A qualitative study of healthcare providers' attitudes toward assisted partner notification for people with HIV in Indonesia.

BACKGROUND: Assisted partner notification (APN) is recommended as a public health strategy to increase HIV testing in people exposed to HIV. Yet its adoption in many countries remains at an early stage. This qualitative study sought the opinions of HIV health service providers regarding the appropriateness and feasibility of implementing APN in Indonesia where such services are on the cusp of adoption. METHODS: Four focus group discussions totaling 40 health service providers were held in Jakarta, Indonesia to consider APN as an innovative concept and to share their reactions regarding its potential implementation in Indonesia. Voice-recorded discussions were conducted in Bahasa, transcribed verbatim, and analyzed. RESULTS: Participants recognized APN's potential in contacting and informing the partners of HIV-positive clients of possible viral exposure. They also perceived APN's value as a client-driven service permitting clients to select which of three partner notification methods would work best for them across differing partner relationships and settings. Nonetheless, participants also identified personal and health system challenges that could impede successful APN adoption including medical and human resource limitations, the need for specialized APN training, ethical and equity considerations, and lack of sufficient clarity concerning laws and government policies regulating 3rd party disclosures. They also pointed to the job-overload, stress, personal discomfort, and the ethical uncertainty that providers might experience in delivering APN. CONCLUSION: Overall, providers of HIV services embraced the concept of APN but forecast practical difficulties in key service areas where investments in resources and system change appeared necessary to ensure effective and equitable implementation.

Exploring HIV stigma among future healthcare providers in Indonesia.

Future healthcare professionals are an important group for interventions to eliminate HIV stigma in the health workforce. Researchers examined HIV stigma and its relationship with healthcare discipline, HIV knowledge, and religiosity among nursing, medical, and midwifery students (N = 505) in three regions of Indonesia. In a multivariable linear model, higher HIV stigma was associated with male sex, lower levels of income and HIV knowledge, and higher levels of religiosity. An interaction of healthcare discipline and province was also significant. Medical students in Jakarta had higher predicted stigma scores compared to nursing students in Jakarta and compared to medical students in other provinces. Nursing students in Papua had lower predicted stigma scores compared to medical and midwifery students in Papua and compared to nursing students elsewhere. Strategies to reduce HIV stigma in the Indonesian health workforce should include a strong focus on pre-clinical educational settings and consider public nursing institutions as providing possible best practice models.

Adherence to Antiretroviral Therapy Among Incarcerated Persons with HIV: Associations with Methadone and Perceived Safety.

With adequate support, people with HIV (PWH) may achieve high levels of adherence to antiretroviral therapy (ART) during incarceration. We examined factors associated with ART utilization and adherence among incarcerated PWH (N = 150) in Indonesia. ART utilization was positively associated with HIV status disclosure (adjusted odds ratio [aOR] = 5.5, 95% CI 1.2-24.1, p = 0.023), drug dependency (aOR = 3.9, 95% CI 1.2-12.6, p = 0.022), health service satisfaction (aOR = 3.2, 95% CI 1.7-6.2, p < 0.001), and perceived need for medical treatment (aOR = 1.6, 95% CI 1.1-2.5, p = 0.011), and negatively associated with chance locus of control (aOR = 0.3, 95% CI 0.1-0.7, p = 0.013). Most participants utilizing ART (74.5%) reported less than "perfect" ART adherence. ART adherence was independently associated with perceived personal safety (ß = 0.21, 95% CI 0.01-0.40, p = 0.032) and methadone utilization (ß = 0.84, 95% CI 0.10-1.67, p = 0.047). PWH receiving methadone had a sixfold higher adjusted odds of being highly-adherent to ART (aOR = 6.3, 95% CI 1.1-35.7, p = 0.036). Interventions that increase methadone utilization and personal safety may improve ART adherence among incarcerated PWH.

Phenomenological study: the experiences of patients with nasopharyngeal cancer after undergoing chemoradiation.

