Pelayanan Farmasi untuk Daerah Tertinggal, Terdepan, dan Terluar (3T) Terkait Program Penyakit HIV Berdasarkan Integrasi Model Pemberi Layanan yang Terdiferensiasi (PLD): Sebuah Tinjauan Sistematis
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Latar Belakang: Differentiated Service Delivery (DSD) diusulkan untuk meningkatkan kesinambungan pengobatan HIV di wilayah terpencil, namun keberhasilannya bergantung pada integrasi dukungan sistemik. Tujuan: Tinjauan ini mensintesis bukti mengenai efektivitas model DSD berbasis komunitas dan faktor penentu keberhasilannya di wilayah 3T, khususnya terkait rantai pasokan, jaminan mutu, serta tata kelola dan pembiayaan. Metode: Dilakukan tinjauan sistematis dengan sintesis naratif mengikuti pedoman PRISMA. Pencarian literatur dilakukan pada basis data PubMed, Scopus, Web of Science, dan repositori abu-abu (2010–2025). Dari 1.520 rekaman, 32 studi memenuhi kriteria inklusi. Hasil: Model DSD berbasis komunitas (kelompok ART, MMD) efektif meningkatkan kepatuhan dan retensi serta mengurangi beban kunjungan. Keberhasilan ini sangat ditentukan oleh: (1) stabilitas rantai pasokan ARV (minimnya hari kehabisan stok, sinkronisasi dengan MMD); (2) jaminan mutu penyimpanan-distribusi (kontrol suhu, FEFO); dan (3) tata kelola-pembiayaan yang selaras (peran apoteker, insentif kader, pembiayaan last-mile). Temuan kualitatif mengidentifikasi kedekatan layanan, kerahasiaan, dan keandalan logistik sebagai pendorong utama. Kesimpulan: DSD merupakan intervensi sistemik yang keefektifannya bergantung pada kesiapan multidimensi. Penguatan layanan farmasi HIV di wilayah 3T memerlukan pendekatan terpadu yang secara simultan membangun ketahanan pasokan, mutu layanan, dan tata kelola yang adaptif. Tinjauan ini mengusulkan indikator operasional dan peta jalan bertahap untuk implementasi kontekstual.
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Referensi
Maluleke K, Musekiwa A, Kgarosi K, Gregor E Mac, Dlangalala T, Nkambule S, et al. A scoping review of supply chain management systems for point of care diagnostic services: Optimising covid-19 testing capacity in resource-limited settings. Diagnostics 2021;11. https://doi.org/10.3390/diagnostics11122299. DOI: https://doi.org/10.21203/rs.3.rs-591015/v1
Kiekens A. Exploring HIV Drug Resistance in Sub-Saharan Africa as a Complex Adaptive System. 2022. DOI: https://doi.org/10.1186/s12889-022-12738-4
Okere NE, Lennox L, Urlings L, Ford N, Naniche D, Rinke De Wit TF, et al. Exploring Sustainability in the Era of Differentiated HIV Service Delivery in Sub-Saharan Africa: A Systematic Review. Implementation Science 2021. DOI: https://doi.org/10.1097/QAI.0000000000002688
Nyamuzihwa T, Tembo A, Martyn N, Venter F, Maimin J, Houghton J, et al. The South African community pharmacy sector an untapped reservoir for delivering HIV services. Frontiers in Reproductive Health 2023;5. https://doi.org/10.3389/frph.2023.1173576. DOI: https://doi.org/10.3389/frph.2023.1173576
Sadoyu S, Tanni KA, Punrum N, Paengtrai S, Kategaew W, Promchit N, et al. Methodological approaches for assessing certainty of the evidence in umbrella reviews: A scoping review. PLoS One 2022;17. https://doi.org/10.1371/journal.pone.0269009. DOI: https://doi.org/10.1371/journal.pone.0269009
Kusdiyah E, Rahmadani F. Faktor-Faktor Yang Berhubungan Dengan Kepatuhan Pasien Hiv Dalam Mengonsumsi Terapi Antiretroviral Di Puskesmas Simpang Kawat Kota Jambi. E-SEHAD, 2022;3. DOI: https://doi.org/10.22437/esehad.v3i1.20279
Fitzgerald I, Harrison M, Clibbens N, Howe J. Realist reviews: making sense of evidence for complex nursing interventions. Evid Based Nurs 2025;28:199–202. https://doi.org/10.1136/ebnurs-2025-104289. DOI: https://doi.org/10.1136/ebnurs-2025-104289
