Peran Pengasuh, Stigma, dan Dukungan Psikososial terhadap Kepatuhan Terapi Antiretroviral pada Anak dan Remaja Dengan HIV: Systematic Literature Review
The Role of Caregivers, Stigma, and Psychosocial Support in Antiretroviral Therapy Adherence among Children and Adolescents Living with HIV: Systematic Literature Review
Keywords:
Anak dengan HIV, Kepatuhan Antiretroviral, Pengasuh, Stigma, Dukungan Psikososial, PRISMAAbstract
Penelitian ini bertujuan untuk menyintesis bukti mengenai peran pengasuh, stigma, dukungan psikososial, dan faktor layanan kesehatan terhadap kepatuhan ART pada anak dan remaja dengan HIV. Tinjauan literatur sistematis disusun mengikuti PRISMA 2020. Pencarian dirancang pada PubMed, Google Scholar, DOAJ, Garuda, dan ScienceDirect untuk artikel tahun 2020-2026 menggunakan kombinasi kata kunci terkait HIV, anak/remaja, ART, kepatuhan, pengasuh, stigma, dan dukungan psikososial. Studi primer kuantitatif, kualitatif, dan intervensi yang melibatkan anak atau remaja dengan HIV serta pengasuhnya dipertimbangkan. Kualitas studi dinilai menggunakan instrumen Joanna Briggs Institute sesuai desain penelitian, kemudian temuan disintesis secara naratif-tematik. Sintesis awal terhadap 13 studi menunjukkan enam kelompok determinan: faktor perkembangan dan psikologis anak; pengetahuan, keyakinan, dan konsistensi pengasuh; stigma dan pengungkapan status HIV; beban terapi dan kondisi klinis; hambatan ekonomi serta akses layanan; dan ketepatan metode pengukuran kepatuhan. Pengasuh yang terlibat, komunikasi keluarga yang aman, dukungan emosional dan instrumental, konseling yang tidak menghakimi, serta pengingat digital meningkatkan peluang kepatuhan. Sebaliknya, stigma, depresi, ketidakjelasan pengungkapan status, biaya transportasi, waktu tunggu, pergantian pengasuh, dan penggunaan laporan diri sebagai satu-satunya ukuran dapat menghambat atau melebihkan estimasi kepatuhan. Kepatuhan ART pada anak dan remaja dengan HIV merupakan perilaku yang terbentuk melalui interaksi anak, pengasuh, keluarga, terapi, dan sistem layanan. Intervensi perlu bersifat multikomponen dengan menempatkan pengasuh dan anak sebagai satu unit pelayanan, mengintegrasikan dukungan psikososial, pengurangan stigma, pemantauan objektif, dan layanan yang mudah dijangkau.
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