CC BY
11
Section 2. Life Sciences
Safrizal,
Airport Region III Port Health Office of Banda Aceh
Asriwati,
Helvetia Health Institute, Medan E-mail: ublicnew.research@gmail.com
A STUDY OF EPIDEMIOLOGY SURVEILANCE IMPLEMENTATION OF HIV-AIDS MOBILE VCT ON RISK POPULATION
Abstract. Voluntery Counseling and Testing (VCT), is now widely known internationally as an effective and very important strategy, both for HIV-AIDS prevention and tackling. The purpose of this study is to determine the study of the implementation ofVCT inspection measures in the Banda Aceh Port working area. This type of research is an observational descriptive study. The research subjects were the reporting system for VCT-HIV and STI mobile activities, health checks and early detection screening through rapid testing of HIV antibodies, namely by using HIV ^ 3.0 Rapid Test reagent 1, with the target being Ship Crew (ABK), Labor and Unloading Load (TKBM) and the community. Data collection is done by document study. The results of the study shows that there were no patients who are suspected of HIV or HIV Reactive from the physical working area of Banda Aceh with a physical examination and blood was Non Reactive. It is recommended that efforts were made to promote health and provide education about the dangers and ways to prevent HIV AIDS and STIs, especially in the port area and the entrance of other countries.
Keywords: Voluntery Counseling and Testing (VCT), HIV AIDS.
Introduction wider areas in Indonesia since 2005 [2]. However,
Voluntary counseling and detection of HIV or the number of cases and people with HIV AIDS VCT (voluntary counseling and testing) is now (PLWHA) still tends to increase. In fact HIV-AIDS widely known internationally as an effective and is an incurable disease. However, prevention of trans-very important strategy for both HIV-AIDS preven- mission can be done in various steps [3]. The use tion and services, especially among those at high risk of antiretroviral drugs will increase the positive im-of HIV-AIDS [1]. estimates that there are at least pact on the level of individual health as well as at the 4.5 million people in the world, and 98% of them community level, namely increasing the quality of are in developing countries. In Indonesia, with ap- life for PLWHA and decreasing HIV transmission proximately 202 million people facing a big prob- in the community [4]. The number of people living lem with HIV AIDS infection. Much progress has with HIV who know their status faster or earlier [5]. been made by programs such as the development of For the diagnosis and finding of those living with HIV-related service facilities that have penetrated HIV at the beginning of the program a voluntary
HIV counseling and testing (VCT) guideline was then followed by guidelines for HIV counseling and testing at the initiative of health care providers and counseling (TIPK) or Provider Initiated Testing and Counseling (PITC) [6].
Indonesia has become the fifth country in Asia at the highest risk of HIV-AIDS, so it is inevitable that Indonesia will implement an international level agreement followed by national policy. As we know, the fundamental problem faced by people with HIV / AIDS (PLWHA) is not only the disease, but also many people still cannot accept the existence of PLWHA. The stigma against PLWHA is still quite a lot coupled with a judgmental attitude, distancing, ostracizing, discriminating, even to treatment that not only violates human rights but also crimes. For this reason, efforts are needed to prevent stigma and discrimination through counseling, support, care and treatment programs that involve all parties involved so that PLWHA can function socially again.
HIV testing is the most important "entrance" to prevention, care, support and treatment services. After a long time the availability of HIV antibody tests in Indonesia, and with increasing coverage of HIV testing in Indonesia, it is still not enough to reach the public to know their HIV status. HIV testing and counseling (TKHIV) will encourage a person and partner to take steps to prevent transmission of HIV infection. Further HIV testing will provide an opportunity to obtain preventive services including prevention of mother-to-child transmission and is an important component of antiretroviral treatment interventions as a prevention measure such as early treatment for sero discordant couples, so that increased coverage of HIV testing in partners is very necessary. At the community level, expanding the reach of TKHIV services will "normalize" HIV testing itself and reduce stigma and discrimination related to HIV status and HIV testing [7].