Mutiara AR, Astuti B. Efforts to Improve Students’ Self-Acceptance Through Group Guidance. KnE Social Sciences 2021. https://doi.org/10.18502/kss.v6i2.9974. DOI: https://doi.org/10.18502/kss.v6i2.9974
Ibiloye O, Masquillier C, Jwanle P, Van Belle S, van Olmen J, Lynen L, et al. Community-Based ART Service Delivery for Key Populations in Sub-Saharan Africa: Scoping Review of Outcomes Along the Continuum of HIV Care. AIDS Behav 2022;26:2314–37. https://doi.org/10.1007/s10461-021-03568-3. DOI: https://doi.org/10.1007/s10461-021-03568-3
Eluwa GIE, Geibel S, Callens S, Vu L, Iyortim I. Evaluation of differentiated service delivery models on HIV treatment retention among key populations in Nigeria: a prospective cohort analysis. BMC Public Health 2025;25. https://doi.org/10.1186/s12889-025-21630-w. DOI: https://doi.org/10.1186/s12889-025-21630-w
Ekwuofu AA, Dim OF, Adibe MO. Impact of differentiated care service delivery systems on adherence among the HIV-positive patients receiving antiretroviral therapy in a Southeastern Nigerian State. AIDS Res Ther 2025;22. https://doi.org/10.1186/s12981-024-00671-y. DOI: https://doi.org/10.1186/s12981-024-00671-y
Crawford ND, Myers S, Young H, Klepser D, Tung E. The Role of Pharmacies in the HIV Prevention and Care Continuums: A Systematic Review. AIDS Behav 2021;25:1819–28. https://doi.org/10.1007/s10461-020-03111-w. DOI: https://doi.org/10.1007/s10461-020-03111-w
Tapera T, Odimegwu C, Petlele R, Sello MV, Dzomba A, Aladejebi O, et al. Intersecting epidemics: COVID-19 and HIV in sub-Saharan Africa. A systematic review (2020-2022). J Public Health Afr 2023;14. https://doi.org/10.4081/jphia.2023.2658. DOI: https://doi.org/10.4081/jphia.2023.2658
Zakumumpa H, Tumwine C, Milliam K, Spicer N. Dispensing antiretrovirals during Covid-19 lockdown: re-discovering community-based ART delivery models in Uganda. BMC Health Serv Res 2021;21. https://doi.org/10.1186/s12913-021-06607-w. DOI: https://doi.org/10.1186/s12913-021-06607-w
Nha Hong Q, Gonzalez-Reyes A, Pluye P. Improving the usefulness of a tool for appraising the quality of qualitative, quantitative and mixed methods studies, the Mixed Methods Appraisal Tool (MMAT). Pharmacological Studies 2020.
Tang X, Zeng Z, Huang H, Symonds J. Quality Appraisal Tools for Quantitative, Qualitative, and Mixed-Methods Studies: A Review and a Brief New Checklist. ECNU Review of Education 2025. https://doi.org/10.1177/20965311251371227. DOI: https://doi.org/10.1177/20965311251371227
Hong QN, Fàbregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, et al. The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Education for Information 2018;34:285–91. https://doi.org/10.3233/EFI-180221. DOI: https://doi.org/10.3233/EFI-180221
Bwire GM, Njiro BJ, Ndumwa HP, Munishi CG, Mpondo BC, Mganga M, et al. Impact of differentiated service delivery models on retention in HIV care and viral suppression among people living with HIV in sub-Saharan Africa: A systematic review and meta-analysis of randomised controlled trials. Rev Med Virol 2023;33. https://doi.org/10.1002/rmv.2479. DOI: https://doi.org/10.1002/rmv.2479
Long L, Kuchukhidze S, Pascoe S, Nichols B, Cele R, Govathson C, et al. Differentiated models of service delivery for antiretroviral treatment of HIV in sub-Saharan Africa: A rapid review protocol. Syst Rev 2019;8. https://doi.org/10.1186/s13643-019-1210-6. DOI: https://doi.org/10.1186/s13643-019-1210-6
Roy M, Bolton Moore C, Sikazwe I, Holmes CB. A Review of Differentiated Service Delivery for HIV Treatment: Effectiveness, Mechanisms, Targeting, and Scale. Curr HIV/AIDS Rep 2019;16:324–34. https://doi.org/10.1007/s11904-019-00454-5. DOI: https://doi.org/10.1007/s11904-019-00454-5
Ehimen C. Improving Medicines Availability In The Pharmaceutical Supply Chain In Nigeria. University of Warwick, 2024.
