BAB VII SIMPULAN DAN SARAN
7.2. Saran
1. Untuk Tatalaksana Pengobatan Pasien, disarankan dalam melakukan terapi ARV, pasien dapat disarankan oleh petugas kesehatan agar memulai terapi ARV dengan kadar CD4 yang masih tinggi.
2. Untuk Pemegang Kebijakan, hasil penelitian ini dapat dipakai sebagai bukti tambahan untuk memperluas atau meningkatkan inisiasi dini terapi ARV di Indonesia serta meningkatkan perhatian yang lebih mendalam pada pasien IDU saat melakukan terapi ARV.
3. Untuk Penelitian lebih lanjut jika hendak dilakukan studi lebih lanjut, maka sebaiknya melakukan penelitian dengan desain prospektif atau dengan metode fokus group discussion (FGD) maupun survei pada pasien sehingga masalah ketersediaan data dapat diatasi.
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FORMULIR PENGUMPULAN DATA PASIEN
HIV/AIDS YANG MELAKUKAN TERAPI ARV
TAHUN 2002-2012 DI KLINIK AMERTA YAYASAN
KERTI PRAJA DENPASAR
DATA DEMOGRAFI PASIEN
NO VARIABEL DATA
1 Nama Pasien 2 No RM
3 Tanggal Lahir / Umur (saat kunjungan pertama) 4 Nama Konselor 5 Jenis Kelamin 6 Risiko atau Paparan
(saat kunjungan pertama)
1. Risiko seksual
(Jabarkan apa risikonya: misalnya apakah ganti-ganti pasangan, bagaimana pemakaian kondom, mencari pekerja seks, mencari waria, cewek café) 2. Risiko IDU
(Jabarkan apa risikonya: misalnya apakah
menggunakan jarum suntik, menyuntik bersama)
3. Risiko lainnya (jelaskan: misal tatto, piercing, transfuse darah)
7 Pekerjaan 8 Pendidikan
9 Kadar CD4 Tanggal Test CD4 Pertama Kali: Hasil:
Tanggal Kunjungan Kunjungan Ke-
Kadar CD4+
Alasan Kunjungan Tanggal Test Tanggal Hasil
Hasil Test Jumlah CD4 %CD4
Infeksi Opportunistik Pemeriksaan Fisik
Jenis IO Tanggal Diagnosis Berat Badan
Darah
Tanggal Test Tanggal Hasil Hemoglobin
Terapi ARV
Tanggal Mulai ART
Supervisor ART atau Pengawas Minum Obat
(PMO) ada/tidak Hubungan
Output STATA Analisis Univariat Total 311 100.00 female 126 40.51 100.00 male 185 59.49 59.49 sex2 Freq. Percent Cum. . tab sex2
last observed exit t = 8.692676 earliest observed entry t = 0 764.6407 total analysis time at risk, at risk from t = 0 143 failures in single failure-per-subject data
311 subjects
311 obs. remaining, representing
0 exclusions
311 total obs.
origin: time start_date
t for analysis: (time-origin)/365.25 exit on or before: failure
obs. time interval: (even_date[_n-1], even_date] failure event: outcome != 0 & outcome < . id: id
. stset even_date , origin( start_date) fail (outcome) id (id) scale(365.25)
75 35 34 37 50 30 29.70856 31 Age 311 25 27 26 27 Variable Obs Percentile Centile [95% Conf. Interval] Binom. Interp. . centile Age, centile(25 50 75)
Total 311 100.00 >=40 years old 41 13.18 100.00 30-39 years old 111 35.69 86.82 <30 years old 159 51.13 51.13 Age2 Freq. Percent Cum. . tab Age2
Total 311 100.00
none 69 22.19 100.00 yes 242 77.81 77.81 2 Freq. Percent Cum. supervisior . tab supervisior2 Total 311 100.00 tb and other 10 3.22 100.00 other 38 12.22 96.78 none 263 84.57 84.57 oi2 Freq. Percent Cum. . tab oi2 Total 311 100.00 homoseksual 48 15.43 100.00 heteroseksual 176 56.59 84.57 idu 87 27.97 27.97 risk_group3 Freq. Percent Cum. . tab risk_group3 Total 311 100.00 no work 85 27.33 100.00 work 226 72.67 72.67 occupation3 Freq. Percent Cum. . tab occupation3
Total 311 100.00
senior high school 159 51.13 100.00 junior high school 64 20.58 48.87 no education & elemantary 88 28.30 28.30 education2 Freq. Percent Cum. . tab education2
75 14.2 13.8 14.5 50 12.9 12.6 13.1 haemoglobin 306 25 11.675 11.3 11.9 Variable Obs Percentile Centile [95% Conf. Interval] Binom. Interp. . centile haemoglobin, centile(25 50 75)
