Syntax Literate: Jurnal Ilmiah Indonesia p�ISSN:
2541-0849
e-ISSN:
2548-1398
Vol.
7, No. 5, Mei 2022
KNOWLEDGE ABOUT HIV/AIDS
WITH COMPLIANCE TO PROVIDER INITIATED TESTING AND COUNSELING IN 1ST TRIMESTER
PREGNANT WOMEN
Ni Made Ayu Wulandari, Lina Darmayanti Bainuan, Sabrina Farani
Triatma Mulya
University, Bali, Indonesia
Email: [email protected]c.id, [email protected], [email protected]
Abstract
Human Immunodeficiency Virus-Aquaired
Immunodeficiency syndrom (HIV-AIDS) was one of
disease that got special attention from the health world. The research was
based on a large number of mothers still do not understand deeply about
HIV/AIDS and do not follow PITC (Provider Initiated Testing and Counceling) so as not to be detected early possibility of
the risk of transmission of HIV/AIDS from mother to baby. The purpose of this
research was to know the correlation of knowledge about HIV/AIDS with the
compliance to Provider From Testing And Counseling
(PITC) on 1st trimester of pregnant women. The design used in this study was
analytic approach with cross sectional correlation. The population in this
research was all 1st trimester pregnant women in PPM (Private Practice Midwife)
Mrs "W" of the Yehsumbul
Village, Mendoyo sub district, Jembrana
Regency, Bali province in December 2021 a number of 30 persons. This research
sampling was total sampling. Data analysis used Spearman's rho test. The
results suggested that nearly half (26.7%) of respondents who had less knowledge,
had negative behavior in the following Provider From
Testing and Counseling (PITC). The results of the analysis of data obtained pvalue = 0.002 or less of α = 0.05 means there was a
correlation between the knowledge about HIV/AIDS with the compliance to PITC on
1st trimester pregnant mothers In PPM Mrs
"W" Yehsumbul Village, Mendoyo
sub district, Jembrana, Bali province Year 2021.
Based on the results of the research, then the Midwife must provide more
intense communication, counceling, and education to pregnant
women in 1st trimester of the ANC with integrated Provider From
Testing and Counseling (PITC).
Keywords: knowledge
of hiv/aids; pitc;1st trimester pregnant
mothers
Introduction
Human Immunodeficiency Virus Aquaired Immunodeficiency Syndrome (HIV/AIDS)
was one of the diseases that received special attention worldwide health. The
number of women infected with HIV-AIDS from year to year was increasing, along
with the increasing number of men who had unsafe sexual relations who would
transmit HIV-AIDS in sexual partners. In the first trimester of pregnancy,
HIV-AIDS was not only a threat to the safety of the mother's life, but also
affected the fetus because of transmission that
occurs from mother to child (Kemenkes RI, 2011a).
The number of women infected with HIV from year to year was increasing, along
with the increasing number of men who had sex unsafe sex, which would transmit
HIV to their sexual partners. In a number of developing countries, HIV/AIDS was
girl to mother leading cause of reproductive age death. Pregnant HIV infection
could be life-threatening the life of mothers and mothers could transmit the
virus to their babies (Kemenkes RI, 2013).
Global
HIV-AIDS epidemic report (United Nations Program on HIVAIDS/ UNAIDS, 2012)
shows that there were 34 million people living with HIV/AIDS worldwide. 50%
including women and 2.1 million children aged less than 15 years. In Southeast
Asia there were approximately 4 million people with HIV-AIDS. The report
development of HIV/AIDS in South Asia Regional Office (Kemenkes RI, 2011b) shows that about
1.3 million people (37%) women had been infected with HIV (Kemenkes RI, 2016).
Profile
Health Indonesia noted that in 2016, the number of cases of mother-to-child
transmission of HIV/AIDS was 3.8% of the total number of new HIV/ AIDS cases in
Indonesia. In Bali Province in 2021 there were 2,367 new cases (Kemenkes RI, 2017). The proportion of
HIV/ AIDS transmission from mother to child in Bali Province in 2017 in 2016
was 1.03%, and developed into AIDS at the age of 4 years as many as 3.52% (Dinkes Provinsi Bali, 2016). The
proportion of HIV/AIDS transmission from mother to child in Bali Province in 2021 was 2.70%,
and developed into AIDS at the age of 4 years as much as 2.94% (Dinkes Jembrana, 2018).