Lewin S, Bohren M, Rashidian A, Munthe-Kaas H, Glenton C, Colvin CJ, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings-paper 2: How to make an overall CERQual assessment of confidence and create a Summary of Qualitative Findings table. Implementation Science 2018;13. https://doi.org/10.1186/s13012-017-0689-2. DOI: https://doi.org/10.1186/s13012-017-0689-2
Okere NE, Urlings L, Naniche D, De Wit TFR, Gomez GB, Hermans S. Evaluating the sustainability of differentiated service delivery interventions for stable ART clients in sub-Saharan Africa: A systematic review protocol. BMJ Open 2020;10. https://doi.org/10.1136/bmjopen-2019-033156. DOI: https://doi.org/10.1136/bmjopen-2019-033156
Colvin CJ, Garside R, Wainwright M, Munthe-Kaas H, Glenton C, Bohren MA, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings-paper 4: How to assess coherence. Implementation Science 2018;13. https://doi.org/10.1186/s13012-017-0691-8. DOI: https://doi.org/10.1186/s13012-017-0691-8
Hardani R, Rumi A, Kusumawati A, Putri A, Ambianti N, Studi Farmasi P, et al. Analisis Faktor yang Mempengaruhi Kepatuhan Pengobatan Antiretroviral pada Pasien HIV/AIDS. Jurnal Pharmascience 2023;10:175–86. DOI: https://doi.org/10.20527/jps.v10i1.14610
Lewin S, Booth A, Glenton C, Munthe-Kaas H, Rashidian A, Wainwright M, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings: Introduction to the series. Implementation Science 2018;13. https://doi.org/10.1186/s13012-017-0688-3. DOI: https://doi.org/10.1186/s13012-017-0688-3
Glenton C, Carlsen B, Lewin S, Munthe-Kaas H, Colvin CJ, Tunçalp Ö, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings-paper 5: How to assess adequacy of data. Implementation Science 2018;13. https://doi.org/10.1186/s13012-017-0692-7. DOI: https://doi.org/10.1186/s13012-017-0692-7
Wainwright M, Zahroh RI, Tunçalp Ö, Booth A, Bohren MA, Noyes J, et al. The use of GRADE-CERQual in qualitative evidence synthesis: an evaluation of fidelity and reporting. Health Res Policy Syst 2023;21. https://doi.org/10.1186/s12961-023-00999-3. DOI: https://doi.org/10.1186/s12961-023-00999-3
Liang R, Chen F, Tang H, Wang J, Zhao D, Wang J, et al. The impact of a comprehensive strategy on HIV treatment continuum in a highly endemic area of China: an interrupted time series analysis. BMC Infect Dis 2025;25. https://doi.org/10.1186/s12879-025-10861-2. DOI: https://doi.org/10.1186/s12879-025-10861-2
Scott GY, Aborode AT, Adesola RO, Khan M, Elebesunu EE, Oluwaseun AA, et al. Enhancing Vaccine Quality and Accessibility: Strategies for Efficient Storage and Distribution in Resource-Constrained Environment. Outbreak Management and Response 2025;1. https://doi.org/10.1080/29947677.2024.2443439. DOI: https://doi.org/10.1080/29947677.2024.2443439
Sekhon M, De Thurah A, Fragoulis GE, Schoones J, Stamm TA, Vliet Vlieland TPM, et al. Synthesis of guidance available for assessing methodological quality and grading of evidence from qualitative research to inform clinical recommendations: A systematic literature review. RMD Open 2024;10. https://doi.org/10.1136/rmdopen-2023-004032. DOI: https://doi.org/10.1136/rmdopen-2023-004032
António D, Uetela M. Process, impact and economic evaluation of differentiated service delivery models for HIV treatment in Mozambique. University of Washington, 2023.
