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"Buku yang berjudul "Panduan untuk intervensi HIV/AIDS dalam situasi darurat" ini membahas tentang HIV/AIDS."

"Sampai saat ini, belum ada obat untuk menyembuhkan infeksi HIV tetapi ada pengobatan yang bisa memperlambat perkembangan HIV dalam tubuh yang disebut Antiretroviral Treatment. Perkembangan HIV secara in vivo dapat dimodelkan ke dalam sistem persamaan diferensial biasa menggunakan pendekatan deterministik. Pada tesis ini dibentuklah model matematika untuk dinamika virus HIV di dalam tubuh dengan adanya intervensi Antiretroviral Treatment dan memperhitungkan pengaruh Apoptosis pada sel-T. Analisis sistem dinamik pada model untuk menentukan kestabilan dari titik keseimbangan bebas infeksi dan titik keseimbangan endemik menggunakan kriteria Routh-Hurwitz. Simulasi numerik menunjukkan bahwa penurunan jumlah sel-T sehat (T) dan perkembangan jumlah virus HIV (V) di dalam tubuh dapat dihambat dengan signifikan jika pengobatan ART diberikan setiap hari secara teratur dan pemilihan nilai parameter Apoptosis (A) berada pada interval [0,1 ; 0,5].

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Until now, there is no medicine to cure HIV infection, but there is a treatment that can slow the progression of HIV in the body called Antiretroviral Treatment. The development of HIV, when evaluated in vivo can be modeled into a system of ordinary differential equations using a deterministic approach. In this paper, be formed a mathematical model for the dynamics of HIV in the body with the intervention of Antiretroviral Treatment and take into account the influence of Apoptosis on T-cells. The dynamic system analysis of the model to determine the stability of the infectious free equilibrium point and the endemic equilibrium point uses the Routh-Hurwitz criterion. Numerical simulations show that a decrease in the number of healthy T-cells (T) and the proliferation of HIV virus (V) in the body can be significantly impeded if ART treatment is administered daily on a regular basis and the selection of Apoptosis (A) parameter values is at interval [0.1 ; 0.5]."

"Latar belakang: Orang dengan HIV/AIDS (ODHA) mengalami berbagai masalah setelah terdiagnosa HIV baik secara fisik maupun psikososial. Hal ini menyebabkan ODHA menutup diri agar mereka tak diketahui orang lain karena merasa terstigma. Masalah ini dapat berlanjut ODHA menstigma dirinya dan dapat menularkan HIV lagi bagi pasangannya atau orang lain. Tujuan penelitian ini untuk memperoleh model intervensi spiritual peka budaya Karo dan menguji model tersebut. Metode penelitian: Tahap I: penelitian ini menggunakan desain penelitian kualitatif dan kuantitatif. Selanjutnya dikembangkan model intervensi spiritual peka budaya Karo. Mengembangkan intervensi menggunakan metode PATH (Problem – Analysis – Test – Help) yang diusulkan oleh Buunk dan Vugt (2008). Tahap II: uji coba model dengan quasi experiment with control group design. Jumlah sampel kelompok intervensi 60 orang dan 60 orang kelompok kontrol. Hasil: hasil penelitian tahap I di penelitian kualitatif dihasilkan 14 thema, dan hasil kualitatif didapatkan Odds Ratio (OR) dari variable Religiusitas adalah 3,5 (5%CI: 2,324-5,329), artinya warga jemaat GBKP yang religiusitas nya kuat akan mempunyai odds (berisiko) mencegah perilaku penularan HIV sebesar 3,5 kali lebih tinggi dibandingkan warga jemaat GBKP yang tidak memiliki Religiusitas kuat di Kabupaten Karo. Lalu model ini dikembangkan berdasarkan teori cultural care dan masukan dari para pakar. Hasil tahap II: Uji korelasi kanonikal secara kolektif fungsi kanonikal signifikan dengan nilai p = 0,0001 di fungsi 1 dan 0,003 di fungsi 2. Kesimpulan: ada hubungan yang kuat antara intervensi spiritual peka budaya Karo terhadap stres dan stigma. Artinya pemberian intervensi model spiritual peka budaya Karo dengan menambah pengetahuan, dukungan sosial dan dukungan keluarga dapat mengurangi stres dan stigma sebesar nilai korelasinya. Rekomendasi: akan dilakukan studi lanjutan tanggapan perawat untuk persfektif ke ODHA.