BACKGROUND: Chemoradiation is a combination therapy of chemotherapy and radiotherapy. Because chemotherapy is given together with radiotherapy, the side effects are heavier and more severe for some patients. For nasopharyngeal cancer patients, the side effects involve nausea, vomiting, anorexia, diarrhea, mucositis, xerostomia, and tasting and hearing loss, which influence their quality of life. The purpose of this study was to explore the experiences of patients with head and neck cancer undergoing chemoradiation. METHODS: A Phenomenogical desctipve, involving in depth interviewes was conducted during a 6 month study period. Eleven patiets with nasopharyngeal cancer participated in indepth inteviews Colaizzi's method was used in analyzing data. The selection of participants in this study using purposive sampling method the inclusion criteria were1) the patient had been diagnosed with head and neck cancer, 2) minimum age of 18 years, and 3 had been received external chemoradiation, minimum 14 times of chmemoradiation. The study was conducted at one out-patientradiotherapy department. at Dharmais Cancer Centre Hospital, Jakarta. RESULT: The findings show three main themes: 1) xerostomia was the main physical complaint, 2) patients had decreased social interaction, and 3) having adequate support from the family was important for patients. CONCLUSION: The findings suggest involving family members when patients are undergoing chemoradiation. Adequate family support is needed to help the patients adapt to the side effects of chemoradiation with the best possible response.

The Influence of Medication Attitudes on Utilization of Antiretroviral Therapy (ART) in Indonesian Prisons.

Negative attitudes toward HIV medications may restrict utilization of antiretroviral therapy (ART) in Indonesian prisons where many people living with HIV (PLH) are diagnosed and first offered ART. This mixed-method study examines the influence of medication attitudes on ART utilization among HIV-infected Indonesian prisoners. Randomly-selected HIV-infected male prisoners (n = 102) completed face-to-face in-depth interviews and structured surveys assessing ART attitudes. Results show that although half of participants utilized ART, a quarter of those meeting ART eligibility guidelines did not. Participants not utilizing ART endorsed greater concerns about ART efficacy, safety, and adverse effects, and more certainty that ART should be deferred in PLH who feel healthy. In multivariate analyses, ART utilization was independently associated with more positive ART attitudes (AOR = 1.09, 95 % CI 1.03-1.16, p = 0.002) and higher internalized HIV stigma (AOR = 1.03, 95 % CI 1.00-1.07, p = 0.016). Social marketing of ART is needed to counteract negative ART attitudes that limit ART utilization among Indonesian prisoners.

The Relationship between Distress Tolerance and Spiritual Well-Being towards ARV Therapy Adherence in People Living with HIV/AIDS.

A crucial factor in the success of treatment for patients with Human Immunodeficiency Virus (HIV) is adherence to antiretroviral (ARV) therapy among People Living with HIV/AIDS (PLWHA). Adherence issues remain a persisting problem with multifaceted causes. There are many studies on variables related to ARV therapy adherence, but no study has been found on spiritual well-being and distress tolerance in ARV therapy adherence. This study aims to determine the relationship between distress tolerance and spiritual well-being on adherence to ARV therapy in PLWHA. This research used a quantitative approach with a cross-sectional design. The sample collection process followed a consecutive sampling technique, with data gathered from 129 participants at the South Lampung Regional General Hospital located in Indonesia. Data collection was conducted using three questionnaires administered by the interviewer, which assessed distress tolerance using the Miller-Smith Rating Scale For Stress Tolerance (MSRS-ST), evaluated spiritual Well-Being using the Spiritual Well-Being Scale (SWBS), and gauged ARV therapy adherence using the Medication Adherence Rating Scale (MARS). Data analysis using a simple logistic regression with a 95% confidence interval (CI) showed a significant relationship between distress tolerance (p-value 0.002) and spiritual well-being (p-value 0.036) towards ARV therapy adherence in PLWHA. The results of multiple logistic regression yielded distress tolerance as the most dominant and influential variable in this research. Distress tolerance and spiritual well-being impact adherence to ARV therapy in PLWHA. Suggestions for healthcare services should consider these factors to decrease the risk of non-adherence to therapy and inadvertently heighten mortality risk.

Resilience in Relation to Adherence to Antiretroviral Therapy in People Living With HIV: A Qualitative Study.