Dzinamarira T, Rwibasira G, Mwila L, Moyo E, Mangoya D, Moyo P, et al. Advancing Sustainable HIV Services Through Integration in Primary Healthcare in Sub-Saharan Africa: A Perspective on Practical Recommendations. Healthcare (Switzerland) 2025;13. https://doi.org/10.3390/healthcare13020192. DOI: https://doi.org/10.3390/healthcare13020192
Metcalfe R, Ragonnet-Cronin M, Bradley-Stewart A, McAuley A, Stubbs H, Ritchie T, et al. From hospital to the community: Redesigning the human immunodeficiency virus (HIV) clinical service model to respond to an outbreak of HIV among people who inject drugs. Journal of Infectious Diseases 2020;222:S410–9. https://doi.org/10.1093/infdis/jiaa336. DOI: https://doi.org/10.1093/infdis/jiaa336
Mukumbang FC, Ndlovu S, van Wyk B. Comparing Patients’ Experiences in Three Differentiated Service Delivery Models for HIV Treatment in South Africa. Qual Health Res 2022;32:238–54. https://doi.org/10.1177/10497323211050371. DOI: https://doi.org/10.1177/10497323211050371
Igboanugo JC, Uzoma U, Healthcare A, Nigeria B, Nigeria P. Evaluating the Resilience of Public Health Supply Chains During COVID-19 in Sub-Saharan Africa. vol. 09. 2020.
Shourya S, Liu J, McInerney S, Casimir T, Kenniff J, Kershaw T, et al. A Remote Intervention Based on mHealth and Community Health Workers for Antiretroviral Therapy Adherence in People With HIV: Pilot Randomized Controlled Trial. JMIR Form Res 2025;9. https://doi.org/10.2196/67997. DOI: https://doi.org/10.2196/67997
Sterne J, Savovic J. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ Journal 2019. DOI: https://doi.org/10.1136/bmj.l4898
Salgado S, Felzien G, Brumbeloe J. Georgia Leverages Telehealth to Expand HIV Care Management in Underserved Areas. Am J Prev Med 2021;61:S55–9. https://doi.org/10.1016/j.amepre.2021.07.001. DOI: https://doi.org/10.1016/j.amepre.2021.07.001
Yuniar Y, Syaripuddin M, Isakh BM. Manajemen Logistik Obat Antiretroviral di Indonesia (Logistic Management of Antiretrovirals in Indonesia). Buletin Penelitian Sistem Kesehatan 2014.
Angreni Susila S, Wijayanti Subronto Y, Marthias T. Implementasi Kebijakan Tatalaksana HIV di Puskesmas Kabupaten Sleman Implementation of HIV Treatment Management Policy In Puskesmas Sleman Regency. Jurnal Manajemen Pelayanan Kesehatan 2022. DOI: https://doi.org/10.22146/jmpk.v25i03.5121
Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: Reporting guideline. The BMJ 2020;368. https://doi.org/10.1136/bmj.l6890. DOI: https://doi.org/10.1136/bmj.l6890
Yaneri AA, Dwi Nur Geonanda BB. Self-Acceptance of Adolescents with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in Bandung. Tec Empresarial 2024:179–88.
McHugh M. Interrater reliability : the Kappa Statistic. Biochem Med (Zagreb) 2012. DOI: https://doi.org/10.11613/BM.2012.031
Fatti G, Ngorima-Mabhena N, Tiam A, Tukei BB, Kasu T, Muzenda T, et al. Community-based differentiated service delivery models incorporating multi-month dispensing of antiretroviral treatment for newly stable people living with HIV receiving single annual clinical visits: a pooled analysis of two cluster-randomized trials in southern Africa. J Int AIDS Soc 2021. https://doi.org/10.1002/jia2.25819/full. DOI: https://doi.org/10.1002/jia2.25819