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All Journal Acta Interna : The Journal of Internal Medicine Jurnal Kebijakan Kesehatan Indonesia Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Journal of Health (JoH) Medica Hospitalia Indonesian Journal of Global Health research Indonesian Community Journal Berita Kedokteran Masyarakat Jurnal Manajemen Pelayanan Kesehatan (The Indonesian Journal of Health Service Management) Indonesian Journal of Pharmacology and Therapy

Yanri Wijayanti Subronto

Department Of Internal Medicine, Faculty Of Medicine, Public Health And Nursing, Universitas Gadjah Mada, Yogyakarta

Author-ID : 2969385

Agriculture, Biological Sciences & Forestry Computer Science & IT Dentistry Economics, Econometrics & Finance Education Environmental Science Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences Other

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Analisis Stakeholder dalam Penanggulangan HIV dan AIDS di Kabupaten Grobogan Ratna Kusumasari Purbani; Yodi Mahendradhata; Yanri Wijayanti Subronto
Jurnal Kebijakan Kesehatan Indonesia Vol 8, No 3 (2019)
Publisher : Center for Health Policy and Management

HIV-AIDS is one of the world's health problems. Grobogan regency is one of the districts in Central Java with HIV number 4 and the discovery of new cases of HIV-AIDS number 3 in Central Java by 2015. Until 2017, HIV-AIDS cases are still fluctuating and tend to increase. Efforts were made to garner support and political commitment from the Grobogan Government and other stakeholders. The continuity of the program depends on political commitment and stakeholder policy support in the region. Conducting stakeholder analysis becomes important for the development of future strategic HIV / AIDS prevention plans. Objective this research to describe how local government strategic planning in HIV and AIDS prevention in Grobogan District. This research is descriptive research with qualitative approach. There were 20 informants in the study: Executive and Legislative officials, HIV / AIDS Caring NGO, VCT Clinic, community of PLWHA. The data was collected by observation, in-depth interview, and document review. Local government strategic planning on HIV / AIDS prevention efforts is still in the form of policy agenda and exit strategy. Although all stakeholders agree and support HIV / AIDS prevention efforts, stakeholder involvement in the formulation of policies and programs is lacking. Coordination of health offices with other stakeholders is also not working well, so the program is not integrated. The health department advocacy to local leaders is still weak. Health workers began to be evaluated for their performance, especially at sub-district level. Proposed alternatives to HIV / AIDS prevention budget from village funds. Unintegrated HIV / AIDS prevention efforts by stakeholders show weak communication and coordinative functioning. This problem is mainly caused by the key personnel dealing with reshuffle including the head of the health office in addition to the new bupati also not fully understand the case of HIV-AIDS that occurred.

Persistent lymphopenia in septic patients at Dr. Sardjito General Hospital, Yogyakarta Doni Priambodo; Rizka Humardewayanti Asdie; Yanri Wijayanti Subronto; Juvita Kurniawan
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 52, No 4 (2020)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Sepsis triggers immune responseboth pro-inflammatory and anti-inflammatory. Lymphocytes play an important role in the regulation of the inflammatory response. The decrease in lymphocyte numbers due to continuous apoptosis by sepsiscan suppress the immune system and failure to resolve inflammation. Persistent lymphopenia is also associated with a poor prognosis of sepsis. Currently, there are limited studies about persistent lymphopenia in sepsis patients in low- and middle-income countries, including Indonesia. This study aimed to describe the sociodemographic, clinical, and laboratory patterns of sepsis patients with persistent lymphopenia. This was a descriptive study that analyzed patients’ medical records who were treated at the Department of Internal Medicine, Dr. Sardjito General Hospital, Yogyakarta from January 1st, 2016, to December 31th, 2017. Patients diagnosed with clinical sepsis and persistent lymphopenia were included in the study. The status of persistent lymphopenia was described as lymphocyte counts that remained low or lower (<1.62x103/L) on day 4± 24 h compared to the initial value at the time of sepsis diagnosis (day one). Information of patients’ individual and clinical characteristics, complete blood cell count profiles and culture results were included. The outcomes of interest were the survival status and length of stay of the patients. A total of 101 patients with sepsis and persistent lymphopenia were involved in this study. The average increase in lymphocyte numbers was 73.63 ± 426.86/µL. The main source of infection was pulmonary infection, with a mortality rate of 43.6% and a median survival of 19 days. The average length of stay was 13.1±6.8. Persistent lymphopenia in patients with sepsis has a high mortality. Further research is needed to determine the clinical ramifications of persistent lymphopenia.

