RELATIONSHIP BETWEEN PARENT'S MOTIVATION AND COMPLIANCE IN GIVING ANTI-VIRUS MEDICINES TO HIV PATIENTS

2022 ABSTRACT HIV attacks the sufferer's immune system and if coupled with prolonged psychosocial spiritual stress will accelerate the occurrence of AIDS, and even increase the mortality rate. AIDS is incurable. Giving ARV is to suppress the amount of virus (viral load). The purpose of the study was to motivate parents with parental compliance in giving their children anti-HIV drugs. This research is a quantitative method with used purposive sampling, cross sectional technique, 41 respondents were parents or caregivers of children with HIV patients who were taking ARV treatment. The results showed that the level of motivation of parents or caregivers in giving ARV drugs was sufficient 60.98% and Parental Compliance with HIV Drugs was compliant with 73.17%. Based on the Spearman Rank statistical test, the correlation value (r) is 0.372 and the p value is 0.017. P value < (0.05. It is hoped that the officers will improve the provision of health education about treatment and the impact of stopping treatment for patients with the method of giving leaflets to each respondent who comes to take medication so that it can be spread evenly.


INTRODUCTION
World Health Organization (WHO) data is known that as many as 35 million people in the world by the end of in 2015 was exposed to Human Immunodeficiency Virus/Acquired Immuno Deficiency Syndrome (HIV/AIDS), in the same year as many as 2.1 million people infected and 1.5 million die because of HIV /AIDS (Lee & Tashev, 2015) . Projection reason Dead world population by 2030, general Dead consequence disease infectious the more decreased, but Dead because HIV/AIDS continues increase.
AIDS cases in East Java are about 8935 cases of the total cases in Indonesia. Trend highest cases of HIV and AIDS from year 2017 to with 2019 still same, that is part big on the island Java. Data from the Directorate General of P2P (System Information on HIV/AIDS and STIs (SIHA), Report year 2019.
Factors risk HIV/AIDS transmission is very much, but the most important is factor behavior parenteral sex and history disease. Evaluation the known as quality live and recommended as reflection how sufferer the respond something the disease or action medical based on the conditions experienced sufferer (Rachmawati, Al Shaal, Müller, & Keck, 2013).
By physiology of HIV attack system immunity body the sufferer and if added with prolonged psychosocial spiritual stress will speed up occurrence of AIDS, even increase number death. AIDS really is no can healed. Destination main ARV administration is for push the number of viruses (viral load), so that will improve immune status HIV patients and reduce Dead consequence infection opportunistic. And when this combination antiretroviral (ARV) treatment is treatmenttherapy best for patient infected with HIV. So age hope People living with HIV/AIDS (PLWHA) can be extended with ARV (antiretroviral) treatment. Treatment this could increase immunity the body of PLWHA so that quality his life also increased (Rachmawati, 2013). Disobedient against ARV is not only problem medical, but also influenced by social culture public local. When approach social and approach medical conducted together, then the emphasis no only on social processes happening something disease and illness, but also on interventions within structure social and cultural for prevent or even treat disease the (Aryastami, Handayani, & Yuniar, 2013) .
Giving ARV therapy is necessary consider various factor from aspect knowledge, ability, ability treatment period length, resistance medicine, effect side, reach get medicine, as well right time for start therapy. Someone who has perceived susceptibility (perceived vulnerability), meaning that perception individual about possibility caught something disease will influence behavior they specifically for do prevention or look for treatment. (Fibriana, 2013) .
According to study Wardani, et al (2017) PLWHA who get antiretroviral therapy and demonstrated enhancement CD4 value indicates therapy carried out successful. Obedient PLWHA undergo antiretroviral therapy with good for 13-24 months could experience enhancement CD4 count. Compliance level antiretroviral therapy is a the most dominant variable in influence success therapy (Azzahra, 2019).
Data obtained from record medical hospital dr. Saiful Anwar Malang that for Patients suffering from HIV /AIDS in children in 2020 were 89 patients. In studies preliminaries carried out in the month of December 2020 to February 2021, data obtained from record medical that there were 46 patients suffering from HIV /AIDS who were in control to Polyclinic child. From result, observation preliminaries conducted on ten patients who will conduct treatment obtained data that 8 patients obey drink ARV drugs, while 2 people did not obey in drink ARV drugs. Where is a number of late child for control and drink drugs that does not routine due to working parents or busyness other. By detailed the patient who do not obey to drink the first ARV drug that is patient no control for 6 months because her mother give birth to again. Besides, reason covid 19 pandemic so afraid for control to the hospital while second patient that is patient no control because his father die and stay with her grandmother so that no someone delivered to the hospital. Because of that, the treatment for second child must repeat from beginning again.