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Introduction: People living with HIV/AIDS (PLWHA) experience various problems after being diagnosed with HIV, both physically and psychosocially. These problems cause PLWHA to close themselves so that they are not known to others because they feel stigmatised. This problem can cause PLWHA to continue stigmatising themselves and transmit HIV again to their partners or other people. This study aimed to develop a Karo culture-sensitive spiritual intervention model to prevent HIV stigma. Methods: Phase I: this study uses qualitative and quantitative research design. Furthermore, a model of spiritual intervention sensitive to Karo culture was developed. Develop interventions using the PATH (Problem – Analysis – Test – Help) method proposed by Buunk and Vugt (2008). Phase II: model trials with quasi-experiment with control group design. The total sample of the intervention group was 60 people and 60 people of the control group. Result: the results of the phase I study in the qualitative study produced 14 thema, and the qualitative results obtained the Odds Ratio (OR) of the Religiosity variable was 3.5 (5%CI: 2,324-5,329), meaning that GBKP congregation residents whose religiosity is strong will have odds (risk) of preventing HIV transmission behavior by 3.5 times higher than GBKP congregation residents who do not have strong religiosity in Karo Regency. Then this model was developed based on the theory of cultural care and input from experts. Phase II results: Test the canonical correlation collectively of significant canonical functions with p values = 0.0001 in function 1 and 0.003 in function 2. Conclusion: there is a strong link between Karo culture's sensitive spiritual interventions to stress and stigma. This means that the intervention of the Karo culturally sensitive spiritual model by increasing knowledge, social support and family support can reduce stress and stigma by the correlation value. Recommendation: a follow-up study of nurse responses to effectiveness to PLHIV will be carried out."

"ABSTRAKPERMASALAHAN: HIV/AIDS dan Hepatitis B merupakan masalah kesehatan masyarakat yang sangat penting karena belum ditemukan obatnya sampai saat ini. Wanita usia subur, khususnya yang berpenghasilan rendah pengunjung Puskesmas semakin rentan terhadap risiko penularan kedua penyakit tersebut. Sampai saat ini belum ada model upaya promotif dan preventif di Puskesmas yang mengintegrasikan pelayanan penyakit menular seksual (PMS) ke dalam pelayanan BP/KIA/KB di Puskesmas.TUJUAN PENELITIAN: Mengembangkan model intervensi guna menurunkan risiko infeksi PMS termasuk HIV/AIDS dan Hepatitis B bagi wanita usia reproduksi wanita hamil dan peserta KB berpenghasilan rendah melalui keterpaduan program PMS dengan program kesehatan reproduksi di klinik KIA/KB dan BP di Puskesmas daerah perkotaan dan pedesaan.METODA PENELITIAN: Desain penelitian adalah Kuasi eksperimen, yaitu one group pre dan post test tanpa kelompok kontrol. Dalam intervensi ini dilakukan observasi awal, intervensi dan observasi akhir tanpa menggunakan kelompok kontrolPengumpulan data pre intervensi adalah: a) survei PSP (Pengetahuan, Sikap & Praktek) terhadap 400 ibu pengunjung BP/KIA/KB yang dipilih secara acak dan b) skrining terhadap 1200 ibu pengunjung BP/KIA/KB menggunakan sediaan basah dan pewarnaan Gram. Selain itu, dilakukan studi kualitatif dengan melakukan wawancara mendalam 4 dokter Puskesmas; Diskusi Kelompok Terarah (DKT) masing-masing 4 kelompok petugas Puskesmas dan ibu usia reproduksi pengunjung BP/KIA/KB; pengamatan pelayanan BP/KIA/KB dan data Iayanan suntik dan penggunaan jarum & syringe (tabung jarum suntik).Sedangkan pada post intervensi yang dikumpulkan adalah data survei PSP pada 400 ibu pengunjung ' BP/KIA/KB; studi kualitatif pada petugas Puskesmas (dokter, paramedis, petugas lab); pengamatan pada pelayanan BP/KIA/KB serta data layanan suntik dan penggunaan jarum & syringe.Lokasi penelitian adalah di 4 wilayah Puskesmas, yaitu 2 di perkotaan (Puskesmas Kec. Koja dan Ciracas di DKI Jaya) dan 2 di pedesaan (Puskesmas Kec. Pamanukan, Kab. Subang dan Kec. Pulomerak Kab. Serang, Jabar).Analisis data kualitatif dilakukan secara content analysis. Hasil survei disajikan dalam distribusi frekwensi, tabulasi silang PSP yang berkaitan dengan PMS, HIV/AIDS, Hepatitis B & kebiasaan suntik dengan membandingkan pre dan post intervensi dan membandingkan lokasi perkotaan dan pedesaan. Uji kemaknaan dilakukan dengan Chi-square. Dari skrining PMS dikemukakan hasil yang dilakukan oleh Puskesmas dan konfirmasi pemeriksaan oleh Bag. Ilmu Penyakit Kulit & Kelamin, FKUI/RSCM.HASIL PENELITIAN: Karakteristik responden sebelum dan sesudah intervensi tidak berbeda. Dua diantara lima responden baik di kota maupun desa menderita infeksi PMS/ saluran reproduksi. Bila dilihat secara keseluruhan intervensi penyuluhan yang dilakukan berdampak pada kenaikan proporsi responden yang mengetahui HIV/AIDS & bahaya penggunaan jarum suntik tetapi tidak memiliki dampak pada PSP yang berkaitan dengan PMS dan Hepatitis B. Perubahan pengetahuan petugas Puskesmas sebagai hasil intervensi cukup baik tetapi belum memiliki dampak positif terhadap praktek interaksi antara petugas-pasien maupun sterilisasi alat. Namun dari data pelayanan suntikan sekalipun proporsi yang disuntik di BP baik perkotaan maupun pedesaan (kecuali Pamanukan) relatif meningkat tetapi penggunaan jarum suntik berulang berkurang. Demikian juga penggunaan syringe berulang juga turun tetapi rasionya belum mencapai 1:1.Dampak intervensi yang belum nyata dan signifikan ini dapat disebabkan antara lain penyuluhan yang dilakukan hanya intensif pada saat terjadwal sesuai kegiatan proyek, sesudah itu berjalan tetapi kurang intensif, penyuluhan hanya terbatas di Puskesmas sehingga jangkauannya terbatas, sedang yang terpajan penyuluhan mungkin tidak terpilih sebagai sampel, jarak antara selesainya penyuluhan terjadwal dan evaluasi relatif panjang (6 bulan). Dilain pihak, perubahan PSP pada pengunjung maupun petugas memerlukan waktu relatif lama.KESIMPULAN DAN SARAN: Kejadian infeksi PMS dan saluran reproduksi di kalangan WUS pengunjung BP/KIA/KB di perkotaan maupun pedesaan cukup tinggi yaitu sekitar 43,5%. Teknik pemeriksaan PMS sederhana dapat dilakukan di Puskesmas dengan pelatihan dan kualitas tenaga yang memadai dan supervisi yang baik. Sesudah intervensi, PSP WUS mengenai PMS dan Hepatitis B tidak banyak berubah_ Namun pengetahuan tentang HIWAIDS dan bahaya penggunaan jarum suntik berulang meningkat demikian juga kesediaan membayar sendiri jarum/syringe bertambah. Sekalipun interaksi petugas-pasien dan praktek sterilisasi alat di Puskesmas belum banyak perbaikan dan ada kenaikan permintaan suntik di BP tetapi penggunaan jarum dan syringe berulang terjadi kecenderungn penurunan. Telah dikembangkan model intervensi berupa pelatihan petugas Puskesmas mengenai manajemen dan pencegahan PMS termasuk HIV/AIDS, Hepatitis B & Pencegahan pemberian suntikan berulang serta materi baku yang terdiri dari silabus dan bahan serta penunjang pelatihan. Selain itu juga dikembangkan model serupa bagi ibu pengunjung BPIKIAIKB di Puskesmas termasuk materi dan penunjang penyuluhan.Disarankan agar pelaksanaan penyuluhan bagi pengunjung BP di Puskesmas hendaknya tidak dilakukan secara bersamaan dengan pengunjung Klinik KIA/KB. Perlu adanya pemantapan teknik penyuluhan bagi petugas pelaksana, khususnya KIA/KB. Evaluasi dampak dan hasil akhir model ini sebaiknya dilakukan minimal sesudah kegiatan penyuluhan berjalan 6 bulan sehingga perubahan pada kebiasaan dan praktek dapat terlihat lebih nyata.Model skrining PMS di Puskesmas secara sederhana dapat dikembangkan lebih lanjut pada program Paket Ibu Bayi (Mother Baby Package-WHO) yang akan dikembangkan pemerintah dalam waktu dekat. Disarankan, hal ini perlu ditindaklanjuti dengan pemegang kebijakanlpengelola program di Departemen Kesehatan.