Behavior Change After HIV/AIDS Diagnosis of Female Sexuality in The Yogyakarta City Dwi Agustiana Sari; Yanri Wijayanti Subronto; Wiwin Lismidianti
Journal of Health (JoH) Vol 3 No 1 (2016): Journal of Health - January 2016
Publisher : LPPM STIKES Guna Bangsa

Background: Anxiety, panic, inability to accept the conditions and low knowledge about good sexual behaviour can worsen HIV status. Purpose: assess changes in sexual behavior before, the time of diagnosis, and current and causes. Methode: Qualitative research phenomenological, semi-structured interviews with in dept interviews in 6 Participants women of reproductive age, diagnosed with HIV between 1-2 years before study, has been or ever married. Analysis using Collaizy. Result: before diagnosis frequency: rarely and still routine, sexual behavior: oral, anal and masturbated to couples, sexual desire did not a decline. Causal factor that changes sexual behavior is a condition of pain, impaired self-image, increasing socio-economic burden, and change partners. Dicussion: Hankins (1997) the majority of women after hear of HIV positive status will experience a significant disruption to the desire, arousal and orgasm function, is due to physiological and psychological factors. Recurrent pain during sexual intercourse can lead to avoidance. Psychosocial factors (stress, financial crisis, depression, anxiety) inhibit the production of liquid lubrication. Working full- time cause fatigue and decrease sexual desire for women with HIV.

Faktor yang Mempengaruhi Perilaku Ibu Hamil Melakukan Tes HIV di Puskesmas Kota Yogyakarta Dwi Mutia Wenny; Yanri Wijayanti Subronto; Mohammad Hakimi
Berita Kedokteran Masyarakat (BKM) Vol 32, No 11 (2016)
Publisher : Fakultas Kedokteran Universitas Gadjah Mada

Latar Belakang: Peningkatan angka infeksi HIV pada anak usia 1-14 tahun kemungkinan besar berasal dari ibu sejak kandungan. Penularan HIV dari ibu ke anak dapat di tekan dengan mengetahui status HIV ibu, sehingga dapat dilakukan penanganan sedini mungkin.Yogyakarta merupakan daerah terkonsentrasi HIV sehingga setiap ibu hamil harus dilakukan pemeriksaan HIV.Cakupan ibu hamil yang melakukan tes HIV pada tahun 2014 dipuskesmas yang menyediakan fasilitas pemeriksaan HIV hanya sebesar 50%.Persepsi, dukungan tenaga kesehatan, informasi tentang HIV dan faktor lainnya berpengaruh pada pemeriksaan tes HIV pada ibu hamil. Penelitian ini bertujuan untuk melihat faktor yang mempengaruhi perilaku ibu hamil untuk melakukan tes HIV di puskesmas kota YogyakartaMetode: Menggunakan pendekatan kuantitatif dan kualitatif. Kuantitatif bersifat deskriptif analitik dengan desain observasional berupa rancangan cross sectional untuk melihat hubungan antara variabel bebas dan variabel terikat.Kualitatif berupa wawancara mendalam untuk mendukung hasil penelitian kuantitatif.Hasil:Jumlah subjek penelitian sebesar 85 orang dengan usia rata-rata 25-34 tahun, dan responden yang melakukan tes HIV sebesar 92.94%Analisis bivariabel menunjukkan tidak adanya hubungan yang bermakna secara statistik namun secara praktis berhubungan antara pengetahuan HIV, persepsi kerentanan, persepsi keparahan, persepsi manfaat, persepsi hambatan, paparan informasi, dukungan tenaga kesehatan dan usia kehamilan dengan perilaku ibu hamil melakukan tes HIV di Puskesmas Kota YogyakartaKesimpulan: Hampir seluruh ibu hamil melakukan tes HIV di puskesmas walaupun tidak seluruh ibu memiliki pengetahuan, persepsi kerentanan, persepsi keparahan, persepsi manfaat, paparan informasi, dukungan tenaga kesehatan yang tinggi, dan persepsi hambatan yang rendah, hal ini karna tes HIV merupakan tes atas inisiatif tenaga kesehatan dan merupakan program dari pemerintah.

