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KATAKATA PENGANTARPENGANTAR

Assalamu’alAssalamu’alaikumaikum w.ww.w

SegalaSegala pujipuji bagibagi AllahAllah SWT,SWT, TuhanTuhan yangyang menciptakanmenciptakan manusiamanusia dandan menambahmenambah ilmuilmu

pengetahuanpengetahuan bagibagi merekamereka yangyang berusahaberusaha mendapatkannymendapatkannya.a. SalawatSalawat dandan salamsalam senantiasasenantiasa

tercurahkantercurahkan kepadkepadaa RasulullRasulullah,ah, penghulupenghulu dandan mahmahaguruaguru bagibagi kitakita semusemua.a. AlhamdulilAlhamdulillahlah

BAtusangkar,BAtusangkar, JanuariJanuari 20172017

DirekturDirektur

Dr.Dr. AFRIZALAFRIZAL HASANHASAN

NIPNIP 1976052919760529 200604200604 11 008008

Pedoman Kerja Pelayanan HIV AIDS Tahun 2017 RSUD Prof.DR.M.Ali Hanafiah

Pedoman Kerja Pelayanan HIV AIDS Tahun 2017 RSUD Prof.DR.M.Ali Hanafiah

mutu pelayanan di lingkungan RSUD.Prof.DR.M.Ali Hanafiah SM Batusangkaryang

mutu pelayanan di lingkungan RSUD.Prof.DR.M.Ali Hanafiah SM Batusangkaryang

cintaicintai ini.ini.

SM

SM

BatusangkartelahBatusangkartelah kitakita miliki.miliki. PedomanPedoman iniini diharapkadiharapkann menjadimenjadi acuanacuan dalamdalam peningkatanpeningkatan

kita

kita

UcapanUcapan terimakasihterimakasih kepadakepada TimTim HIVHIV –– AIDSAIDS yangyang telahtelah menyelesaikanmenyelesaikan PedomanPedoman

KerjaKerja PelayananPelayanan HIVHIV AIDSAIDS TahunTahun 20172017 didi RSUDRSUD Prof.DRProf.DR.M.Ali.M.Ali HanafiahHanafiah SMSM BatusangkarBatusangkar

ini.ini. KamiKami percayapercaya bahwabahwa tidaktidak adaada yangyang sempurnasempurna keckecualiuali AllahAllah SWT,SWT, saransaran dandan masukanmasukan

daridari kitakita sangatsangat diharapkandiharapkan untukuntuk kesempurnaankesempurnaan pedopedomanman iniini untukuntuk masamasa yangyang akanakan

datang.datang.

Wassalamu’alaikumWassalamu’alaikum w.w. w.w.

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BABBAB II PENDAHULUANPENDAHULUAN

1.11.1 LATARLATAR BELAKANGBELAKANG

HIVHIV dandan AIDSAIDS adalahadalah masalahmasalah daruratdarurat global.global. DiDi seluseluruhruh duniadunia lebihlebih daridari 2020 jutajuta

orangorang meninggalmeninggal sementarasementara 4040 jutajuta orangorang telahtelah terinterinfeksi.feksi. FaktaFakta yangyang lebihlebih memprihatinkanmemprihatinkan

   

adalah bahwa di seluruh dunia setiap hari virus HIV menular kepada sekitar 2000 anak di

adalah bahwa di seluruh dunia setiap hari virus HIV menular kepada sekitar 2000 anak di

usiausia 1515 tahun,tahun, terutamaterutama berasalberasal daridari penularanpenularan ibu-ibu-bayi,bayi, menewaskanmenewaskan 14001400 anakanak didi bawahbawah

1515 tahun,tahun, dandan menginfeksimenginfeksi lebihlebih daridari 60006000 orangorang mudmudaa dalamdalam usiausia produktifproduktif antaraantara 15-2415-24

tahuntahun yangyang jugajuga merupakanmerupakan mayoritasmayoritas daridari orang-oranorang-orangg yangyang hiduphidup dengandengan HIVHIV dandan AIDSAIDS

(ODHA).(ODHA). EstimasiEstimasi yangyang dilakukandilakukan padapada tahuntahun 20032003 dipdiperkirakanerkirakan didi IndonesiaIndonesia terdapatterdapat

sekitarsekitar 90.000-130.00090.000-130.000 orangorang terinfeksiterinfeksi HIV,HIV, sedangsedangkankan datadata yangyang tercatattercatat oleholeh DepartemenDepartemen

KesehatanKesehatan RIRI sampaisampai dengandengan MaretMaret 20052005 tercatattercatat 6.786.7899 orangorang hiduphidup dengandengan HIV/AIDS.HIV/AIDS.

UntukUntuk mengantisipasimengantisipasi dandan menghadapimenghadapi ancamanancaman epidemiepidemi iniini IndonesiaIndonesia telahtelah

menyusunmenyusun dandan melaksanakanmelaksanakan StrategiStrategi PenanggulanganPenanggulangan HHIVIV dandan AIDSAIDS melaluimelalui duadua periodeperiode

yangyang dimuatdimuat dalamdalam StrategiStrategi NasionalNasional PenanggulanganPenanggulangan HIVHIV dandan AIDSAIDS 1994-20031994-2003 dandan tahuntahun

2003-2007.2003-2007.

DiDi tahun-tahuntahun-tahun mendatangmendatang tantangantantangan yangyang dihadapidihadapi dadalamlam upayaupaya penanggulanganpenanggulangan

HIVHIV dandan AIDSAIDS semakinsemakin besarbesar dandan rumit.rumit. MengembangkanMengembangkan hasil-hasilhasil-hasil yangyang telahtelah dicapaidicapai dandan

menjabarkanmenjabarkan paradigmaparadigma barubaru dalamdalam upayaupaya penanggulangpenanggulanganan HIVHIV dandan AIDSAIDS menjadimenjadi upayaupaya

yangyang komprehensif,komprehensif, terpadu,terpadu, dandan diselenggarakandiselenggarakan secsecaraara sinergissinergis oleholeh semuasemua pemangkupemangku

kepentingankepentingan (stakeholders).(stakeholders). AkselerasiAkselerasi upayaupaya perawaperawatan,tan, pengobatanpengobatan dandan dukungandukungan

kepada

kepada

lingkunganlingkungan sub-populasisub-populasi berperilakuberperilaku risikorisiko tinggitinggi mmaupunaupun yangyang berperilakuberperilaku risikorisiko rendahrendah dandan

ODHA

ODHA

dijalankan

dijalankan

bersamaan

bersamaan

dengan

dengan

akselerasi

akselerasi

upaya

upaya

pencegahan

pencegahan

baik

baik

di

di

masyarakatmasyarakat umum.umum.

TingginyaTingginya tingkattingkat penyebaranpenyebaran HIVHIV dandan AIDSAIDS padapada kelokelompokmpok manapunmanapun berartiberarti bahwabahwa

semakinsemakin banyakbanyak orangorang menjadimenjadi sakit,sakit, dandan membutuhkanmembutuhkan jasajasa pelayanpelayananan kesehatan.kesehatan. MelihaMelihatt

tingginyatingginya prevalensiprevalensi didi atasatas makamaka masalahmasalah HIV/AIDSHIV/AIDS merupakanmerupakan masalahmasalah kesehatankesehatan

masyarakatmasyarakat yangyang sangatsangat luas.luas. OlehOleh karenakarena ituitu penangananpenanganan tidaktidak hanyahanya daridari segisegi medismedis

tetapitetapi jugajuga daridari psikososialpsikososial dengandengan berdasarkanberdasarkan penpendekatandekatan kesehatankesehatan kesehatankesehatan

masyarakatmasyarakat melaluimelalui upayaupaya pencehanpencehan primer,primer, sekunder,sekunder, dandan tertier.tertier.

