ORIGINAL ARTICLE
Factors Associated with Hepatitis B and Hepatitis C among Infected Patients in Indonesia and Their Knowledge and Attitude: A Multicenter Observational Study Juferdy Kurniawan1*.
Gita Aprilicia1.
Hery Djagat Purnomo2.
Cecilia O.
Permatawedi2.
Ulfa Kholili3.
Tehar Karo-Karo4.
Haris Widita5.
Aritantri Darmayani6.
Arif Nur Widodo7.
Nenny Agustanti8.
Saptino Miro9.
Suyata10.
Fauzi Yusuf11.
Catharina Triwikatmani12.
Syifa Mustika13.
Rini R.
Bachtiar14.
Fandy Gosal15.
I Ketut Mariadi16.
Irsan Hasan1 Division of Hepatobiliary.
Department of Internal Medicine.
Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital.
Jakarta.
Indonesia.
Division of Gastroenterology-Hepatology.
Department of Internal Medicine.
Faculty of Medicine.
University of Diponegoro - Kariadi Hospital.
Semarang.
Indonesia.
Division of Gastroenterology-Hepatology.
Department of Internal Medicine.
Faculty of Medicine.
University of Airlangga - Soetomo Hospital.
Surabaya.
Indonesia.
Division of Gastroenterology-Hepatology.
Department of Internal Medicine.
Abdul Moeloek Hospital.
Lampung.
Indonesia.
Division of Gastroenterology-Hepatology.
Department of Internal Medicine.
Kota Mataram Hospital.
Mataram.
Indonesia.
Division of Gastroenterology-Hepatology.
Department of Internal Medicine.
Faculty of Medicine.
University of Sebelas Maret.
Moewardi Hospital.
Surakarta.
Indonesia.
Division of Gastroenterology-Hepatology.
Department of Internal Medicine.
Ulin Hospital.
Banjarmasin.
Indonesia.
Division of Gastroenterology-Hepatology.
Department of Internal Medicine.
Faculty of Medicine.
University of Padjadjaran.
Hasan Sadikin Hospital.
Bandung.
Indonesia.
Division of Gastroenterology-Hepatology.
Department of Internal Medicine.
Faculty of Medicine.
University of Andalas - M.
Djamil Padang Hospital.
Padang.
Indonesia.
Division of Gastroenterology-Hepatology.
Department of Internal Medicine.
Faculty of Medicine.
University of Sriwijaya.
Mohammad Hoesin Hospital.
Palembang.
Indonesia.
Division of Gastroenterology-Hepatology.
Department of Internal Medicine.
Faculty of Medicine.
University of Syiah Kuala - Dr.
Zainoel Abidin Hospital.
Aceh.
Indonesia.
Division of Gastroenterology-Hepatology.
Department of Internal Medicine.
Faculty of Medicine.
University of Gadjah Mada - Sardjito Hospital.
Yogyakarta.
Indonesia.
Division of Gastroenterology-Hepatology.
Department of Internal Medicine.
Faculty of Medicine.
University of Brawijaya - Syaiful Anwar Hospital.
Malang.
Indonesia.
Division of Gastroenterology-Hepatology.
Department of Internal Medicine.
Faculty of Medicine.
University of Hasanuddin - Wahidin Sudirohusodo Hospital.
Makassar.
Indonesia.
Division of Gastroenterology-Hepatology.
Department of Internal Medicine.
Faculty of Medicine.
University of Sam Ratulangi - RD Kandau Hospital.
Manado.
Indonesia.
Division Gastroenterology-Hepatology.
Department of Internal Medicine.
Faculty of Medicine.
University of Udayana - Sanglah Hospital.
Bali.
Indonesia.
Indonesian Association for the Study of the Liver (Ina ASL/PPHI) Member of Research Committee.
Acta Med Indones - Indones J Intern Med A Vol 56 A Number 2 A April 2024 Juferdy Kurniawan Acta Med Indones-Indones J Intern Med *Corresponding Author:
Juferdy Kurniawan.
MD.
PhD.
Division of Hepatobiliary.
Department of Internal Medicine.
Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital.
Jl.
Diponegoro no.
Jakarta 10430.
Indonesia.
Email: juferdy.
k@gmail.
com , juferdy.
kurniawan@ui.
ABSTRACT
Background: Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections are global health problems, including in Indonesia.
The purpose of this study was to assess the knowledge and attitudes about HBV and HCV infection among infected patients in Indonesia.