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ABSTRACTIntervention to Reduce Risk of HIV/AIDS And Hepatitis B Among Low Income Reproductive Age Women Attending an Ambulatory/ Mother & Child Health And Family Planning Clinic at The Puskesmas in DKI Jakarta And West Java, 1994-1996THE RESEARCH PROBLEM: In Indonesia, HIV/AIDS and Hepatitis B have become major and critical public health problems. At present there is no cure for these two diseases. The low income married women of reproductive age (MWRA) are becoming more and more susceptible to the risk of infection of sexually transmitted diseases (STDs) including HIV/AIDS. Currently a model of integrating STD services into the existing ambulatory/mother & child health (MCH/family planning (FP) services in the Puskesmas is nonexistent).THE RESEARCH OBJECTIVES: To develop an intervention model in reducing the risk of STDs including HIV/AIDS and Hepatitis B infection for low income MWRA through integrating STD services into MCH/FP services in the Puskesmas both for urban as well as rural areas.METHODOLOGY OF THE STUDY: The design of the study was one group pre and post test without a control group (a Quasi-experimental design). A measurement was conducted at the beginning of the study then followed by intervention and evaluation! measurement after the intervention. Three different measurements were conducted prior to the intervention period namely a (a) KAP (Knowledge, Attitude & Practice) survey on STD/HIV/AIDS, Hepatitis B and Danger of Reuse of Needles and Syringes among randomly selected 400 MWRA visiting ambulatory/MCH and FP clinics, (b) STD screening using wet-mount and Gram stain among 1200 of the similar clinic attendants, and (c) qualitative assessments: in-depth interviews were conducted with 4 PHC doctors, each four FGDs (Focus Group Discussion) with public health center personnel and selected MWRA were performed. Observation were made on the interaction of the health personnel and the clients and the sterilization techniques took place in the PHC.' After the intervention, a similar KAP survey was conducted among another 400 MWRA attending the above same facilities and in-depth interviews with PHC personnel and observation of the personnel-client interaction, sterilization techniques. Data concerning injection practices and the use of needles and syringes were also collected before and after the intervention.Content analysis technique was used to analyse the qualitative data. Frequency distribution and cross tabulation were used to depict the results of the KAP survey describing pre and post intervention status or urbanlrural differences. Chisquare test was performed as required. The results of the STD screening was shown as it was conducted by PHC lab technicians and rechecked by the Dept of Dermatovenerology of the School of Medicine, the Univ. of Indonesia) RSCM General Hospital.RESULTS OF THE STUDY: Social demographic characteristics of the respondents pre and post intervention was quite similar. Two out of five respondents both in the urban and rural areas suffering of STD/Reproductive Tract Infection (RT9. The intervention seems to have an effect on the increase of the proportion of the respondents who knew about HIV/AIDS and the danger of reusing needles and syringes. However, it has no effect on the PSP of the respondents concerning STD and Hepatitis B. There was a change in the knowledge of the PHC personnel concerning STD, HIV/AIDS and Hepatitis B, yet there was no apparent effect on the pattern of interaction between providers and the clients and the sterilization technique in the PHC. Although there is an increased proportion of injection demands in the ambulatory clinic both in the urban and rural areas (except Pamanukan) there was a decrease on the reuse of the needles as well as the syringes. The ratio of the use of syringe were close to I:1.The impact of the intervention was not prominent and significant due to others among the following factors: the intensive health education probably took place during the tight schedule of the project only, after the recommended schedule it took place unregularly; health education was limited in the Puskesmas, therefore the coverage is limited; those who were exposed to the health education were likely not selected as the sample of the survey, and the interval between completed recommended health education intervention and the evaluation was too long. On the other hand change of practice especially among the MWRA attending the PHC and also the personnel of the PHC took a relatively longer time.CONCLUSIONS AND RECOMMENDATIONS: STD and RTI infection among the MWRA attending the PHC clinic both in the urban and rural were relatively high about 43.5%. Simple technique of screening STD at the PHC was feasible with appropriate training and relatively good quality of lab technician and good supervision. After the intervention the KAP of the MWRA concerning STD and Hepatitis B was likely to remain unchanged. However, their knowledge concerning HIV and AIDS and the danger of using needles and syringes were increased. There was also an increase on the willingness of the client to pay for the disposable needle and syringe for the injection. Although the interaction of the client and the health personnel as well as sterilization technique at the Puskesmas was still unsatisfactory and there was an increased demand of injection in the ambulatory clinic, overall there is a reduction on the reuse of the needles and syringes. An intervention model including training for the PHC personnel concerning management and prevention of STD including HIV/AIDS, Hepatitis B and Prevention of Reuse of Needles and Syringes. It also made available of the module of training of the MWRA including health education materials. It is recommended that the ambulatory clinic visitors should be not be the same health education target audience with the MCH and FP clinic attendants. It is also recommended to retrain the skills on health education among the PHC personnel. The final output evaluation should be conducted at least after six months of the health education intervention so that substantial change of practice took place among both MWRA and PHC personnel. The experience of conducting STD screening in the Puskesmas could be useful in the upcoming promotion program of the WHO's Mother Baby Package by the Ministry of Health. An advocation should be made to follow-up the result of this study to both program holder and decision makers at the Ministry of Health."