Antiretroviral therapy (ART) adherence significantly impacts the survival and quality of life of people living with HIV (PLWH). Despite the challenges faced by PLWH, adherence remains crucial. Thus, cultivating resilience in ART is essential for optimal treatment outcomes. This qualitative study explored the experience of resilience in relation to ART adherence among PLWH. Semi-structured interviews with 10 participants were conducted and inductively analyzed. Participants' resilience in ART adherence was reflected in their achievements related to cultivating the habit of taking medication and in their convictions that the medication was a daily necessity. PLWH developed resilience through strategies encompassing finding purpose through faith and motivation, fostering wellness by obtaining adequate information, enjoying life, managing disease therapy, and adopting a healthy lifestyle, and building connections by finding adequate support and involving in the community. Nurses are crucial in HIV management, fostering resilience for successful ART adherence and ensuring effective treatment outcomes.

Impart: findings from a prison-based model of HIV assisted partner notification in Indonesia.

INTRODUCTION: Assisted partner notification (APN) safely and effectively increases partner awareness of HIV exposure, testing and case identification in community settings. Nonetheless, it has not been specifically developed or evaluated for use in prison settings where people with HIV often are diagnosed and may have difficulty contacting or otherwise notifying partners. We developed Impart, a prison-based APN model, and evaluated its efficacy in Indonesia to increase partner notification and HIV testing. METHODS: From January 2020 to January 2021, 55 incarcerated men with HIV were recruited as index participants from six jail and prison facilities in Jakarta in a two-group randomized trial comparing the outcomes of self-tell notification (treatment as usual) versus Impart APN in increasing partner notification and HIV testing. Participants voluntarily provided names and contact information for sex and drug-injection partners in the community with whom they had shared possible HIV exposure during the year prior to incarceration. Participants randomized to the self-tell only condition were coached in how to notify their partners by phone, mail or during an in-person visit within 6 weeks. Participants randomized to Impart APN could choose between self-tell notification or anonymous APN by a two-person team consisting of a nurse and outreach worker. We compared the proportion of partners in each group who were notified of exposure by the end of 6 weeks, subsequently tested and HIV diagnosed. RESULTS: Index participants (n = 55) selected 117 partners for notification. Compared to self-tell notification, Impart APN resulted in nearly a six-fold increase in the odds of a named partner being notified of HIV exposure. Nearly two thirds of the partners notified through Impart APN (15/24) completed HIV testing within 6 weeks post notification compared to none of those whom participants had self-notified. One-third of the partners (5/15) who completed HIV testing post notification were diagnosed as HIV positive for the first time. CONCLUSIONS: Voluntary APN can be successfully implemented with a prison population and within a prison setting despite the many barriers to HIV notification that incarceration presents. Our findings suggest that the Impart model holds considerable promise to increase partner notification, HIV testing and diagnosis among sex and drug-injecting partners of HIV-positive incarcerated men.

"I can live a normal life": Exploring adherence to antiretroviral therapy in Indonesian adolescents living with HIV.

Background: Adherence to antiretroviral therapy (ART) can be challenging since it needs to be continued for a lifetime. At their age, adolescents start to be responsible for their life, and this continued therapy might be a challenge for them. Objective: This study explored the experiences of adherence to ART in adolescents living with HIV in Jakarta, Indonesia. Methods: A qualitative study with an Appreciative Inquiry (AI) approach was employed to explore challenges adolescents face in ART adherence which focused more on positive aspects of the experience. In-depth interviews were conducted with ten adolescents who were selected purposively based on criteria including those aged 13-19 years, having been diagnosed with HIV infection and receiving ART for more than a year, and never having discontinued ART. All participants were registered in the outpatient clinic in one top referral hospital in Jakarta. The data were analyzed using thematic analysis. Results: Five themes were identified from the data: living a normal life, wanting to be healthy, taking medication on time, challenges in undergoing treatment, and there is hope. Conclusion: Adolescents with HIV want to live as normal and healthy as possible, like other adolescents. Even though adolescents face several challenges to comply with ART, they try to take the medication as prescribed. The findings of this study serve as input for nurses to maintain compliance with ARVs in adolescents who have HIV.

The role of the church members and nurses in improving self-awareness to prevent HIV.