Faktor risiko loss to follow up terapi ARV pada pasien HIV Listy Handayani; Riris Andono Ahmad; Yanri Wijayanti Subronto
Berita Kedokteran Masyarakat (BKM) Vol 33, No 4 (2017)
Publisher : Fakultas Kedokteran Universitas Gadjah Mada

Risk factors for loss to follow up of antiretroviral therapy in HIV patientsPurposeThis study aimed to determine risk factors for loss to follow-up of antiretroviral therapy among HIV-infected patients in Dr. Sardjito Yogyakarta, 2011-2014.MethodsA retrospective cohort study was conducted involving 499 HIV patients. Observations were conducted for four years using medical records. Data analysis was performed using Kaplan-Meier and Cox proportional hazards regression tests.ResultsThere were 190 loss to follow-up patients. Risk factors for loss to follow-up of ARV therapy were: a student (AHR = 2.42; 95% CI = 1.20-4.89), the distance ≥ 10 km (AHR = 1.58; 95% CI = 1:09 to 2:31), using health insurance (AHR = 1.67; 95% CI = 1:11 to 2:51) and homosexual as a protective factor of loss to follow-up of antiretroviral therapy (HR = 0:49; 95% CI = 0.30-0.80).ConclusionBeing a college student, the distance between home and ARV service ≥10 km and using health insurance were the risk factors for loss to follow-up of ARV treatment. Adherence counseling for students, cooperation with the drug taking supervisor and decentralization ARV service, as well as effective and efficient services for patients who use health insurance need to be strengthened.

Faktor risiko kejadian multi drug resistant tuberculosis di RSUP Dr. Sardjito Erma Nurjanah Widiastuti; Yanri Wijayanti Subronto; Dibyo Promono
Berita Kedokteran Masyarakat (BKM) Vol 33, No 7 (2017)
Publisher : Fakultas Kedokteran Universitas Gadjah Mada

Determinant of multi-drug resistant tuberculosis events at Dr. Sardjito Hospital Yogyakarta PurposeThe purpose of this study was to identify the determinants of multidrug resistant events in patients with tuberculosis in Dr. Sardjito Hospital in Yogyakarta.MethodsA cross-sectional study was conducted involving 122 patients with suspected MDR TB consisting of 61 cases of MDR TB and 61 non MDR TB cases. The data collected were secondary data from MDR TB.06 registers, medical records, MDR TB.03 registers, and MDR TB patients' baseline data forms at Dr. Sardjito Hospital Yogyakarta from January 2012 until September 2016. Data were analyzed to determine the correlation between independent variables and dependent variable using Chi-Square tests, and to know the most dominant risk factors using multiple logistic regression tests.Results MDR TB patients’ characteristics showed there were more males (63.93%), age >45 years (52.46%), previously TB treatment (96.72%), never smoking (75.41%), no contacts with MDR TB patients (86.89%), and never examined for HIV-AIDS (59.02%). The analysis showed there was no significant association between age, sex, previous TB treatment, smoking, contact with MDR TB patients, and HIV-AIDS status with MDR TB incidence in Dr. Sardjito Hospital Yogyakarta (p value >0.05).Conclusion The variables of age, sex, previous TB treatment, smoking, contacts with MDR TB patients, and HIV-AIDS status were not risk factors for MDR TB incidence in Dr. Sardjito Hospital in Yogyakarta.

Length of Hospitalization and Polypharmacy in Diabetes Multimorbidity with Infectious Diseases Tasrif Ahmad; Hari Saktiningsih; Firdy Permana; Perigrinus Hermin Sebong; Yanri Wijayanti Subronto; Riris Andono Ahmad
Indonesian Journal of Global Health Research Vol 4 No 2 (2022): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Patients with chronic condition have a higher risk of death and disability than others without chronic condition. Meanwhile, low to middle income countries facing challenges in reducing the burden of Non-Communicable Diseases (NCDs) and controlling infectious diseases such as Human Immunodeficiency Virus, Tuberculosis and Malaria. Patients with Diabetes are more often facing infection than people without diabetes. This research aimed to evaluate the length of hospitalization and polypharmacy in patients with multimorbidity of Diabetes with TB, HIV, and Malaria. Design of this research was a retrospective cohort study. All patients diagnosed with Diabetes since 2008 were grouped according to their illnesses to examine the impact of the diseases from the clinical perspective. Data were collected and extracted from the electronic medical records of PT. Freeport Indonesia since 2008. Determination of level of multimorbidities was performed by using principal component analysis, then the clinical impact of those multimorbidities analyzed using ANOVA tests. Multimorbidities have a significant effect on length of stay (p<0.05) and polypharmacy (p<0.05). The highest need for hospitalization and medication was in the Diabetes-Malaria-Tuberculosis group compared to the other multimorbidity groups. Multimorbidities have a significant impact on length of stay and polypharmacy.