"ABSTRAKPERMASALAHAN : HIV/AIDS dan Hepatitis B merupakan masalah kesehatan masyarakat yang sangat penting karena belum ditemukan obatnya sampai saat ini. Wanita usia subur, khususnya yang berpenghasilan rendah pengunjung Puskesmas semakin rentan terhadap risiko penularan kedua penyakit tersebut. Sampai saat ini belum ada model upaya promotif dan preventif di Puskesmas yang mengintegrasikan pelayanan penyakit menular seksual (PMS) ke dalam pelayanan BP/KIA/KB di Puskesmas.TUJUAN PENELITIAN : Mengembangkan model intervensi guna menurunkan risiko infeksi PMS termasuk HIV/AIDS dan Hepatitis B bagi wanita usia reproduksi, wanita hamil dan peserta KB berpenghasilan rendah melalui keterpaduan program PMS dengan program kesehatan reproduksi di klinik KIA/KB dan BP di Puskesmas daerah perkotaan dan pedesaan.HASIL KEGIATAN : Desain penelitian adalah Kuasi eksperimen, yaitu one group pre dan post test tanpa kelompok kontrol. Dalam intervensi ini dilakukan observasi awal, intervensi dan observasi akhir tanpa menggunakan kelompok kontrol. Hasil penelitian tahun I dapat diperoleh informasi bahwa infeksi saluran reproduksi pada wanita usia subur pengunjung BP/KIA/KB di Puskesmas perkotaan maupun pedesaan di daerah penelitian cukup tinggi. Dari pemeriksaan oleh staf laboratorium Puskesmas sendiri diperoleh angka infeksi sebesar 2-29%. Sesudah di periksa ulang oleh Lab. Bagian Ilmu Penyakit Kulit dan Kelamin, FKUI/RSCM diperoleh angka lebih tinggi yaitu 30-40%. Di lain pihak pengetahuan mengenai PMS termasuk HIV/AIDS dan Hepatitis B di kalangan mereka masih sangat terbatas. Bahkan pengetahuan dan kemampuan petugas kesehatan sendiri yang berkaitan dengan PMS termasuk HIV/AIDS dan Hepatitis B juga masih kurang.Pada tahun ke II telah dilakukan intervensi di Puskesmas terpilih. Telah dilakukan persiapan intervensi berupa telaah hasil temuan, penyusunan silabus pelatihan petugas Puskesmas, penyusunan draft materi & media penyuluhan, lokakarya penyusunan jadwal dan model intervensi bersama Puskesmas daerah penelitian, uji coba dan penyempurnaan materi penyuluhan serta perbaikan dan penggandaan materi penyuluhan. Selanjutnya pelaksanaan intervensi dilakukan berupa: pelatihan petugas Puskesmas (dokter, bidan, perawat, tenaga laboratorium) mengenai manajemen dan pencegahan PMS, HIV/AIDS dan Hepatitis B, cara sterilisasi alat kesehatan termasuk jarum suntik, penyuluhan (pendidikan dan motivasi) ibu pengunjung BP/KIA/KB (beserta suaminya) oleh petugas Puskesmas yang telah dilatih, serta pemantauan kegiatan penyuluhan oleh tim peneliti.SIMPULAN DAN SARAN : Telah dikembangkan model intervensi berupa pelatihan petugas Puskesmas mengenai manajemen dan pencegahan PMS termasuk HIV/AIDS dan Hepatitis B serta materi baku yang terdiri dari silabus dan bahan serta penunjang pelatihan. Selain itu juga dikembangkan model serupa bagi ibu pengunjung BP/KIA/KB di Puskesmas termasuk materi dan penunjang penyuluhan. Kegiatan penyuluhan kepada pengunjung BP/KIA/KB di Puskesmas dilakukan langsung oleh petugas Puskesmas yang telah terlatih. Materi dan peraga yang telah diberikan di Puskesmas belum digunakan sebagaimana sesuai petunjuk. Hal ini disebabkan antara lain petugas belum menguasai teknik penyuluhan.Disarankan dilakukan adaptasi dan penyederhanaan materi penyuluhan yang digunakan oleh petugas Puskesmas. Pelaksanaan penyuluhan bagi pengunjung BP di Puskesmas hendaknya tidak dilakukan secara bersamaan dengan pengunjung Klinik KIA/KB. Perlu adanya pemantapan teknik penyuluhan bagi petugas pelaksana, khususnya KIA/KB. Evaluasi akhir mengenai dampak dan hasil akhir model ini harus dilakukan sehingga diperoleh masukan bagi pembuat kebijakan pelayanan, khususnya dalam upaya pencegahan dan penanganan PMS, AIDS/HIV dan Hepatitis B melalui jajaran pelayanan tingkat primer.