Knowledge of HIV status is also needed to start ARV treatment, but until now there is still a high gap between the estimated number of people with
HIV and AIDS (PLWHA) with PLWHA who have reached HIV services [8]. There are still many PL-HIV who have not been diagnosed or know that they infected with HIV. They come to health services after symptoms arise and become symptomatic. HIV testing is a prerequisite for establishing a diagnosis, connecting PLWHA with early prevention and care services. With a diagnosis that has been enforced, access to therapy can begin. Therefore ARV therapy services must be available in all referral hospitals at the provincial and district / city levels so that they can be easily accessed by PLWHA in need [9].
Starting in 2006, the main model of HIV testing services was at the client's initiative or known as voluntary HIV testing and counseling. This approach relies solely on the client's activity in seeking HIV testing services in health facilities or community-based HIV testing services [7]. However, the coverage of KTS services is limited because there are still fears of stigma and discrimination and most people do not feel themselves at risk ofHIV infection even in the regions or in high prevalence groups. In addition to the need to expand the reach of KTS, there needs to be another approach to increase coverage to achieve universal access to HIV prevention, care, support and treatment. 10 Another approach is through HIV testing at the initiative ofhealth care and counseling providers (TIPK) or provider-initiated HIV testing and counseling (PITC) which is the main approach in health services and will be able to increase coverage of HIV testing, improve access of PLHIV to health services that increase opportunities for HIV prevention services [5].
Method
This type of research uses observational qualitative descriptive research conducted to see first hand the VCT HIV - AIDS control program for the discovery of new HIV cases against risky populations in the Banda Aceh Port work area in 2018. Health and early detection screening through rapid testing of HIV antibodies using reagents 1 HIV / 3.0 Rapid Test, with the aim being Ship Crew (ABK), Manpower and Unloading (TKBM) and the community.
The research was carried out at the Banda Aceh Port Health Ministry and 6 working areas. The research was conducted in March - April 2019. The subjects in this study were the epidemiological surveillance system and information system of the VCT mobile HIV-AIDS control program for the discovery of new HIV cases against at-risk populations in the port work area and airports carried out in 2018. Research data were obtained from source of data on reports on the implementation of HIV-AIDS control programs.
Processing and presenting data using data reduction, namely the process ofselection, focusing, simplification, and data abstraction. Displacement data, namely
looking at a presentation of data, all of which are designed to summarize information on a regular basis so that it is easily seen and understood in a systematically arranged form accompanied by a table as a supporter of data presentation. The analysis technique used is analysis of content or narration, tables and graphs.
Results
Distribution of risky population characteristics
The characteristics of the at-risk population on voluntary counseling and testing for the discovery of HIV-AIDS cases in the 6 working areas of the Banda Aceh port and airport in 2018 based on the report can be seen in the following table:
Table 1.- Distribution of the characteristics of the population at risk based on age
Working Area Age Total
15-44 year 45-59 year > 60 year
n f n f n f n f
Sultan Iskandar Muda Airport 18 8.95 8 0.8 0 0 26 7.92
Labuhan Haji Sea 28 13.9 20 0.20 7 25.9 55 16.7
Lhok Nga Sea 35 17.4 19 0.19 0 0 54 16.4
Malahayati Sea 37 18.4 11 0.11 2 7.4 50 15.2
Meulaboh Sea 40 19.9 13 0.13 0 0 53 16.1
Singkil Sea 43 21.3 29 0.29 18 0.66 90 27.4
Total 201 61.2 100 30.4 27 8.23 328 100.0
Source: KKP, Banda Aceh 2018
Table 1 shows that the majority ofthe population old, which is 201(61.2%) and the most in the Singkil carrying out the examination are more 15-44 years sea area 43(21.3%) compared to the other regions.
