EDUCATION WITH BOOKLETS MEDIA ON HIV PATIENTS IN THE HOSPITAL: A QUASI-EXPERIMENTAL CLINICAL TRIAL

Regular visits of HIV patients to the hospital are expected to provide a positive therapeutic out-come because during the visit clinical monitoring, laboratory testing, counseling conducted by health workers and VCT themes, as well as taking antiretroviral (ARV) routine drugs every once a month, so that it is expected that the compliance of HIV patients to take ARV drugs will increase. Marking the success of the treatment of antiretroviral therapy come from HIV patients includes the minimum opportunistic infections related to AIDS and malignancy, increased CD4 cell counts, and increased body weight. The purpose of this study was to determine the effect of booklet media education on the level of adherence, perception, clinical out come and the quality of life of HIV patients in RSUD R. Soedjati Soemodiharjo The method used was quasi experimental with the design of two design pretest-posttest groups. Data were analyzed by univariate and bivariate. Statistical tests using a sample independent-sample test. The results obtained from this study are a description of the demographic characteristics of HIV patients in RSUD R. Soedjati Soemodiharjo, namely the highest age at 18-29 years as many as 22 patients (36%), dominated by women 43 people (70,5%), married as many as 49 people (80,3%), elementary school education 35 patients (57,4%), the most work was not working 23 people (37,8%), the highest duration of illness was above 1 year, 29 patients (47,6%), the most comorbid / comorbidities suffered by HIV patients in RSUD R. Soedjati Soemodiharjo were TB as many as 8 patients (36,4%). Perception on perception shows a P value of > 0,05. Intervention on compliance analysis results P > 0,05. Both treatment and control studies have moderate adherence because they have 48 patients (78,6%). Statistical results showed a significant difference for Hb because the SPSS results were P < 0,05 between the treatment with controls and for the leukocyte number P > 0,05, meaning that there was no significant difference between treatment and control. Interventions with quality of life P < 0,05. The conclusion is the influence of quality of life education intervention, Hb on HIV patients in RSUD R Soedjati between the control and treatment groups P <0,05.


INTRODUCTION
The problems faced by people living with HIV/AIDS (PLWHA) are not only medical or health problems, but also social problems (Arifin, 2005;Baba, 2005). Many changes occur in the individual after being infected with HIV/AIDS. Physical changes due to symptoms of illness caused by a decreased immune system in PLWHA affect personal, social, study, career and even family life (Novrianda et al., 2018). In addition, the issues of stigma and discrimination experienced by PLWHA, both from family, neighbors, the world of work, schools, and other community members, have made their condition worse and even worse

Effect of Education with booklet media on knowledge of (People with HIV/AIDS) PWHA patients about the disease and treatment at R. Soedjati Soemodiharjo Grobogan Hospital
Knowledge is defined as the result of human sensing or the result of someone knowing about objects through their senses (eyes, nose, etc.), so as to produce knowledge. This is strongly related to the intensity of attention and perception of the object (Notoatmodjo, 2007). Before the study was conducted, patients were asked about their illness and the treatment they had taken so far, whether they knew correctly or not, then after answering the questions. After two weeks, education was conducted regarding the description of HIV and its treatment. After one month, data was collected again on the same patient to determine whether there are changes in the patient or not.
Booklet can be designed or made as attractive as possible so the readers feel happy and not bored. The language used is short, concise and easy to understand but comprehensive. The research results can be seen in table 2.  The research results obtained statistical results that have P value > 0,05 which means that the control group and the treatment group have no difference.

Effect of Education with booklet media on perception/BIPQ on HIV patients at R. Soedjati Soemodiharjo Hospital Grobogan
Perception of illness is an interpretation made by a person regarding the disease he is suffering from, it can be good or bad (Chilcot, 2010). The results of HIV/AIDS patients perception's description in this study were reported as scores or descriptive values obtained from each B-IPQ perception domain and can be seen in table 4. BIPQ total value range is from 0 until 80. According to the research of Løchting et al. (2013) A higher BIPQ score indicates that the disease is perceived as a threat. The mean of total B-IPQ score from HIV/AIDS patients in RSUD R. Soedjati Soemodiharjo Grobogan, in control group was 40.45±4.667 and in the treatment group was 38.767±5.63.
Perceptions are classified into two categories, namely good perception < 40 and bad perception if ≥ 40. The results of this study showed that the control group was 40.45, which means it had a poor perception while the treatment group was 38.767 and better than the control group. After education was given to control group and treatment group, average result showed a difference. Treatment group is much less, the value is 38.76 compared to the control group, which is much higher, with 40.45 value, which means it causes anxiety and worries because it is included in the poor perception range.