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ABSTRACTIntervention To Reduce Risk Of HIV/AIDS And Hepatitis B Among Low Income Reproductive Age Women Attending An Ambulatory/Mother & Child Health And Family Planning Clinic At The Puskesmas In Dki Jaya And West Java, 1995 - 1996THE RESEARCH PROBLEM : In Indonesia, HIV/AIDS and Hepatitis B have become major and critical public health problems. At present there is no cure for these two diseases. The low income married women of reproductive age (MWRA) are becoming more and more susceptible to the risk of infection of sexually transmitted diseases (STDs) including HIVI AIDS. Currently a model of integrating STD services into the existing ambulatory/ mother & child health (MCH)/ family planning (FP) services in the Puskesmas is nonexistent.THE RESEARCH OBJECTIVES : To develop an intervention model in reducing the risk of STDs including HIV/AIDS and Hepatitis B infection for low income MWRA through integrating STD services into MCH/FP services in the Puskesmas both for urban as well as rural areas.METHODOLOGY AND RESULTS OF THE STUDY : The design of the study is one group pre and post test without a control group (a Quasi-experimental design). A measurement was conducted at the beginning of the study then followed by intervention and evaluation/ measurement after the intervention. Three different measurements were conducted prior to the intervention period namely both qualitative and quantitative study (survey) and STD screening.Results of the first year study are as follows: there is a significantly high proportion of STD among the MWRA visiting the ambulatory, MCH and FP clinic both in the urban and rural public health centers (Puskesmas). Screening test by lab technician of the Puskesmas indicated infection proportion of 2-29%. The results of the screening were rechecked by the Dept. of Dermatovenereology of the Cipto Mangunkusumo Hospital, Jakarta and showed higher infection proportion i.e. 30-40%. On the other hand, knowledge on STD including HIV/AIDS and Hepatitis B among the women visiting the Puskesmas was very limited. Besides that, the knowledge and skills of the health personnel of the Puskesmas concerning the same subject was also relatively low.During the second year of the study (199511996) an intervention was conducted in the four Puskesmas under the study. Preparation of the intervention was completed such as review of the study results, development of syllabus of training for the Puskesmas staff, development of draft of materials and media for health education, workshop on the scheduling and model of intervention with the participating Puskesmas, pre test and revision and reproduction of information, education & communication (IEC) materials. Furthermore, the following intervention was conducted in each Puskesmas namely training for Puskesmas staff (doctor, midwives, nurses and lab technicians) concerning management and prevention of STD including HIVIAIDS and Hepatitis B, methods of sterilization of medical instruments, education and motivation (health education) for women attending ambulatory, MCH and FP clinic of the Puskesmas by trained health personnel and monitoring of the activity at the Puskesmas by selected trained personnel as well as research team members.CONCLUSIONS AND RECOMMENDATIONS: A model of intervention to prevent risk of STD including HIV/AIDS and Hepatitis B infection has been developed. It consists of syllabus and training materials including visual aids for STD including HIV/AIDS and Hepatitis B management and prevention for the health personnel of the Puskesmas, and training materials of the same subject for women (including their spouses) attending ambulatory, MCH and FP clinics at the Puskesmas.An adaptation and simplification of the educational materials for the ultimate target audience namely women attending service at the Puskesmas should be made. During the education session, the attendants of the ambulatory clinic should be separated from these attending MCH/FP services. In addition, it is indispensable to improve the technical skills in health education among the personnel of MCH/FP section of the Puskesmas.It is strongly recommended to evaluate both the impact and outcome of the above intervention. Hopefully, the results will be useful for advocating policy concerning prevention and management of STD including HIV/AIDS and Hepatitis B at the primary care level namely at the Puskesmas in Indonesia."