Determinant
factors of HIV/AIDS in pregnant women were due to unhealthy sexual relations.
Vaginal penetration or anal unprotected against HIV individual infection.
Contact sexual that oral or mouth direct (mouth to penis vagina) was included
to risk category low prevalence of HIV. The level of risk depends on the amount
of virus that comes out and enters a person's body, such as in cuts/scrapes in
the mouth, bleeding gums, and or dental disease in the mouth or on the
genitals. In addition, transmission from blood could occur if the donor's blood
was not screened for HIV testing, reuse of needles and injection syringes, or
the use of other medical devices that could penetrate the skin (Kemenkes RI, 2013).
Determinant
factors of HIV transmission from mother to baby were divided into 3 factors, as
many as maternal factors, infant factors, and obstetric action factors. The
most important factor influencing the risk of mother-to-child transmission of
HIV was HIV levels (viral load) in the mother's blood at the time of delivery
and HIV levels in breast milk when the mother breastfeeds her baby. Generally,
one or two weeks after a person was infected with HIV, HIV levels would rapidly
increase in a person's body. If the mother suffers from Sexually Transmitted
Infections (STIs) or other reproductive infections, HIV levels would increase, there by increasing the risk transmission of HIV to infants
(Setiyawati & Meilani, 2015).
The risk of
HIV transmission through breastfeeding would increases if there were problems
with the mother's breast, such as mastitis, abscesses and sores on the nipples.
Babies who were born prematurely and had low birth weight were thought to be
more susceptible to contracting HIV because the baby's organ systems were not
well developed, such as the skin and mucosal systems. Most of the transmission
of HIV from mother to baby occurs during delivery, because during delivery the
pressure on the placenta increases which could cause a connection between the
mother's blood and the baby's blood. This was more common if the placenta was
inflamed or infected. In addition, during delivery the baby was exposed to the
mother's blood and mucus in the birth canal. The skin of newborns
was still very weak and more easily infected when in contact with HIV. The
impact of HIV infection on mothers and babies was a systemic decline in health,
decreased quality of life, increased maternal and infant morbidity and
mortality (Kemenkes RI, 2013).
All infants
born to HIV mothers should be given prophylactic ARV (Zidovudin)
from the first day (12 hours of age) for 6 weeks. 12 months old, all babies
born from HIV mothers should be referred to the nearest hospital for monitoring
and receive follow-up care. Efforts to prevent mother-to-child transmission of
HIV are: carry out 4 prong activities that refer to WHO recommendations 2010,
where basically all pregnant women were offered an HIV test, antiretroviral
(ARV) administration to HIV-positive pregnant women, selection of appropriate
contraception for HIV- positive women, selection of safe delivery for
HIV-positive pregnant women, and providing the best food for babies born to
HIV-positive mothers (Kemenkes RI, 2013).
Based on the
above background, the researcher was interested in examining the correlation
between knowledge about HIV/AIDS and following behavior
Provider Initiated Testing and Counseling (PITC) for
pregnant women in the 1st trimester at PPM Mrs "W" Yehsumbul Village, Mendoyo
District, Jembrana Regency, Bali Province in 2021.
Research Methods
The design used in this study was
analytic approach with cross sectional correlation. The population in this
research was all pregnant women 1st trimester in PPM Mrs "W" of the Yehsumbul
Village, Mendoyo sub district, Jembrana
Regency, Bali province in December 2021 a number of 30 persons. This research
sampling was total sampling. Data processing is done by editing, coding,
scoring in this study for variable knowledge about HIV/AIDS was given a score
of 1 if the answer was correct and 0 if the answer was wrong. The knowledge
criteria score is good if 76 � 100%, enough if 56 � 75%, and less if < 56%.
Scoring behavior according to Hidayat (2014) used a
Likert scale as follows: if the position statement strongly agrees: 4, agrees:
3, disagrees: 2, strongly disagrees:1, and a negative statement means that
strongly agree:1, agree: 2, disagree: 3, strongly disagree: 4. Then interpreted
if the score T ≥ group mean, meant positive behavior, and if T score <
group mean, meant negative behavior. Data analysis used. Spearman's rho test.