Table 2.- Distribution Characteristics of risk population by sex
Working Area Sex
Man Woman
n f n f
Sultan Iskandar Muda Airport 15 7.81 11 8.08
Labuhan Haji Sea 43 22.3 12 8.82
Lhok Nga Sea 23 11.9 31 22.7
Malahayati Sea 36 18.7 14 10.2
Meulaboh Sea 52 27.0 1 0.73
Singkil Sea 23 11.9 67 49.2
Total 192 58.5 136 41.4
Based on the results of the study, it was found that the population at risk of VCT examination was more men, ie 192(58.5%) than women as many as
136(41.4%). Voluntary counseling and detection of HIV or VCT (voluntary counseling and testing), provides the following results:
Figure 1. Distribution of characteristics of at-risk populations based on type of work in the airport area
Table 3.- Health examination and early detection screening data in the Port area and Banda Aceh Airport in 2018
Working Area Risk Popu ation
Number of participants % Result of Reagen 1 Rapid Test HIV / 3.0
Sultan Iskandar Muda Airport 26 7.92 Non Reactive
Labuhan Haji Sea 55 16.7 Non Reactive
Lhok Nga Sea 54 16.4 Non Reactive
Malahayati Sea 50 15.2 Non Reactive
Meulaboh Sea 53 16.1 Non Reactive
Singkil Sea 90 27.4 Non Reactive
Total 328 100.0 Non Reactive
Table 3 showed 328 VCT (voluntary counseling and testing) testing in populations at risk ofHIV-AIDS and STIs in the port and airport areas showed that of the 6 most working areas the number ofparticipants in the Singkil Sea was 90(27.4%). Health screening and early detection screening through rapid testing of HIV antibodies, namely using reagent 1 HIV / 3.0 Rapid Test, with the aim of being a Ship Crew (ABK), Labor and Dismantling (TKBM) and the community carried out by surveillance officers resulted non reactive.
Discussion
Human Immunodeficiency Virus (HIV) is caused by a virus called HIV, which is a type of virus that is in human blood that can weaken the body's resistance, so that the sufferer is susceptible to other infections, such as tuberculosis, canker sores and prolonged diarrhea [11]. Acquired Immune Deficiency Syndrome (AIDS) is a collection of symptoms of a disease caused by the decline of human immunity by HIV. Based on the most recent data on the transmission of HIV infection in Indonesia, the HIV virus is present in the blood and body fluids of someone who has been infected, even though the person has not shown any complaints or symptoms of the disease. The first is through sexual relations with people who have been infected without using condoms, second is through the use of blood-contaminated syringes containing HIV, which is possible, among others, due to the use of shared syringes among injecting drug users, and third is transmitted from mothers HIV sufferers to children, both during pregnancy, childbirth or during breastfeeding [12]. Other modes of transmission are through blood transfusions containing viruses, puncture devices and other equipment (tattoos, etc.) that have the potential to transmit HIV and the presence of sexually transmitted infections such as syphilis. People who have high risk behaviors for HIV infection are: Women and men who have risky sexual behavior, such as changing partners in unprotected sexual intercourse and having sex with strangers, as well as injecting narcotics, who use syringes together (alternately).
5 Indonesia has become the fifth country in Asia at the highest risk of HIV-AIDS, so it is inevitable that Indonesia will implement an international level agreement followed by national policy. HIV testing is the most important "entrance" to prevention, care, support and treatment services. After a long time the availability of HIV antibody tests in Indonesia, with the increase in coverage of HIV testing in Indonesia, it is still not enough to reach people to find out their HIV status [9]. HIV testing and counseling (TKH-IV) will encourage individuals and partners to take steps to prevent transmission of HIV infection [13]. Furthermore HIV testing will provide opportunities to obtain preventive services including prevention of mother-to-child transmission and an important component of treatment interventions [14]. ARVs as a preventive measure such as early treatment in serodiscordant couples, so that increased coverage of HIV testing in partners is very necessary [15]. At the community level, expanding the reach of TKHIV services will "normalize" HIV testing itself and reduce stigma and discrimination related to HIV status and HIV testing [12].
The Banda Aceh Port Health Office has the main task of carrying out prevention of the entry and exit of infectious and potential outbreaks of disease, limited health services in the Port / Airport and cross-western work areas and control of environmental health impacts based on legislation and applicable provisions [16]. In carrying out these tasks, described through the roles and functions that must be carried out in the implementation ofvarious programs / activities by not disturbing the smooth flow of international / national traffic both for people, goods and tools [17].
Effective disease observation is needed to determine the endemicity of the disease or to find out early the possibility of cases of HIV-AIDS sufferers. 10 Based on the characteristics in this study are age and gender. Participants in the health examination using the mobile VCT were found to be 15-44 years old as many as 201 participants in 6 banda Aceh KKP
work areas and more than the age of45-59 years and
> 60 years old while the majority were in the Singkil sea working area of 90 people obtained 43(21.3%) participants and ages 45-59 years 29(0.29%) and
> 60 years old ie 18(0.66%).