Children who suffer from HIV/AIDS are of course very dependent to parents and caregivers. Parents ' motivation and support or family is needed by children that. Like our know parents or family from HIV children also have each one is busy work or busyness House ladder other. Therefore, that parents or family needs knowing how motivation and support in obedience give drug to HIV children.
Based on Thing the on so in effort for reduce percentage the amount of loss to follow-up researchers need do study with title: "Relationship" Among Parents' motivation with parental obedience in give drug anti Virus pediatric HIV patients at the Children's Polyclinic RSUD dr. Saiful Anwar Malang". Destination from research this that is Knowing Connection Among parents motivation with parental obedience in give drug anti-viral HIV for children At the Children's Polyclinic, RSUD dr. Saiful Anwar Malang.

METHOD RESEARCH
Method research that has been used in study this that is descriptive analytic with cross sectional design. The cross sectional research is research that emphasizes time variable data measurement independent and variable dependent only one time at one moment or study this conducted without existence treatment to respondents and research this aim for learn there is whether or not something connection Among parents motivation with parental obedience give HIV drugs at the Children's Polyclinic, RSUD Dr. Saiful Anwar. Population in study this is all parents or companion living patient together with patient child with HIV disease at the Children's Poly Hospital, dr. Saiful Anwar Malang in the month July until with August 2021 is 45.
Sample study this is all parents or companion patient Children's HIV disease at the Children's Poly Hospital, dr. Saiful Anwar Malang who entered criteria inclusion and within 1 month that is month January 2022 as many as 45. Sample in study this determined with use formula Slovin. Taking Sample with Purposive sampling method. Test used is a statistical test analysis Sparman Row Test different this is a non -paremetric test used for analyze legal or not difference the average value of two group mutual samples in pairs.

Research result
Research results served Becomes three part that is description general the place research, general data, and special data. General data will serve characteristics respondents who include age, type gender. Special data containing about parents motivation with parental obedience give HIV drugs at the Children's Polyclinic, RSUD Dr. Saiful Anwar Malang. Study this carried out at the Children's Polyclinic RSUD dr. Saiful Anwar Malang in the month January 2022 with total sample study as many as 41 people. Data obtained will serve in form table. Characteristics respondent in study this collected for knowing description the respondent used as subject research. Characteristics respondent shown in Table 1. Characteristics respondent based on age almost from half respondents (31.71 %) aged 41-50 years. Type gender, it was found that the data more from half respondents (58.54%) type sex woman 24 people Criteria the motivation of parents to give HIV drugs at the Children's Polyclinic, RSUD Dr. Saiful Anwar Malang g presented in Table 2. Source: Primary data Research results show more from part big respondent that is as many as 25 respondents (60.98%) have motivation give adequate HIV drugs in children. Grouping data criteria parental compliance in giving HIV drugs at the Children's Polyclinic, RSUD Dr. Saiful Anwar Malang presented in Table 3.

Tabulation cross
Result data motivation of parents with parental compliance in giving HIV drugs at the Children's Polyclinic, RSUD Dr. Saiful Anwar Malang presented in Table 4. commitment someone. This thing including the factors that cause, channel, and sustain Act in demand man in direction determination certain (Efendi, 2008). Research results show more from part big respondent that is as many as 25 respondents (60.98%) have motivation give adequate HIV drugs in children. Study this in line with Puspitasari (2016) level motivation respondent in drink ARV drugs. Majority Mother with HIV has level low motivation and sufficient in drink ARV drugs. High level of motivation tends little.
Research results this gap with results research by Amico et al. (2017) in Mississippi, on 150 people living with HIV. Amico's research results show that information have influence although no live by significant to obedience drink medication to the patient with HIV. Amico explains on his research that get enough information about this ARV therapy no take effect big to height obedience drink medicine for PLWHA, however effect on skills behave in the PLWHA, which skills? behave by live take effect to level obedience treatment for PLWHA. Research results Hovarth (2014) also points out that for make patient obey in drink ARV drugs then PLWHA must have relevant information, skills good behavior and sufficient motivation.
