PENGARUH WAKTU INISIASI TERAPI ANTIRETROVIRAL TERHADAP LUARAN KLINIS PADA PASIEN HIV DI PUSKESMAS KABUPATEN SLEMAN

Devy Melati, Prof. dr. Yanri Wijayanti Subronto, Ph.D., Sp.PD-KPTI, FINASIM; Prof. Dr. Erna Kristin, Apt, M.Si

2025 | Tesis | S2 Ilmu Kedokteran Tropis

Latar Belakang. Penyakit HIV/AIDS masih menjadi salah satu tantangan kesehatan global utama, dengan tingkat penanganan yang masih belum optimal. Strategi Universal Test and Treat dilakukan untuk diagnosis dini dan menganjurkan inisiasi terapi antiretroviral (ARV) dalam waktu tujuh hari setelah diagnosis. Meskipun pendekatan ini diharapkan dapat mempercepat pengendalian HIV, bukti mengenai dampak jangka panjangnya masih terbatas. Tujuan. Penelitian ini mengevaluasi pengaruh inisiasi cepat terapi antiretroviral terhadap luaran terapi berupa kepatuhan pengobatan, lost to follow up, supresi viral, dan mortalitas pada pasien HIV di puskesmas Kabupaten Sleman, DIY. Metode. Penelitian ini menggunakan desain penelitian kohort retrospektif, melibatkan 307 pasien HIV yang memulai inisiasi terapi antiretroviral pada Januari 2018 hingga Desember 2022 di puskesmas Kabupaten Sleman. Waktu observasi dilakukan selama 24 bulan. Analisis data dengan menggunakan Kaplan Meier, bivariat (Chi-square), dan multivariat (regresi logistik dan cox regression). Hasil. Dari 307 pasien (76,2% inisiasi cepat ART; mayoritas usia 25-49 tahun [48,5%], laki-laki [84,4%], LSL [67,4%]), stadium klinis 3 berasosiasi dengan inisiasi lambat (aOR=0,23; p=0,047). Tidak ada perbedaan kepatuhan/supresi viral antar kelompok inisiasi pada bulan 6, 12, 24, meskipun LTFU (8,5% vs 4,1%) dan mortalitas (3% vs 2,7%) lebih tinggi di kelompok cepat. Kepatuhan bulan-6 meningkat pada LSL (aOR=2,22; p=0,027), menurun pada pengguna efavirenz (aOR=0,31); kepatuhan bulan-12/24 rendah pada usia 25-49 tahun (aOR=2,04/1,87) dan pekerja (aOR=2,01). LTFU lebih tinggi pada narapidana (aHR=15,41; p=0,005), rendah pada LSL (aHR=0,18; p=0,001) dan pengguna awal efavirenz (aHR=0,18; p=0,011). Supresi viral bulan-6 lebih rendah pada pengguna efavirenz (aOR=0,35; p=0,003) dan inisiasi lintas kabupaten (aOR=0,34; p=0,046); lebih tinggi pada pasien patuh di bulan-24 (aOR=2,02; p=0,008). Mortalitas lebih rendah dengan pendidikan menengah (aHR=0,11; p=0,035) dan status LSL (aHR=0,05; p=0,007). Probabilitas survival 24-bulan 97,1% (bebas-LTFU 92,5%) tanpa perbedaan signifikan antar kelompok inisiasi. Kesimpulan. Inisiasi cepat ART tidak memengaruhi luaran terapi, tetapi karakteristik pasien menentukan keberhasilan. Intervensi berbasis profil populasi diperlukan untuk optimalkan retensi antiretroviral.

Background: HIV/AIDS remains a major global health challenge, with suboptimal management rates. The Universal Test and Treat (UTT) strategy aims to enable early diagnosis and recommends initiating antiretroviral therapy (ART) within seven days of diagnosis. While this approach is expected to accelerate HIV control, evidence of its long-term impact remains limited. Objective: This study evaluated the effect of rapid antiretroviral therapy initiation on treatment outcomes – including medication adherence, loss to follow-up (LTFU), viral suppression, and mortality – among HIV patients at community health centers in Sleman Regency, Yogyakarta Special Region (DIY). Methods: A retrospective cohort study was conducted involving 307 HIV patients who initiated antiretroviral therapy between January 2018 and December 2022 at Sleman Regency health centers. Participants were observed for 24 months. Data analysis utilized Kaplan-Meier survival curves, bivariate analysis (Chi-square), and multivariate analysis (logistic and Cox regression). Results. Among 307 patients (76.2% rapid ART initiation; majority aged 25-49 years [48.5%], male [84.4%], MSM [67.4%]), clinical stage 3 was associated with delayed initiation (aOR=0.23; p=0.047). No differences in adherence/viral suppression existed between initiation groups at months 6, 12, 24, though LTFU (8.5% vs 4.1%) and mortality (3% vs 2.7%) were higher in the rapid-initiation group. Month-6 adherence increased among MSM (aOR=2.22; p=0.027) but decreased with efavirenz-based regimens (aOR=0.31); month-12/24 adherence was higher in those aged 25-49 (aOR=2.04/1.87) and employed patients (aOR=2.01). LTFU increased in prison inmates (aHR=15.41; p=0.005) but decreased among MSM (aHR=0.18; p=0.001) and TLE (tenofovir-lamivudine-efavirenz) regimen users (aHR=0.18; p=0.011). Month-6 viral suppression was lower with efavirenz regimens (aOR=0.35; p=0.003) and cross-regency diagnosis/initiation (aOR=0.34; p=0.046), yet higher in adherent patients at month 24 (aOR=2.02; p=0.008). Mortality was reduced with secondary education (aHR=0.11; p=0.035) and MSM status (aHR=0.05; p=0.007). 24-month survival probability was 97.1% (LTFU-free: 92.5%), with no significant difference between initiation groups. Conclusions. Rapid ART initiation did not influence core treatment outcomes, but patient characteristics determined therapeutic success. Population-profile-based interventions are essential to optimize antiretroviral retention.

Kata Kunci : Inisiasi cepat, ODHIV, kepatuhan pengobatan, lost to follow up, supresi viral, mortalitas; Rapid initiation, PLHIV, adherence, lost to follow up, viral suppression, mortality