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Paradigma Baru Konseling Tes HIV untuk “Getting to Zero”

Paradigma Baru Konseling Tes HIV untuk “Getting to Zero” . Zubairi Djoerban Pusat Layanan HIV FKUI RS Cipto Mangunkusumo. empati. Konseling Tes HIV. Pra dan Pasca Tes VCT PITC Informed Consent Tes Rutin. Pokok Bahasan. Getting to Zero. Tema Hari AIDS Sedunia Konseling

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Paradigma Baru Konseling Tes HIV untuk “Getting to Zero”

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  1. ParadigmaBaruKonselingTes HIV untuk “Getting to Zero” Zubairi Djoerban Pusat Layanan HIV FKUI RS Cipto Mangunkusumo empati

  2. KonselingTes HIV PradanPascaTes VCT PITC Informed Consent TesRutin

  3. PokokBahasan Getting to Zero. TemaHari AIDS Sedunia Konseling Data Lapangan Kesimpulan

  4. Getting to Zero Zero New HIV Infections Zero Discrimination Zero AIDS-related deaths

  5. Zero HIV Infections Deborah Donells et al di Lancet 12 June 2010 Odhaminum ART mengurangipenularan HIV 92% Perlumemperluas, meningkatkanjumlahtes HIV

  6. Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis The Lancet, 375:2092 - 98, 12 June 2010, Deborah Donnell et al A peer-reviewed study showed that placing people living with HIV on antiretroviral treatment created a 12-fold reduction in transmission to their HIV-negative partner. This 92% decrease in the likelihood of transmission confirms the importance of scaling up widespread testing and reaching universal access (at least 80% coverage) to AIDS treatment

  7. PenelitianHPTN 052 oleh US National Inst. of Allergy and Infectious Diseases 1.763 pasangandari 9 negaraAmerika, Botswana Brazil, India, Kenya, Malawi, AfrikaSelatan, Thailand, dan Zimbabwe Kelompok I: minum ARV segerasetelahtes HIV + Kelompok II: ditundasampai CD4 turun < 250 Hasil: kelompok I ygtertular 1 orang, Kelp-II: 27 ARV dinimengurangipenularan96% Amatsignifikan, shgpenelitian yang dijadualkan sp 2015 dihentikanawal 2011 agar semuaodhasegeradapat ARV

  8. Mengobatiodha dg ARV mengurangiangkapenularan 96%

  9. 25 Maret 2010.Afrika Selatan mulaitesHIV masal, 15 jutaorangdalamwaktu 1 tahun. Jumlahpenduduk 50 juta Tujuanmeningkatkancakupanpengobatan ARV agar mortalitasdanmorbiditasturun, bagiodha yang jumlahnyaamatbesardanmemperbaikimanajementb Penularan HIV diAfselterutamamelalui heterosexual, disusulpenularanibukebayi

  10. Universal Access: Tes HIV sebanyakmungkin# Afrika Selatan: tes HIV 15/50 jutapenduduk# Botswana: semuapenduduk# Amerika: semuapasiendilayanankesehatan# Indonesia: ratusanribusaja# Dites HIV untukdiobati# Diobati ARV: menjaditidaksakit, tetapsehat, panjangumurdantidakmenularkanlagi!# HAM, hakazasiodhauntukmendapat ARV

  11. Di negara2 maju, sekaranginipenularanibukebayipraktissudah zero. Jugakematianbayidananak dg HIV bisadicegah total. Di tahun2015, bayi2 ygdilahirkandimanapundapatlahirtanpatertular HIV, danibunyatetaphidup normal produktif Terima kasih Countdown to Zero UNAIDS 2011 Michel Sidibé (UNAIDS Executive Director) Eric Goosby (United States Global AIDS Coordinator)

  12. Gel Tenofovir PenelitiandiAfSelmembuktikan, pemakaian gel tenofovirdi vagina menekanpenularan HIV 50% , amatsignifikan, setelahdipakai 1 tahun. Gel mengurangipenularansebesar 39% stlh 2.5 tahun. Bermanfaatketikapasanganmenolakpakaikondom.