Methods: This cross-sectional study used a questionnaire The questionnaire was adapted and translated into Indonesian language, and trialed with 27 HBV and 27 HCV patients.
The final validated questionnaire was later used in the target population.
Patients diagnosed with Hepatitis B or Hepatitis C were included.
The patients were enrolled from November 2019 until February 2020 in sixteen multicenter locations.
Multivariate analysis with logistic regression was conducted to determine the factors that are associated with the knowledge and attitude among HBV and HCV patients toward their Results: A total of 931 HBV patients and 254 HCV patients were included in this survey.
The proportion of infected patients with adequate knowledge of Hepatitis B and Hepatitis C was 72.
1% and 53.
9%, respectively.
Positive attitudes about Hepatitis B and Hepatitis C were 28.
5% and 41.
3%, respectively.
Multivariate analysis revealed that higher education level, higher income level, diagnosis duration of more than 5 years, and receiving of antiviral therapy were independent factors associated with adequate knowledge about Hepatitis B among HBV patients.
Among HCV patients, independent factors associated with adequate knowledge about Hepatitis C were being married, higher education level, higher income level, and receiving antiviral therapy.
Moreover, older age and receiving of antiviral therapy were independent factors associated with positive attitudes towards Hepatitis B among HBV patients.
However, only higher education level was found to be an independent factor associated with positive attitudes towards Hepatitis C among HCV patients.
Conclusion: The knowledge and attitude of patients regarding HBV and HCV were quite low among infected patients in Indonesia.
Keywords: Knowledge.
Attitude.
Hepatitis B.
Hepatitis C.
INTRODUCTION
Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are global health problems, including in Indonesia.
According to a national study of Basic Health Research 2013 in Indonesia, the prevalence of chronic hepatitis B and C in Indonesia was 7.
1% and 1%, respectively.
Within 10-20 years, 20-50% of chronic hepatitis B patients and 10-20% of chronic hepatitis C patients may develop cirrhosis.
2,3 In the long term, chronic hepatitis B and C can result in severe liver problems, such as liver cirrhosis, decompensation of liver cirrhosis .
sophageal variceal, hepatic encephalopathy, hepatorenal syndrom.
, liver cancer, and death.
HBV and HCV pathogens are transmitted through blood and certain body fluid, primarily through blood contact with an infected personAos blood, sexual contact, sharing of needles, or from an infected mother to her baby during vaginal birth, which is more common in Hepatitis B.
Patients with inadequate knowledge tend to have misconceptions about their disease, which can contribute to the continued transmission of the virus, missed opportunities for medical treatment, and poor health outcomes.
6 Chronic hepatitis B and C require long-term anti-viral medication.
Forcmost HBV patients, therapy of antiviral requires lifelong therapy and reactivation may occur after discontinuation of the medication.
Inadequate knowledge about medication can lead to poor adherence to treatment, resulting in disease progression.
7 Despite clinical medication, psychosocial issues are a rising concern as an important component of the quality of life for Patients with chronic HBV and HCV might involve serious aspects of psychosocial impairment such as fear, anxiety, stigma, and Vol 56 A Number 2 A April 2024 Factors associated with Hepatitis B and Hepatitis C among infected patients a lack of social support .
8 Psychosocial issues related to knowledge and attitudes about chronic HBV and HCV greatly affect patientsAo quality of Misunderstandings can lead to fear, anxiety, and stigma, while lack of social support worsens the situation.
Studies examining the knowledge and attitudes of individuals living with chronic hepatitis B and C in Indonesia are currently This scarcity of data underscores the importance of conducting research to better understand the specific challenges faced by patients in Indonesia.
Local data is essential for developing targeted interventions aimed at improving education, support, and the overall quality of life for individuals affected by these conditions in Indonesian context.
A study of 520 patients in India who tested positive for HBsAg and anti-HCV revealed that only two-thirds of the respondents were knowledgeable about transmission and prevention.
Additionally, only one-third of the respondents provided correct answers about the consequences of chronic HBV and HCV infection.
9 Addressing inadequate knowledge is essential not only to prevent the spread of these infections but also to improve the quality of life for those affected.
10 The purpose of this study was to evaluate the knowledge and attitude about HBV and HCV infection in infected patients.
The findings of this study could serve as evidence to provide education and interventions for improving the quality of life of infected patients.
METHODS
Setting and Participants A cross-sectional study with a questionnaire survey was used to perform this study.
A pilot study was conducted to pretest the questionnaire.
