families, communities and health services.

Kata Kunci : fast track, tatalaksana HIV, perawatan dukungan pengobatan, puskesmas