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Sianturi EI, Latifah E, Gunawan E, Sihombing RB, Parut AA, Perwitasari DA. Adaptive Stigma Coping Among Papuans Living with HIV: a Qualitative Study in One of the Indigenous People, Indonesia. J Racial Ethn Health Disparities 2023; 10:2244-2251. [PMID: 36042114 DOI: 10.1007/s40615-022-01403-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The indigenous Papuans of Indonesia's Tanah Papua Island have been a distinct cultural and racial entity from the rest of the country's inhabitants. Furthermore, antiretroviral therapy's inability to reduce mortality and incidence rates in this region has sparked public interest in HIV issues, which has resulted in increased stigma. Papuans were more interested in memorizing the symptoms than using antiretroviral as an effective therapy. This study aimed to analyze the coping level of HIV-infected Papuans to overcome related stigma. METHODS A qualitative study was conducted with data collected through semi-structured interviews in 2018, and 13 Papuans who had experiences with antiretroviral therapy (ART) participated in audio-recorded interviews. The discussions were focused on the ways to deal with stigma after the HIV diagnosis. Furthermore, data were transcribed verbatim using the framework analysis for qualitative study. RESULTS According to the study results, Papuans were shown to have effectively used self-distancing, self-blame, and self-stigmatization coping mechanisms, according to the results. The people temporarily utilize ART until their health returns to normal. CONCLUSIONS This study indicates that ART has been used to cope with stigma. However, the use was temporary since the misunderstanding regarding use of ART remains high. ART education should be addressed since Papuans are willing to adopt the method provided the benefits are fully comprehended. In addition, the participation of healthcare workers such as pharmacies should be increased since they can explain antiretroviral terms.
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Affiliation(s)
- E I Sianturi
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Universitas Cenderawasih, Abepura, Indonesia.
| | - E Latifah
- Department of Pharmacy, Faculty of Health Science, Universitas Muhammadiyah Magelang, Magelang, Indonesia
| | - E Gunawan
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Universitas Cenderawasih, Abepura, Indonesia
| | | | | | - D A Perwitasari
- Faculty of Pharmacy, University of Ahmad Dahlan, Yogyakarta, Indonesia
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Sianturi EI, Latifah E, Pane M, Perwitasari DA, Satibi, Kristina SA, Hastuti EB, Pavlovich J, Taxis K. Knowledge, empathy, and willingness to counsel patients with HIV among Indonesian pharmacists: a national survey of stigma. AIDS Care 2021; 34:21-28. [PMID: 33565323 DOI: 10.1080/09540121.2021.1883506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aimed to assess the level of HIV treatment knowledge, empathy, and HIV stigma of pharmacy students and pharmacists working with patients as well as potential factors associated with stigma. This survey included 250 hospital pharmacists within 33 provinces and 1013 final-year pharmacy students from Java, the most populated island in Indonesia. The data were collected via Qualtrics® and distributed by WhatsApp. The mean age of the participants was (Mean ± SD) 24.68 ± 5.30 years, and 80.0% were female. The mean knowledge score of students and pharmacists were 14.14 ± 2.01 and 15.39 ± 1.87, respectively, out of the maximum score of 21. The mean empathy score of students and pharmacists was 72.06 ± 5.39 and 77.40 ± 1.35, respectively out of the maximum score of 105. The mean stigma score of students and pharmacists was 21.02 ± 4.65 and 20.66 ± 4.41, respectively, out of a maximum score of 48. Regression analysis showed that knowledge, empathy, and willingness to counsel patients were negatively associated with stigma. Working with patients was positively associated with stigma. A multi-level intervention including education may reduce stigma and strengthen the role of pharmacists in caring for patients.