"ABSTRAKPermasalahan penelitian: HIV/AIDS dan Hepatitis B merupakan masalah kesehatan masyarakat yang sangat penting karena belum ditemukan obatnya sampai saat ini. Wanita usia subur, khususnya yang berpenghasilan rendah pengunjung Puskesmas semakin rentan terhadap risiko penularan kedua penyakit tersebut. Sampai saat ini belum ada model upaya promotif dan preventif di Puskesmas yang mengintegrasikan pelayanan penyakit menular seksual (PMS) ke dalam pelayanan BP/KIA/KB di Puskesmas.Tujuan penelitian: Mengembangkan model intervensi guna menurunkan risiko infeksi PMS termasuk HIV/AIDS dan Hepatitis B bagi wanita usia reproduksi, wanita hamil dan peserta KB berpenghasilan rendah melalui keterpaduan program PMS dengan program kesehatan reproduksi di klinik KIA/KB dan BP di Puskesmas daerah perkotaan dan pedesaan.Kegiatan dan hasil intervensi yang telah dilakukan: Desain penelitian adalah Kuasi eksperimen, yaitu one group pre dan post test tanpa kelompok kontrol. Dalam intervensi ini dilakukan observasi awal, intervensi dan observasi akhir tanpa menggunakan kelompok kontrol. Hasil penelitian tahun I dapat diperoleh informasi bahwa infeksi saluran reproduksi pada wanita usia subur pengunjung BP/KIA/KB di Puskesmas perkotaan maupun pedesaan di daerah penelitian cukup tinggi. Dari pemeriksaan oleh staf lab Puskesmas sendiri diperoleh angka infeksi sebesar 2-29%., sesudah di periksa ulang oleh Lab. Bagian Ilmu Penyakit Kulit dan Kelamin, FKUIIRSCM diperoleh angka lebih tinggi yaitu 30-40%. Di lain pihak pengetahuan mengenai PMS termasuk HIV/AIDS dan Hepatitis B di kalangan mereka masih sangat terbatas. Bahkan pengetahuan dan kemampuan petugas kesehatan sendiri yang berkaitan dengan PMS termasuk HIV/AIDS dan Hepatitis B juga masih kurang.Pada tahun ke II telah dan sedang dilakukan intervensi di Puskesmas terpilih. Telah dilakukan persiapan intervensi berupa telaah hasil temuan, penyusunan silabus pelatihan petugas Puskesmas, penyusunan draft materi & media penyuluhan, lokakarya penyusunan jadwal dan model intervensi bersama Puskesmas daerah penelitian, uji coba dan penyempurnaan materi penyuluhan serta perbaikan dan penggandaan materi penyuluhan. Selanjutnya pelaksanaan intervensi dilakukan berupa: pelatihan petugas Puskesmas (dokter, bidan, perawat, tenaga laboratorium) mengenai manajemen dan pencegahan PMS, HIV/AIDS dan Hepatitis B, cara sterilisasi alat kesehatan termasuk jarum suntik, penyuluhan (pendidikan dan motivasi) ibu pengunjung BP/KIA/KB (beserta suaminya) oleh petugas Puskesmas yang telah dilatih; serta pemantauan kegiatan penyuluhan oleh tim peneliti.Kesimpulan dan Saran: Telah dikembangkan model intervensi berupa pelatihan petugas Puskesmas mengenai manajemen dan pencegahan PMS termasuk HIV/AIDS dan Hepatitis B serta materi baku yang terdiri dari silabus dan bahan serta penunjang pelatihan. Selain itu juga dikembangkan model serupa bagi ibu pengunjung BP/KIA/KB di Puskesmas (beserta suaminya) termasuk materi dan penunjang penyuluhan. Kegiatan intervensi penyuluhan langsung bagi pengunjung BP/KIA/KB di Puskesmas sedang dilaksanakan oleh petugas Puskesmas terlatih.Disarankan untuk dilakukan evaluasi akhir mengenai dampak dan hasil akhir model intervensi ini di Puskesmas sehingga diperoleh hasil yang dapat merupakan masukan bagi pembuat kebijakan pelayanan khususnya dalam upaya penanganan dan pencegahan PMS termasuk HIV/AIDS dan Hepatitis B melalui jajaran pelayanan primer di tingkat Puskesmas di Indonesia.