 

MengetahuiMengetahui statusstatus HIVHIV lebihlebih dinidini memungkinkanmemungkinkan pemanpemanfaatanfaatan pelayananpelayanan HIVHIV AIDSAIDS

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perubahanperubahan emosionalemosional dandan pengetahuanpengetahuan dalamdalam suatusuatu proprosesses yangyang mendorongmendorong nuraninurani dandan
logika.logika. ProsesProses mendorongmendorong iniini sangatsangat unikunik dandan membutmembutuhkanuhkan pendekatanpendekatan individual.individual.
OlehOleh karenakarena ituitu perluperlu adanyaadanya program-programprogram-program pencegpencegahanahan HIVHIV AIDSAIDS yangyang efektifefektif
dandan memilikimemiliki jangkauanjangkauan layananlayanan yangyang semakinsemakin luasluas seseperti,perti, programprogram pengobatan,pengobatan,
perawatanperawatan dandan dukungandukungan yangyang komprehensifkomprehensif bagibagi ODHAODHA untukuntuk meningkatkanmeningkatkan kualitaskualitas
hidupnya.hidupnya. SehubunganSehubungan dengandengan permasalahanpermasalahan tersebuttersebut mmakaaka TIMTIM HIVHIV AIDSAIDS RSUDRSUD ProfProf DRDR
MM AliAli HanafiahHanafiah SMSM BatusangkarperluBatusangkarperlu menyusunmenyusun pedomanpedoman pelayananpelayanan terkaitterkait dengandengan
PelayananPelayanan HISVHISV AIDS.AIDS.
1.2.1.2. TUJUANTUJUAN
a.a.
UmumUmum ::
MeningkatkanMeningkatkan mutumutu layananlayanan didi RSUDRSUD Prof.DR.M.AliProf.DR.M.Ali HanHanafiahafiah SMSM BatusangkarBatusangkar
b.b.
berkaitanberkaitan dengandengan PelayananPelayanan HIVHIV AIDSAIDS didi RumahRumah SakitSakit
KhususKhusus ::
1.1. SebagaiSebagai PedomanPedoman bagibagi semuasemua jajaranjajaran pelaksanapelaksana pelpelayananayanan didi RSUDRSUD
Prof.DR.M.AliProf.DR.M.Ali HanafiahHanafiah SMSM BatusangkardalamBatusangkardalam halhal pelapelayananyanan HIVHIV AIDSAIDS didi RS.RS.
2.2. MenurunkanMenurunkan angkaangka kesakitakesakitann HIVHIV didi RSRS terkaitterkait dengandengan MDG’MDG’ss 66
1.3.1.3. SASARANSASARAN
Pimpinan,Pimpinan, pengambilpengambil kebijakankebijakan didi rumahrumah sakit,sakit, petugpetugasas kesehatankesehatan dandan pelaksanapelaksana
kesehatankesehatan lainnyalainnya didi RSUDRSUD Prof.DR.M.AliProf.DR.M.Ali HanafiahHanafiah SMSM BatusangkarBatusangkar
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BABBAB IIII

SITUASISITUASI HIVHIV AIDSAIDS DIDI INDONESIAINDONESIA

2.12.1 EPIDEMIOLOGIEPIDEMIOLOGI HIVHIV AIDSAIDS DIDI INDONESIAINDONESIA

PenyakitPenyakit HIV-AIDSHIV-AIDS hinggahingga kinikini tetaptetap belumbelum dapatdapat disdisembuhkan,embuhkan, tercatattercatat oleholeh WHOWHO

secarasecara kumulatifkumulatif jumlahjumlah kematiankematian akibatakibat AIDSAIDS didi dunduniaia padapada tahuntahun 20062006 mencapaimencapai lebihlebih daridari

2525 jutajuta jiwa.jiwa. PenularanPenularan HIV/AIDSHIV/AIDS dapatdapat terjaditerjadi melamelaluilui tigatiga jalurjalur utamautama masuknyamasuknya virusvirus HIVHIV

keke dalamdalam tubuh,tubuh, yaituyaitu melaluimelalui hubunganhubungan seksualseksual beriberisiko,siko, paparanpaparan dengandengan cairancairan atauatau

) yaitu lebih besar dari 1% pada masyarakat umum. H

placenta,placenta, saatsaat persalinanpersalinan melaluimelalui cairancairan genitalgenital dadann saatsaat menyusuimenyusui melaluimelalui pemberianpemberian ASI.ASI.

jaringan tubuhtubuh yangyang terinfeksiterinfeksi (misalnya(misalnya penggunpenggunaanaan jarumjarum suntiksuntik yangyang tidaktidak sterilsteril dandan

jaringan

tranfusitranfusi darah),darah), sertaserta daridari ibuibu keke janinjanin atauatau bayibayi (perinatal)(perinatal) selamaselama dalamdalam kandungankandungan melaluimelalui

JumlahJumlah HIV/AIDSHIV/AIDS yangyang tercatattercatat sebenarnyasebenarnya jauhjauh lebihlebih kecilkecil daridari prevalensiprevalensi

sesungguhnyasesungguhnya yangyang dibaratkandibaratkan sebagaisebagai fenomenafenomena gunungunungg es.es. IndonesiaIndonesia termasuktermasuk dalamdalam

kategorikategori epidemiepidemi dengandengan tingkattingkat prevalensiprevalensi HIVHIV yangyang rendahrendah didi dunia,dunia, yaituyaitu sekitarsekitar 0,2%.0,2%.

JumlahJumlah kasuskasus barubaru AIDSAIDS didi IndonesiaIndonesia dalamdalam kurunkurun wakwaktutu tigatiga tahuntahun terakhirterakhir mengalamimengalami

turunturun naiknaik yaituyaitu padapada tahuntahun 20082008 sebanyaksebanyak 4.9694.969 kaskasus,us, tahuntahun 20092009 sebanyaksebanyak 3.8633.863 kasus,kasus,

tahuntahun 20102010 sebanyaksebanyak 4.1584.158 kasus.kasus. SecaraSecara kumulatifkumulatif jjumlahumlah HIVHIV positifpositif didi IndonesiaIndonesia hinggahingga

DesemberDesember 20102010 tercatattercatat sebanyaksebanyak 44.29244.292 kasuskasus dandan AIAIDSDS sebanyaksebanyak 24.13124.131 kasus,kasus,

diantaranyadiantaranya berdasarkanberdasarkan jenisjenis kelaminkelamin laki-lakilaki-laki sebsebesaresar 73,04%,73,04%, perempuanperempuan sebesarsebesar

26,58%,26,58%, dandan sisanyasisanya tidaktidak diketahuidiketahui sebesarsebesar 0,38%,0,38%, usiausia reproduksireproduksi aktifaktif (15-49(15-49 tahun)tahun)

sebesarsebesar 62,5%,62,5%, transmisitransmisi perinatalperinatal sebesarsebesar 2,60%,2,60%, bbalitaalita (<4(<4 tahun)tahun) sebesarsebesar 1,99%1,99% dengandengan

totaltotal kematiankematian sebesarsebesar 18,81%18,81% daridari jumlahjumlah totaltotal 24.24.131131 kasus.kasus.

SaatSaat iniini perkembanganperkembangan epidemiepidemi HIVHIV didi IndonesiaIndonesia termtermasukasuk yangyang tercepattercepat didi Asia.Asia.

IndonesiaIndonesia beradaberada padapada levellevel epidemiepidemi HIVHIV terkonsentrterkonsentrasiasi (( concentratedconcentrated epidemicepidemic)) kecualikecuali

TanahTanah PapuaPapua yangyang termasuktermasuk epidemiepidemi HIVHIV yangyang meluas.meluas. SebagianSebagian besarbesar infeksiinfeksi barubaru

diperkirakandiperkirakan terjaditerjadi padapada beberapabeberapa sub-populasisub-populasi berberisikoisiko tinggitinggi yaituyaitu penggunapengguna napzanapza

suntik,suntik, heterohetero dandan homoseksualhomoseksual (( WPS,WPS, wariawaria ).). SejaSejakk tahuntahun 2000,2000, prevalensiprevalensi HIVHIV mulaimulai

konstankonstan didi atasatas 5%5% padapada beberapabeberapa sub-populasisub-populasi berisberisikoiko tinggitinggi tertentu.tertentu. DiDi TanahTanah PapuaPapua

(Provinsi(Provinsi PapuaPapua dandan PapuaPapua Barat),Barat), prevalensiprevalensi HIVHIV memenunjukkannunjukkan tingkattingkat epidemiepidemi yangyang

meluasmeluas ((generalizedgeneralized epidemicepidemic) yaitu lebih besar dari 1% pada masyarakat umum. H

estimasiestimasi jumlahjumlah ODHAODHA didi IndonesiaIndonesia tahuntahun 20112011 berkisberkisarar 591.823591.823 ODHA.ODHA. PenularanPenularan melaluimelalui

asil

asil

heteroseksualheteroseksual menjadimenjadi faktorfaktor risikorisiko utamautama (59,8%)(59,8%) ddiikutiiikuti penggunaanpenggunaan jarumjarum suntiksuntik (18%)(18%)

padapada akhirakhir MaretMaret 2013.2013. MenurutMenurut datadata KementerianKementerian KesKesehatanehatan RIRI hinggahingga MaretMaret 2013,2013, secarasecara