Motivation intrinsic is motivation that comes from in self someone. Motivation this sometimes appear without influence whatever from outside. Usually motivated people by intrinsic more easy pushed for take action. Motivation extrinsic is the opposite motivation intrinsic, that is motivation that appears because influence environment outside. Motivation this use trigger for make somebody motivated. Motivation in self-respondent that alone influenced by various factor that is education and knowledge, the more tall level education Somebody so will the more high level _ motivation. As well as knowledge, more tall level knowledge somebody eat will the more high level motivation somebody in carry out treatment programs and drink drug so that will the more obey in carry out treatment. Besides that, research from Adiatma & Aris (2013) also explains that motivation somebody influenced by internal factors and factors external. Internal factors are originating factorfrom in self patient that self and factor external is originating factor _ from outside individual that itself which includes family, friends, environment and staff health. Whereas according to Widyaningrum, (2017) internal factors that influence motivation covers covers desire from in self alone, knowledge individual, level education, management self and age. Whereas factor external that is factor economy, religion, factors supporter family and caregivers.
According to opinion researcher, factor intrinsic and extrinsic greatly affect parents motivation in give drug anti-HIV patient children at the Children's Clinic RSUD dr. Saiful Anwar Malang. The factor in question is about existence parents wish condition child Becomes more good with drink drug by regularly. Besides that, part big respondent 31-50 years old where are they still have a desire know big, enough spirit tall for study about illness suffered child so that will increase parental knowledge.
Compliance is the behavioral action of a person who receives treatment, follows a diet, and carries out a lifestyle in accordance with the recommendations of health care providers (Avelina, 2021). Another theory states that medication adherence is a behavior in completing swallowing drugs according to the recommended schedule and dosage of drugs according to the specified category, complete if treatment is on time, and incomplete if not on time.
The results of this study support Fisher's theory, namely the IMB Model of ART Adherence (2017). Where motivation affects the level of adherence to taking medication in PLWHA either directly or indirectly. Motivation includes attitudes/beliefs about the impact of compliance and noncompliance behavior and evaluation of the results of these behaviors as well as perceptions of support from others to comply with taking medication and motivation to meet the expectations of others. Motivation is needed in carrying out ARV therapy adherence, without motivation ARV therapy cannot be continued. Meanwhile, Puspitasari (2016) states that compliance is the level of a person in implementing an internal rule and recommended behavior. Compliance is the level of a person in carrying out the care, treatment and behavior recommended by nurses, doctors or other health workers. Compliance (compliance or adherence) describes the extent to which the patient behaves to carry out the rules in treatment and behavior suggested by health workers.
According to Lawrence Green's theory of Preced-Proced behavior in (Wulandari & Laksito, 2015) Based on a person's actions that influence behavior related to medication adherence, it is influenced by 3 factors, namely: Predisposing factors, factors that precede a person's behavior that will encourage behavior, namely knowledge, attitudes, beliefs, beliefs, values and perceptions that encourage a person or groups to take action, supporting or enabling factors, factors that motivate individuals or groups to take action in the form of a physical environment, availability of health facilities and facilities, ease of reaching health facilities, service time, and ease of transportation, reinforcing factors (reinforce factors), including attitudes and support from family, friends, teachers, health care providers, leaders and decision makers.
The highest 3rd compliance score in the first question is, "my child always takes ARV according to the dose recommended by the doctor/nurse/volunteer", "my child usually wears a clock or cellphone that contains an alarm that can be set to sound every time he takes medicine" and "Because he is used to taking ARVs, my child has memorized the frequency of taking drugs every day". Amanda (2020), stated that HIV medicines must be taken for life regularly, continuously, and on time. Some important tips for taking medicine are taking medicine at the same time every day, medicine must always be available wherever the patient is usually located, for example at the office, at home, and other places, taking medicine wherever he goes (pockets, bags, etc.), using equipment (clock, cell phone that contains an alarm that can be set to sound every time you take medicine) to remind you when to take medicine.
According to the researcher's opinion, parental adherence to drinking is obedient in giving anti-viral drugs to children with HIV at the Children's Clinic, RSUD dr. Saiful Anwar Malang is very high, because there is hope about the expectations of parents so that their children have better conditions. This is also evidenced by the results of research showing the habits of parents such as the dosage and frequency as well as the regular hours of taking medication. From the results of this study, it was found that one of the respondents had good motivation, but the level of compliance was less than obedient. This is because both of the patient's parents died of HIV/AIDS, so the patient is being cared for by his elderly grandmother. The grandmother of the patient hopes that her grandson can be cured. However, this patient is very difficult to take medicine because he does not feel sick. So the researchers concluded that the patient should be informed about the condition of the disease slowly and adjusted to the age and psychology of the child.