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ABSTRACTIn Indonesia, HIV/AIDS and Hepatitis B have become major and critical public health problems. At present there is no cure for these two diseases. The low income married women of reproductive age (MWRA) are becoming more and more susceptible to the risk of infection of sexually transmitted diseases (STDs) including HIV/ AIDS. Currently a model of integrating STD services into the existing ambulatory/ mother & child health (MCH)/ family planning (FP) services in the Puskesmas is nonexistent.The research objectives:To develop an intervention model in reducing the risk of STDs including HIV/AIDS and Hepatitis B infection for low income MWRA through integrating STD services into MCH/FP services in the Puskesmas both for urban as well as rural areas.Methodology and results of the study:The design of the study is one group pre and post test without a control group (a Quasi-experimental design). A measurement was conducted at the beginning of the study then followed by intervention and evaluation/ measurement after the intervention.Three different measurements were conducted prior to the intervention period namely both qualitative and quantitative study (survey) and STD screening.Results of the first year study are as follows: there is a significantly high proportion of STD among the MWRA visiting the ambulatory, MCH and FP clinic both in the urban and rural public health centers (Puskesmas). Screening test by lab technician of the Puskesmas indicated infection proportion of 2-29%. The results of the screening were rechecked by the Dept. of Dermatovenereology of the Cipto Mangunkusumo Hospital, Jakarta and showed higher infection proportion i.e. 30-40%. On the other hand, knowledge on STD including HIV/AIDS and Hepatitis B among the women visiting the Puskesmas was very limited. Besides that, the knowledge and skills of the health personnel of the Puskesmas concerning the same subject was also relatively low.During the second year of the study (1995/1996) an intervention was conducted and still taking place in the four Puskesmas under the study. Preparation of the intervention was completed such as review of the study results, development of syllabus of training for the Puskesmas staff, development of draft of materials and media for health education, workshop on the scheduling and model of intervention with the participating Puskesmas, pre test and revision and reproduction of information, education & communication (IEC) materials. Furthermore, the following intervention was conducted in each Puskesmas namely training for Puskesmas staff (doctor, midwives, nurses and lab technicians) concerning management and prevention of STD including HIV/AIDS and Hepatitis B, methods of sterilization of medical instruments, education and motivation (health education) for women attending ambulatory, MCH and FP clinic of the Puskesmas by trained health personnel and monitoring of the activity at the Puskesmas by selected trained personnel as well as research team members.Conclusions and recommendations:A model of intervention to prevent risk of STD including HIVIAIDS and Hepatitis B infection has been developed. It consists of syllabus and training materials including visual aids for STD including HIVIAIDS and Hepatitis B management and prevention for the health personnel of the Puskesmas, and training materials of the same subject for women (including their spouses) attending ambulatory, MCH and FP clinics at the Puskesmas.It is strongly recommended to evaluate both the impact and outcome of the above intervention. Hopefully, the results will be useful for advocating policy concerning prevention and management of STD including HIVIAIDS and Hepatitis B at the primary care level namely at the Puskesmas in Indonesia."