The reliability of the questionnaire was evaluated with Cronbach Alpha, while validity was evaluated with Pearson correlation .
Patients aged above 18 years who were diagnosed with Hepatitis B/Hepatitis C .
roven by HBsAg/ Anti-HCV positiv.
and voluntarily agreed to participate in the survey were included.
The study was conducted between November 2019 and February 2020, with a member of Ina ASL/PPHI in each region acting as the study Each center had a research assistant who was trained by the study investigator to collect survey data through face-to-face interviews and conducted interviews in the native Indonesian language.
Co-variates Age is categorized into two groups:
participants who are younger than 40 years old (< 40 year.
and those who are 40 years old or older (Ou 40 year.
according to the mean age of the subjects.
Sex is classified as either women or men.
Marital status includes three categories:
married, single, and divorced.
Education status is divided into primary .
-9 years of formal educatio.
, secondary .
-12 years of formal educatio.
, and tertiary .
ore than 12 years of formal education, including college or university Income level is divided into low .
elow Rp 3.
, middle (Rp 3.
Ae 7.
, and high .
bove Rp 7.
based on the income of patients from the 1st to the 3rd quartile.
The years of diagnosis are classified into two groups based on the third quartile data, which aligns with Mohamed et alAos11 findings that the longer a patient has been diagnosed with hepatitis B, the lower their level of worry about the disease.
Participants are categorized as diagnosed less than 5 years ago (< 5 year.
and those diagnosed 5 years ago or more (Ou 5 year.
from the time they were initially diagnosed as positive for hepatitis B or C.
Antiviral therapy is defined as a patient who already nucleotide analog for HBV patients and directacting antivirals for HCV patients.
Cirrhosis was determined based on ultrasound results or transient elastography indicating a fibrosis stage above F4, as reported by patient interviews.
Survey Instrument Patients with HBV and HCV in each center who agreed to participate in this study were informed about the aim of this survey and sign the informed consent.
Participants of the study were asked to fill out a questionnaire containing the demography, knowledge, and attitude about HBV and HCV.
The questionnaire was adapted and translated into Indonesian language and trialed with 10% of minimal sample sizes.
The final validated questionnaire was later used in Juferdy Kurniawan the target population.
The section of knowledge consists of 17 items.
One score was given for each correct answer, while zero score was given for each wrong or does not know the answer.
The participants were classified in two group .
on-adequate vs.
adequate knowledg.
based on the mean of the overall knowledge score .
out of .
A participantAos score of less than 50% .
Ae 7 scor.
was considered as non-adequate knowledge, while a score of more than 50% .
was considered as adequate knowledge.
The section on attitude consists of 12 items.
Score range from -2 to 2.
A participant was classified into two groups .
egative vs.
positive attitud.
based on the overall attitude score.
A participant with more positive score was defined as positive attitude, while a less or negative score was defined as negative attitude.
The cut-off values of variables knowledge and attitude were set based on the median scores from the study result.
Statistical Analysis The data that has been collected was analyzed with SPSS 25 IBM Corporation United States.
Demographic data were processed Numerical data was displayed as mean with a standard deviation and categorical data was displayed as percentage.
Multivariate analysis with logistic regression was conducted to determine the factors that associate with the knowledge and attitude among HBV and HCV patients towards their illness.
Variable with p value below 0.
05 was considered as statistically Ethical Statement The authors declare that all procedures performed in studies involving human participants were following the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical This study was approved by the Ethics Committee of Faculty Medicine Universitas Indonesia, with the registered protocol number 19-10-1205.
All participants signed the informed consent before the study.
All data collected in this study were kept confidential and can only be accessed by the principal investigator and co-investigator.
Acta Med Indones-Indones J Intern Med
RESULTS
Characteristic of Study Population Out of 980 HBV patients and 286 HCV patients were sampled consecutively for the Out of those assessed, 931 HBV patients and 254 HCV patients agreed to participate in this survey.
The participant rate was 94.
9% for HBV patients and 88.
8% for HCV patients.
Figure 1.
The mean age of HBV patients was 43 A 74 years and that of HCV patients was 48 A 98 years.
Major of HBV and HCV patients were male .
6%, 62.
6%, respectivel.
Most of level education were secondary education in HBV patients .
4%), while most of level education were tertiary education in HCV patients .
5%).
Most of them in low-income category .
4% in HBV patients and 58.
7% in HCV patient.
Characteristic of study population were summarized in Table 1.