Results and Discussion
A. Results
Table 1
Characteristic Frequency Distribution (N=30)
|
Characteristics |
Frequencies |
Percentage (%) |
|
Age |
|
|
|
< 20 years |
2 |
6 |
|
20-35
years old |
20 |
67 |
|
>
30 years |
8 |
27 |
|
Education |
|
|
|
Elementary
(Elementary school) |
3 |
10 |
|
Intermediate
(Junior-High School) |
23 |
77 |
|
College
(College) |
4 |
13 |
|
Profession
|
|
|
|
Does
Not Work |
22 |
73 |
|
Private |
5 |
17 |
|
Civil
Servant |
1 |
3 |
|
Enterpreneur |
2 |
7 |
|
Farmer |
0 |
0 |
|
Parity |
|
|
|
Primipara |
9 |
30 |
|
Multipara |
20 |
67 |
|
Grandemultipara |
1 |
3 |
|
Total |
30 |
100 |
Characteristics respondent
based on age suggested that most of the 20 people (67%) of the respondents were
aged 20-35 years. Characteristics of respondents based on education shows that
almost all of them, as many as 23 people (77%) of respondents with secondary
education (high school). Characteristics of respondents based on work showthat that most of the 22 people (73%) of the
respondents did not work. Characteristics respondent based on parity show that
most of the 20 respondents were (67%) multipara.
Table 2
Frequency Distribution of Respondents Based on
Knowledge
of HIV/AIDS and Behavior Follow PITC (N=30)
|
Variable |
Frequencies |
Percentage
(%) |
|
Knowledge About
HIV/AIDS |
|
|
|
Good |
7 |
23 |
|
Moderate |
14 |
47 |
|
Less |
9 |
30 |
|
Compliance to
PITC |
|
|
|
Positive |
13 |
43 |
|
Negative |
17 |
57 |
|
Total |
30 |
100 |
Based on table 2 shows
that almost half, as many as 14 people (47%) of respondents had sufficient
knowledge about HIV/AIDS, and most of them, as many as 17 people (57%) of
respondents had negative behavior in follow Provider Initiated Testing and
Counseling (PITC).
Table 3
Cross-Tabulation of Knowledge about HIV/AIDS
and Following Behavior PITC
|
|
Behavior
PITC |
Total |
||||
|
Knowledge
About HIV/AIDS |
Positive |
Negative |
||||
|
f |
% |
f |
% |
f |
% |
|
|
Good |
6 |
20 |
1 |
3 |
7 |
23 |
|
Moderate |
6 |
20 |
8 |
27 |
14 |
47 |
|
Less |
1 |
3 |
8 |
27 |
9 |
30 |
|
Total
|
13 |
43 |
17 |
57 |
30 |
100 |
|
P value= 0.002 |
α=05 |
Coefisien correlation=0,541 |
||||
Table 3 suggested that
almost half (27%) of respondents who had less knowledge, had negative behavior
in follow Provider Initiated Testing and
Counseling (PITC). Test resultsSpearman Rho suggested
that the result pvalue= 0.002 or less than = 0.05, and a
correlation coefficient of 0.541 which means that H0 rejected and H1 accepted,
it means that there was a moderate correlation between knowledge about HIV/AIDS
with compliance to Provider Initiated
Testing and Counseling (PITC) at PPM Mrs
"W" Village Yessumbul, Mendoyo
District, Jembrana Regency, Bali Province in 2021.
B. Discussion
1.
Knowledge About HIV/AIDS
The results suggested that
almost half of respondents had sufficient knowledge about HIV/AIDS, as many as
14 people (47%). Knowledge influenced by various factors including education,
information/mass media occupation, social, cultural and economic, environment,
experience, and age (S Notoatmodjo, 2014).
Respondent's knowledge was
influenced by age, education, occupation and experience which was known from
parity, because the experience of pregnant women was known from what the mother
has done in previous pregnancies.