Effect of intervention on compliance in HIV patients at R. Soedjati Soemodiharjo Hospital Grobogan
Compliance is very important in ARV therapy, because high compliance can provide good clinical outcomes. This study uses the MARS questionnaire which is one of the selfreport methods to measure compliance. Table 5 shows a description of adherence level of HIV/AIDS patients at R. Soedjati Soemodiharjo Hospital Grobogan. The MARS assessment score is divided into 3 categories, it is low compliance with a score of 5, moderate compliance with a score of 6-24, and high compliance with a score of 25. However, the weakness of this assessment is the answers given by the patient are subjective and not necessarily appropriate with actual conditions, such as the patient lying so it can tend to give higher results than the truth (Houlbrooke et al., 2004;Mahler & Fritzler, 2010). Based on the stduy results shown in table 5, it shows that there are no patients who have low adherence. The results of the questionnaire provide an illustration after the intervetion had been given to patients, there's an increase in taking medication. Patients in treatment group with high medication adherence, 26.7% (8 patients) was higher than the control group that was not given intervention, which was 16.1% (5 people). Although statistically it did not show a significant difference because the results of the SPSS analysis p value was 0,886, the p value > 0,05. However, if examined in detail, there are changes in the treatment group that has been given an intervention that means the patients are increasingly aware of adherence to taking medication and understand the success of treatment starting with adherence of taking medication even though not all patients experience changes. Based on the results of research at RSUD R. Soedjati Soemodiharjo, it can be concluded that the level of patient adherence to ARV treatment is moderate because above 50% of patients have started to realize and understand the importance of ARV treatment for their survival.

Effect of intervention on Outcome in HIV patients at RSUD R. Soedjati
Soemodiharjo Grobogan Anemia is one of the most common hematological complications found in people with HIV infection. The prevalence of anemia in HIV infection ranges from 1.3%-95%, depending on the clinical stage of the disease. Increased disease progression will increase the incidence of anemia and worsen clinical situation. One study showed that anemia was an independent death risk factor in HIV/AIDS infection, in addition to CD4 cell count (cluster of differentiation) and viral load. On the other hand, it has been shown that anemia improves.
Zidovudine is one of the drugs that has been reported as a cause of hematological disorders (Kiragga et al., 2010), especially anemia, since Zidovudine was first introduced as antiretroviral therapy (Akhtar, 2008;Hidayati et al., 2013). Anemia is a hematological problem that is often found in HIV infection. Anemia can increase morbidity and mortality in HIV infection so the proper management can improve the quality of life of people living with HIV/AIDS.

Effect of intervention on Quality of Life in HIV patients at R. Soedjati Soemodiharjo Hospital Grobogan
The quality of life evaluation in HIV/AIDS patients at R. Soedjati Soemodiharjo Hospital Grobogan was carried out by using WHOQOL-HIV questionnaire Bref. On this questionnaire, the quality of life assessment is divided based on 6 domains, it is physical function domain, psychological, level of independence, social relations, environment, and spiritual/religious (O'Connell & Skevington, 2012;O'Connor, 1993). From the results of the SPSS analysis, the effect of the intervention on the patient's quality of life was very significant because the p value < 0,05 in all domains. Quality of life itself is classified into 3, it is good quality of life with 76-100%, moderate quality of life with 56-75%, and low quality of life with < 56%. From the results of data analysis, it was obtained that the treatment group was 62,60% which was classified as moderate quality of life because it was in the 56-75% range and for the control group had a low quality of life because the results of the analysis were 54,67% which was in the < 56% range. It means that carried out interventions using booklets can affect the patient's quality of life.

CONCLUSION
Based on quasi experimental with pretest-posttest groups design, it can be conclude that there is an effect of educational intervention on quality of life, Hb on HIV patients in RSUD R.Soedjati between the control and treatment groups P < 0,05.