KAPASITAS SUSTAINABILITY PROGRAM HIV/AIDS DI KABUPATEN SINTANG Hermanto; Yodi Mahendrahata; Yanri Wijayanti Subronto
Journal of Health Service Management Vol 23 No 02 (2020)
Publisher : Departemen Kebijakan dan Manajemen Kesehatan, Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada, Yogyakarta Jl. Farmako Sekip Utara Yogyakarta 55281 Telp 0274-547490

Background: HIV/AIDS sufferers in Sintang Districts recorded the number of new cases from 29 people in 2012 to 63 people in 2017. Funding for the HIV/AIDS program from the Global Fund is uncertain, while funding from the Sintang Regency APBD tends to decrease. These data indicated that the dependence on funding for the HIV/AIDS program from donors, namely the Global Fund, is large enough that a study on the sustainability of the HIV/AIDS program is required if funding support from donors ceases. This can be a consideration for local governments and managers of the HIV/AIDS program to maintain the sustainability of the HIV/AIDS program to achieve the benefits and objectives to be achieved in the HIV/AIDS prevention program. Objective: To describe capacity sustainability (funding stability, or ganizational capacity, program evaluation, program adaptation and communication) of HIV/AIDS programs in Sintang District. Methods: This research used a qualitative approach with descriptive research type. Subjects of this study were 21 people. This research used purposive sampling and snowballing sampling for People living with HIV/Aids (PLWHA), with data analysis used is content analysis. Results: The sustainability of HIV/AIDS programs has not been supported by varied funding sources and the ability to obtain funding through the private sector (CSR). Priority setting of the proposed funding program is not evenly distributed, especially on cross-sectoral OPD and lack of NGO independence in terms of funding. Increased availability of health personnel and improvement of facilities at puskesmas to be able to perform HIV / AIDS testing. Standard evaluation report formats are still not getting attention, not yet supported by the local monitoring and evaluation team as well as some OPD across sectors have not benefited from the evaluation. weak aspects of prevention of HIV/AIDS transmission and cross sectoral involvement in monitoring. lack of availability of counselors and weak cross-sectoral involvement in communicating programs. Conclusion: The capacity of funding stability, organizational capacity, program evaluation, program adaptation and communication still require improvement and improvement with priority setting policy and funding through the private sector, support for the role of stakeholders related to the HIV/AIDS program.

Implementasi Kebijakan Tatalaksana HIV di Puskesmas Kabupaten Sleman Seruni Angreni Susila; Yanri Wijayanti Subronto; Tiara Marthias
Journal of Health Service Management Vol 25 No 03 (2022)
Publisher : Departemen Kebijakan dan Manajemen Kesehatan, Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada, Yogyakarta Jl. Farmako Sekip Utara Yogyakarta 55281 Telp 0274-547490

Background: HIV AIDS is still a global and national challenge. The government is trying to control it by expanding access to HIV treatment at the Puskesmas, including 4 Puskesmas in Sleman Regency. However, efforts to expand access to treatment have not yet reached the target of 95% of people living with HIV who are receiving ART and 95% of people living with HIV who are viral loadsuppressed. WHO in 2017 recommended the immediate initiation of diagnosed HIV-positive people regardless of CD4 cell count and followed by changes in the national HIV management policy through a fast-track strategy in 2018 to provideimmediate initiation of ARVs, provision of Tuberculosis Preventive Therapy, and viral load monitoring. The rapid change in HIV management strategies raises the question of whether the Puskesmas in Sleman Regency can carry out HIVmanagement according to the latest policy recommendations in achieving the target of 90% of people living with HIV who are suppressed by viral load. Objectives: Measuring the suitability of the implementation of HIV management at the Puskesmas based on regulations and finding the supporting factors and obstacles in the implementation of HIV management at the Puskesmas.Methods: This is mixed-method research with a sequential explanatory approach. The location of research was carried out in four health centres in Sleman Regency, which had organized the HIV Treatment Support Care Service Program. Data was collected in May-June 2022. Quantitative data was secondary data on cases of people with HIV who accessed PDP services registered at the Puskesmas from 2019 until July 2021. Qualitative data were taken from 9 informants, selected by the purposive sampling method, through in-depth interviews. The quantitative sampling method uses a non-probability sampling method. Results: There is a discrepancy in the suitability of treatment at the Puskesmas with management standards according to regulations, as well as the low number of people living with HIV who are monitored for viral load suppression. The inhibiting factor for implementing HIV management in Puskesmas is the attitude of health workers to delay treatment related to perceptions of HIV prevention policies that have not been well socialized. Not all service providers are trained,lack of viral load testing facilities in hospitals, inefficient HIV management records systems, and stigma are obstacles to implementing HIV management. The supporting factors for the implementation of PDP HIV are the attitude of the willingness of health workers to provide treatment related to the perception of peer support and the presence of trained officers in counseling and logisticalsupport for adequate drugs. Conclusion: Not all people living with HIV treated at the Puskesmas have received treatment according to regulations until viral load suppression is monitored. For this reason, it is necessary to increase the capacity of HIV counselingand management for all health workers involved in providing PDP services, adding viral load testing facilities at regional hospitals, and providing HIV stigma prevention programs for people living with HIV, families, communities and health services.