Total 311 100.00 9 5 1.61 100.00 >10 g/dl 280 90.03 98.39 <10 g/dl 26 8.36 8.36 _recode Freq. Percent Cum. haemoglobin . tab haemoglobin_recode 75 60 59 63 50 54 53 55 weight 308 25 48 47 49 Variable Obs Percentile Centile [95% Conf. Interval] Binom. Interp. . centile weight, centile(25 50 75)
Total 311 100.00 9 3 0.96 100.00 >=58 kg 111 35.69 99.04 50-57 kg 100 32.15 63.34 18-49 kg 97 31.19 31.19 de Freq. Percent Cum. weight_reco . tab weight_recode 75 203 194.5316 219.9834 50 108 84.70856 130.5829 CD4_Baseline 311 25 32 23.00829 42.93689 Variable Obs Percentile Centile [95% Conf. Interval] Binom. Interp. . centile CD4_Baseline, centile(25 50 75)
Total 311 100.00 201-350 cell/mm3 83 26.69 100.00 100-200 cell/mm3 80 25.72 73.31 <100 cell/mm3 148 47.59 47.59 ode Freq. Percent Cum. CD4_Baseline_rec
Grafik Kaplan-Meier Analisis Bivariat total 764.6406571 .187016 311 1.475702 4.030116 6.30527 >350 cel 278.0260096 .5143404 143 .6543463 1.396304 2.956879 <350 cel 486.6146475 0 168 . . . outcome time at risk rate subjects 25% 50% 75% incidence no. of Survival time id: id
origin: time start_date
analysis time _t: (even_date-origin)/365.25 failure _d: outcome . stsum, by (outcome) Total 311 100.00 >350 cell/mm3 143 45.98 100.00 <350 cell/mm3 168 54.02 54.02 outcome Freq. Percent Cum. . tab outcome
. sts graph, by (outcome)
. sts graph, failure risktable ytitle (proportion of participans)
54.02 45.98 100.00 Total 168 143 311 39.68 60.32 100.00 female 50 76 126 63.78 36.22 100.00 male 118 67 185 sex2 <350 cell >350 cell Total outcome row percentage frequency Key . tab sex2 outcome, row
_Isex2_2 1.926014 .3243581 3.89 0.000 1.384553 2.679227 _t Haz. Ratio Std. Err. z P>|z| [95% Conf. Interval] Log likelihood = -708.95251 Prob > chi2 = 0.0001 LR chi2(1) = 15.10 Time at risk = 764.6406571
No. of failures = 143
No. of subjects = 311 Number of obs = 311 Cox regression -- Breslow method for ties
Iteration 0: log likelihood = -708.95251 Refining estimates:
Iteration 2: log likelihood = -708.95251 Iteration 1: log likelihood = -708.97106 Iteration 0: log likelihood = -716.50218 id: id
origin: time start_date
analysis time _t: (even_date-origin)/365.25 failure _d: outcome
i.sex2 _Isex2_1-2 (naturally coded; _Isex2_1 omitted) . xi:stcox i.sex 54.02 45.98 100.00 Total 168 143 311 56.10 43.90 100.00 >=40 years old 23 18 41 53.15 46.85 100.00 30-39 years old 59 52 111 54.09 45.91 100.00 <30 years old 86 73 159 Age2 <350 cell >350 cell Total outcome row percentage frequency Key . tab Age2 outcome, row
_IAge2_3 1.286774 .3406648 0.95 0.341 .7658649 2.161982 _IAge2_2 .9278241 .1687669 -0.41 0.680 .649585 1.325242 _t Haz. Ratio Std. Err. z P>|z| [95% Conf. Interval] Log likelihood = -715.83845 Prob > chi2 = 0.5149 LR chi2(2) = 1.33 Time at risk = 764.6406571
No. of failures = 143
No. of subjects = 311 Number of obs = 311 Cox regression -- Breslow method for ties
Iteration 0: log likelihood = -715.83845 Refining estimates:
Iteration 3: log likelihood = -715.83845 Iteration 2: log likelihood = -715.83845 Iteration 1: log likelihood = -715.84663 Iteration 0: log likelihood = -716.50218 id: id
origin: time start_date
analysis time _t: (even_date-origin)/365.25 failure _d: outcome
i.Age2 _IAge2_1-3 (naturally coded; _IAge2_1 omitted) . xi: stcox i.Age2
Age2 1.064208 .132668 0.50 0.618 .8335137 1.358753 _t Haz. Ratio Std. Err. z P>|z| [95% Conf. Interval] Log likelihood = -716.37867 Prob > chi2 = 0.6192 LR chi2(1) = 0.25 Time at risk = 764.6406571
No. of failures = 143
No. of subjects = 311 Number of obs = 311 Cox regression -- Breslow method for ties
Iteration 0: log likelihood = -716.37867 Refining estimates:
Iteration 2: log likelihood = -716.37867 Iteration 1: log likelihood = -716.37869 Iteration 0: log likelihood = -716.50218 id: id
origin: time start_date
analysis time _t: (even_date-origin)/365.25 failure _d: outcome
54.02 45.98 100.00 Total 168 143 311 60.00 40.00 100.00 tb and other 6 4 10 57.89 42.11 100.00 other 22 16 38 53.23 46.77 100.00 none 140 123 263 oi2 <350 cell >350 cell Total outcome row percentage frequency Key . tab oi2 outcome, row
_Ioi2_3 .6065762 .3089024 -0.98 0.326 .2235662 1.645753 _Ioi2_2 .868653 .2312338 -0.53 0.597 .5155349 1.463641 _t Haz. Ratio Std. Err. z P>|z| [95% Conf. Interval] Log likelihood = -715.83013 Prob > chi2 = 0.5107 LR chi2(2) = 1.34 Time at risk = 764.6406571
No. of failures = 143
No. of subjects = 311 Number of obs = 311 Cox regression -- Breslow method for ties
Iteration 0: log likelihood = -715.83013 Refining estimates:
Iteration 3: log likelihood = -715.83013 Iteration 2: log likelihood = -715.83016 Iteration 1: log likelihood = -715.84688 Iteration 0: log likelihood = -716.50218 id: id
origin: time start_date
analysis time _t: (even_date-origin)/365.25 failure _d: outcome
i.oi2 _Ioi2_1-3 (naturally coded; _Ioi2_1 omitted) . xi: stcox i.oi2
Prob > chi2 = 0.5525 chi2( 2) = 1.19 ( 2) _Ioi2_3 = 0 ( 1) _Ioi2_2 = 0 . testparm _Ioi* 54.02 45.98 100.00 Total 168 143 311 26.51 73.49 100.00 201-350 cell/mm3 22 61 83 56.25 43.75 100.00 100-200 cell/mm3 45 35 80 68.24 31.76 100.00 <100 cell/mm3 101 47 148 ode <350 cell >350 cell Total CD4_Baseline_rec outcome row percentage frequency Key
. tab CD4_Baseline_recode outcome, row
_ICD4_Basel_3 4.376091 .8604664 7.51 0.000 2.976566 6.433648 _ICD4_Basel_2 1.661272 .3717586 2.27 0.023 1.071419 2.57586 _t Haz. Ratio Std. Err. z P>|z| [95% Conf. Interval] Log likelihood = -688.841 Prob > chi2 = 0.0000 LR chi2(2) = 55.32 Time at risk = 764.6406571
No. of failures = 143
No. of subjects = 311 Number of obs = 311 Cox regression -- Breslow method for ties
Iteration 0: log likelihood = -688.841 Refining estimates:
Iteration 4: log likelihood = -688.841 Iteration 3: log likelihood = -688.841 Iteration 2: log likelihood = -688.85275 Iteration 1: log likelihood = -692.89875 Iteration 0: log likelihood = -716.50218 id: id
origin: time start_date
analysis time _t: (even_date-origin)/365.25 failure _d: outcome
i.CD4_Baseli~de _ICD4_Basel_1-3 (naturally coded; _ICD4_Basel_1 omitted) . xi: stcox i.CD4_Baseline_recode
CD4_Baseline_recode 2.107826 .2132113 7.37 0.000 1.728757 2.570016 _t Haz. Ratio Std. Err. z P>|z| [95% Conf. Interval] Log likelihood = -689.56274 Prob > chi2 = 0.0000 LR chi2(1) = 53.88 Time at risk = 764.6406571
No. of failures = 143
No. of subjects = 311 Number of obs = 311 Cox regression -- Breslow method for ties
Iteration 0: log likelihood = -689.56274 Refining estimates:
Iteration 3: log likelihood = -689.56274 Iteration 2: log likelihood = -689.56282 Iteration 1: log likelihood = -690.10381 Iteration 0: log likelihood = -716.50218 id: id
origin: time start_date
analysis time _t: (even_date-origin)/365.25 failure _d: outcome
. xi: stcox CD4_Baseline_recode
54.02 45.98 100.00 Total 168 143 311 66.67 33.33 100.00 9 2 1 3 54.95 45.05 100.00 >=58 kg 61 50 111 55.00 45.00 100.00 50-57 kg 55 45 100 51.55 48.45 100.00 18-49 kg 50 47 97 ode <350 cell >350 cell Total weight_rec outcome row percentage frequency Key
_Iweight_re_9 .5379353 .5441865 -0.61 0.540 .0740691 3.906818 _Iweight_re_3 1.297204 .2663116 1.27 0.205 .8674799 1.939801 _Iweight_re_2 1.059106 .2215948 0.27 0.784 .7028196 1.596007 _t Haz. Ratio Std. Err. z P>|z| [95% Conf. Interval] Log likelihood = -715.29111 Prob > chi2 = 0.4895 LR chi2(3) = 2.42 Time at risk = 764.6406571
