Tesis

Prevalens Loss-to-follow Up pada Anak dengan HIV pada Periode Sebelum dan Selama Pandemi serta Faktor-faktor yang Memengaruhi = Prevalence and Risk Factors of Loss-to-Follow Up in Children with HIV in the Period Before and During Pandemic.

Latar belakang. Human Immunodeficiency Virus (HIV) merupakan masalah kesehatan global yang merupakan target pemberantasan epidemi pada akhir tahun 2030. Untuk mencapai target 95- 95-95, perlu pengawasan untuk mencegah loss-to-follow up (LTFU) karena dapat menyebabkan resistensi virus dan kematian. Beberapa faktor seperti usia saat terdiagnosis, stadium klinis, jarak tempat tinggal, status pengasuh dapat memengaruhi terjadinya LTFU. Pandemi COVID-19 juga menurunkan kepatuhan anak dengan HIV serta menimbulkan hambatan finansial maupun sosial dalam berobat sehingga dapat menyebabkan terjadinya LTFU. Tujuan. Untuk melihat perbedaan prevalens kejadian LTFU sebelum dan selama pandemi, serta faktor - faktor yang memengaruhi LTFU anak dengan HIV di RSCM sesuai periode. Metode. Studi kohort retrospektifterhadap 402 subjek berusia 6 bulan – 18 tahun dengan HIV dan berobat di Rumah Sakit dr. Cipto Mangunkusumo (RSCM). Data berasal dari penelusuran rekam medis yang memenuhi kriteria inklusi dan tidak memenuhi kriteria eksklusi pada periode Februari 2017 hingga Februari 2023 Hasil. Tidak terdapat perbedaan prevalens yang bermakna pada kasus LTFU antara periode sebelum (15,5%) dan selama pandemi (19,2%), p 0,237. Pada periode sebelum pandemi, proporsi LTFU terbesar pada kelompok usia 5-10 tahun (19,3%), stadium klinis IV (17,9%), jarak tempat tinggal lebih dari 10 km (16,1%), dan status pengasuh orang tua kandung (15,8%). Sedangkan pada periode selama pandemi, proporsi LTFU terbesar pada kelompok usia 10-18 tahun (23,8%), stadium klinis I (30%), jarak tempat tinggal lebih dari 10 km (19,5%), dan status pengasuh bukan orang tua kandung (22,3%). Usia saat terdiagnosis, stadium klinis, jarak antara rumah ke RSCM, dan status pengasuh tidak memberikan pengaruh yang signifikan terhadap kejadian LTFU, baik pada periode sebelum maupun selama pandemi (p > 0,05). Kesimpulan. Tidak terdapat perbedaan prevalens kasus LTFU yang bermakna pada periode sebelum dan selama pandemi. Usia saat terdiagnosis, stadium klinis, jarak antara rumah ke RSCM, dan status pengasuh tidak memberikan pengaruh yang signifikan terhadap kejadian LTFU, baik pada periode sebelum maupun selama pandemi.
Kata kunci: anak, Human Immunodeficiency Virus (HIV), pandemi COVID-19, loss-to-follow up (LTFU)


Background. Human Immunodeficiency Virus (HIV) is a global health problem which is the target for eradication by the end of 2030. To achieve the 95-95-95 target, close monitoring is necessary to prevent loss-to-follow up (LTFU) because it can cause virus resistance and death. Several factors such as age at diagnosis, WHO clinical stage, distance from residence, caregiver status can influence the occurrence of LTFU. The COVID-19 pandemic has also reduced compliance of children with HIV and created financial and social barriers to treatment, which can lead to LTFU. Objective. To observe the differences in prevalence of LTFU events before and during the pandemic, as well as factors influencing LTFU of children with HIV according to the period. Method. This research is a retrospective cohort study of 402 subjects aged 6 months – 18 years with HIV and undergoing HIV treatment in Cipto Mangunkusumo Hospital (RSCM). Data were obtained from medical records that meet the inclusion and exclusion criteria in the period February 2017 to February 2023. Result. There is no significant difference in the prevalence of LTFU cases between the period before (15.2%) and during the pandemic (19.2%), p 0,237. In the pre-pandemic period, the largest proportion of LTFU was in the 5-10 year age group (19.3%), clinical stage IV (17.9%), distance from residence more than 10 km (16.1%), and caregiver status of biological parents (15.8%). Meanwhile, in the period during the pandemic, the largest proportion of LTFU in the 10-18 year age group (23.8%), clinical stage I (30%), residence distance of more than 10 km (19.5%), and caregiver status is not a biological parent (22.3%). Age at diagnosis, clinical stage, distance between home and RSCM, and caregiver status did not have a significant influence on the incidence of LTFU, both in the period before and during the pandemic (p > 0.05). Conclusion. There are no significant differences in the prevalence of LTFU cases between the period before and during the pandemic. Age at diagnosis, clinical stage, distance between home to RSCM, and caregiver status did not have a significant influence on the incidence of LTFU, both in the period before and during the pandemic.
Keywords: children, Human Immunodeficiency Virus (HIV), COVID-19 pandemic, loss-tofollow up (LTFU).