BACKGROUND: Karo District is one of the districts in North Sumatera province where from 2016 to 2018 the number of HIV sufferers increased dramatically to 384 people and then it increased to 775 people up to September 2020. The aim of this study was to explore the experiences of people with HIV/AIDS and the experiences of the church members regarding people living with HIV/AIDS (PLWHA). DESIGN AND METHODS: Qualitative research design with descriptive phenomenology approach. Data collection was carried out by interviewing 34 participants in Karo District. The data analysis in this study used the Collaizi technique. RESULTS: Five themes were obtained from the results of the study, namely the responses of the participants diagnosed with HIV/AIDS, health problems faced by PLWHA, stigma and discrimination, the support of family and church members given to PWLHA, and family/church members' expectations toward PLWHA. CONCLUSIONS: Based on the findings of the themes, the role of the National AIDS Commission of Moderamen Karo Batak Protestant Church (GBKP) in responding to HIV and AIDS cannot be optimally implemented because of some obstacles namely, localization which is a determinant of the spread of cases, the unavailability of service and ARV in all health centers, lack of sectoral cross-cooperation, very insufficient financial support from the government, the role of nurses played only in the hospitals and the stigmatism to those people with HIV/AIDS due to lack of knowledge of HIV and AIDS.

Cognitive Perception among Post-Chemotherapy, Non-Chemotherapy Breast Cancer Survivors and Non-Cancer.

OBJECTIVE: This study aims to compare the cognitive function perceived by post-chemotherapy breast cancer survivors, breast cancer survivors without chemotherapy, and non-cancer woman patients. METHODS: This study was conducted by a descriptive comparative method. The respondents consisted of 82 survivors of post-chemotherapy breast cancer, 81 non-chemotherapy breast cancer survivors, and 80 non-cancer woman patients who were recruited using consecutive sampling. The data were collected from October until December 2017 by using a FACT-Cog version 3 questionnaire. Data analysis was performed by using a comparative test of Kruskal-Wallis followed by a Mann-Whitney posthoc analysis. RESULTS: The results showed that the median of cognitive function perception in breast cancer survivors post-chemotherapy, non-chemotherapy, and non-cancerous women are 94 (52-122), 113 (53-130), and 121 (69-132), respectively. Mann-Whitney's post-hoc analysis showed a significantly different perception of cognitive function between post-chemotherapy survivors and non-chemotherapy survivors; also between post-chemotherapy survivors and non-cancer women, and between non-chemotherapy survivors with non-cancer women. CONCLUSION: Perceived cognitive impairment, comments from others, perceived cognitive abilities, and effects on quality of life in breast cancer survivors who received chemotherapy are significantly different as compared to the survivor group without chemotherapy and non-cancerous healthy women.

Condom-use negotiation, alcohol consumption, and HIV-risk sexual behavior among female sex workers in Kupang, East Nusa Tenggara, Indonesia: A cross-sectional study.

BACKGROUND: Female sex workers play a crucial part in HIV transmission. Having unprotective condom during sexual activity can lead to HIV infection. Having lower power in condom negotiation with clients can lead  FSW not to using condoms during sexual activity. Alcohol consumption was also mediated HIV risk behavior among FSW. This study aimed to evaluate the relationship between condom use-negotiation, alcohol consumption and HIV-risk sexual behavior among female sex workers (FSW) in Kupang. DESIGN AND METHODS: A cross-sectional study was conducted with 125 FSWs aged 18 to 60 years recruited from Yayasan Tanpa Batas Kupang with consecutive sampling. The data were analyzed using univariate and the Chi-square test. RESULTS: The majority of FSWs (61.6%) reported had low negotiation condom use with their clients, about 77.6% reported high levels of alcohol consumption and 64.8% had high-risk sexual behavior. Condom-use negotiation (p-value: 0.003) and alcohol consumption (p-value: 0.037) were found to be significantly associated with HIV-risk sexual behavior. CONCLUSIONS: Future interventions on HIV prevention should focus on empowering young FSWs with condom negotiation skills in order to increase condom use. It is also recommended to include information about alcohol consumption and its relationship with HIV-risk behavior in order to have better health outcomes for FSW.

The experiences of women from Atoin Meto tribe who performed Sifon ritual in the context of HIV/AIDS transmission.