STUDI KASUS TERAPI ARV PADA PASIEN LOST TO FOLLOW-UP DI JAKARTA PUSAT TAHUN 2021 Awani Luksita; Yodi Mahendradhata; Yanri Wijayanti Subronto
Journal of Health Service Management Vol 25 No 02 (2022)
Publisher : Departemen Kebijakan dan Manajemen Kesehatan, Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada, Yogyakarta Jl. Farmako Sekip Utara Yogyakarta 55281 Telp 0274-547490

Background: There are 9,338 patients undergoing ARV therapy in Central Jakarta and based on data from April to June 2021, 3,651people are missing due to follow-up. Lost To Follow-Up (LTFU) is when the patient does not revisit after three months or more after thelast visit. Objective: Knowing the factors influencing ARV therapy in LTFU patients in Central Jakarta.Methods: This research is a case study research with a total of 12 informants consisting of LTFU patients, NGOs, doctors, and nursesfrom the priority health office in Central Jakarta. Data collection techniques using in-depth interviews and document review. Data analysis using framework analysis technique. Results: This study shows that the experience of LTFU patients wheninitially diagnosed with HIV experienced a pause in ARV therapy because they could not accept themselves as being HIV positive, andsome patients still did not understand ARV therapy treatment. ARV therapy decision-making is based on the motivation to be healthy andwant to see the child’s growth and development into adulthood. Patients feel that undergoing ARV therapy adds to activities that makethem unable to adjust their medication schedule, hampering work time because they must go to drug collection services. Some alsooften forget to bring medicine and feel the need to hide to take medicine when outside the house. The inhibiting factors for LTFU patientsare the effects of drugs; the COVID-19 pandemic condition; feeling healthy; tired of undergoing therapy; being far from health services,the number of costs incurred to go to services; not receiving complete information; and loss of support from the closest people.Conclusion: The government needs to improve strategies for LTFU patients to return to ARV therapy by optimizing the multi-month dispensing (MMD) program; inviting and providing education for family members or relatives of LTFU patients to take ARV therapy treatment by becoming a Drug Swallowing Supervisor (PMO); and it is important to support the design of HIV treatment telemedicine during the COVID-19 pandemic.

Co-Authors Awani Luksita Chatarina Wariyah Dibyo Promono Doni Priambodo Dwi Agustiana Sari Dwi Agustiana Sari, Dwi Agustiana Eko Andriyanto Erna Kristin Firdy Permana Hari Saktiningsih Helmi, Hamid Hermanto Ida Nur Faizah Ida Safitri Laksanawati Jarir At Thobari Juvita Kurniawan Listy Handayani Lukman Ade Chandra Mohammad Hakimi Mubasysyir Hasanbasri Nurjanah Widiastuti, Erma Ratna Kusumasari Purbani Renie Cuyno Mellen Retna Siwi Padmawati Riris Andono Ahmad Riyanto Rizka Humardewayanti Asdie Saktiawati, Antonia Morita Iswari Sebong, Perigrinus Hermin Seruni Angreni Susila Sri Purwaningsih Syafriani Syafriani Tasrif Ahmad Tiara Marthias Wijisaksono, Doni Priambodo Wiwin Lismidianti Wiwin Lismidianti, Wiwin Yodi Mahendradhata Yodi Mahendrahata

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