  13. Upayapencegahanpenularan UpayaBiomedik Obat Anti Retro Viral 96% PMTCT 60% Sunat, Sirkumsisi 60% Gel Intravaginal 40%, Kondom, (vaksin 30%, Thailand) Pengobatan penyakit menular seksual UpayaStruktural Ekonomi, Budaya, Pendidikan, Hukum, Gender HAM PerubahanPerilaku

  14. Zero AIDS-related deaths Makin dinimengobatimakinbaik Dahulumenunggukondisiburuktuk ARV Asimptomatik, CD4 < 200 CD4< 350 CD4< 500 CD4>500 kemudian Test and Treat

  15. Pengobatan ARV dini, CD4 < 350 mengurangiangkakematian 75%. Menekanangkakematian 75%, angkakejadiantbc 50% DuviraldanEfavirenz. Penelitian 816 odha Haiti, 2005 – 08 Kelompokpengobatandini, CD4 antara 200 -350, tanpariwayatgejala AIDS, sewaktuodhamasihsehat, beratbadannyabelumturun, tanpasariawanmaupundiare, tanpapanasbatuk, tanpagejala. Kelompokstandar lama, dengan CD4 kurangdari 200 N Engl J Med. 2010;363:257-65

  16. Pengobatan ARV amatdini, CD4<500, jgterbuktimengurangiangkakematian PenelitiankohorEuropa, Australia danKanada, 9.455 odha yang diteliti 1996 - 2009. Manfaat ARV nyatabilamulaiketika CD4: 0 - 49 cells/mm3, mengurangiangkakematian 70% Untuk CD4: 200 - 349 cells/mm3mengurangi 40% CD4 350 - 499 cells/mm3:  25% Jonsson Funk M et al. HAART initiation and clinical outcomes. Abstract THLBB201, 2010

  17. Botswana : Tes HIV rutin ! • 48% penduduk Botswana tes HIV • MTCT turundari 30% ke 6% • VCT gagal, kurangcepatdan kurangefisien • Panelismenekankanbahwamasalah KesehatanMasyarakatdan HAM tidakharusdantidakperludipertentangkan • KonpertensiInternasional AIDS Toronto 2006. Sheila D Tlou, Menkes Botswana

  18. Amerika: Tes HIV rutin • CDC mengeluarkanrekomendasibarutes HIV rutin, padaremaja, dewasadanibuhamil. Alasannyakarena 25% odhaAmerika, tidakwaspadaakan status HIVnya, dan • 40% odhaterlambat diagnosis • CDC, TELAH merekomendasitesrutin HIV untukkelompokrisikotinggidandilingkungandenganprevalensitinggi Bayer R, Fairchild AL: Changing the Paradigm for HIV Testing The End of Exceptionalism. New England J Med, 17 Agustus 2006 Malave MH et al Making HIV testing a routine part of medical care. City Health Information. Vol. 25. No. 2. February 2006:9-12. New York

  19. CDC Recommendations for Routine HIV Testing • Routine, voluntary HIV screening in healthcare settings recommended for all patients 13-64 yrs of age • Except in populations with documented prevalence of undiagnosed HIV infection < 0.1% • Without prevalence data, voluntary HIV screening appropriate until diagnostic yield < 1/1000 patients screened is established • Separate written consent not recommended • Pre- or post-test prevention counseling should not be required with testing or screening programs Branson BM, et al. MMWR Recomm Rep. 2006;55:1-17.

  20. USPSTF HIV Testing Recommendations • Screening strongly recommended for all adolescents and adults at increased risk for HIV and all pregnant women USPSTF recommendations. July 2005.

  21. Zero Discrimination Kebijakan , UU terkendalaoleh Praduga, stigma dandiskriminasiterhadappopulasikunci Kriminalisasipenggunanarkotika Masalahkesetaraan gender, kekerasanperempuan KEMAJUAN 18 negara Asia Pasifikmemp UU perlindunganodha Bbrpnegaratlhmencabutaturanperundanganygnegatif

  22. 4067-ON-AB-B Realisasi Uu.No.35 Tahun 2009 Tentang Narkotika (Pecandu Adalah Korban) Dikota Bekasi Adalah Omong KosongMohammad IwanIkhsan SH, LSM GrapiksBekasi Dari ke 14 penangkapan yang dilakukan oleh polisi dikota Bekasi rata-rata semuanya mendapatkanpasal 112/114. Di keduapasaltersebuttertulisancamanpidanapenjarasedangkanjadirealitapecanduadalahkorbandikotaBekasiadalahomongkosong.

  23. Prioritaskan Upaya Pencegahan yang high-impact Pengobatanmengurangipenularan 96% Tingkatkan odha yang mendapat ARV, tes 15 juta Menjaga kelangsungan pengobatan ARV HAM dan Gender Terima kasih Getting to Zero

  24. Prasarat Sukses Komitmen Kepemimpinan Politik Partnership dg LSM dan odha Akses ARV. Minimalkanketergntungan ManfaatkanARV produk dalam negeri Tes HIV sebanyakmungkin Akses tes HIV, CD4 dan VL yang murah Hapus UU dan kebijakan yang memicu diskriminasi