BACKGROUND: Sifon is ritual sexual intercourse after male circumcision from the Atoin Meto tribe that contributes to HIV/AIDS transmission. Ritual Sifon may put at risk for HIV infection and also sexual transmission diseases (STDs). Doing ritual Sifon as a culture, without using protection during intercourse becomes one way to get HIV infection from infected men. Few studies explore this phenomenon among women who become Sifon. Therefore, the aim of this study is to explore the experience of Sifon women in the context of HIV/AIDS transmission. DESIGN AND METHODS: The data were collected from March to July 2020. This study used a phenomenological approach with a purposive sampling technique. INCLUSION CRITERIA: the women from Atoin Meto tribe aged above eighteen years old who have been Sifon women for at least six months. The participants were recruited through traditional healers in Nekbaun village of Kupang District and Timor Tengah Selatan District. The data were analyzed by the Colaizzi method. RESULTS: Thirteen women were interviewed and we found four themes: lack of knowledge about HIV/AIDS transmission, unaware Sifon women, women who experienced STDs, using traditional medicine to treat STDs (Timor medicine). CONCLUSIONS: The interpretation of Sifon women's experiences that performed Sifon rituals indicated that Sifon is a risk factor for transmitting HIV/AIDS. Preventive and promotional educational programs with a cultural approach are needed to reduce the risk of HIV/AIDS transmission.

The relationship between self-efficacy and spirituality in condom use behaviour among MSM-PLWHA in Bandung, indonesia.

BACKGROUND: The prevalence of HIV/AIDS, especially among men who have sex with men (MSM), is increasing. Disease transmission occurs because of the low use of condoms. This study aimed to identify the relationship between condom self-efficacy and spirituality in condom use behavior. DESIGN AND METHODS: This study used a cross-sectional design with consecutive sampling techniques. It involved 251 people living with HIV/AIDS (PLWH) MSM. Chi-square test was used in bivariate analysis and then continued with the logistic regression analysis for multivariate analysis. RESULTS: The results show that there was a significant relationship between condom self-efficacy and condom use behavior with p-value <0.05 (OR=11.298; 95% CI: 4.35-20.1, p=0.000) and spirituality towards condom use behavior p-value <0.05 (OR=3.405; 95% CI: 0.85-3.21, p=0.00). In multivariate analysis of multiple logistic regression, condom self-efficacy is the factor that predominantly influences condom use behaviour. CONCLUSIONS: To improve the consistency of condom use, nurses need to prioritize interventions such as counselling activities that focus on increasing self-confidence (self-efficacy).

Sexual violence experiences and pornography media exposure with sexual risk behavior among PLWHA MSM in Bandung, Indonesia.

BACKGROUND: HIV number continues to increase, especially among the minority of men who have sex with men (MSM) due to the high risks of their sexual behavior. This study aims to identify the correlation between sexual violence experiences and pornography media exposure to sexual risk behavior among people with HIV/AIDS (PLWHA) MSM. DESIGN AND METHODS: The study employed a cross-sectional design with the consecutive sampling technique and involved 258 PLWHA MSM under the guidance of an NGO in Bandung, Jawa Barat, Indonesia. The data were collected by employing an online questionnaire. RESULTS: The results show that there is a significant correlation between sexual violence experiences and sexual risk behavior (p=0.000, α=0.05; OR=6.496), pornography media exposure and sexual risk behavior (p=0.000, α=0.05; OR=4.271). The multivariate analysis of multiple logistics regression results reveals that the sexual violence experience is the factor that mostly influences the sexual risk behavior among PLWHA MSM (p=0.000, α=0.05; OR=3.784). CONCLUSIONS: The sexual violence experiences and pornography media exposure have a significant positive relationship to sexual risk behavior. Therefore, nurses need to improve a comprehensive assessment, counseling, and personal education to reduce sexual risk behavior that can transmit HIV and other sexually transmitted diseases and create innovations through positive activities to reduce pornography consumption.

Correlations between drug use, HIV disclosure and interpersonal communication on sexual risk behaviour of HIV-positive men who have sex with men.

