Fidelity Program Tripel Eliminasi Ibu Hamil di Kebupaten Kebumen: Implementation Research

Siti Mutoharoh, Prof. dr. M. Hakimi, Sp.O.G, Subsp.Obginsos, Ph.D

2025 | Disertasi | S3 Kedokteran Umum

Latar Belakang: Penyakit HIV, Hepatitis B, dan sifilis merupakan tiga penyakit menular yang sangat rentan ditularkan dari ibu ke anak selama kehamilan, persalinan, maupun menyusui. Penyakit tersebut menimbulkan kecatatan, kesakitan, dan kematian, sehingga berdampak buruk terhadap kelangsungan hidup dan kualitas hidup anak.

Tujuan: Mengkaji fidelity pelaksanaan program tripel eliminasi pada ibu hamil di Kabupaten Kebumen.

Metode: Jenis penelitian yang digunakan adalah implementation research dengan desain mixed methods bersifat sequential explanatory. Populasi penelitian adalah semua ibu hamil dan tenaga kesehatan di puskesmas yang memberikan layanan ANC terpadu tripel eliminasi. Teknik pengambilan sampel yang digunakan adalah total sampling untuk ibu hamil, accidental sampling untuk tenaga kesehatan, dan purposive sampling pada tahap kualitatif. Lokasi penelitian mencakup 6 puskesmas yang diambil secara acak dari 21 puskesmas. Tahap kuantitatif mengkaji cakupan program, strategi fasilitasi, dan kualitas penyampaian program. Tahap kualitatif menjelaskan hambatan dan faktor pendukung pelaksanaan program. Analisa data kuantitatif dilakukan dengan persentase dan frekuensi, sedangkan analisa data kualitatif menggunakan software opencode.

Hasil: Fidelity pelaksanaan program tripel eliminasi pada ibu hamil berdasarkan cakupan pemeriksaan selama tahun 2020-2023 termasuk dalam kategori kurang baik (<95>. Berdasarkan strategi fasilitasi, ketersediaan kebijakan, pedoman, dan standard operating procedure (SOP) termasuk dalam kategori buruk. Sementara itu, petugas kesehatan yang terlatih dalam layanan tripel eliminasi serta dukungan dana dan logistik berada pada kategori dapat diterima. Layanan dan penawaran program tripel eliminasi, serta kegiatan monitoring dalam kategori baik. Kualitas penyampaian program secara keseluruhan berada dalam kategori cukup. Terdapat beberapa hambatan dan dukungan dalam pelaksanaan program tersebut.

Kesimpulan: Fidelity pelaksanaan program tripel eliminasi pada ibu hamil berdasarkan data cakupan pemeriksaan HIV, Hepatitis B, dan sifilis selama tahun 2020-2023 berada dalam kategori kurang baik.

Background: HIV, Hepatitis B, and syphilis are three infectious diseases that are highly susceptible to mother-to-child transmission during pregnancy, childbirth, or breastfeeding. These diseases can cause disability, morbidity, and mortality, adversely affecting child survival and quality of life.    

Purpose: To assess the fidelity of the implementation of triple elimination program for pregnant women in Kebumen Regency.

Methods: This study employed an implementation research approach with a sequential explanatory mixed-methods design. The population included all pregnant women and healthcare workers at public health centers (PHCs) providing integrated antenatal care for triple elimination program. Sampling methods included total sampling for pregnant women, accidental sampling for healthcare workers, and purposive sampling for the qualitative phase. The study was conducted at 6 randomly selected PHCs out of 21. The quantitative phase evaluated program coverage, facilitation strategies, and program delivery quality. The qualitative phase explored barriers and supporting factors in implementation. Quantitative data were analyzed using percentages and frequencies, while qualitative data were analyzed using Opencode software. 

Results: The fidelity of program implementation, based on screening coverage from 2020 to 2023, was categorized as suboptimal (<95 lang="id">standard operating procedures (SOPs)  was categorized as poor. The availability of trained healthcare workers and supports in funding and logistics were considered acceptable, while triple elimination program services and offering as well as monitoring activities were categorized as good. Overall, the quality of program delivery was rated as sufficient. Several barriers and supporting factors were identified in the program’s implementation.

Conclusion: The fidelity of the triple elimination program for pregnant women, based on HIV, Hepatitis B, and syphilis screening coverage from 2020 to 2023, was suboptimal.

Kata Kunci : fidelity, hepatitis B, HIV, sifilis, tripel eliminasi.