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Affiliation(s)
- E I Sianturi
- PharmacoTherapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, Netherlands.,Faculty of Mathematics and Natural Sciences, University of Cenderawasih, Papua, Indonesia
| | - E Latifah
- Department of Pharmacy, Faculty of Health Science, Universitas Muhammadiyah Magelang, Magelang, Indonesia.,Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - M Pane
- National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia.,Indonesia Epidemiological Association Perhimpunan Ahli Epidemiologi Indonesia (PAEI), Jakarta, Indonesia.,Public Health Post-Graduate Program, University of Sari Mutiara Indonesia, Medan, Indonesia
| | - D A Perwitasari
- Faculty of Pharmacy, University of Ahmad Dahlan, Yogyakarta, Indonesia
| | - Satibi
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - S A Kristina
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - E B Hastuti
- Directorate General of Diseases Control, Ministry of Health Republic of Indonesia, Indonesia
| | - J Pavlovich
- PharmacoTherapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, Netherlands
| | - K Taxis
- PharmacoTherapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, Netherlands
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Sianturi EI, Perwitasari DA, Islam MA, Taxis K. The association between ethnicity, stigma, beliefs about medicines and adherence in people living with HIV in a rural area in Indonesia. BMC Public Health 2019; 19:55. [PMID: 30634953 PMCID: PMC6330480 DOI: 10.1186/s12889-019-6392-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/03/2019] [Indexed: 11/24/2022] Open
Abstract
Background Indonesia is one of Asia’s countries with the fastest growing rate of human immunodeficiency virus (HIV) infections according to the World Health Organization (WHO). The prevalence of HIV infections in the province of Papua is 2.4% which is 24 times higher than the national rate in Indonesia. This study aimed to investigate the association between stigma, beliefs about medicines, sociodemographic characteristics including ethnicity and adherence in People living with HIV (PLHIV) in Papua, Indonesia. Methods We conducted a cross-sectional study using questionnaires. We included participants from two hospital-outpatient clinics who were on antiretroviral treatment (ART) for more than 6 months, were at least 18 years old, and signed informed consent. Participants completed the Medication Adherence Rating Scale (MARS), Beliefs about Medicines Questionnaire (BMQ), an HIV stigma scale and questions on demographic information. Data on antiretroviral medications were collected from medical records. The outcome was self-reported adherence as measured by the MARS using an 80% cut-off score. Multivariate logistic regression was used to analyse the data. Results Overall, 331 out of 363 eligible participants were included with a mean age of 33.3 (± 9.4) years, 61.6% were female, 67.1% were Papuan. A total of 65.9% of participants were adherent. Being Papuan decreased the likelihood of adherence (odds ratio (OR) = 0.53; 95% confidence interval (CI) = 0.32–0.89). Feeling more distant, a stigma type, also decreased the likelihood of adherence (OR = 0.93; 95% CI = 0.88–0.99). Conclusion The ethnicity of being Papuan and taking a distance to others were associated with non–adherence. Targeted interventions should be developed to improve adherence in this group. Electronic supplementary material The online version of this article (10.1186/s12889-019-6392-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E I Sianturi
- PharmacoTherapy, Epidemiology & Economics (PTEE) Department of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands. .,Faculty of Mathematics and Natural Sciences, University of Cenderawasih, Papua, Indonesia.
| | - D A Perwitasari
- Faculty of Pharmacy, University of Ahmad Dahlan, Yogyakarta, Indonesia
| | - Md A Islam
- PharmacoTherapy, Epidemiology & Economics (PTEE) Department of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands.,Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - K Taxis
- PharmacoTherapy, Epidemiology & Economics (PTEE) Department of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
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Zazuli Z, Barliana MI, Mulyani UA, Perwitasari DA, Ng H, Abdulah R. Polymorphism of PXR gene associated with the increased risk of drug-induced liver injury in Indonesian pulmonary tuberculosis patients. J Clin Pharm Ther 2015; 40:680-4. [PMID: 26417664 DOI: 10.1111/jcpt.12325] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 08/25/2015] [Indexed: 01/28/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Tuberculosis is still a major infectious disease in Indonesia. Patients are treated mostly using fixed-dose combination treatment in primary public health facilities. The incidence of antituberculosis drug-induced liver injury (AT-DILI) is approximately 10% among Indonesian tuberculosis patients who used standard fixed combination regimens during the intensive phase of treatment. However, information regarding genetic polymorphism associated with the increase risk of drug-induced liver injury is still limited. The aim of this study was to investigate pregnane X receptor (PXR) gene polymorphisms as one of the risk factors of AT-DILI. METHODS In this prospective cohort study, we recruited 106 adult patients diagnosed with pulmonary tuberculosis and treated with category I FDC (fixed-dose combination). The identification of SNP -25385C>T (rs3814055) was conducted by ARMS (amplification refractory mutation system). Hepatotoxicity was defined as ALT and/or AST levels above the normal threshold on the second, fourth and sixth months of monitoring during tuberculosis treatment. RESULTS AND DISCUSSION The logistic regression analysis showed that patients with the TT genotype of PXR gene (rs3814055) significantly had a greater risk of AT-DILI (OR 8·89; 95% CI 1·36-57·93, P < 0·05), compared with those of wild-type CC genotype. WHAT IS NEW AND CONCLUSION The result suggests that in Indonesian patients with tuberculosis, the risk of having AT-DILI was associated with TT genotype of the PXR gene.