Knowledge of Hepatitis B and Hepatitis C Among Infected Patients A 29-item questionnaire assessing knowledge and attitude was evaluated in the patients.
For HBV patients, the reliability of the knowledge and attitude sections showed CronbachAos alpha values 920 and 0.
830, respectively.
For HCV patients, these values were 0.
808 and 0.
813, respectively.
Regarding the questionnaireAos validity, 10% of the questions demonstrated a moderate correlation .
= 0.
4 Ae 0.
, while the remaining 90% showed a strong correlation .
> 0.
Out of the 931 HBV patients, 808 .
patients were aware that the etiology of Hepatitis B was a viral infection.
Most HBV patients knew Population target:
HBV and HCV patients who visited multi-center hospitals in Indonesia.
Eligible Patients:
Patients with HBV .
= .
Patients with HCV .
Enrolled (Agree to participat.
Patients with HBV .
= .
Patients with HCV .
= .
Figure 1.
Flowchart of sample selection Vol 56 A Number 2 A April 2024 Factors associated with Hepatitis B and Hepatitis C among infected patients Table 1.
Characteristic of study population.
Variables Age, mean A SD Age, n (%) < 40 years > 40 years Sex, n (%) Women Men Marital status, n (%) Married Single Divorced Education status, n (%) Primary .
Ae 9 year.
Secondary .
-12 year.
Tertiary .
bove 12 year.
Income level, n (%) Low Middle High Years of Diagnosis, n (%) < 5 years > 5 years Has received anti-viral therapy, n (%) Yes Has diagnosed cirrhosis, n (%) Yes that Hepatitis B might cause chronic inflammation of the liver 773 .
0%), liver failure 697 .
9%), and liver cancer 717.
0%).
Poor knowledge of transmission of Hepatitis B was found in sharing personal food equipment 352 .
8%), coughing and sneezing 528 .
7%).
Only 639 .
6%) patients knew that antiviral for Hepatitis B was available for therapy.
8%) patients knew that the hepatitis B vaccine can prevent of HBV infection.
Overall.
HBV patients have better knowledge than HCV patients.
Out of the 254 HCV patients, only 202 .
5%) patients knew the etiology of Hepatitis C is viral infection.
HCV patients knew Hepatitis C can cause chronic inflammation of the liver 191 .
2%), liver failure 168 .
1%), and liver cancer 170 .
9%).
Similar to HBV patients, poor knowledge of transmission of Hepatitis C among HCV patients was found in sharing personal food equipment 90 .
4%), coughing and sneezing 139 .
7%).
Only 165 .
HBV Patients .
= .
HCV Patients .
= .
43 A 12.
48 A 12.
patients knew that an antiviral for Hepatitis C was available for therapy.
The knowledge of item HBV and HCV infection among infected patients was summarized in Table 2.
Attitude of Hepatitis B and Hepatitis C Among Infected Patients The attitudes of infected patients toward HBV and HCV infection are summarized in Table 3.
Emotional instability among HBV patients was dominated by fear of developing liver cancer 779 .
6%), fear of transmitting the disease to other people 779 .
6%), and fear that Hepatitis B disease will worsen and damage the liver 771 .
8%).
Most HBV patients believed that Hepatitis B could be controlled with medication 812 .
2%) and could be cured 808 .
8%).
Of 468 .
3%) patients who were unlike to talk about hepatitis B to others, 327 .
2%) patients were kept thinking about their disease all the time, while 416 .
6%) patients saw life differently after diagnosed with hepatitis Juferdy Kurniawan Acta Med Indones-Indones J Intern Med Table 2.
Knowledge of Hepatitis B and Hepatitis C among infected patients.
Knowladge (N = .
Hepatitis B etiology Viral infection Hepatitis B effect Chronic inflammation of the liver Liver failure Liver cancer Hepatitis B transmission Blood Sexual intercourse Unsterilized needles Tattoo Mother to child during childbirth Sharing personal food equipment Coughing and sneezing Casual contact with infected person Sharing toothbrush or razor Hepatitis B symptom Tiredness Asymptomatic Hepatitis B therapy Available antiviral for hepatitis B Hepatitis B prevention Vaccination hepatitis B Correct Answer, n (%) 808 .
Correct Answer, n (%) Knowledge (N = .
Hepatitis C etiology Viral infection Hepatitis C effect Chronic inflammation of the liver Liver failure Liver cancer Hepatitis C transmission Blood Sexual intercourse Unsterilized needles Tattoo Mother to child during childbirth Sharing personal food equipment Coughing and sneezing Casual contact with infected person Sharing toothbrush or razor Hepatitis C symptom Tiredness Asymptomatic Hepatitis C therapy Available antiviral for hepatitis C 202 .