BACKGROUND: The Human Immunodeficiency Virus (HIV) epidemic is a global health problem whose number of cases are always higher among men who have sex with men (MSM). Most existing MSM have moderate and very high risk behaviour in HIV transmission. This study was designed to identify correlations between drug use, HIV disclosure and interpersonal communication patterns on sexual risk behaviour among HIV-positive MSM. METHODS: This study used a cross sectional design with a purposive sampling technique for participants who visited the voluntary counselling and testing (VCT) clinic in a referral hospital and snowball sampling technique for participants in the work area of a community health centre in Batam involving 126 HIV-positive MSM. Data were collected by 5 part questionnaire, namely demographic questionnaire, drug screening questionnaire, brief scale for HIV self disclosure, communication pattern questionnaire-short form, and safe sex behaviour questionnaire. Bivariate analysis was applied to determine whether there is a relationship between drug use, HIV disclosure, interpersonal communication and demographic characteristics (ethnicity, educational status) with sexual risk behaviour of MSM. Logistic regression analysis was used to explore the variables that most associated variable to sexual risk behaviour. THE RESULTS: The results showed that there was significant correlation between HIV disclosure and sexual risk behaviour (p = 0.019, α = 0.05, OR = 2.530) and significant correlation between interpersonal communication patterns and sexual risk behaviour (p = 0.016, α = 0.05, OR = 2.589). There is no significant correlation between demographic characteristics, namely: ethnicity and educational status with sexual behaviour at risk of MSM. In multiple logistic regression analysis, educational status was the factor that most associated with sexual risk behaviour among HIV-positive MSM (p = 0.027, α = 0.05, OR = 2.807, 95% CI = 1.125-7.006). CONCLUSIONS: HIV disclosure and interpersonal communication patterns have a significant negative correlation with sexual risk behaviour among HIV-positive MSM. MSM with low HIV disclosure have high risk sexual behaviour opportunities. MSM with the closed interpersonal communication pattern also has a high risk of sexual behaviour. Education status was the most associated variable to sexual risk behaviour of HIV-positive MSM. Nurses as professional health workers need to improve comprehensive assessment, personal counselling and plan specific learning model by involving HIV-positive MSM in reducing HIV transmission from risky behaviour.

Exploring the acceptability of HIV partner notification in prisons: Findings from a survey of incarcerated people living with HIV in Indonesia.

Assisted HIV partner notification services provide a safe and effective way for people living with HIV (PLHIV) to inform their partners about the possibility of exposure and to offer them testing, treatment, and support. This study examined whether or not PLHIV in prison might be willing to participate in assisted HIV partner notification services and their reasons for and against disclosing their HIV-positive status to their partners. PLHIV (n = 150) recruited from Jakarta's two largest all-male prisons completed an interviewer-administered questionnaire collecting demographic and risk behavior data, and attitudes toward HIV disclosure and partner services. Among those who were sexually active and/or injecting drugs before incarceration, two-thirds (66.4%, 91/137) endorsed provider referral as an acceptable way to notify their sex partners, and nearly three quarters (72.4%, 89/123) endorsed provider referral to notify their drug-injecting partners. Only a quarter (25.1%) of participants reported that their main sex partner had ever received an HIV test. Participants with anticipated stigma were less likely to endorse provider referral for sex partners (adjusted odds ratio [aOR] = 0.58, 95% CI: 0.35, 0.96) and drug-injecting partners (aOR = 0.54, 95% CI: 0.29, 1.00). Relationship closeness was associated with higher odds of endorsing provider referral for drug-injecting partners (aOR = 2.08, 95% CI: 1.25, 3.45). Protecting partners from infection and a moral duty to inform were main reasons to disclose, while stigma and privacy concerns were main reasons not to disclose. Most incarcerated PLHIV have at-risk partners in the community who they would be willing to notify if provided with assistance. Assisted partner notification for prison populations offers a promising public health approach to accelerate diagnosis, treatment, and prevention of HIV infection in the community, particularly among women.

The Correlation between Stigma and Family Acceptance with Religiosity of PLWH MSM in Medan, Indonesia.