  25. Unit PelayananTerpadu HIV/AIDS RS CiptoMangunusumo 7 Juni 2011: 5.414 odhayang pernahmendapat ARV

  26. UNIT PELAYANAN TERPADU HIV RSCM Layanan HIV di Lembaga Permasyarakatan (Salemba, Cipinang, Pondok Bambu, Tangerang ) Layanan VCT Layanan Obat

  27. JUMLAH PASIEN 31 JAN. 2010: 4.590 odha 27 Oktober 2010: 5.082

  28. UPT HIV SEMESTER I - 2010

  29. Pattern of opportunistic infections of newly diagnosed HIV-infected patients in Cipto Mangunkusumo hospital 2008-2009 Karjadi TH, Yunihastuti E, Pramundita R, Aziza S, Lie S, Imran D, et al. Presented at 2010 PDPAI Clinical Research Meeting

  30. Hepatitis coinfection in HIV patients N=4551 HIV patients Missing value= 938 Age = median 28 (16-77) Pokdicare Database, 2004-2009

  31. Update Terpenting Lebihdinimengobatilebihbaik Angkakematian HIV/AIDS turundrastis, 75% Mengobati ARV = mencegahpenularan 92% Test and Treat 5.2 jutaorangmendapat ARV Gel intravaginaTenofovirefektifcegahpenularan 54% DeklarasiWina

  32. KapanMulai ARV?

  33. DHHS 2009: When to Start *Panel divided: 55% strongly recommend and 45% moderately recommend. †50% favor initiating therapy at this stage; 50% view initiating therapy at this stage as optional. http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf.

  34. Zidovudine r Stavudine Lamivudine Nevirapine r Efavirenz + + • Pilihankombinasi: • Duviral + Neviral • Staviral + Hiviral + Neviral • Duviral + Efavir • Staviral + Hiviral + Efavir

  35. Towards a Paradigm Shift in HIV Treatment and PreventionJuly 18, 2010 UN Under Secretary General Michel Sidibe Head of International AIDS Society and Chair of International AIDS Conference, Julio Montaner.

  36. MICHEL SIDIBE, direktureksekutif UNAIDS1. Universal access is about social justice2. Universal access will never happen, if we don’t bring innovation, if we don’t have prevention revolution3. We have circumcisions, which are being accepted today socially, which were not. We could continue to use condoms, preservatives which are made available to young people. So, that is the revolution, ….

  37. Towards a Paradigm Shift in HIV Treatment and Prevention, Vienna, July 18, 2010Treatment is Prevention: But certainly what is important for me is Treatment 2.0. … We need to have drugs which can be administered easily. We need to make it owned by communities. We need to make sure that we can have the which are more costly, and we will work with our colleagues from WHO... We will work to make people understanding that this treatment for prevention is not just a dream. It is possible

  38. 5 million people in ARV, what do you have to say about the 10 million people who are still waiting? JULIO MONTANER: “I think it is a crime. It is a crime. We cannot wait. People infected with HIV who have a medical indication to be on treatment, they are dying because they are not being treated. Not only they are dying, their families are suffering. They are also weakening our economies so this is bad for the people, this is bad for their people. This is bad for society”

  39. People who are not treated are more likely, dramatically more likely to transmit infection. We have to stop this. This is nonsense. We have to stop it. We have got to stop it now!

  40. KonselingTes HIV PradanPascaTes VCT PITC Informed Consent TesRutin TahapPeralihan

  41. Expanding HIV Testing n Counseling Parameter Program HTC (HIV Testing and Couseling yang efektifadalah: jumlahbesarorangdengan HIV/AIDS yang mendapatpengobatan ARV tahapdini memenuhikebutuhankliendan provider Pendekatankeklien yang baik

  42. Pelatihan Konselor Modul Inti: VCT dan PITC Modul Inti + Populasi Khusus Modul Inti + Aderens + Disclosure Modul Inti + Antenatal

  43. Tujuan Konseling Untuk mengurangi penularan Untuk meningkatkan aderens pengobatan Untuk mengurangi masalah psikologi HIV Untuk memperbaiki kualitas hidup

  44. 440 konselorikutlokakarya 3 hari Selamath 2010 ada 70.580 IDUs menerima VCT dg rapid test, 4 903 positif HIV 76% IDUs kedokteruntukmemastikanhasiltes HIV 97% puas dg layanan VCT, 46% klienmemakaikondom, 36% klienhentikanpakaijarumsalingpinjam Mendapatpengobatan ARV Terima kasih V. Isakov, P. Smyrnov: VCT dg rapid test sbgintervensiutamakeakses universal kepencegahan, pengobatandandukunganuntukpenggunanarkotikaTUPE371 Konp IAS 2011, Juli 2011, Roma

  45. Kesimpulan Getting to Zero Zero New HIV Infections Zero Discrimination Zero AIDS-related deaths KONSELING

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