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PeningkatanPeningkatan jumlahjumlah penderitapenderita HIV/AIDSHIV/AIDS tersebuttersebut tidatidakk menunjukkanmenunjukkan indikasiindikasi kearahkearah
pencapaianpencapaian targettarget MillenniumMillennium DevelopmentDevelopment GoalsGoals untukuntuk HIVHIV dandan AIDS,AIDS, dimanadimana akanakan
dicapaidicapai pengendalianpengendalian penyebaranpenyebaran dandan mulaimulai penurunanpenurunan jumlahjumlah kasuskasus barubaru HIV/AIDSHIV/AIDS hinggahingga
tahuntahun 2015.2015. JumlahJumlah wanitawanita yangyang terinfeskiterinfeski HIVHIV lebihlebih sedikitsedikit dibandingdibanding laki-lakilaki-laki namunnamun
demikiandemikian penderitapenderita HIV/AIDSHIV/AIDS padapada usiausia reproduksireproduksi akaktiftif (15-49(15-49 tahun)tahun) tinggi.tinggi. KondisiKondisi
tersebuttersebut berpotensiberpotensi padapada penularanpenularan HIVHIV melaluimelalui ibuibu keke bayibayi cenderungcenderung meningkatmeningkat seiringseiring
dengandengan meningkatnyameningkatnya jumlahjumlah perempuanperempuan HIVHIV positifpositif yayangng tertulartertular daridari pasanganpasangan sexnya.sexnya.
BerdasarkanBerdasarkan hasilhasil proyeksiproyeksi daridari KomisiKomisi PenanggulangPenanggulanganan AIDSAIDS Nasional,Nasional,
diperkirakandiperkirakan ibuibu hamilhamil HIVHIV positifpositif sebanyaksebanyak 5.7305.730 oorangrang padapada tahuntahun 20102010 akanakan meningkatmeningkat
menjadimenjadi 8.1708.170 orangorang padapada tahuntahun 2014.Lebih2014.Lebih daridari 90%90% kasuskasus bayibayi yangyang terinfeksiterinfeksi HIV,HIV, akibatakibat
penularanpenularan daridari ibuibu keke bayi.bayi. DiDi negaranegara maju,maju, risikorisiko seorangseorang bayibayi tertulartertular HIVHIV daridari ibunyaibunya
sekitarsekitar 1-2%1-2% karenakarena tersediatersedia layananlayanan optimaloptimal pencegpencegahanahan penularanpenularan HIVHIV daridari ibuibu keke bayi.bayi.
TetapiTetapi didi negaranegara berkembangberkembang atauatau negaranegara miskin,miskin, tantanpapa adanyaadanya aksesakses intervensi,intervensi, risikonyarisikonya
antaraantara 25%-45%.525%-45%.5 BayiBayi HIVHIV positifpositif kemungkinankemungkinan akanakan terjaditerjadi gangguangangguan tumbuhtumbuh kembangkembang
karenakarena lebihlebih seringsering mengalamimengalami infeksiinfeksi bakteribakteri maupumaupunn virus,virus, mendapatmendapat hukumanhukuman sosialsosial
berupaberupa stigmatisasi,stigmatisasi, diskriminasidiskriminasi daridari masyarakatmasyarakat ddanan tentunyatentunya akanakan kehilangankehilangan ibunya.ibunya.
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BABBAB IIIIII PROGRAMPROGRAM PELAYANANPELAYANAN HIVHIV AIDSAIDS

 

3.1.3.1. KEBIJAKANKEBIJAKAN

ProgramProgram PelayananPelayanan HIVHIV AIDSAIDS didi RSUDRSUD Prof.DR.M.AliProf.DR.M.Ali HaHanafiahnafiah SMSM BatusangkarBatusangkar

berdasarkanberdasarkan padapada SKSK DirekturDirektur RSUDRSUD Prof.DR.M.AliProf.DR.M.Ali HanHanafiahafiah SMSM BatusangkarBatusangkar tentangtentang

kebijakankebijakan pelayananpelayanan HIVHIV AIDSAIDS dengandengan kebijakankebijakan‐‐kebijakankebijakan sebagaisebagai berikutberikut ::

 

1.1. PeningkataPeningkatann penyelenggaraanpenyelenggaraan pelayananpelayanan atauatau perawatanperawatan kesehatankesehatan HIVHIV -AIDS-AIDS

yangyang berkesinambunganberkesinambungan yangyang berfokusberfokus kepadakepada pasien,pasien, RSUDRSUD Prof.DR.M.AliProf.DR.M.Ali

Hanafiah SM Batusangkar melihat kebutuhan pasien selama perawatan, baik di

Hanafiah SM Batusangkar melihat kebutuhan pasien selama perawatan, baik di

rawatrawat jalanjalan maupunmaupun rawatrawat inap.inap.

 

2.2. UntukUntuk pasienpasien yangyang sedangsedang dirawatdirawat inapinap dandan melihatmelihat aadada gejalagejala gejalagejala infeksiinfeksi

opportunistik , maka RSUD Prof.DR.M.Ali Hanafiah SM Batusangkar melalui

opportunistik , maka RSUD Prof.DR.M.Ali Hanafiah SM Batusangkar melalui

medismedis atauatau keperawatankeperawatan dapatdapat melakukanmelakukan pemeriksaanpemeriksaan rapidrapid testtest tanpatanpa melaluimelalui

tim

tim

konselingkonseling dengandengan menggunakanmenggunakan konsepkonsep TestTest InisiatifInisiatif PetugasPetugas KesehatanKesehatan (TIPK)(TIPK)

3.3. UntukUntuk pasienpasien yangyang sudahsudah didi diagnosadiagnosa dengandengan OrangOrang DenganDengan HIV-AIDSHIV-AIDS (ODHA)(ODHA)

atauatau punpun pasangannyapasangannya yangyang inginingin mempunyaimempunyai keturunanketurunan makamaka dianjurkandianjurkan untukuntuk

mengikutimengikuti ProgramProgram PencegahanPencegahan PenularaPenularann IbuIbu AnakAnak (PPIA)(PPIA)

4.4. UntukUntuk papasiensien yyangang menmendapatdapat lalayananyanan keke rumarumahh sakit,sakit, makamaka RRSUDSUD PProf.DR.M.Alirof.DR.M.Ali

HanafiahHanafiah SMSM BatusangkarBatusangkar akanakan memberimemberi konseling,konseling, informasiinformasi dandan edukasiedukasi kepadakepada

pasienpasien dandan keluargakeluarga yangyang tepattepat tentangtentang tindaktindak lanjulanjutt pelayananpelayanan atauatau perawatanperawatan

5.5. UntukUntuk pasienpasien yangyang tidaktidak langsunglangsung dirujukdirujuk keke rumarumahh sakitsakit lain,lain, makamaka RSUDRSUD

Prof.DR.M.AliProf.DR.M.Ali HanafiahHanafiah SMSM BatusangkarBatusangkar akanakan memberimemberi informasiinformasi dandan edukasiedukasi

kepadakepada pasienpasien dandan keluargakeluarga yangyang tepattepat tentangtentang tindatindakk lanjutlanjut pelayananpelayanan atauatau

perawatanperawatan

6.6. UntukUntuk merujukmerujuk pasienpasien kerumahkerumah sakitsakit RSUDRSUD Prof.DR.M.Prof.DR.M.AliAli HanafiahHanafiah SMSM BatusangkaBatusangkarr

menentukanmenentukan bahwabahwa rumahrumah sakitsakit penerimapenerima dapatdapat menyedimenyediakanakan kebutuhankebutuhan pasienpasien

yangyang akanakan dirujukdirujuk

7.7. UntukUntuk pasienpasien yyangang sudahsudah ddidiagnosisidiagnosis oorangrang dengandengan HHIV-AIDSIV-AIDS (ODHA),(ODHA), makamaka sesetiaptiap

   

kunjungankunjungan dilakukandilakukan skreningskrening TBTB

 

8.8. UntukUntuk pasienpasien yangyang sudahsudah didiagnosadidiagnosa dengandengan ODHAODHA makamaka konselorkonselor // petugaspetugas RSUDRSUD

Prof.DR.M.AliProf.DR.M.Ali HanafiahHanafiah SMSM BatusangkarBatusangkar harusharus merujukmerujuk keke kelompokkelompok dukungandukungan

sebaya/sebaya/ pendampingpendamping (LSM)(LSM) yangyang sudahsudah bekerjasamabekerjasama degdeganan RS.RS.

