Lost to Follow-Up : Reasons and True Outcome for Patients on Arv Treatment in Teratai Clinic Bandung Indonesia

Abstract

Klinik RSHS Teratai HIV telah merawat pasien dari September 2004 sampai Desember 2009, sebanyak 2.060 ODHA dan 1290 menerima ARV (63%). Selama periode ini, sebesar 11% (141 orang) kehilangan kontak lebih tinggi dari keseluruhan persentase di Indonesia yaitu 10,7% (Depkes, 2009). Tujuan dari penelitian ini adalah untuk menyelidiki hasil yang benar dan faktor hilang tindak lanjut ARV di klinik RSHS Teratai ARV. Penelitian ini menggunakan metode wawancara mendalam dengan 25 pasien HIV / AIDS bawah pengobatan ARV di klinik Teratai RSHS dan mangkir sejak tahun 2009 yang tinggal di daerah Bandung. Informan dipilih secara acak dan dihubungi untuk kunjungan rumah untuk diwawancarai oleh pewawancara yang berpengalaman. Peneliti melakukan wawancara mendalam di rumah pasien sekitar 60 menit. Data direkam oleh pita digital direkam, ditranskrip dan dicetak oleh dua peneliti bidang independen menggunakan analisis tematik.Hasil penelitian ini menunjukkan tujuh tema yang pengetahuan yang tidak benar, optimisme yang tidak realistis, masalah aadministratif, perasaan efek samping negatif, masalah interpersonal, masalah kecanduan, dan kurangnya perawatan diri. Oleh karena itu, penting untuk mengembangkan tindakan pencegahan melalui rincian kontak pasien, meminta pasien persetujuan untuk dihubungi, telepon, kunjungan rumah setelah 3 minggu kehilangan kontak, dan menyarankan pasien untuk mendaftar ke klinik ART lebih dekat dengan rumah mereka , dan mengembangkan sistem reminder untuk mengingatkan pasien untuk mengambil ARV tepat waktu. ABSTRACTTeratai clinic HIV RSHS has treated patients from September 2004 to December 2009, as much as 2060 PLWHA and 1290 receive ARV (63%). Over this period, 11% (141) were lost to follow-up that is higher than overall lost to follow up percentage in Indonesia which is 10.7% (MOH annually report December 2009). The aim of this study was to investigate the true outcomes and factors of lost follow up to ARV. This study used indepth interview method to 25 HIV/AIDS patients under ARV treatment in the Teratai clinic RSHS and lost to follow up since 2009 who lived in Bandung area. Informants were randomly selected and contacted for a home visit to be interviewed by experienced interviewer. The interviewers obtained verbal informed consent and conducted an in depth interview in the patients home. Interview took about 60 minutes. Data were recorded by digital tape recorded, transcribed and scored by two field researchers independently using thematic analysis. The result of this study shows seven themes which are incorrect knowledge, unrealistic optimism, administrative problems, feeling of negative side effect, interpersonal problem, addiction problem, and lack of self-care. Therefore, it is important to develop preventive measure through up-dating patients’ contact details, ask patients consent to be contacted, up date phone contact, home visit after 3 weeks lost of contact, advice patients to register to ART clinic closer to their homes, and develop a reminding system to remind patients to take ARV on time.

Healthcare needs of people living with human immunodeficiency virus: A qualitative descriptive study

“…Furthermore, they include unfamiliarity with health facilities, disconnection in communication with healthcare providers, and lack of understanding regarding women's needs. These barriers were more apparent for sub-risk group population such as homosexual, transgender, and PLWH with disabilities (Haroen et al, 2017).…”

“…Access to affordable healthcare service is also a concern among PLWH since their health is susceptible due to the virus progression in their body. The remaining significant number of PLWH was loss to follow-up (Handayani et al, 2017;Haroen et al, 2017;Widyanthini et al, 2014), and lower percentage of virally suppression (Januraga et al, 2018) was due to barrier to access healthcare services. Also, Previous study reported some inhibiting factors for PLWH in accessing healthcare services, which include stigma, long distances, lack of confidentiality, financial constraints, multiple appointments (Ayon et al, 2018).…”

“…with HIV loss to follow up were reported significant and ranged between 14% and 30% (Frijters et al, 2020;Haroen et al, 2017;Widyanthini et al, 2014). Therefore, retention in care becomes a crucial issue for the success of treatment.…”

Costs of HIV/AIDS treatment in Indonesia by time of treatment and stage of disease

“…Yet, there seem to be advantages in scaling up ART at the community level as this may potentially increase early detection and reduce the burden in hospital clinics [ 46 ]. Also, the shorter waiting and travel time to the clinic may lead to lower patient’s costs and better uptake and adherence of ART [ 46 – 49 ]. In this scenario, the hospital and community health centres will have different roles (Table 5 ).…”

“…Transportation comprises the highest proportion of costs: 62 and 43 % for patients with CD4 cell counts below and above 200 cells/mm 3 , respectively, and this is comparable with the finding of Riyarto et al [ 16 ] in Indonesia. A study by Haroen et al [ 49 ] in Bandung, Indonesia, and international studies by Portelli et al [ 47 ], Brinkhof et al [ 48 ], and Posse et al [ 15 ] have shown that transportation costs are a common reason why patients cease ARV. This information provides another reason to scale up ART at community level, as it likely reduces transportation costs for patients and may increase the uptake of ART, especially of patients with CD4 cell counts <200 cells/mm 3 .…”