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Affiliation(s)
- Z Zazuli
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - M I Barliana
- Department of Biological Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - U A Mulyani
- Center for Applied Health Technology and Clinical Epidemiology, National Institute of Health Research and Development, Ministry of Health Republic of Indonesia, Jakarta, Indonesia
| | - D A Perwitasari
- Faculty of Pharmacy, Universitas Ahmad Dahlan, Yogyakarta, Indonesia
| | - H Ng
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - R Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
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Perwitasari DA, Gelderblom H, Atthobari J, Mustofa M, Dwiprahasto I, Nortier JWR, Guchelaar HJ. Anti-emetic drugs in oncology: pharmacology and individualization by pharmacogenetics. Int J Clin Pharm 2011; 33:33-43. [PMID: 21365391 PMCID: PMC3042115 DOI: 10.1007/s11096-010-9454-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 11/09/2010] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Nausea and vomiting are the most distressful side effects of cytotoxic drugs in cancer patients. Antiemetics are commonly used to reduce these side effects. However, the current antiemetic efficacy is about 70-80% in patients treated with highly-emetogenic cytotoxic drugs. One of the potential factors explaining this suboptimal response is variability in genes encoding enzymes and proteins which play a role in metabolism, transport and receptors related to antiemetic drugs. Aim of this review was to describe the pharmacology and pharmacogenetic concepts of of antiemetics in oncology. METHOD Pharmacogenetic and pharmacology studies of antiemetics in oncology published between January 1997 and February 2010 were searched in PubMed. Furthermore, related textbooks were also used for exploring the pharmacology of antiemetic drugs. The antiemetic drugs which were searched were the 5-hydroxytryptamine 3 receptor antagonists (5-HT3RAs), dopamine antagonists, corticosteroids, benzodiazepines, cannabinoids, antihistamines and neurokinin-1 antagonists. RESULT The 5-HT3RAs are widely used in highly emetogenic chemotherapy in combination with dexamethasone and a neurokinin-1 antagonist, especially in acute phase. However, the dopamine antagonists and benzodiazepines were found more appropriate for use in breakthrough and anticipatory symptoms or in preventing the delayed phase of chemotherapy induced nausea and vomiting. The use of cannabinoids and antihistamines need further investigation. Only six articles on pharmacogenetics of the 5-HT3RAs in highly emetogenic chemotherapy are published. Specifically, these studies investigated the association of the efficacy of 5-HT3RAs and variants in the multi drug resistance 1 (MDR1) gene, 5-HT3A,B and C receptor genes and CYP2D6 gene. The pharmacogenetic studies of the other antiemetics were not found in this review. CONCLUSION It is concluded that pharmacogenetic studies with antiemetics are sparse. It is too early to implement results of pharmacogenetic association studies of antiemetic drugs in clinical practice: confirmation of early findings is required.
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Affiliation(s)
- D A Perwitasari
- Department of Pharmacy, Ahmad Dahlan University, Yogyakarta, Indonesia
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Perwitasari DA, Atthobari J, Dwiprahasto I, Hakimi M, Gelderblom H, Putter H, Nortier JWR, Guchelaar HJ, Kaptein AA. Translation and Validation of EORTC QLQ-C30 into Indonesian Version for Cancer Patients in Indonesia. Jpn J Clin Oncol 2011; 41:519-29. [DOI: 10.1093/jjco/hyq243] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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