 
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10.10. KebijakanKebijakan iniini ssecaraecara teknisteknis pelaksanaannyapelaksanaannya dijabarkandijabarkan lebihlebih lanjutlanjut dalamdalam benbentuktuk StandarStandar ProsedurProsedur OperasionalOperasional (SPO)(SPO)

3.23.2 PELAYANANPELAYANAN HIVHIV DADANN AAIDSIDS

PelayananPelayanan kesehatankesehatan primerprimer yangyang komprehensifkomprehensif (( ComprehensiveComprehensive PrimaryPrimary HealthHealth CareCare)) adalahadalah strategistrategi untukuntuk meningkatkanmeningkatkan kesehatankesehatan masymasyarakatarakat secarasecara menyeluruh.menyeluruh. HalHal tersebuttersebut dilakukandilakukan dengandengan memandangmemandang pentingpenting berbagaberbagaii masalahmasalah sosialsosial yangyang berpengaruhberpengaruh

terhadapterhadap masalahmasalah kesehatan,kesehatan, melibatkanmelibatkan masyarakatmasyarakat ddanan menyediakanmenyediakan fasilitasfasilitas pelayananpelayanan kesehatankesehatan secarasecara meratamerata yangyang dapatdapat menjangkaumenjangkau selurseluruhuh lapisanlapisan masyarakat.masyarakat. PelayananPelayanan kesehatankesehatan primerprimer yangyang komprehensifkomprehensif padapada dasarnyadasarnya adadalahalah strategistrategi meningkatkanmeningkatkan derajatderajat kesehatankesehatan individuindividu dandan masyarakatmasyarakat melaluimelalui aktifitasaktifitas menyeluruhmenyeluruh yangyang mencakupmencakup promotif,promotif, preventif,preventif, kuratifkuratif dandan rehabilitatif.rehabilitatif. HalHal tersebuttersebut dilakukandilakukan dengandengan memfokuskanmemfokuskan perhatianperhatian padapada upayaupaya mengentaskanmengentaskan masalahmasalah mendasarmendasar ((underlyingunderlying)) yangyang menjadimenjadi penyebabpenyebab masalahmasalah kesehatankesehatan masyarakat.masyarakat. PelayananPelayanan kesehatankesehatan primerprimer yangyang komprehensifkomprehensif tersebtersebutut dilakukandilakukan melaluimelalui kerjakerja samasama berbagaiberbagai sektorsektor sertaserta keterlibatanketerlibatan pemerintah,pemerintah, kekuatankekuatan politikpolitik dandan partisipasipartisipasi masyarakat.masyarakat. StrategiStrategi pelayananpelayanan kesehatankesehatan primerprimer yanyangg komprehensifkomprehensif perluperlu memperhatikanmemperhatikan mekanismemekanisme mendasarmendasar yangyang menjadimenjadi penyebabpenyebab munculnyamunculnya masalahmasalah HIV/AIDSHIV/AIDS tersebut.tersebut. Selanjutnya,Selanjutnya, dilakukandilakukan berbagaiberbagai langkahlangkah edukasiedukasi dandan promosipromosi kesehatankesehatan padapada seluruhseluruh lapisanlapisan masyarakat,masyarakat, khususnyakhususnya kelompokkelompok yangyang berisikberisikoo sangatsangat tinggi.tinggi. SelainSelain itu,itu, jugajuga perluperlu dilakukandilakukan pengobatanpengobatan dandan rehabilitasirehabilitasi terhadapterhadap parapara penderitapenderita HIV/AIDSHIV/AIDS PelayananPelayanan didi tingkattingkat puskemaspuskemas merupakanmerupakan pelayananpelayanan HHIVIV dasardasar yangyang tentunyatentunya padapada tahaptahap tertentutertentu memerlukanmemerlukan rujukanrujukan keke tingkattingkat ppelayananelayanan sekundersekunder atauatau tertiertertier (rumah(rumah sakit)sakit) sertaserta melibatkanmelibatkan seluruhseluruh pihakpihak sepertiseperti KPA,KPA, SKPDSKPD lainnya,lainnya, LSM,LSM, KelompokKelompok DampinganDampingan Sebaya,Sebaya, masyarakatmasyarakat maupunmaupun keluarga.keluarga. RSUDRSUD Prof.DR.M.AliProf.DR.M.Ali HanafiahHanafiah SMSM Batusangkart.Batusangkart. RumahRumah SakitSakit iniini memberikanmemberikan

 
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2.2. Perawatan,Perawatan, DukunganDukungan dandan PengobatanPengobatan (PDP)(PDP) SebagaiSebagai tindaktindak lanjutlanjut terhadapterhadap hasilhasil testes HIVHIV yangyang mmenyatakanenyatakan hasilhasil positifpositif HIVHIV selanjutnyaselanjutnya akanakan didi rujukrujuk keke RumahRumah SakitSakit AchmadAchmad MocMochtarhtar (RSAM)(RSAM) BukittinggiBukittinggi dandan RSUPRSUP DRDR MM DjamilDjamil PadangPadang untukuntuk dilakukandilakukan pemeriksaanpemeriksaan CD4CD4 dandan pemberianpemberian ARV.ARV. PasienPasien dapatdapat memilihmemilih apakahapakah iaia akanakan melanjutkanmelanjutkan pengobatannypengobatannyaa didi RumahRumah SakitSakit atauatau dirujukdirujuk kerumahkerumah sakitsakit rujukanrujukan yangyang dekatdekat dengandengan tempattempat berdomisilinya.berdomisilinya. DalamDalam layananlayanan HIVHIV AIDSAIDS pemberianpemberian ARVARV dapatdapat langsunglangsung diberikandiberikan tanpatanpa

memandangmemandang jumlahjumlah CD4nyaCD4nya kepadakepada merekamereka yangyang HIVHIV (+)(+) yaituyaitu padapada ibuibu hamil,hamil, pasienpasien koinfeksikoinfeksi TB,TB, pasienpasien koinfeksikoinfeksi HepatitisHepatitis BB ddanan C,C, LSL,LSL, WPS,WPS, Penasun,Penasun, ODHAODHA yangyang pasanganpasangan tetapnyatetapnya memilikimemiliki statusstatus HIVHIV (-)(-) dandan tidaktidak menggunakanmenggunakan kondomkondom secarasecara konsisten.konsisten. 3.3. PencegahanPencegahan PenularanPenularan HHIVIV daridari IbuIbu keke AnakAnak (PPIA)(PPIA) LayananLayanan iniini mencakupmencakup pelayananpelayanan AnteAnte NatalNatal CareCare (ANC(ANC)) dandan mmelakukanelakukan testes HIVHIV bagibagi ibuibu hamil,hamil, PelaksanakanPelaksanakan layananlayanan PPIAPPIA dengandengan memenitikberatkannitikberatkan padapada upayaupaya promotifpromotif dandan preventif.preventif. 4.4. ProgramProgram TerapiTerapi RumatanRumatan MetadonMetadon (PTRM)(PTRM) LayananLayanan iniini dilaksanakandilaksanakan dalamdalam rangkarangka mengurangimengurangi ririsikosiko penularanpenularan HIVHIV melaluimelalui penggunaanpenggunaan jarumjarum suntiksuntik padapada kelompokkelompok Penasun.Penasun. PencPencanduandu obatobat obatanobatan yangyang menggunakanmenggunakan jarumjarum suntiksuntik akanakan beralihberalih meminummeminum obatobat dandan secarasecara perlahan-lahanperlahan-lahan diharapkandiharapkan dapatdapat terlepasterlepas daridari kecanduankecanduan obat.obat.

 
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BABBAB IVIV
PENGENALANPENGENALAN PENYAKITPENYAKIT HIVHIV AIDSAIDS
4.14.1
DEFINISIDEFINISI HIVHIV AIDS.AIDS.
HIVHIV adalahadalah singkatansingkatan daridari HumanHuman ImmunodeficiencyImmunodeficiency VirusVirus yaituyaitu virusvirus yangyang termasuktermasuk
kelompokkelompok keluargakeluarga retrovirusretrovirus dandan dapatdapat menyebabkanmenyebabkan penyakitpenyakit AIDS.AIDS. SeseorangSeseorang yangyang
terinfeksiterinfeksi HIV,akanHIV,akan mengalamimengalami infeksiinfeksi seumurseumur hidup.hidup. BanyakBanyak ODHAODHA tetaptetap asimptomatikasimptomatik
(tanpa(tanpa tandatanda dandan gejalagejala darisuatudarisuatu penyakit)penyakit) untukuntuk jjangkaangka waktuwaktu panjangpanjang dandan tidaktidak
mengetahuimengetahui bahwabahwa dirinyadirinya terinfeksi.terinfeksi. MeskipunMeskipun demikdemikian,ian, merekamereka dapatdapat menularimenulari orangorang lain.lain.
AIDSAIDS adalahadalah sisingkatanngkatan daridari AcquiredAcquired ImmunImmunee DeficienDeficiencycy SyndromeSyndrome AcquiredAcquired artinyaartinya
tidaktidak diturunkanditurunkan tetapitetapi ditularkanditularkan daridari satusatu keke oraorangng lainnya;lainnya; ImmuneImmune adalahadalah sistemsistem dayadaya
tahantahan tubuhtubuh atauatau kekebalankekebalan tubuhtubuh terhadapterhadap penyakit;penyakit; DeficiencyDeficiency artinyaartinya tidaktidak cukupcukup atauatau
kurang;kurang; dandan SyndromeSyndrome adalahadalah kumpulankumpulan tandatanda dandan gejalagejala penyakit.penyakit. AcquiredAcquired ImmuneImmune
DeficiencyDeficiency SyndromeSyndrome adalahadalah bentukbentuk lanjutlanjut daridari infeksiinfeksi HIV.HIV. AIDSAIDS merupakmerupakanan kumpulankumpulan
gejalagejala penyakitpenyakit yangyang disebabkandisebabkan oleholeh virusvirus HIVHIV (Hum(Humanan ImmunodeficiencyImmunodeficiency Virus)Virus) yangyang
mengakibatkanmengakibatkan rusaknya/menurunnyarusaknya/menurunnya sistemsistem kekebalankekebalan tubuhtubuh terhadapterhadap berbagaiberbagai penyakit.penyakit.
Apabila HIV iniini masukmasuk keke dalamdalam peredaranperedaran darahdarah seseorang,seseorang, makamaka HIVHIV tersebuttersebut menyerapmenyerap
Apabila HIV
sel-selsel-sel darahdarah putih.putih. Sel-selSel-sel darahdarah putihputih iniini adalahadalah bagianbagian daridari sistemsistem kekebalankekebalan tubuhtubuh yangyang
berfungsiberfungsi melindungimelindungi tubuhtubuh daridari seranganserangan penyakit.penyakit. HIVHIV secarasecara berangsur-angsurberangsur-angsur merusakmerusak
selsel darahdarah putihputih hinggahingga tidaktidak bisabisa berfungsiberfungsi dengandengan baik.baik.
4.24.2
SEJARAHSEJARAH HIVHIV AIDSAIDS
PenyakitPenyakit iniini pertamapertama kalikali timbultimbul didi Afrika,Afrika, Haiti,Haiti, dandan AmerikaAmerika SerikatSerikat padapada tahuntahun
1978.1978. PadaPada tahuntahun 19791979 pertamapertama kalikali dilaporkandilaporkan adanyadanyaa kasus-kasuskasus-kasus SarkomaSarkoma KaposiKaposi dandan
penyakitpenyakit penyakitpenyakit infeksiinfeksi yangyang jarangjarang terjaditerjadi didi ErEropa,opa, penyakitpenyakit iniini menyerangmenyerang orang-orangorang-orang
AfAf ikik
bb
kiki
didi EE
SS
ii
tt
ii
ii bb
ll
didi
dd
ii
ll
hh
ilil
bb
hh
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forfor DiseaseDisease Control)Control) AmerikaAmerika SerikatSerikat untukuntuk pertamakpertamakaliali membuatmembuat defenisidefenisi kasuskasus AIDS.AIDS.