Age associated with the VCT method gets results that the characteristics of participants to carry out early detection examinations aged 45-59 years and
> 60 years have a tendency to decrease work productivity. According to Robbins and judge (2008), increasing age means productivity also decreases compared to productive age [17]. Based on research it is known that most populations in the productive age category think that screening with a health check with VCT is very useful for early detection of health conditions so they can remain carry out daily activities. Productive age is a period where someone already has a great curiosity so that they will find out as much information as possible and will behave according to their life experience and knowledge, they will process that information and adapt it to their own knowledge [18]. This is appropriate with the results of research that Indonesia estimated that 75% of people with HIV-AIDS are aged 15-50 years, so that it will reduce productivity in the community.
Based on gender, the proportion of health examinations with VCT more that health check is male gender 192(58.5%) compared to women which is equal to 136(41.4%). This happened because more men were working in the port and airport areas, screening tests with male sex had a risk factor for contracting HIV-AIDS compared to women. The circulation of the HIV-AIDS virus is more focused on populations that have risk factors such as changing sexual partners both heterosexual, bisexual and homosexual or those who are under the influence of drug dependence [19]. Therefore sexuality is a medium of transmission, so the practice of heterosexuals and bisexuals determines the transmission of viruses that are generally male and have a family. They often use the services of sex workers in fulfilling their biological needs as a consequence of the
work they do. The types of jobs considered risky are jobs that require high mobility such as truck drivers, mobile workers, traders and seafarers and crew, labor and loading and unloading (TKBM).
The connection of the progress ofmodernity with the epidemic of AIDS leads us to understand rationally the pyramids ofAIDS cases that occur a lot in the young or productive age population. This population group has a strong drive with stimuli ofmodernity offered in various forms and manifestations [7].
The results of the study with medical examinations and early detection screening through rapid testing of HIV antibodies, namely by using reagent 1 HIV 3.0 Rapid Test, of the 6 working areas of the Banda Aceh CTF were not found to be reactive or positive test results, all population results were non reactive.
If an in-depth analysis of trans-dimensional analysis is conducted between the speed of transmission and the highest incidence of productive population groups, then we will be faced with the problem of regeneration. The phenomenon of death at a young age will break the chain of human reproduction which should occur cyclic through marital ties or family ties. At some point the loss-generation phenomenon emerges. This is where the VCT HIV and IMS mobile activities program finds its significance as an issue that has the impact of HIV and AIDS. The model of socializing knowledge with conventional communication styles requires critical evaluation towards participatory community involvement at all stages of control. Participatory engagement requires the existence of community empowerment capabilities that the surveillance officer must possess for the discovery and early detection and management [20]. Visiting the community, listening to them, and opening social dialogues and providing them with ample opportunities to define their own problems and solve them in their own way to avoid the risk of HIV AIDS transmission [21].
Conclusion
The results of the research that have been carried out show that the proportion of the population at
greater risk for productive age and male sex is because the VCT HIV-AIDS examination is conducted with the aim of Ship Crew (ABK), Labor and Unloading (TKBM) as well as the community conducted by surveillance officers the results are Non Reactive. It is expected that the executors of the HIV-AIDS and STI control programs can provide education on HIV-AIDS and VCT regularly. To the population in the area of the Port and Airport work area, given the
high mobility where they dominate and work, they can understand about HIV-AIDS and the impact of transmission and want to do a VCT examination.
Acknowledgement
Thank you to the officers who carried out the epidemiological surveillance program and information system for the HIV-AIDS control program in the Banda Aceh CTF Working Area that had contributed to this research.
References:
1. Habib A. G., Abdulmumini M., Dalhat M. M., Hamza M., Iliyasu G. Anti-retroviral therapy among HIV infected travelers to Hajj pilgrimage. Journal of travel medicine. May-Jun 2010; 17(3) : 176-181.
2. Amiruddin R. Surveilans Kesehatan Masyarakat. IPB Press, Bogor, 2013.
3. Patel P., Bennett B., Sullivan T., et al. Rapid HIV screening: missed opportunities for HIV diagnosis and prevention. Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology. May 2012; 54(1) : 42-47.