The results suggested that
most of the respondents were aged 20-35 years, as many as 20 people (67%). Age
affects a person's perception and mindset. The older they get, the more their
grasping power and mindset would develop so that the knowledge gained was
getting better. At middle age, individuals would play a more active role in
society and social life, and do more activities preparation for the sake of
success effort adjust self towards old age Ability intellectual, solving
problem and to decline at this age (Budiman & Riyanto, 2013).
According to researcher,
maternal age which was the optimal age in intellectual ability so they could
think logically eventhough they had never heard about
Provider Initiated Testing and Counseling
(PITC) before. Thus, respondents could answer questions in questionnaire
quite well. Mothers who had less knowledge were classified as 20-35 years old
and more than 35 years old. Mother's age was approaching late adulthood which
if not supported by higher education would be difficult.
The results suggested that
almost all respondents had secondary education (high school) that was 23 people
(77%). Education affected to the learning process, the higher a person's
education, the easier it was for that person to receive information. Higher
education makes a person more tend to get information, both from other people
and from the mass media. The more information entered, the more knowledge
gained about health (Budiman & Riyanto, 2013).
Increased knowledge was not absolutely obtained from formal education, but
could also be obtained in non-formal education (Soekidjo Notoatmodjo, 2016).
According to researchers,
education intermediate channels from the formal channels would make it easier
for respondents to understand and absorb the information they get from outside.
Information about Provider Initiated Testing and Counseling (PITC) was not
always obtained from formal education, especially in secondary education, but
could be obtained from higher formal education in the health sector. Mother's
knowledge was limited to what they get at a glance from health workers or from
electronic media which were not obtained in detail so that most mothers had
sufficient knowledge.
Mother with low education
could even had sufficient knowledge because of information about Provider Initiated Testing and Counseling (PITC)
could be accessed via the internet which was currently widespread in the wider
community. While mother with middle education still had knowledge less because
they not ever got previous information and being passive, not trying to find
information.
The results suggested that
most of the respondents did not work, as many as 22 people (73%). A person who
does not work has poor access to various forms of information, including
According to obtained health (Setiyawati N, 2015).
According to researchers, knowledge could from various access including from
the work environment. A person's work was very influential knowledge, because
gathering with other people could be used as a means of exchanging ideas and
information about health. Mother with profession as Civil servants had
knowledge good, caused in civil servant environment could exchange health
information including: Provider Initiated
Testing and Counseling (PITC). Meanwhile, there was less knowledge of
housewives who do not work so that the information obtained was limited if it
was not from the mother herself who was actively seeking health information
from other access or sources.
The results suggested that
most of the respondents were multiparous, as many as 20 people (67%).
Experience as a source of knowledge was a way of obtaining the truth of
knowledge by repeating the knowledge gained in solving problems faced in the
past. The learning experience in work that was developed would provide
professional knowledge and skills, and could develop decision-making abilities
which were a manifestation of the integration of scientific and ethical
reasoning that departs from real problems (S Notoatmodjo, 2014).
According to the
researcher, multiparous mothers already had experience with HIV/AIDS, because
according to service standards midwifery that every pregnant woman has the
right to get information about sexually transmitted diseases including HIV/AIDS
so that mothers who already had at least 1 child or were pregnant with a child
tend to had better knowledge than mothers who were pregnant for the first time.
2.
Compliance to PITC
The results suggested that
most of them had negative compliance to Provider Initiated Testing and
Counseling (PITC) was mild, as many as 17 people (57%). Factors that had health
behavior were predisposing factors (Predisposing
factors) which was manifested in beliefs, beliefs, values and also
demographic variations, such as:
economic status, age, gender and family structure. This factor was more from
within the individual; enabling factors (Enabling
Factors) manifested in the physical environment, including various kinds of
facilities and infrastructure, for example: funds, transportation, facilities,
government policies and so on; and upporting factors
(reinforcing factors) include:
attitude and behavior factors community leaders, religious leaders, attitudes
and behavior of officers including officers health, laws and regulations regulations from both the central and local government
related to health (S Notoatmodjo, 2014).
According to the
researcher, respondents who had negative behavior were caused by various
factors, Among them was the age at which older mothers
tend to feel that they were more at risk than younger ones because the
frequency and intensity and duration of sexual intercourse were longer than
younger ones, so they tend to refuse to had sex.