SejakSejak tahuntahun 19821982 dilakukandilakukan surveilanssurveilans terhadapterhadap kasukasus-kasuss-kasus AIDS.AIDS.

 

PadaPada tahuntahun 19821982 ––19831983 mulaimulai diketahuidiketahui adanyaadanya transmisitransmisi diluardiluar jalurjalur hubunganhubungan

seksual,seksual, yaituyaitu melaluimelalui transfusitransfusi darah,darah, penggunaanpenggunaan jarumjarum suntiksuntik secarasecara bersamabersama oleholeh parapara

penyalahgunaanpenyalahgunaan narkotiknarkotik dandan obat-obatobat-obat terlarang.terlarang. PaPadada tahuntahun iniini jugajuga LucLuc MontagnierMontagnier daridari

PasteurPasteur Institute,Institute, ParisParis InstituteInstitute menemukanmenemukan bahwabahwa penyebabpenyebab kelainankelainan iniini adalahadalah LAVLAV

(Lymphadeno(Lymphadenopathypathy AssociatedAssociated Virus).Virus).

 

PadaPada tahuntahun 19841984 diketahuidiketahui adanyaadanya transmisitransmisi heteroseheteroseksualksual didi AfrikaAfrika dandan padapada tahuntahun

 

yangsamayangsama diketahuidiketahui bahwabahwa HIVHIV menyerangmenyerang selsel limfositlimfosit TT penolong.penolong. PadaPada tahuntahun ituitu jugajuga

Gallo dkk dariNational Institute of Health, Bethesda, Amerika Serikat menemukan HTLV III

Gallo dkk dariNational Institute of Health, Bethesda, Amerika Serikat menemukan HTLV III

(Human(Human TT CellCell LymphotropicLymphotropic VirusVirus TypeType III)III) sebagaisebagai penyebabkanpenyebabkan kelainankelainan ini.ini. PadaPada tahuntahun

19851985 ditemukanantigenditemukanantigen untukuntuk melakukanmelakukan testes Elisa,Elisa, papadada tahuntahun ituitu jugajuga diketahuidiketahui bahwabahwa HIVHIV

juga menyera

juga menyerangng selotak.selotak.

PadaPada tahuntahun 19861986 InternationalInternational CommitteeCommittee onon TaxonomyTaxonomy ofof VirusVirus memutuskanmemutuskan

namapenyebabnamapenyebab penyakitpenyakit AIDSAIDS adalahadalah HIVHIV sebagaisebagai penggpenggantianti LAVLAV dandan HLTV.AIDSHLTV.AIDS

(Acquired(Acquired ImmuneImmune DeficiencyDeficiency Syndrome)Syndrome) atauatau SIDASIDA (Sy(Syndromndrom ImunoImuno DeficiencyAkuisita)DeficiencyAkuisita)

adalah sebuah penyakit yang dengan cepat menyebar keseluruhan dunia (pandemi).

adalah sebuah penyakit yang dengan cepat menyebar keseluruhan dunia (pandemi).

IndonesiaIndonesia pertamapertama kalikali mengetahuimengetahui adanyaadanya kasuskasus AIDSAIDS padapada bulanbulan AprilApril tahuntahun 1987,1987, padapada

Di

Di

seorangseorang wargawarga negaranegara BelandaBelanda yangyang meninggalmeninggal didi RSUPRSUP SanglahSanglah BaliBali akibatakibat infeksiinfeksi

sekundersekunder padapada paru-paru,paru-paru, sampaisampai padapada tahuntahun 19901990 penpenyakityakit iniini masihmasih belumbelum

mengkhawatirkan,mengkhawatirkan, namunnamun sejaksejak awalawal tahuntahun 1991telah1991telah mmulaiulai adanyaadanya peningkatanpeningkatan kasuskasus

HIV/AIDSHIV/AIDS menjadimenjadi duadua kalikali lipatlipat (doubling(doubling time)time) kurkurangang daridari setahun,setahun, bahkanbahkan mengalamimengalami

peningkatanpeningkatan kasuskasus secarasecara ekponensiaekponensial.l.

 

4.34.3 PERJALANANPERJALANAN ALAMIAHALAMIAH HIVHIV

SecaraSecara umumumum tahapantahapan perjalananperjalanan alamiahalamiah infeksiinfeksi HIVHIV sebagaisebagai berikut:berikut:

3 minggu setelah terinfeksi virus, berupa demam, s

SindromaSindroma retroviralretroviral akutakut terjaditerjadi 22 –– 3 minggu setelah terinfeksi virus, berupa demam, s

akit

akit

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tubuhtubuh ituitu terinfeksiterinfeksi dandan virusvirus mulaimulai bereplikasibereplikasi teterutamarutama dalamdalam selsel limfositlimfosit TT CD4CD4 dandan makrofag.makrofag. HumanHuman ImmunodeficiencyImmunodeficiency VirusVirus akanakan mempengaruhimempengaruhi sistemsistem kekebalankekebalan tubuhtubuh dengandengan menghasilkanmenghasilkan antibodiantibodi untukuntuk HIV.HIV. MasaMasa antaraantara masukmasuk virusvirus sampaisampai terbentuknyaterbentuknya antibodiantibodi yangyang dapatdapat dideteksidideteksi melaluimelalui pemeriksaanpemeriksaan llaboratoriumaboratorium adalahadalah selamaselama 4-124-12 minggu.minggu. MasaMasa iniini disebutdisebut sebagaisebagai masamasa jendelajendela ((windowwindow periodperiod).). SelamaSelama masamasa jendela,jendela, pasienpasien sangatsangat infeksius,infeksius, mudahmudah menularkanmenularkan HIVHIV kepadkepadaa orangorang lain,lain, meskipunmeskipun hasilhasil

pemeriksaanpemeriksaan laboratoriumlaboratorium antibodiantibodi masihmasih negatif.negatif. OrOrangang yangyang terinfeksiterinfeksi HIVHIV dapatdapat tetaptetap tanpatanpa gejalagejala untukuntuk jangkajangka waktuwaktu yangyang cukupcukup lamalama bahbahkankan sampaisampai 1010 tahuntahun atauatau lebih.lebih. OrangOrang iniini sangatsangat mudahmudah menularkanmenularkan infeksinyainfeksinya kepadakepada orangorang lainlain dandan hanyahanya dapatdapat dikenalidikenali daridari pemeriksaanpemeriksaan antibodiantibodi HIV.HIV. KemudianKemudian virusvirus mempememperbanyakrbanyak diridiri secarasecara cepatcepat (replikasi)(replikasi) dandan diikutidiikuti dengandengan perusakanperusakan selsel limfositlimfosit TT CD4CD4 dandan selsel kekebalankekebalan lainnyalainnya sehinggasehingga terjadilahterjadilah sindromasindroma penurunanpenurunan dayadaya tahantahan tubuhtubuh yangyang progresifprogresif (( progressiveprogressive immunodeficiencyimmunodeficiency syndromesyndrome).). ProgresivitasProgresivitas tergantungtergantung beberapabeberapa faktorfaktor sepertiseperti ususiaia (sangat(sangat cepatcepat padapada usiausia kurangkurang daridari 55 tahuntahun atauatau didi atasatas 4040 tahun),tahun), infeksiinfeksi lainnyalainnya dandan adanyaadanya faktorfaktor genetikgenetik (herediter).(herediter).