As a result of having Hepatitis B, patients felt difficult to get a job or school 296 .
8%) and made them ostracized from their environment 154 .
5%).
Similar to HBV patients, emotional instability among HCV patients was dominated by fear of developing liver cancer 197 .
5%), fear of transmitting the disease to other people 188 .
%), and fear that Hepatitis C disease will worsen and damage the liver 197 .
6%).
Most HCV patients believed that Hepatitis C could be controlled with medication 210 .
and could be cured 211 .
1%).
Of 127 .
%) patients who were unlike to talk about hepatitis C to others, 86 .
8%) patients were kept thinking about their disease all the time, while 98 .
patients saw life differently after diagnosed with hepatitis C.
As a result of having Hepatitis C, patients felt difficult to get a job or school 53 .
9%), and made them ostracized from their environment 40 .
7%).
Knowledge and Attitudes Scores of Hepatitis B and Hepatitis C Among HBV patients, mean scores for knowledge about Hepatitis B was 12 A 4 out Patients with adequate knowledge of Hepatitis B was 671.
1%).
Only 265 .
patients have a positive attitude towards Hepatitis Table 3.
Attitude of Hepatitis B and Hepatitis C among infected patients.
Attititudes In patients with HBV .
= .
Hepatitis B Ae related emotional Worried about suffering from liver cancer due to hepatitis Worried about transmitting my disease to Worried that my illness will worsen and damage the liver Hepatitis B makes me feel guilty Often feel sad and helpless because of Strongly Agree Agree Neutral Disagree Strongly Disagree 342 .
Vol 56 A Number 2 A April 2024 Factors associated with Hepatitis B and Hepatitis C among infected patients Attititudes Hepatitis B Ae related confidence Believe hepatitis B can be controlled with Sure there will be a cure for hepatitis B Hepatitis B Ae related fear of deprivation Do not like to talk about my hepatitis B to Thinking about hepatitis B all the time Seeing life differently since I was diagnosed with hepatitis B Hepatitis B Ae related social withdrawal Hepatitis B makes it difficult for me to get a job/school Hepatitis B made me ostracized from my In patients with HCV .
= .
Hepatitis C Ae related emotional Worried about suffering from liver cancer due to hepatitis C Worried about transmitting my disease to Worried that my illness will worsen and damage the liver Hepatitis C makes me feel guilty Often feel sad and helpless because of Hepatitis C Ae related confidence Believe hepatitis B can be controlled with Sure there will be a cure for hepatitis C Hepatitis C Ae related fear of deprivation Do not like to talk about my hepatitis C to Thinking about hepatitis B all the time Seeing life differently since I was diagnosed with hepatitis C Hepatitis C Ae related social withdrawal Hepatitis C makes it difficult for me to get a job/school Hepatitis C made me ostracized from my Strongly Agree Agree Neutral Disagree Strongly Disagree 308 .
Meanwhile among HCV patients, mean scores for knowledge about Hepatitis C was lower than HBV patients 10 A 4 out of 16.
Patients with adequate knowledge of Hepatitis C was 137 .
9%).
Positive attitude towards Hepatitis C was observed higher in HCV patients than HBV patients 105 .
3%) (Table .
Factor Associated with Knowledge and Attitudes of Hepatitis B In multivariate analysis, independent factors associated with adequate knowledge Hepatitis B among HBV patients were education level (AOR high education level 9.
25 (CI 95%: 5.
18 Ae 16.
p-value <0.
and AOR middle education level = 3.
92 (CI 95%: 2.
46 Ae 6.
, p-value <0.
, income level (AOR high-income level = 5.
56 (CI 95%: 1.
24 Ae 25.
1, p-value <0.
and AOR middle-income level = 1.
52 (CI 95%:
04 Ae 2.
, p-value 0.
, diagnosis above 5 years (AOR = 1.
82 (CI 95%: 1.
13 Ae 2.
, and has received antiviral therapy (AOR = 1.
89 (CI
95%: 1.
36 Ae 2.
63, p-value <0.
Independent factors associated with positive attitude Hepatitis B among HBV patients were age older (AOR= 99 (CI 95%: 1.
42 Ae 2.
80, p-value <0.
and received antiviral therapy (AOR = 1.
