ANALISIS IMPLEMENTASI LAYANAN BERBASIS KOMUNITAS DAN DIGITAL DALAM PENINGKATAN PENGOBATAN HIV DI KABUPATEN KOTAWARINGIN BARAT

Abstrak

Pendahuluan: Kepatuhan orang dengan HIV (ODHIV) dalam menjalani terapi antiretroviral (ARV) merupakan tantangan utama dalam pengendalian HIV. Kabupaten Kotawaringin Barat telah mengembangkan layanan berbasis komunitas dan pemanfaatan teknologi digital untuk mendukung keberlanjutan pengobatan HIV. Penelitian ini bertujuan untuk menganalisis implementasi layanan berbasis komunitas dan digital dalam pengobatan HIV di Kabupaten Kotawaringin Barat. Metode: Penelitian ini menggunakan pendekatan mixed methods dengan desain explanatory sequential. Data kuantitatif dikumpulkan melalui kuesioner Morisky Medication Adherence Scale (MMAS-8) terhadap 69 ODHIV yang menjalani pengobatan ARV dan dianalisis menggunakan analisis univariat. Data kualitatif diperoleh melalui wawancara mendalam dengan tenaga kesehatan, pendamping komunitas, dan ODHIV sebagai penerima layanan. Analisis kualitatif dilakukan menggunakan model implementasi kebijakan Grindle yang meliputi dimensi content of policy dan context of implementation. Hasil penelitian: Hasil penelitian menunjukkan bahwa tingkat kepatuhan ODHIV terhadap pengobatan ARV masih bervariasi, dengan kepatuhan rendah sebanyak 31 responden, kepatuhan sedang 25 responden, dan kepatuhan tinggi 13 responden. Temuan kualitatif menunjukkan bahwa layanan berbasis komunitas dan digital memberikan manfaat dalam meningkatkan komunikasi antara ODHIV dengan layanan kesehatan, mendukung penelusuran pasien yang mengalami lost to follow up.  Implementasi program masih menghadapi beberapa tantangan, antara lain keterbatasan sumber daya, hambatan akses geografis, serta stigma sosial terhadap ODHIV. Kesimpulan: Implementasi layanan berbasis komunitas dan digital berperan dalam mendukung kepatuhan pengobatan ARV, tingkat keberhasilannya dipengaruhi oleh faktor isi kebijakan dan konteks implementasi sebagaimana dijelaskan dalam model Grindle.

Introduction: Adherence to antiretroviral (ARV) therapy among People Living with HIV (PLHIV) is a primary challenge in HIV control efforts. Kotawaringin Barat  has implemented community-based services combined with digital support as a strategy to strengthen treatment adherence among PLHIV. This study aimed to analyze the implementation of community-based and digital services in supporting HIV treatment in Kotawaringin Barat. Methods: This study uses a mixed-methods approach with an explanatory sequential design. Quantitative data were collected using the Morisky Medication Adherence Scale (MMAS-8) questionnaire administered to 69 PLHIV receiving ARV terapy and analyzed using univariate analysis. Qualitative data were obtained through in-depth interviews with healthcare providers, community outreach workers, and PLHIV receiving the services. The qualitative analysis was conducted using Grindle’s policy implementation framework, which includes the dimensions of content of policy and context of implementation. Result: The findings show that antiretroviral therapy (ART) adherence among people living with HIV (PLHIV) varied, with 31 respondents categorized as low adherence, 25 as moderate adherence, and 13 as high adherence. Qualitative findings indicate that community-based and digital services improved communication between PLHIV and healthcare providers and supported the tracing of patients experiencing lost to follow up. However, the program implementation still faced several challenges, including limited resources, geographical access barriers, and social stigma toward PLHIV. Conclusion: The implementation of community-based and digital services contributes to improving ART adherence among PLHIV. However, its effectiveness is influenced by policy content and the context of implementation, as described in Grindle’s framework