 

4.44.4 CARACARA PENULARANPENULARAN

PenularanPenularan HIVHIV terjaditerjadi melaluimelalui kontakkontak seksual,seksual, darahdarah,, penularanpenularan daridari ibuibu keke anakanak

selamaselama masamasa kehamilan,kehamilan, persalinanpersalinan dandan pemberianpemberian ASIASI

HumanHuman ImmunodeficiencyImmunodeficiency VirusVirus

tidaktidak ditularkanditularkan daridari orangorang keke orangorang lainlain melaluimelalui bbersalaman,ersalaman, berpelukan,berpelukan, bersentuhanbersentuhan atauatau berciuman.berciuman. TidakTidak adaada buktibukti bahwabahwa HIVHIV dapatdapat ditularkditularkanan melaluimelalui penggunaanpenggunaan toilet,toilet, kolamkolam renang,renang, alatalat makanmakan atauatau minumminum secarasecara bersamabersama atauatau ggigitanigitan seranggaserangga sepertiseperti nyamuk.nyamuk. PenularanPenularan melaluimelalui hubunganhubungan heteroseksualheteroseksual adalahadalah carcaraa yangyang palingpaling dominandominan daridari semuasemua caracara penularan.penularan. PenularanPenularan melaluimelalui hubunganhubungan seseksualksual dapatdapat terjaditerjadi selamaselama kontakkontak seksualseksual dengandengan penetrasipenetrasi vaginal,vaginal, anal,anal, oraloral seksuaseksuall antaraantara duadua individu.individu. RisikoRisiko tertinggitertinggi

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InfeksiInfeksi
MenularMenular
SeksualSeksual
(IMS)(IMS)
diketahuidiketahui
mempermudahmempermudah
penularanpenularan
HIVHIV
yangyang
selanjutnyaselanjutnya dapatdapat berkembangberkembang menjadimenjadi AIDSAIDS dengandengan titingkatngkat kematiankematian yangyang tinggi.tinggi. InfeksiInfeksi
menularmenular seksualseksual jugajuga merupakanmerupakan petunjukpetunjuk tentangtentang terterdapatnyadapatnya perilakuperilaku seksualseksual berisikoberisiko
tinggi.tinggi. SecaraSecara umum,umum, IMSIMS dapatdapat meningkatkanmeningkatkan risikorisiko penularanpenularan HIVHIV melaluimelalui hubunganhubungan
seksualseksual sebanyaksebanyak 33 -- 55 kalikali lebihlebih besar.besar. OlehOleh karenkarenaa itu,itu, jikajika dijumpaidijumpai pasienpasien TBTB dengandengan
gejalagejala IMSIMS harusharus segerasegera dirujukdirujuk keke layananlayanan IMS.IMS. InfInfeksieksi MenularMenular SeksualSeksual yangyang palingpaling seringsering
dijumpaidijumpai adalahadalah herpesherpes genitalis,genitalis, HIVHIV dandan sifilis,sifilis, gonoregonore dandan klamidia.klamidia.
4.54.5 KELOMPOKKELOMPOK BERISIKOBERISIKO
PenyebaranPenyebaran HIVHIV dipengaruhidipengaruhi oleholeh perilakuperilaku berisikoberisiko ppadaada kelompokkelompok masyarakat.masyarakat.
BerdasarkanBerdasarkan perilakuperilaku dandan potensipotensi tertulartertular HIV,HIV, masymasyarakatarakat dapatdapat dikelompokkandikelompokkan sebagaisebagai
berikut:berikut:
a.a. KelompokKelompok tertulartertular ((infectedinfected peoplepeople)) adalahadalah merekamereka yangyang sudahsudah terinfeksiterinfeksi HIV.HIV.
b.b. KelompokKelompok berisikoberisiko tertulartertular ataatauu rawrawanan tertultertularar ((high-riskhigh-risk peoplepeople)) adalahadalah merekamereka yangyang
berperilakuberperilaku sangatsangat berisikoberisiko untukuntuk tertulartertular HIV.HIV. DalDalamam kelompokkelompok iniini termasuktermasuk penjajapenjaja
seksseks baikbaik perempuan,perempuan, laki-lakilaki-laki dandan wariawaria sertaserta pelapelanggannya,nggannya, penggunapengguna napzanapza
suntiksuntik (penasun).(penasun). NarapidanaNarapidana termasuktermasuk dalamdalam kelompokelompokk ini.ini.
c.c. KelompokKelompok rentanrentan ((vulnerablevulnerable peoplepeople)) adalahadalah kelompokkelompok masyarakatmasyarakat yangyang karenakarena
lingkuplingkup pekerjaan,pekerjaan, lingkungan,lingkungan, ketahananketahanan dandan atauatau kkesejahteraanesejahteraan keluargakeluarga yangyang
rendahrendah dandan statusstatus kesehatankesehatan yangyang labillabil sehinggasehingga renrentantan terhadapterhadap penularanpenularan HIV.HIV.
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b.b. PencegahanPencegahan penularanpenularan melaluimelalui darahdarah dapatdapat berupaberupa :: pencegahanpencegahan dengandengan caracara

memastikanmemastikan bahwabahwa darahdarah dandan produk-produknyaproduk-produknya yangyang didipakaipakai untukuntuk transfusitransfusi tidaktidak

tercemartercemar virusvirus HIV,HIV, janganjangan menerimamenerima donordonor darahdarah dardarii orangorang yangyang berisikoberisiko tinggitinggi

tertulartertular AIDS,AIDS, gunakangunakan alat-alatalat-alat kesehatankesehatan sepertiseperti jarumjarum suntik,suntik, alatalat cukur,cukur, alatalat tusuktusuk

untukuntuk tindiktindik yangyang bersihbersih dandan sucisuci hama.hama.

 

c.c. PencegahanPencegahan ppenularanenularan dadariri Ibu-AnakIbu-Anak (Perina(Perinatal).tal). Ibu-ibuIbu-ibu yangyang ternyternyataata mengidapmengidap

virusvirus HIV/AIDSHIV/AIDS disarankandisarankan untukuntuk tidaktidak hamilhamil atauatau memengikutingikuti programprogram PencegahanPencegahan

penularanpenularan ibu-anakibu-anak (PPIA)(PPIA)

 

SelainSelain daridari berbagaiberbagai caracara pencegahanpencegahan yangyang telahtelah diudiuraikanraikan diatas,diatas, adaada beberapabeberapa

caracara pencegahanpencegahan lainlain yangyang secarasecara langsunglangsung maupunmaupun titidakdak langsunglangsung ikutikut mencegahmencegah

penularanpenularan atauatau penyebaranpenyebaran HIV/AIDS.HIV/AIDS. KegiatanKegiatan tersebtersebutut berupaberupa kegiatankegiatan komunikasi,komunikasi,

informasiinformasi dandan edukasiedukasi (KIE)(KIE) yangyang dalamdalam implementasiimplementasinyanya berupaberupa :: konselingkonseling AIDSAIDS dandan

upayaupaya mempromosikanmempromosikan kondomisasi,kondomisasi, yangyang ditujukanditujukan kepkepadaada keluargakeluarga dandan seluruhseluruh

masyarakatmasyarakat yangyang potensialpotensial tertulartertular HIV/AIDSHIV/AIDS melaluimelalui hubunganhubungan seksualseksual yangyang dilakukanndilakukannya.ya.

DenganDengan caracara iniini keluargakeluarga dandan masyarakatmasyarakat secarasecara teruteruss menerusmenerus akanakan mendapatmendapat informasiinformasi

yangyang barubaru (up(up toto date)date) tentangtentang HIV/AIDSHIV/AIDS sehinggasehingga kekeluargaluarga akanakan lebihlebih waspadawaspada dandan

langkah praktis untuk melindungi anggota keluarganya

mampumampu mengembangkanmengembangkan langkahlangkah ––langkah praktis untuk melindungi anggota keluarganya

daridari penularanpenularan HIVHIV sertaserta untukuntuk mengurangimengurangi tumbuhnyatumbuhnya sikapsikap yangyang menganggapmenganggap bahwabahwa

keluarganyakeluarganya sendirisendiri tidaktidak mungkinmungkin akanakan terinfeterinfeksiksi oleholeh virusvirus AIDSAIDS ini.ini.