4. Vanmeulebrouk B., Rivett U., Ricketts A., Loudon M. Open source GIS for HIV/AIDS management. International Journal of Health Geographics. 2008; 7 : 53.
5. Penda C. I., Tejiokem M. C. Low rate of early vertical transmission of HIV supports the feasibility of effective implementation of the national PMTCT guidelines in routine practice of referral hospitals in Cameroon. Apr 24,2019 : 1-8.
6. Long E. F., Brandeau M. L., Owens D. K. The cost-effectiveness and population outcomes of expanded HIV screening and antiretroviral treatment in the United States. Annals of internal medicine. 2010; 153(12):778-789.
7. Sofeu C. L., Ndiang S. T., Ateba Ndongo F., et al. Primary health care: an opportunity for early identification of people living with undiagnosed HIV infection. Paediatrics and international child health. Apr 24, 2019.
8. Van Herck K., Van Damme P., Castelli F., et al. Knowledge, attitudes and practices in travel-related infectious diseases: the European airport survey. Journal of travel medicine. Jan-Feb 2004; 11(1) : 3-8.
9. Sanders G. D., Bayoumi A. M., Holodniy M., Owens D. K. Cost-effectiveness of HIV screening in patients older than 55 years of age. Annals of internal medicine. 2008; 148(12): 889-903.
10. Whiteside A. How the transport sector drives HIV / AIDS and how HIV/ AIDS drives transport. Economic impact: Southern Africa. AIDS analysis Africa. Apr 1998; 8(2) : 5-6, 15.
11. Moore R. D. Epidemiology of HIV infection in the United States: implications for linkage to care. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. Jan 15,2011; 52, Supp l 2.- P. 208-213.
12. Saxena A., Deschamps M. M., Dorvil N., et al. Association between intimate partner violence and HIV status among Haitian Women. Global public health. Apr 18,2019 : 1-12.
13. Abdullah A. S., Hedley A. J., Fielding R., Ebrahim S. H. Determinants of HIV antibody testing among selected groups of Chinese residents in Hong Kong. International journal of STD & AIDS. Sep 2004; 15(9):608-614.
14. Tapera O., Kadzatsa W., Nyakabau A. M., et al. Sociodemographic inequities in cervical cancer screening, treatment and care amongst women aged at least 25 years: evidence from surveys in Harare, Zimbabwe. BMC public health. Apr 24,2019; 19(1) : 428.
15. Vinken L., Fransen K., Cuypers L., et al. Earlier Initiation ofAntiretroviral Treatment Coincides With an Initial Control of the HIV-1 Sub-Subtype F 1 Outbreak Among Men-Having-Sex-With-Men in Flanders, Belgium. Frontiers in Microbiology. 2019; 10 : 613.
16. Aceh D. Profil Kesehatan Provinsi Aceh. Banda Aceh. 2016.
17. Tedaldi E. M., Armon C., Patel V., et al. Safety and efficacy of VRC01 broadly neutralising antibodies in adults with acutely treated HIV (RV397): a phase 2, randomised, double-blind, placebo-controlled trial. SAGE open medicine. Apr 15, 2019.
18. Ayaya S. O., Sitienei J., Odero W., Rotich J. Knowledge, attitudes, and practices of private medical practitioners on tuberculosis among HIV/AIDS patients in Eldoret, Kenya. East African medical journal. Feb 2003; 80(2) : 83-90.
19. Islam M. M., Conigrave K. M., Miah M. S., Kalam K. A. HIV awareness of outgoing female migrant workers of Bangladesh: a pilot study. Journal of immigrant and minority health. Dec 2010; 12(6): 940-946.
20. Placek C. D., Madhivanan P. Exploring the perceptions of pregnancy loss between two populations of South Indian women: a pilot study. Public Health. 7// 2017; 148 : 9-12.
21. Elmosaad Y. M., Elhadi M., Khan A., Malik E. M., Mahmud I. Communication for behavioural impact in enhancing utilization of insecticide-treated bed nets among mothers of under-five children in rural North Sudan: an experimental study. Malaria Journal. Oct 18,2016; 15(1) : 509.
