Evaluasi pelayanan HIV-AIDS di Klinik VCT Kabupaten Bandung

MILANTIKA, I Putu, dr. Yanri Wijayanti Subronto, Sp.PD, PhD

2009 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang : Hasil estimasi kasus HIV/AIDS tahun 2007 di Kabupaten Badung menunjukkan jumlah ODHA sekitar 1.042 orang. Sedangkan kasus HIV/AIDS yang dilaporkan hingga 31 Desember 2008 hanya mencapai 454 orang. Hal ini mengindikasikan masih banyak ODHA yang belum ditemukan dan memanfaatkan layanan HIV/AIDS di klinik VCT. Klinik VCT merupakan pintu gerbang untuk memperoleh informasi HIV/AIDS, melakukan konseling dan tes HIV, serta dukungan pengobatan yang tepat bagi ODHA. Namun pelayanan dan pemanfaatan klinik VCT belum memberikan hasil yang memuaskan sehingga perlu dievaluasi melalui pendekatan sistem input, proses, dan output. Tujuan penelitian : Mengevaluasi pelayanan HIV/AIDS di klinik VCT dengan melihat gambaran kebijakan dan pedoman, peran konselor dan petugas lapangan, dana dan logistik serta permasalahannya melalui pendekatan sistem input, proses dan output. Metode : Penelitian ini merupakan penelitian deskriptif studi kasus tunggal terpancang. Total informan adalah 32 orang, yaitu kasie P2PL 1 orang, pemegang program KPAD Badung 1 orang, konselor 8 orang, petugas lapangan 2 orang, dan klien 20 orang. Data dikumpulkan melalui wawancara mendalam, DKT, observasi dokumen dan observasi langsung di lapangan. Hasil Penelitian : Evaluasi input : Kebijakan pemberian insentif merujuk klien sering dimanfaatkan hanya untuk mendapatkan honor dan memenuhi kuota. Sebagian besar konselor mempunyai tugas rangkap. Petugas lapangan dari LSM HIV/AIDS belum maksimal merujuk klien. Dukungan dana pemerintah daerah belum optimal dan masih tergantung The Global Fund ATM. Ketersediaan brosur, leaflet, dan kondom yang berkualitas masih terbatas. Evaluasi proses : Layanan VCT lebih banyak bersifat pasif, sedangkan mobile VCT belum rutin dilakukan. Evaluasi Output : Dropout klien pada tes HIV dan konseling post tes selain karena klien belum siap secara psikologis, juga karena kualitas konseling yang tidak baik. Kesimpulan : Berdasarkan pedoman Kepmenkes RI No. 1507/MENKES/ SK/X/2005 dan hasil evaluasi faktor input, proses, dan output, maka disimpulkan pelayanan dan pemanfaatan klinik VCT belum optimal.

Background : The result of HIV/AIDS case estimation in 2007 at District of Badung showed there were 1,042 people living with HIV/AIDS. Meanwhile HIV/AIDS cases reported until 31st December, 2008 were as many as 454 people. This indicates that many people living with HIV/AIDS are not yet detected and do not utilize HIV/AIDS at voluntary counseling and testing clinic (VCT). This clinic is a gate to obtain information on HIV/AIDS, ask for HIV counseling and test, and get suitable medication for people living with HIV/AIDS. However, the service and utilization of VCT clinic have not given satisfactory result so that it is necessary to evaluate VCT clinic through input, process, and output system approach. Objective : To evaluate HIV/AIDS service at VCT clinic by observing the policy and guideline, role of counselor and staff in the field, budget and logistics as well as the problem through input, process and output system approach. Method : This was a descriptive case study with a single case study embedded design involving as many as 32 people, i.e. 1 head of primary disease eradication program section, 1 program manager of Badung local AIDS prevention commission, 8 counselors, 2 staff in the field, and 20 clients. Data were obtained through indepth interview, focus group discussion, document observation and direct observation in the field. Result : The result of input evaluation showed: the policy on the provision of incentive for referring clients was often used to obtain honor and fulfill quota; the majority of counselors had dual duties; staff in the field from non government organization had not referred patients to their best; support from local government budget was limited and still depended on the Global Fund ATM; availability of brochures, leaflet and quality condom was limited. The result of process evaluation showed: VCT service tended to be passive whereas mobile VCT was not regularly provided. The result of output evaluation showed: drop out of clients in HIV test and post test counseling was due to psychological unpreparedness of clients and poor quality of counseling. Conclusion : Based on the guidelines Kepmenkes RI No. 1507/MENKES/ SK/X/2005 the result of evaluation on factors of input, process and output, the service and utilization of VCT clinic were not yet optimum.

Kata Kunci : Evaluasi,Konselor,HIV,AIDS,VCT, evaluation, counseling, HIV/AIDS, VCT