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BABBAB VV PENATALAKSAPENATALAKSANAANNAAN PELAYANANPELAYANAN HIVHIV AIDSAIDS

 

5.15.1 PelayananPelayanan KonselingKonseling dandan TestTest HIVHIV (( KTS)KTS) KonselingKonseling dandan TestingTesting SukarelaSukarela yangyang dikenaldikenal sebagaisebagai VoluntaryVoluntary CounsellingCounselling andand TestingTesting (VCT)(VCT) merupakanmerupakan salahsalah satusatu strategistrategi kesehatkesehatanan masyarakatmasyarakat dandan sebagaisebagai pintupintu

masukmasuk keke seluruhseluruh layananlayanan kesehatankesehatan HIV/AIDSHIV/AIDS berkelaberkelanjutan.njutan. KonselingKonseling dalamdalam VCTVCT adalahadalah kegiatankegiatan konselingkonseling yangyang menyediakanmenyediakan dukungandukungan psikologis,psikologis, informasiinformasi dandan pengetahuanpengetahuan HIV/AIDS,HIV/AIDS, mencegahmencegah penularanpenularan HIV,HIV, memprmempromosikanomosikan perubahanperubahan perilakuperilaku yangyang bertanggungbertanggung jawab,jawab, pengobatanpengobatan ARVARV dandan memastikmemastikanan pemecahanpemecahan berbagaiberbagai masalahmasalah terkaitterkait dengandengan HIV/AIDS.HIV/AIDS.

 

MasyarakatMasyarakat yangyang membutuhkanmembutuhkan pemahamanpemahaman diridiri akanakan stastatustus HIVHIV agaragar dapatdapat mencegahmencegah dirinyadirinya daridari penularanpenularan infeksiinfeksi penyakitpenyakit yayangng lainlain dandan penularanpenularan kepadakepada orangorang lain.lain. MasyarakatMasyarakat yangyang datangdatang keke pelayananpelayanan VCTVCT disebdisebutut dengandengan klien.klien. SebutanSebutan klienklien dandan bukanbukan pasienpasien merupakanmerupakan salahsalah satusatu pemberdayaanpemberdayaan dimadimanana klienklien akanakan berperanberperan aktifaktif dalamdalam prosesproses konseling.konseling. TanggungTanggung jawabjawab klienklien dalamdalam konselingkonseling adalahadalah bersamabersama mendiskusikanmendiskusikan hal-halhal-hal yangyang terkaitterkait dengandengan informasiinformasi akuratakurat dandan lengkaplengkap tentangtentang HIV/AIDS,HIV/AIDS, perilakuperilaku berisiko,berisiko, testingtesting HIVHIV dandan pertimbanganpertimbangan yanyangg terkaitterkait dengandengan hasilhasil negativenegative atauatau itifitif

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b.b.
TahapanTahapan PelayananPelayanan VCTVCT
AlurAlur penatalaksanpenatalaksanaanaan VCTVCT dandan keterampilanketerampilan melakukanmelakukan konselingkonseling prapra testingtesting dandan
konselingkonseling pascapasca testingtesting perluperlu memperhatikanmemperhatikan tahapantahapan berikutberikut iniini ::
PerencanaanPerencanaan RawatanRawatan
PsikososialPsikososial anjutananjutan
KonselingKonseling Pasca-tesPasca-testingting
KoselingKoseling Pra-testingPra-testing
PenilaianPenilaian RisikoRisiko KlinikKlinik
KeterampilanKeterampilan MikroMikro KonselingKonseling DasarDasar
KomunikasiKomunikasi PerubahanPerubahan PerilakuPerilaku
AlasanAlasan didi lakukannyalakukannya VCTVCT
InformasiInformasi DasarDasar HIHI
TahapanTahapan PenatalaksanaanPenatalaksanaan ::
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d.d. AlasanAlasan kunjungankunjungan dandan klariklarisifikasisifikasi tentangtentang faktafakta dandan mitosmitos tentangtentang HIV/AIDSHIV/AIDS

 

e.e. PenilaianPenilaian riskorisko untukuntuk membantumembantu klienklien mengetahuimengetahui factorfactor resikoresiko dandan menyiapkanmenyiapkan

diridiri untukuntuk pemeriksaanpemeriksaan darahdarah

 

f.f. MemberikanMemberikan pengetahuanpengetahuan akanakan implikasiimplikasi terinfeksiterinfeksi atauatau tidaktidak terinfeksiterinfeksi HIVHIV dandan

memfasilitasimemfasilitasi diskusidiskusi tentangtentang caracara menyesuaikanmenyesuaikan dirdirii dengandengan statusstatus HIVHIV

 

g.g. DiDi dalamdalam konseingkonseing prapra testingtesting seorangseorang konselorkonselor VVCTCT harusharus dapatdapat membuatmembuat

keseimbangankeseimbangan antaraantara pemberianpemberian informasi,informasi, penilaianpenilaian resikoresiko dandan meresponmerespon

kebutuhankebutuhan emosiemosi klien.klien.

 

h.h. KonselorKonselor VCTVCT melakukanmelakukan penilaianpenilaian sistemsistem dudukunagnkunagn

 

i.i. KlienKlien membmemberikaerika persetpersetujuanujuan terttertulisnyaulisnya (Inf(Informedormed Consent)Consent) sebelumsebelum

dilakukannydilakukannyaa ttestingesting HIV/AIDS.HIV/AIDS.

 

at inap

KonselingKonseling PraPra testingtesting HIV/AIDSHIV/AIDS dalamdalam keadaankeadaan khususkhusus atauatau sedangsedang dirawdirawat inap

RSUDRSUD ProfProf DRDR MM AliAli HanafiahHanafiah SMSM Batusangkar:Batusangkar:

di

di

a.a. DalamDalam keadaankeadaan klienklien sedangsedang dalamdalam rawatrawat inapinap makamaka konselingkonseling dapatdapat dilakukandilakukan

didi ruanganruangan pasienpasien dirawatdirawat oleholeh konselorkonselor sampingsamping temtempatpat tidurtidur atauatau dengandengan

memindahkanmemindahkan tempattempat tidurtidur klienklien keke ruangruang yangyang nyamannyaman dandan terjagaterjaga

kerahasiaanyakerahasiaanya

b.b. DalamDalam keadaankeadaan klienklien tidaktidak stabilstabil makamaka VCTVCT dapatdapat dilakukandilakukan langsunglangsung kepadakepada

klienklien dengandengan prinsipprinsip ProviderProvider‐‐initiatedinitiated HIVHIV testingtesting andand counsellingcounselling ((PITCPITC)) yaituyaitu

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4.4.

TestingTesting HIVHIV dalamdalam VCTVCT

PrinsipPrinsip testingtesting HIVHIV adalahadalah sukarelasukarela dandan terjagaterjaga kerkerahasiaannya.ahasiaannya. TestingTesting dimaksuddimaksud untukuntuk

menegakkanmenegakkan diagnose.diagnose. TerdapatTerdapat serangkaianserangkaian testingtesting yyangang berbeda-bedaberbeda-beda karenakarena perbedaanperbedaan

prinsipprinsip metodametoda yangyang didi gunakan.gunakan. TestingTesting yangyang digunadigunakankan adalahadalah testingtesting serologisserologis untukuntuk

mendeteksimendeteksi antibodyantibody HIVHIV dalamdalam serumserum atauatau plasma.plasma. SpSpesimenesimen adalahadalah darahdarah klienklien yangyang didi

ambilambil secarasecara intravena,intravena, plasmaplasma atauatau serumnya.serumnya. PenggPenggunaanunaan metodemetode testingtesting cepatcepat (rapid(rapid

testing)testing) memungkinkanmemungkinkan klienklien mendapatkanmendapatkan hasilhasil testitestingng padapada harihari yangyang sama.sama. TujuanTujuan testingtesting

HIVHIV adaada 44 yaituyaitu untukuntuk membantumembantu menegakkanmenegakkan diagnosisdiagnosis,, pengamananpengamanan darahdarah donordonor

 

(skrining),(skrining), untukuntuk surveilans,surveilans, dandan untukuntuk penelitian.penelitian. HasilHasil testingtesting yangyang disampaikandisampaikan kepadakepada

klienklien adalahadalah benarbenar milikmilik klien.klien. PetugasPetugas laboratoriulaboratoriumm harusharus menjagamenjaga mutumutu dandan kofidensialitas.kofidensialitas.

HindariHindari terjadinyaterjadinya kesalahan,kesalahan, baikbaik teknisteknis (technica(technicall error)error) maupunmaupun manusiamanusia (human(human error).error).

Petugas laboratorium (perawat) (mengambil) darah setelah klien menjalani konseling

Petugas laboratorium (perawat) (mengambil) darah setelah klien menjalani konseling

testing.testing.

pra

pra

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

 



PastikanPastikan klienklien siapsiap menerimamenerima hasilhasil TekananTekanan kerahasiaankerahasiaan

LakukanLakukan secarasecara jelasjelas dandan langsunglangsung SediakanSediakan waktuwaktu cukupcukup untukuntuk menyerapmenyerap informasiinformasi tentangtentang hasil,hasil, SelanjutnyaSelanjutnya ::



 

a.a.

