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Evaluasi perkembangan “triple eliminasi” penularan penyakit HIV, syphilis, dan hepatitis B dari ibu ke bayi di Belanda

Di Belanda, seluruh wanita hamil diharuskan untuk menjalani screening untuk Human Immunodeficiency Virus (HIV), syphilis dan hepatitis B virus (HBV). Bila hasil screening positif, maka dilanjutkan dengan tes konfirmasi. Bila hasil tes lanjutan juga positif, sang ibu akan dirujuk ke pelayanan sekunder untuk perawatan dan atau pengukuran pencegahan lainnya.

Pada tahun 2014 World Health Organization (WHO) menetapkan kriteria validasi untuk mengeliminasi transmisi ibu ke bayi atau mother-to-child-transmission (EMTCT) untuk penyakit HIV dan syphilis yang kemudian diperbarui pada tahun 2017. Kriteria ini mencakup 3 dampak – 6 proses indikator minimum untuk validasi EMTCT HIV, syphilis, dan kriteria tambahan untuk hepatitis B. Tim peneliti yang dipimpin oleh Maartje Visser, melakukan evaluasi terhadap praktek yang telah berjalan di Belanda apakah telah mencapai kombinasi kriteria WHO untuk HIV, syphilis, dan HBV.

Data terkait HIV, syphilis, dan infeksi HBV pada ibu hamil dan anak-anak (yang lahir di Belanda dengan infeksi kongenital) sejak tahun 2009 – 2015, dan data yang dibutuhkan untuk memvalidasi kriteria WHO dikumpulkan dari berbagai sumber seperti: screening antenatal registry, database yayasan monitoring HIV, Perinatal Registry of the Netherlands, laboratorium referensi nasional untuk syphilis kongenital, dan data notifikasi HBV nasional.

Hasil penelitian menunjukkan bahwa cakupan screening diantara perempuan hamil mencapai lebih dari 99% dalam semua rentang umur, prevalensi HIV, syphilis, dan HBV sangat rendah. Pada tahun 2015, pervalensi HIB sebesar 0,006%; syphilis sebesar 0,006%; dan HBV sebesar 0,29%. Tidak ditemukan infeksi ketiga penyakit ini pada bayi yang baru lahir di Belanda yang dilaporkan sepanjang tahun 2015. Pada tahun tahun sebelumnya hanya kasus sporadic yang diobservasi pada tahun 2015. Terapi wanita hamil yang positif HIV sebesar 100% dan vaksinasi HBV pada anak-anak dengan ibu yang positif HBV mencapai lebih dari 99%. Untuk syphilis, data komprehensif untuk memvalidasi kriteria WHO sangat kurang.

Penelitian ini menyimpulkan bahwa prevalensi HIV, syphilis, dan HBV maternal di Belanda rendah dan infeksi kongenital terbilang sangat jarang. Di Belanda semua kriteria WHO minimum untuk validasi EMTCT dijumpai untuk HIV dan HBV, namun untuk syphilis masih membutuhkan lebih banyak data untuk membuktikan eliminasi. Dapat disimpulkan juga bahwa Belanda memiliki program antenatal screening dengan cakupan yang tinggi, dan bahwa layanan tambahan untuk mengurangi EMTCT HIV dan HBV seperti perawatan dan vaksinasi sudah diselenggarakan dengan baik.

Dirangkum oleh: drg. Puti Aulia Rahma, MPH, CFE

Referensi: Visser et al., 2019, Evaluating progress towards triple elimination of mother-to-children transmission of HIV, syphilis and hepatitis B in the Netherlands, BMC Public Health, 19:353, https://doi.org/10.1186/s12889-019-6668-6 

 

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