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Abstract

Non-adherence to scheduled antiretroviral (ARV) medication pickup can reduce treatment effectiveness, increase the risk of drug resistance, and contribute to poor HIV infection control. This study aimed to identify factors associated with missed ARV pickup appointments among people living with HIV/AIDS in Bekasi District. An analytical cross-sectional study was conducted using secondary data from HIV/AIDS patients undergoing ARV therapy in 2023–2024. Data were analyzed descriptively (univariate), using Chi-square tests (bivariate), and log-binomial regression (multivariate). Among 811 patients, 341 (42%) were recorded as non-adherent to their medication pickup schedule. The results showed that having an unsuppressed viral load (>50 copies/ml) significantly increased the risk of non-adherence (PR: 2.23; 95% CI: 1.74–2.86; p<0.001). Additionally, patients who had been on treatment for more than five years showed a higher tendency for non-adherence, although this was not statistically significant (PR: 1.17; 95% CI: 0.91–1.49; p=0.214). These findings highlight the importance of regular viral load monitoring and sustained support for long-term ARV patients to improve adherence.

Keywords : HIV/AIDS, Adherence of Appointment, Viral Load, Antiretroviral Therapy, Treatment Duration

References

  1. UNAIDS. Global HIV & AIDS statistics Fact sheet. https://www.unaids.org/en/resources/fact-sheet. 2023.
  2. Kemenkes. Laporan Kinerja Direktorat P2PM Tahun 2023. 2024 https://p2p.kemkes.go.id/wp-content/uploads/2024/02/Lapkin-2023-P2PM_16022024.pdf (accessed Dec 14, 2024).
  3. Dinas Kesehatan Provinsi Jawa Barat. Profil Kesehatan Provinsi Jawa Barat. 2024.
  4. WHO. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring : recommendations for a public health approach. World Health Organization, 2021.
  5. Scanlon ML, Vreeman RC. Current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings. HIV/AIDS - Research and Palliative Care. 2013; 5: 1–17.
  6. Haberer JE, Sabin L, Amico KR, et al. Improving antiretroviral therapy adherence in resource-limited settings at scale: A discussion of interventions and recommendations. J Int AIDS Soc. 2017; 20. DOI:10.7448/IAS.20.1.21371.
  7. Kemenkes. Pedoman Nasional Pelayanan Kedokteran Tatalaksana HIV. https://siha.kemkes.go.id/portal/files_upload/PNPK_HIV_Kop_Garuda 1_.pdf. 2019.
  8. Kemenkes. Laporan Tahunan HIV AIDS 2022. 2022.
  9. WHO. Guidelines HIV Prevention, Testing, Treatment, Service Delivery and Monitoring: 2021.
  10. Sitanggang HD, Wahyono TYM, Rusli A, Sudaryo MK. Description Of 3-Years Survival Patient With Hiv/Aids Based On Non-Compliance Medication At The Infectious Diseases Hospital Prof. The Indonesian Journal of Infectious Disease 2013; : 2010–2.
  11. Woldasemayat LA, Jiru BI, Edossa ZK. Factors associated with non-adherence to Antiretroviral Therapy among HIV infected adolescents at Guji zone Health Facilities, South Ethiopia. 2020; published online Nov 17. DOI:10.21203/rs.3.rs-108419/v1.
  12. Rao D, Kekwaletswe TC, Hosek S, Martinez J, Rodriguez F. Stigma and social barriers to medication adherence with urban youth living with HIV. AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV 2007; 19: 28–33.
  13. Bhat VG, Ramburuth M, Singh M, et al. Factors associated with poor adherence to anti-retroviral therapy in patients attending a rural health centre in South Africa. European Journal of Clinical Microbiology and Infectious Diseases 2010; 29: 947–53.
  14. Langebeek N, Gisolf EH, Reiss P, et al. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis. 2014 http://www.biomedcentral.com/1741-7015/12/142.
  15. Zullig LL, Bosworth HB. Engaging patients to optimize medication adherence. NEJM Catal 2017; 3: 1–13.
  16. Nachega JB, Parienti JJ, Uthman OA, et al. Lower pill burden and once-daily antiretroviral treatment regimens for HIV infection: A meta-analysis of randomized controlled trials. Clinical Infectious Diseases 2014; 58: 1297–307.
  17. Protopopescu C, Raffi F, Roux P, et al. Factors associated with non-adherence to long-term highly active antiretroviral therapy: A 10 year follow-up analysis with correction for the bias induced by missing data. Journal of Antimicrobial Chemotherapy 2009; 64: 599–606.
  18. Bangsberg DR, Perry S, Charlebois ED, et al. Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS 2001; 15.
  19. Barros AJ, Hirakata VN. Alternatives For Logistic Regression In Cross-Sectional Studies: An Empirical Comparison Of Models That Directly Estimate The Prevalence Ratio Cox Regression Cross-Sectional Studies Logistic Regression Odds Ratio Poisson Regression Prevalence Ratio Robust Variances Tatistical Models. 2003 http://www.biomedcentral.com/1471-2288/3/21.
  20. O’Brien N, Greene S, Carter A, et al. Envisioning Women-Centered HIV Care: Perspectives from Women Living with HIV in Canada. Women’s Health Issues 2017; 27: 721–30.
  21. Levin KA. Study design III: Cross-sectional studies. Evid Based Dent 2006; 7: 24–5.
  22. Lester RT, Ritvo P, Mills EJ, et al. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. The Lancet 2010.
  23. Finitsis DJ, Pellowski JA, Johnson BT. Text message intervention designs to promote adherence to antiretroviral therapy (ART): A meta-analysis of randomized controlled trials. PLoS One 2014; 9. DOI:10.1371/journal.pone.0088166.
  24. Enriquez M, Farnan R, Neville S. What experienced HIV-infected lay peer educators working in midwestern U.S. HIV medical care settings think about their role and contributions to patient care. AIDS Patient Care STDS 2013; 27: 474–80.
  25. Nachega JB, Knowlton AR, Deluca A, et al. Treatment Supporter to Improve Adherence to Antiretroviral Therapy in HIV-Infected South African Adults A Qualitative Study.