PeriksaPeriksa apapaa yangyang diketahudiketahuii klienklien tentangtentang hasihasill testingtesting

b.b. DenganDengan tenangtenang bicarakanbicarakan apaapa artiarti hasilhasil pemeriksaanpemeriksaan c.c. GalilahGalilah ekspresiekspresi dandan ventilasikaventilasikann emosiemosi d.d. TerangkanTerangkan secarasecara ringkasringkas tentangtentang :: TersedianyaTersedianya fasilitasfasilitas untukuntuk tindaktindak llanjutanjut dandan dukungan,dukungan, 2424 jamjam pendampingan,pendampingan, dukungandukungan informasiinformasi vverbalerbal dengandengan informasiinformasi tertulis,tertulis, rencanarencana nyata,nyata, ddanyaddanya dukungandukungan dandan orangorang terdekat,aApaterdekat,aApa yangyang akanakan dilakukandilakukan klienklien dalamdalam 4848 jam,jam, strategistrategi mekanismemekanisme pepenyesuaiannyesuaian diri,diri, tanyakantanyakan apakahapakah klienklien masihmasih inginingin bertanya,bertanya, beriberi kesempatankesempatan klienklien untukuntuk mengajukanmengajukan

 
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terminal,pelatihanterminal,pelatihan untukuntuk keluargakeluarga didi rumah,rumah, pendidipendidikankan pencegahanpencegahan dandan promosipromosi kondom.kondom. d.d. PerawatanPerawatan didi rumahrumah dandan masyarakat,masyarakat, meliputimeliputi pelapelatihantihan keluargakeluarga dandan tenagatenaga sukarelasukarela dalamdalam peningkatanpeningkatan kesehatan,kesehatan, pengobatanpengobatan gegejalajala umumumum dandan perawatanperawatan paliatif.paliatif. e.e. PromosiPromosi nutrisinutrisi yangyang baik,baik, dukungandukungan psikogispsikogis dandan emosional,emosional, dukungandukungan spiritualspiritual dandan konseling.konseling.

f.f. MembentukMembentuk kelompokkelompok pendukungpendukung didi masmasyarakatyarakat untukuntuk memmemberikanberikan ddukunganukungan emosiemosi padapada ODHAODHA dandan keluarganya.keluarganya. g.g. EliminasiEliminasi stigmastigma HIV/AIDSHIV/AIDS dandan mengembangkanmengembangkan sikapsikap positifpositif dalamdalam masyarakatmasyarakat bagibagi ODHAODHA dandan keluarganya.keluarganya. h.h. PendidikanPendidikan kepkeperawatanerawatan daldalamam HIV/AIDSHIV/AIDS bagibagi pemberipemberi asuasuhanhan HIV/AIDS,angHIV/AIDS,anggotagota keluarga,keluarga, tetanggatetangga dandan tenagatenaga sukarela/sukarela/ volunteer.volunteer. i.i. MembangunMembangun kemitraankemitraan diantaradiantara pemberipemberi pelayananpelayanan (klinik(klinik sosialsosial kelompokkelompok

 
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5.35.3

PencegahanPencegahan PenularanPenularan HIVHIV daridari IbuIbu keke AnakAnak (PPIA)(PPIA)

 

SejakSejak pertamapertama kalikali ditemukanditemukan padapada tahuntahun 19871987 sampaisampai dengandengan tahuntahun 2011,2011, kasuskasus AIDSAIDS telahtelah tersebartersebar didi 368368 (73,9%)(73,9%) daridari 498498 kabupaten/kota.kabupaten/kota. PadaPada tahuntahun 20112011 tercatattercatat kasuskasus AIDSAIDS terbesarterbesar justrujustru terjaditerjadi padapada kelompokkelompok ibibuu rumahrumah tanggatangga (22%)(22%) dandan 2,7%2,7% kasuskasus AIDSAIDS ditularkanditularkan daridari ibuibu HIVHIV positifpositif keke bayinyabayinyanya.nya. 2,53%).2,53%). LebihLebih daridari 90%90% kasuskasus anakanak yangyang terinfeksiterinfeksi HIV,HIV, ditularkanditularkan melaluimelalui prosesproses penupenularanlaran daridari ibuibu keke anak.anak. VirusVirus HIVHIV dapatdapat ditularkanditularkan daridari ibuibu yangyang terinfeksiterinfeksi HIVHIV kepadakepada anakanaknyanya selamaselama kehamilan,kehamilan, padapada saatsaat

persalinan,persalinan, dandan selamaselama menyusui.menyusui.

 

DampakDampak burukburuk daridari penularanpenularan HIVHIV daridari ibuibu keke bayibayi dadapatpat dicegahdicegah apabila:apabila:

1.1. TerdeteksiTerdeteksi dinidini 2.2. TerkendaliTerkendali (ibu(ibu melakukanmelakukan prilakuprilaku hiduphidup sehat,sehat, ibuibu mendapatkamendapatkann ARVARV profilaksisprofilaksis secarasecara teratur,teratur, ibuibu melakukanmelakukan ANCANC secarasecara teratur,teratur, ppetugasetugas kesehatankesehatan menerapkanmenerapkan pencegahanpencegahan infeksiinfeksi sesuaisesuai KewadaanKewadaan Standar).Standar).

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2.2. JanganJangan berhubunganberhubungan seksualseksual dengandengan priapria berisikoberisiko tinggitinggi aatautau saiapapumsaiapapum tanpatanpa mengetahuimengetahui statusstatus HIVHIV

3.3. SetiapSetiap perempuanperempuan dalamdalam usiausia reprodukreproduksisi untukuntuk tidaktidak menggunakanmenggunakan alatalat suntiksuntik tidaktidak

steril.steril. BeberapaBeberapa kegiatankegiatan yangyang dapatdapat dilakukandilakukan dalamdalam upayaupaya pencegahanpencegahan primerprimer antaraantara lain:lain:

 

1.1. SosialisasiSosialisasi mengenaimengenai HIV/AIDSHIV/AIDS dilakukandilakukan padapada usiusiaa dinidini mengenaimengenai kesehatankesehatan reproduksi,reproduksi, HIV/AIDSHIV/AIDS dandan napzanapza disesuaikandisesuaikan dengandengan ttingkatingkat umur.umur.

2.2. InformasInformasii dandan pendidikanpendidikan kesehatakesehatann umum.umum.

   

3.3. TesTes HIVHIV dandan konseling.konseling.

4.4. TesTes rutinrutin bagibagi yangyang pernahpernah melakukanmelakukan kegiatankegiatan berisiko.berisiko.

5.5. KonselingKonseling pasanganpasangan dandan testes kepadakepada pasangan.pasangan.

 

6.6. MempraktekanMempraktekan kegiatankegiatan seksseks yangyang aman.aman.

7.7. MenundaMenunda kegiatankegiatan seksual.seksual.

8.8. KomunikasiKomunikasi perubahanperubahan perilakuperilaku uuntukntuk menghimenghindarindari periperilakulaku risirisikoko tinggi.tinggi.

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 InsersiInsersi AKDRAKDR tidaktidak direkomendasikandirekomendasikan padapada perempuanperempuan dengandengan AIDSAIDS dandan tidaktidak mendapatmendapat ARV.ARV. AKDRAKDR jugajuga tidaktidak direkomendasikdirekomendasikanan untukuntuk peperempuanrempuan yangyang mendapatmendapat ARVARV tetapitetapi secarasecara klinisklinis tidaktidak baik.baik. JikaJika seorangseorang penggunapengguna AKDRAKDR terinfekterinfeksisi HIVHIV atauatau jikajika penggunapengguna AKDRAKDR dengandengan HIVHIV kemudiankemudian menderitamenderita AIDS,AKDRAIDS,AKDR tidaktidak harusharus dicabut.dicabut. NNamun,amun, perempuanperempuan tersebuttersebut harusharus dipantaudipantau kemungkinankemungkinan terkenaterkena PID.PID.



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anakanak dapatdapat mengurangimengurangi risikorisiko penularanpenularan hinggahingga kurankurangg daridari 2%2% didi negaranegara –– negaranegara maju.maju. PemberianPemberian ARVARV padapada ibuibu hamilhamil dengandengan HIVHIV mempunyaimempunyai ttujuanujuan profilaksiprofilaksi dandan terapi.terapi. ProfilaksisProfilaksis ARVARV adalahadalah penggunaanpenggunaan obatobat antiretrovirantiretroviralal jangkajangka pendekpendek yangyang digunakandigunakan perempuanperempuan hamilhamil dengandengan HIVHIV selamaselama masamasa kehamilankehamilan ununtuktuk mengurangimengurangi risikorisiko penularanpenularan HIVHIV keke janinjanin yangyang dikandundikandungya.gya. SedangkanSedangkan terapiterapi AARVRV dalamdalam programprogram PMTCTPMTCT mempunyaimempunyai manfaatmanfaat serupaserupa dengandengan terapiterapi ARVARV untukuntuk pasienpasien HIVHIV ppadaada umumnya,yaitu:umumnya,yaitu:

1.1.

MemperbaikiMemperbaiki statusstatus kesehatankesehatan dandan kualitaskualitas hiduphidup

 
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