No. of failures = 143
No. of subjects = 311 Number of obs = 311 Cox regression -- Breslow method for ties
Iteration 0: log likelihood = -715.29111 Refining estimates:
Iteration 4: log likelihood = -715.29111 Iteration 3: log likelihood = -715.29111 Iteration 2: log likelihood = -715.29127 Iteration 1: log likelihood = -715.31395 Iteration 0: log likelihood = -716.50218 id: id
origin: time start_date
analysis time _t: (even_date-origin)/365.25 failure _d: outcome
i.weight_recode _Iweight_re_1-9 (naturally coded; _Iweight_re_1 omitted) . xi: stcox i.weight_recode
weight_recode 1.139365 .1182997 1.26 0.209 .9295719 1.396506 _t Haz. Ratio Std. Err. z P>|z| [95% Conf. Interval] Log likelihood = -709.6974 Prob > chi2 = 0.2088 LR chi2(1) = 1.58 Time at risk = 753.7467488
No. of failures = 142
No. of subjects = 308 Number of obs = 308 Cox regression -- Breslow method for ties
Iteration 0: log likelihood = -709.6974 Refining estimates:
Iteration 2: log likelihood = -709.6974 Iteration 1: log likelihood = -709.69741 Iteration 0: log likelihood = -710.4873 id: id
origin: time start_date
analysis time _t: (even_date-origin)/365.25 failure _d: outcome
54.02 45.98 100.00 Total 168 143 311 40.00 60.00 100.00 9 2 3 5 52.86 47.14 100.00 >10 g/dl 148 132 280 69.23 30.77 100.00 <10 g/dl 18 8 26 n_recode <350 cell >350 cell Total haemoglobi outcome row percentage frequency Key
. tab haemoglobin_recode outcome, row
_Ihaemoglob_9 2.71565 1.845646 1.47 0.142 .7167523 10.28913 _Ihaemoglob_2 1.780192 .649798 1.58 0.114 .8704925 3.640565 _t Haz. Ratio Std. Err. z P>|z| [95% Conf. Interval] Log likelihood = -714.74893 Prob > chi2 = 0.1732 LR chi2(2) = 3.51 Time at risk = 764.6406571
No. of failures = 143
No. of subjects = 311 Number of obs = 311 Cox regression -- Breslow method for ties
Iteration 0: log likelihood = -714.74893 Refining estimates:
Iteration 3: log likelihood = -714.74893 Iteration 2: log likelihood = -714.7491 Iteration 1: log likelihood = -714.82471 Iteration 0: log likelihood = -716.50218 id: id
origin: time start_date
analysis time _t: (even_date-origin)/365.25 failure _d: outcome
i.haemoglobin~e _Ihaemoglob_1-9 (naturally coded; _Ihaemoglob_1 omitted) . xi:stcox i.haemoglobin_recode
haemoglobin_recode 1.79144 .6538277 1.60 0.110 .8760654 3.663263 _t Haz. Ratio Std. Err. z P>|z| [95% Conf. Interval] Log likelihood = -698.93571 Prob > chi2 = 0.0814 LR chi2(1) = 3.04 Time at risk = 755.1101985
No. of failures = 140
No. of subjects = 306 Number of obs = 306 Cox regression -- Breslow method for ties
Iteration 0: log likelihood = -698.93571 Refining estimates:
Iteration 3: log likelihood = -698.93571 Iteration 2: log likelihood = -698.93585 Iteration 1: log likelihood = -698.9915 Iteration 0: log likelihood = -700.4537 id: id
origin: time start_date
analysis time _t: (even_date-origin)/365.25 failure _d: outcome
. xi:stcox haemoglobin_recode if haemoglobin_recode ~=9
54.02 45.98 100.00 Total 168 143 311 55.35 44.65 100.00 senior high school 88 71 159 48.44 51.56 100.00 junior high school 31 33 64 55.68 44.32 100.00 no education & eleman 49 39 88 education2 <350 cell >350 cell Total outcome row percentage frequency Key
_Ieducation_3 .874343 .176069 -0.67 0.505 .5892138 1.29745 _Ieducation_2 .9454291 .2263353 -0.23 0.815 .5913597 1.511493 _t Haz. Ratio Std. Err. z P>|z| [95% Conf. Interval] Log likelihood = -716.26814 Prob > chi2 = 0.7913 LR chi2(2) = 0.47 Time at risk = 764.6406571
No. of failures = 143
No. of subjects = 311 Number of obs = 311 Cox regression -- Breslow method for ties