59 (CI 95%:
Juferdy Kurniawan Acta Med Indones-Indones J Intern Med Table 4.
Knowledge and Attitudes Scores of Hepatitis B and Hepatitis C Variables In patients with HBV .
= .
Knowledge about Hepatitis B
Number of correct answers Overall Score, mean A SD
12 A 4
Knowledge about Hepatitis B, n (%) Adequate 671 .
Non-Adequate 260 .
Attitude about Hepatitis B, n (%) Positive 265 .
Negative 666 .
In patients with HCV .
= .
Knowledge about Hepatitis C
Number of correct answers Overall Score, mean A SD
10 A 4
Knowledge about Hepatitis C, n (%) Adequate 137 .
Non-Adequate 117 .
Attitude about Hepatitis C, n (%) Positive 105 .
Negative 149 .
16 Ae 2.
18, p-value <0.
(Table .
Factor Associated with Knowledge and Attitudes of Hepatitis C In multivariate analysis, independent factors associated with adequate knowledge of Hepatitis C among HCV patients were marital status (AOR single = 0.
25 (CI 95%: 0.
08 - 0.
78, p-value 0.
an education level (AOR high education level 7.
(CI 95%: 2.
50 Ae 22.
19, p-value <0.
and AOR middle education level = 4.
34 (CI 95%: 1.
55 Ae .
, p-value 0.
, income level (AOR highincome level = 2.
68 (CI 95%: 1.
02 Ae 6.
99, p-value <0.
045, and has received antiviral therapy (AOR = 1.
97 (CI 95%: 1.
09 Ae 3.
58, p-value <0.
Independent factors associated with positive attitude Hepatitis C among HCV patients was only education level (AOR middle education level= 3.
(CI 95%: 1.
32 Ae 7.
99, p-value 0.
(Table .
Table 5.
Multivariate factorstitudes of Hepatitis B Variables Knowledge NonAdequate Adequate Attitude AOR .
% CI) Negative Positive AOR .
% CI) Age, n (%) < 40 years > 40 years 97 .
Ref .
65 Ae 1.
Ref 99 .
42 Ae 2.
<0.
Sex, n (%) Female Male 112 .
55 Ae 1.
83 Ae 1.
Marital status, n (%) Married Single 215 .
Ref 99 .
61 Ae 1.
Ref .
71 Ae 1.
55 Ae 2.
41 Ae 1.
Ref <0.
81 Ae 2.
<0.
68 Ae 2.
Ref 77 .
54 Ae 1.
61 Ae 2.
Ref 21 .
84 Ae 1.
Divorced Education level, n (%) Primary .
Ae 9 70 .
Secondary .
-12 151 .
Tertiary .
bove 12 39 .
Income level, n (%) Low 199 .
Middle 59 .
High 2 .
Years of Diagnosis, n (%) < 5 years 234 .
> 5 years 26 .
Ref 355 .
46 Ae 6.
18 Ae 16.
Ref .
04 Ae 2.
24 Ae 25.
Ref .
13 Ae 2.
Vol 56 A Number 2 A April 2024 Factors associated with Hepatitis B and Hepatitis C among infected patients Has received anti-viral therapy, n (%) 139 .
Yes 121 .
Ref .
36 Ae 2.
<0.
Ref 59 .
16 Ae 2.
Ref .
94 Ae 0.
Ref 95 .
65 Ae 1.
Attitude AOR
% CI)
Has diagnosed cirrhosis, n (%) Yes 207 .
AOR: Adjusted Odd Ratio.
CI: Confidence Interval Table 6.
Multivariate factors associated with Knowledge and Attitudes of Hepatitis C Variables Knowledge AOR .
% CI) Non Adequate Adequate Age, n (%) < 40 years > 40 years 20 .
Ref .
12 Ae 0.
Sex, n (%) Female Male 46 .
Ref .
40 Ae 1.
Marital status, n (%) Married Single 89 .
Ref .
08 Ae 0.
22 Ae 1.
Years of Diagnosis, n (%) < 5 years > 5 years 24 .
Has received anti-viral therapy, n (%) Yes 78 .
Has diagnosed cirrhosis, n (%) Yes 97 .
Divorced Education level, n (%) Primary .
Ae 9 year.
Secondary .
-12 Tertiary .
bove 12 Income level, n (%) Low Middle High Negative Positive 44 .
Ref .
57 Ae 2.
Ref .
47 Ae 1.
Ref .
09 Ae 1.
25 Ae Ref .
55 Ae 12.
<0.