There are several factors related to religiosity of PLWH MSM in Medan. This study aimed to identify the correlation between stigma and family acceptance with religiosity of PLWH MSM in Medan. This cross-sectional study applied purposive sampling technique and involved 175 samples from H. Adam Malik Public Central Hospital, Medan Pirngadi Hospital, Padang Bulan and Teladan Public Health Centers. The data was analyzed using the multiple logistic regression technique. Bivariate analysis showed a significant correlation between stigma along with family acceptance with religiosity of PLWH MSM in Medan (p = 0.005; α = 0.005).

Verbal Learning and Memory Function and the Influencing Factors on Breast Cancer Survivors: A Cross-Sectional Study.

Impairment of cognitive function is a common complaint by post-chemotherapy breast cancer survivors, specifically impairment of verbal learning and memory. The objective of this study was to identify the association between age, duration of education, chemotherapy type, hormone therapy usage, menopausal status, sleep quality, fatigue, stress, and hemoglobin (Hb) levels to memory and verbal learning function. This cross-sectional study consisted of 82 post-chemotherapy breast cancer survivors, 81 non-chemotherapy survivors, and 80 non-cancer female patients in two hospitals. The data were collected using the Hopkins Verbal Learning Test in Indonesian, Pittsburgh Sleep Quality Index, 10-item Perceived Stress Scale, and the Piper Fatigue Scale-12. All instruments were already adopted into Indonesian. Characteristic data were obtained from hospital reports. The mean age of the respondents was 43.06 (8.18) years, 197 (81.1%) had been educated for ≤12 years, 82 (33.7%) were post-chemotherapy survivors, 46 (18.9%) were using hormonal therapy, and 125 (51.4%) had gone through menopause. Among the remaining respondents, 91 (37.4%) were anemic, 124 (51.0%) had poor sleep quality, and 115 (47.3%) experienced moderate fatigue. Twenty-one (25.6%) of post-chemotherapy survivors had a high possibility of having dementia. The significant variables associated with memory and verbal learning function included age, stress, survivor type, chemotherapy category, sleep quality, and fatigue. The insignificant variables included the length of education, hormone therapy usage, menopausal status, and hemoglobin levels. A logistic regression analysis showed that stress was the most influential variable with an odds ratio of 1.159. It is recommended that nurses consider the significant variables when providing services to post-chemotherapy breast cancer survivors.

Predictors of Mortality within Prison and after Release among Persons Living with HIV in Indonesia.

OBJECTIVES: HIV-related mortality is increasing in Indonesia, where prisons house many people living with HIV and addiction. We examined all-cause mortality in HIV-infected Indonesian prisoners within prison and up to 24 months post-release. MATERIALS AND METHODS: Randomly selected HIV-infected male prisoners (n=102) from two prisons in Jakarta, Indonesia completed surveys in prison and were followed up for 2 years (until study completion) or until they died or were lost to follow-up. Death dates were determined from medical records and interviews with immediate family members. Kaplan-Meier and Cox proportional hazards regression models were analyzed to identify mortality predictors. RESULTS: During 103 person-years (PYs) of follow-up, 15 deaths occurred, including ten in prison. The crude mortality rate within prison (125.2 deaths per 1,000 PYs) was surpassed by the crude mortality rate in released prisoners (215.7 deaths per 1,000 PYs). HIV-associated opportunistic infections were the most common probable cause of death. Predictors of within-prison and overall mortality were similar. Shorter survival overall was associated with being incarcerated within a specialized "narcotic" prison for drug offenders (hazard ratio [HR] 9.2, 95% confidence interval [CI] 1.1-76.5; P=0.03), longer incarceration (HR 1.06, 95% CI 1.01-1.1; P=0.01), and advanced HIV infection (CD4+ T-cell count<200cells/µL; HR 4.8, 95% CI 1.2-18.2; P=0.02). Addiction treatment was associated with longer survival (HR 0.1, 95% CI 0.01-0.9; P=0.03), although treatment with antiretroviral therapy (ART) or methadone was not. CONCLUSIONS: Mortality in HIV-infected prisoners is extremely high in Indonesia, despite limited provision of ART in prisons. Interventions to restore immune function with ART and provide prophylaxis for opportunistic infections during incarceration and after release would likely reduce mortality. Narcotics prisons may be especially high-risk environments for mortality, emphasizing the need for universal access to evidence-based HIV treatments.