The results showed that from 25 respondents who had sufficient motivation, 60% (15 people) were obedient in giving drugs and the remaining 10 people were not compliant in giving drugs. Of the 16 respondents who have good motivation, as many as 15 people are obedient in that it can be concluded that there is a relationship between parental motivation and parental adherence to HIV medication at the Children's Polyclinic, RSUD Dr. Saiful Anwar Malang. The level of closeness of parents' motivation with parental compliance in giving HIV drugs at the Children's Polyclinic, RSUD Dr. Saiful Anwar Malang by 37.2% is positive with weak strength. The higher the motivation of parents, the higher the compliance of parents in giving HIV drugs at the Children's Polyclinic, RSUD Dr. Saiful Anwar Malang.
The results of this study are in line with Indiyah's research (2018), showing that of the 31 respondents, 18 respondents (58.1%) had strong motivation, all were obedient in taking TB medicine, 8 respondents (25.8%) had moderate motivation, all were obedient in taking TB medicine.
taking TB medicine and from 5 respondents (16.1%) whose motivation is weak, 1 respondent (3%) is obedient in taking TB medicine, while 4 respondents (12.9%) are not compliant in taking TB medicine. The results of the Spearman Rho test showed that the correlation coefficient = 0.632, p = 0.000, there was a relationship between motivation and medication adherence in TB patients at Ngujung Health Center, Maospati District, Magetan Regency.
HIV/AIDS causes multiple crises simultaneously, causing a health crisis, a development crisis. In other words, HIV/AIDS causes a multidimensional crisis. As a health crisis, AIDS requires a response from the community and requires treatment and care services for infected individuals (Munir, Elahi, Ayub, Frezza, & Rizzi, 2019) . Children are small humans who still need other people in terms of parents. Parents here have an important role in responsibilities to their children. Children with HIV must comply with taking ARV drugs. Children's compliance in consuming can not be separated from the role of parents.
Patient adherence to the treatment program is strongly influenced by self-motivation and self-awareness to comply with the treatment rules. Individual motivation to want to maintain their health is very influential on factors related to the behavior of patients in controlling their disease (Arunkumar et al., 2019) .
If you take medication regularly, the virus cannot reproduce itself. Both the "normal" virus and both are suppressed because the combination of the 3 drugs continuously reaches a very strong suppression level in the blood. Therefore it is very important to swallow the medicine regularly and on time to be effective. If we do not take the medicine on time, the concentration of the drug in our body will decrease. If the consistency of the drug in our body decreases, the effect of controlling the virus will be less good. The HIV virus can defend itself against drugs at low concentrations, but not at concentrations high enough to inhibit viral replication. Therefore, we must guarantee the level of the drug by taking the drug properly (Astuti & Amanda, 2020) .
The motivation of parents living with HIV in their children is influenced by two things, namely from within the child with HIV himself, with the encouragement, desire to seek treatment or do something better and support from family, community and health workers in handling cases of the child's HIV disease through health education, providing support, encouragement in accordance with the expected goals. Motivation is said to be good when a person is able to control himself towards good things. To increase motivation, it is necessary to provide counseling about diseases and the dangers of these diseases to threats to human life (Sasongko et al., 2017) . In addition, based on the questionnaire, it explains the motivating factor of parents' motivation is the desire for a better child's condition. The desire for a better condition for children is the main desire of every parent, humans work to be able to eat and eat can continue their life.
According to researchers with strong motivation, a person has positive expectations, high expectations and high confidence in carrying out activities related to the problems faced, in this case the problem of HIV disease treatment.

CONCLUSION
Based on discussion and results study connection Among parents motivation with parental obedience give HIV drugs at the Children's Polyclinic, RSUD Dr. Saiful Anwar Malang, get concluded that results of research show more from part big respondent that is as many as 25 respondents (60.98%) have motivation give adequate HIV drugs in children. Research results show part big that is 30 respondents (73.17 %) complied in give HIV drugs. Correlation test obtained P value of 0.017< (0.05), which means H1 is accepted so that could concluded there is connection Among parents motivation with parental obedience give HIV drugs at the Children's Polyclinic, RSUD Dr. Saiful Anwar Malang is significant. Closeness level parent's motivation with parental obedience give HIV drugs at the Children's Polyclinic, RSUD Dr. Saiful Anwar Malang by 37.2% is positive with strength weak. The more tall parents motivation so the more tall parental obedience give HIV drugs at the Children's Polyclinic, RSUD Dr. Saiful Anwar Malang.