50 Ae 22.
Ref .
63 Ae 2.
02 Ae 6.
Ref .
35 Ae 1.
Ref .
33 Ae 1.
Ref .
09 Ae 3.
Ref .
59 Ae 1.
Ref 64 Ae 2.
Ref .
52 Ae 2.
Ref .
32 Ae 7.
39 Ae 2.
Ref .
77 Ae 3.
75 Ae 4.
AOR: Adjusted Odd Ratio.
CI: Confidence Interval Juferdy Kurniawan DISCUSSION Characteristics of education in Indonesia were a little different from the result of Indonesia Education Statistics 2020.
National data suggested that 50.
9% of residents had completed secondary education, while only 5% had completed tertiary education .
12 In this study, we found that 34.
2% of HBV patients and 5% of HCV patients had completed tertiary education, which is higher than the data in the It might reflect that individuals person with higher education have more awareness and accessibility to healthcare service utilization and seek medical treatment than the population in 13 The discrepancy in education levels between the general population and the Hepatitis B (HBV) and Hepatitis C (HCV) patients in the study may influence the applicability of the results to the broader population.
In this study.
HBV and HCV patients with higher education levels are overrepresented compared to the general population due to the use of consecutive sampling techniques.
However, this study obtained the proportion of HBV patients with adequate knowledge of Hepatitis B was 72.
1%, while adequate knowledge of Hepatitis C in HCV patients was Dwiartama reported that the knowledge level among the HBV respondents in four cities in Indonesia was very high, with an average index level of knowledge was 86.
This variation might happened as a result of differences in geographical study locations.
Compared to other countries, the overall average scores of knowledge HBV patients in Indonesia were higher than Malaysia and Gambia .
/17 A 4 vs.
57/20 A 4.
4 in Malaysia, 11.
09/20 A
89 in the Gambi.
, but lower than Singapore and Canadian .
/17 A 4 vs.
4/14 A 0.
1 in Singapore, 10/14 in Canadia.
11,15,16,17 ThereAos no data of knowledge Hepatitis C in Indonesia.
this study, we found that patients with adequate knowledge were slightly low in Hepatitis C compared to Hepatitis B patients.
All the thought HCV patients in thibeingbeing s studying have a level of income comparable to HBV patients, however, there was a difference oof of the level of knowledge amfrom from ong these professionals Consultation with healthcare professionals Acta Med Indones-Indones J Intern Med as reliable sources was essential to provide knowledge about evidence-based Hepatitis B and Hepatitis C, especially in patients with newly diagnosed.
A study from Ul Haq18.
Pak A19.
Velvzhi G 20, and Gambhir R 21 reports a similar finding, which underscores the importance of implementing extensive health educational campaigns in a diverse research population, including the healthy population 18, medical students 19,20, and healthcare workers21 .
In this study, we found that HBV and HCV patients have good knowledge about etiology and the consequences of HBV and HCV Hepatitis, but less knowledge of transmission in items of sharing personal food equipment, coughing, and sneezing.
The common myths about HBV and HCV transmission such as mosquito bites, sharing toilets, and sharing cup was also observed among patients in Poland.
22 The myth of transmission in patients could be a barrier to social interaction because of fear of spreading the virus to others.
Public health education might have a role in preventing the myth of HBV and HCV transmission, especially in the general The differential attitudes towards HBV and HCV have significant impacts.
The result data showed differing attitudes between HBV and HCV patients, impacting their emotional well-being and social interactions.
While both express worry about transmission and health consequences.
HCV patients, on the other hand, display slightly more confidence in treatment Before the availability of DAA medication.
Enescu et al.
Aos23 study reported that more drop was seen in HCV patients than in HBV patients regarding psychiatric components.
However, this study found the opposite, which may be linked to the high effectiveness of DAA in treating hepatitis C patients.
24 Socially, both groups report difficulties in employment or education, with HBV patients experiencing slightly more challenges.
This is also consistent with a systematic review of Asian populations, which reported that up to 30% of patients with HBV experience workplace discrimination.
Our study revealed that education level, income level, and antiviral therapy were factors linked to contributing adequate knowledge in Vol 56 A Number 2 A April 2024 Factors associated with Hepatitis B and Hepatitis C among infected patients patients, while marital status was only found significant for contributing adequate knowledge in Hepatitis C patients.
Several studies support this result.
A study in Malaysia also reported that tertiary education level was a significant factor in the higher knowledge of patients.