In addition, the
limitations of facilities and infrastructure for HIV testing also affect the
behavior of pregnant women in the first trimester in followingProvider Initiated Testing and Counseling (PITC) because the facilities
were difficult to obtain would make pregnant women reluctant to do Provider Initiated Testing and Counseling (PITC).
The most important thing was the attitude and behavior of health workers, if
there was no initiation from health workers, pregnant women would also not
participate Provider Initiated Testing
and Counseling (PITC).
3.
Knowledge Correlation
About HIV/AIDS With Compliance To PITC
The results suggested that
almost half (27%) of respondents who had less knowledge had negative behavior
in follow Provider Initiated Testing and
Counseling (PITC). Test resultsSpearman Rho show
that the result pvalue =0.
002 or less than = 0.05, and a correlation coefficient of 0.541 which means
that H0 rejected and H1 accepted, it means that there was a moderate
correlation between knowledge about HIV/AIDS with compliance to Provider Initiated Testing and Counseling (PITC)
at PPM Mrs "W" Yehsumbul
Village, Mendoyo District, Jembrana
Regency, Bali Province in 2021.
Pregnancy was an excellent
time to discuss prevention of HIV infection because many women would be in
contact with health services during pregnancy. Prevention of transmission HIV-AIDS
performed with program antenatal care (ANC)
or care before birth. Unit Maternal and child health services were at the
forefront of efforts to prevent transmission from HIV-positive mothers to their
children. There were several factors that determine the motivation of pregnant
women in The prevention of HIV transmission to infants
includes knowledge, attitudes, the role of the husband, and the role of
officers health. Knowledge affects pregnant women in the use of services Provider Initiated Testing and Counseling (PITC),
pregnant women were aware of the dangers of HIV but their awareness about
prevention of HIV transmission from mother to baby was lacking and only a few
pregnant women know about Provider
Initiated Testing and Counseling (PITC) (Setiyawati & Meilani, 2015).
According
to researcher, mother that had good knowledge, tend to have positive compliance
to Provider Initiated Testing and Counseling (PITC) because the basis of
someone doing an action was because of knowledge, so his behavior depends on
how well knowledge, how a person would behave if he does not know what he would
do. However, some pregnant women who had good knowledge turns out to had
negative behavior in follow Provider Initiated Testing and Counseling (PITC) because they were afraid to know the results, or
feel that they were at risk so that they were afraid to accept the fact if it
was later known that the results would be positive, and also because they feel
that they were healthy and had never done anything that could transmit HIV/AIDS
so that the mother feels that she does not need to do anything. Provider Initiated Testing and Counseling (PITC).
This
result contrary with research conducted (Nurmasari et
al., 2016) regarding the correlation between the level of knowledge of pregnant
women about HIV/AIDS with the behavior of PITC examinations at the Sleman
Health Center Yogyakarta which stated that most respondents had good knowledge
about HIV/AIDS as many as 50 respondents (69.4%). Most of the respondents
conducted PITC examination as many as 71 respondents (98.6%). There was no
correlation between the level of knowledge of pregnant women about HIV/ AIDS with PITC
examination behavior at Puskesmas Sleman Yogyakarta (pvalue=0.243 >005). there was a correlation
knowledge of pregnant women Conclusion no between levels about HIV/AIDS with
PITC examination behavior inTC Puskesmas
Sleman Yogyakarta.
Conclusion
Conclusion result research this
almost half of pregnant women in the first trimester at PPM Mrs
"W" Yehsumbul Village, Mendoyo
District, Regency of Jembrana, Bali Province in 2020
had sufficient knowledge about HIV/AIDS, as many as 14 respondents (47%), Most
of the first trimester pregnant women at PPM Mrs
"W" Yehsumbul Village, Mendoyo
District, Jembrana Regency, Bali Province in 2021 had negative behavior in
follow Provider Initiated Testing and
Counseling (PITC) that was 17 respondents (57%). There was a correlation
between knowledge about HIV/ AIDS with compliance to Provider Initiated Testing and Counseling (PITC) at PMB Mrs
"W" Yehsumbul Village, Mendoyo
District, Jembrana Regency, Bali Province in 2021.
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Copyright holder: Ni Made Ayu Wulandari, Lina Darmayanti Bainuan, Sabrina Fahrani (2022) |
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