Bahasa Abstract

Ketidakpatuhan terhadap jadwal pengambilan obat antiretroviral (ARV) dapat menurunkan efektivitas terapi, meningkatkan risiko resistensi obat, dan berkontribusi pada kegagalan pengendalian infeksi HIV. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan ketidakpatuhan janji ambil obat pada pasien HIV/AIDS di Kabupaten Bekasi. Desain penelitian ini adalah potong lintang analitik menggunakan data sekunder pasien HIV/AIDS yang menjalani pengobatan ARV tahun 2023–2024. Analisis dilakukan secara univariat untuk mendeskripsikan karakteristik responden, bivariat menggunakan uji Chi-square, dan multivariat dengan cox regresi. Dari 811 pasien, sebanyak 341 orang (42%) tercatat tidak patuh dalam mengambil obat. Hasil analisis menunjukkan bahwa kadar viral load yang tidak tersupresi (>50 kopi/ml) secara signifikan meningkatkan risiko ketidakpatuhan (PR: 2,23; 95% CI: 1,74–2,86; p<0,001). Selain itu, lama pengobatan juga menunjukkan kecenderungan berpengaruh secara substansi, di mana pasien yang telah menjalani pengobatan lebih dari lima tahun memiliki kecenderungan lebih tinggi untuk tidak patuh, meskipun tidak signifikan secara statistik (PR: 1,17; 95% CI: 0,91–1,49; p=0,214). Temuan ini menunjukkan pentingnya pemantauan rutin terhadap kadar viral load dan pemberian dukungan berkelanjutan bagi pasien yang telah lama menjalani terapi.

Kata Kunci : HIV/AIDS, kepatuhan, pengobatan ARV, viral load, lama pengobatan

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