HBV and HCV patients with higher degrees of education might have an easier understanding of information regarding their health status.
A study in Europe revealed that people with lower education and low socio-economic were vulnerable to having limited health literacy.
Ever received antiviral therapy in HBV and HCV patients also associated with higher knowledge of The possibility of duration consultation with doctors perhaps can be explained that the patients who have received antiviral therapy have better knowledge compared with not yet received anti-viral therapy.
27 Being single is associated with less knowledge of hepatitis C.
Ministry of Health Indonesia reported that the distribution of HCV is concentrated in injecting drug users (IDU), hemodialysis, and blood The prevalence of HCV among IDUs in Indonesia was reported high accounting for 8 % - 31.
28 The IDUs in Indonesia were relatively high in young adults with initiation of injecting occurring in age 15-34 years old.
It might explain why single patients have less knowledge of Hepatitis C.
The young adult likes to explore the risk behavior, including the use of IDUs.
Pre-marital screening and counseling for hepatitis might be important to get a person tested and informed about the transmission of Hepatitis B/C-related concerns was qualitative explored in this study.
This study demonstrates the perspective of patients toward life since being diagnosed with hepatitis.
Above 80% of subjects in this study have a fear of developing liver cancer, fear of transmitting the disease to other people, and fear that Hepatitis B will worsen and damage the liver.
These results are similar to the most common concern of patients related to fear and worries about having Hepatitis B in Australia.
31 HBV
and HCV patients, especially newly diagnosed patients might be shocked for the first time knowing diagnosed with hepatitis.
Counseling services from healthcare professionals were urgently needed to provide emotional support to this group of patients.
This service should be available to reduce the psychological stressor the first time diagnosed and the entire time during the treatment.
This study provides information that patients with HBV and HCV might have social implications.
About 30-50% of patients were unlike to talk about their hepatitis to others, kept thinking about their disease all the time, and seeing life differently after being diagnosed with That perspective could lead them to become self-isolated and avoid social life.
This study also revealed that 20 Ae 30% of HBV and HCV patients found it difficult to get a job or school as a consequence of social withdrawal due to having hepatitis.
Patients with HBV and HCV often face discrimination during the selection of students or employment.
32,33
Many companies in Indonesia have a trend to conduct HBsAg testing as a tool for selecting employees to be accepted, where a person with positive HBsAg is considered an unhealthy person to be employed.
Meanwhile the Labor laws from Director Labor number NO.
SE07/B MW/1997 already exists to guarantee the legal rights of hepatitis patients in Indonesia.
The companies should provide guidance and workplace programs for HBV and HCV workers rather than avoid them from working in their companies.
A person with Hepatitis B/C-related illness may have the ability to work and be productive as long as they are medically performed and fit to work.
The government has the responsibility to protect the HBV and HCV workers from stigma by giving education to the In this study, fears and anxiety were less found in increasing age and patients who have ever received antiviral therapy among Hepatitis B patients.
The increasing age might linger with obtaining information from medical treatment and already not worried about a job since they were already employed at a young age.
Among patients with Hepatitis C, the level of education was associated with less fear and anxiety.
Education might strengthen the knowledge.
The knowledgeable patients seem not to worry about their illness because they already know the Juferdy Kurniawan characteristics of the disease and how to prevent their illness for not getting worse by obtaining medical treatment.
CONCLUSION
Despite the relatively high prevalence of HBV and HCV in Indonesia, the knowledge and attitude of patients regarding HBV and HCV were quite low.
The myth of transmission and social discrimination against HBV and HCV also exists in Indonesia.
As a suggestion, the physician should have a package program to educate patients about the route of transmission and treatment, especially in patients with newly Counseling service is also needed to reduce anxiety and social implications related to HBV and HCV.
Discrimination about not hiring HBV and HCV patients to work is not following the Labor laws in Indonesia.
The government has implications to protect HBV and HCV workers from stigma by giving eduimplicationshe companto ies.
For non-modfollowingch such as marital status, education level, and income level take into account these socio-economic variables to ensure equitable access to healthcare and improve knowledge and attitudes towards HBV and HCV.
ACKNOWLEDGMENTS
The authors would like to thanks for patients and research assistant who contribute in this ABBREVIATIONS AOR: Adjusted Odds Ratio.
HBV: Hepatitis B Virus.
HCV: Hepatitis C Virus.
CI: Confidence Interval.
Ina ASL/PPHI: The Indonesian Association for the Study of the Liver
REFERENCES