"Journal of Dentistry 2006; Special Edition KPPIKG XIV: 374-378Timing of orthodontic treatment for Class III malocclusion has always been somewhat controversial. Many orthodontic pioneers like Angle, Tweed, and Graber have advocated early interception of class III malocclusion because this kind of skeletal discrepancy once established, would usually progress rapidly. What kind of early treatment would be appropriate for this malocclusion? Would this approach be effective and promises a stable result? Early orthodontic treatment is defined as a treatment that is initiated during the primary or the mixed dentition stage to enhance skeletal and dental development. It is usually done in two phases. The first phase is intended to correct skeletal discrepancy by taking advantage of growth and development period. The second phase followed to improve occlusal relationship. Early treatment of Class III malocclusion is a possible alternative to improve skeletal discrepancy or at the very least may serve to prevent a worsening malocclusion. Principles of Class III early treatment depend on whether it is dental Class III, functional Class III, or skeletal Clas III. Practitioners should consider positive and negative factors of a patient before initiating treatment. Likewise, they should understand factors that affect prognosis and stability of the results."

"Saat ini fenomena HIV positif meningkat di kalangan ibu rumah tangga. Banyak penelitian yang menunjukkan bahwa pada ibu rumah tangga terinfeksi HIV, mereka mengalami shock, depresi, cemas dan stress akibat dari kondisi fisik mereka serta stigma dari kondisi HIV positif. Dampak psikologis lain yang juga dialami oleh para pengidap HIV adalah trauma. Trauma yang disebabkan oleh diagnosis HIV positif, bersamaan dengan dampak psikologis lainnya, menyebabkan ibu rumah tangga yang mengidap HIV positif tidak dapat menjalani perannya dalam keluarga dengan maksimal. Sebagai hasil dari usaha mengatasi pengalaman traumatis, dalam diri individu dapat mucul perubahan yang bersifat positif yang dikenal dengan istilah posttraumatic growth. Meningkatnya posttraumatic growth pada para pengidap HIV positif dapat membantu mereka beradaptasi dengan kondisinya lebih cepat dan meningkatkan kemungkinan membaiknya kondisi kesehatan mereka.Saat ini belum ditemukan penangangan psikologis yang menangani dampak traumatis dari diagnosis HIV positif serta dapat meningkatkan posttraumatic growth pada ibu rumah tangga. Salah satu intervensi penanganan trauma yang berfokus pada peningkatan posttraumatic growth adalah posttraumatic growth path. Oleh karena itu, penelitian ini dilakukan untuk melihat efektivitas posttraumatic growth path dalam meningkatkan posttraumatic growth pada ibu rumah tangga yang mengidap HIV positif.Metode Penelitian ini tergolong penelitian kuantitatif dan kualitatif yang menggunakan metode one group before-and-after study design dengan pemberian intervensi posttraumatic growth path sebanyak 4 sesi. Hasil Pada kedua partisipan dalam penelitian ini terlihat adanya peningkatan posttraumatic growth berdasarkan meningkatnya skor Posttraumatic Growth Inventory (PTGI), meskipun pada salah satu partisipan ditemukan penurunan pada salah satu dimensi skor. Secara kualitatif, kedua partisipan merasa diri mereka lebih dapat memaknai secara positif diagnosis HIV positif yang dialami, dapat mengatasi masalah-masalah yang dikeluhkan sebelumnya, dan dapat menerapkan peningkatan posttraumatic growth yang dialami ke dalam kehidupan sehari-hari.

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These days the phenomenon of HIV positive in housewives population has been raised. Previous studies showed that shock, depression, anxiety, and stress occur in housewives living with HIV positive caused by their physical condition and stigma among societies as well. Another psychological impact of HIV positive is trauma. The trauma of HIV positive diagnoses joint other psychological impacts of this diagnoses has caused the housewives living with HIV positive unable to perform their roles in the family at their maximum capacity. In other hands, as a result of attempts to struggle with the aftermath of traumatic event, there could be a positive changes occur within individuals which termed posttraumatic growth. Increased posttraumatic growth within individuals living with HIV positive could help them adapt with their condition faster and the possibility of improve physic health becomes higher.

These days, in Indonesia, psychological intervention to handle trauma and to increase posttraumatic growth for housewives living with HIV positive has not been found yet. One of many interventions used to handling trauma that focused on increasing posttraumatic growth is posttraumatic growth path. Therefore, the purpose of this research is to examine the effectiveness of posttraumatic growth path in increasing posttraumatic growth within housewives living with HIV positive.

Method This is a quantitative and qualitative research using one group before-and-after study design. The intervention was conducted in 4 sessions. Results In participants, posttraumatic growth were reported increased indicated by improved score in Posttraumatic Growth Inventory (PTGI), important to note that in one participant one of dimension score is decreased. Both participants also reported that they could value the diagnoses in a positive way, coped with their previous problems, and applied their increased posttraumatic growth in daily life."