himpunan riset covid19

*A total of 64 patients who did not provide clear informed consent regarding follow-up were excluded. Comparisons are of each
trial drug with concurrent assignment to the same treatment without it. Because the control groups overlap, the total number
(11,266) is less than the sum of the numbers in the pairwise comparisons. The few patients (always <0.4%) with a particular
characteristic not yet known were merged with the largest category of that characteristic: 33 were merged with male sex, 40
were merged with an age of 50 to 69, and 45 were merged with previous days in the hospital of 2 or more. Interferon
randomization was interferon plus lopinavir as compared with lopinavir until July 4, 2020, then it was interferon as compared
with the local standard of care. Shown are any in-hospital deaths, regardless of whether they occurred before or after day 28
(total, 1253 deaths). Shown is the Kaplan–Meier 28-day risk of in-hospital death, expressed as a percentage (overall value,
11.8%). Percentages may not total 100 because of rounding. Countries in Europe were Albania, Austria, Belgium, Finland,
France, Ireland, Italy, Lithuania, Luxembourg, North Macedonia, Norway, Spain, and Switzerland. Countries included
Argentina, Brazil, Colombia, Honduras, and Peru.
** Countries included Egypt, India, Indonesia, Iran, Kuwait, Lebanon, Malaysia, Pakistan, the Philippines, Saudi Arabia, and
South Africa. Percentage of patients (rather than number of patients) is shown for this variable. Adherence was calculated
only among patients who died or were discharged alive and was defined as the percentage of patients who were taking the trial
drug midway through its scheduled duration (or midway through the time from entry to death or discharge, if this was shorter).

Figure 2. Effects of Remdesivir, Hydroxychloroquine, Lopinavir, and Interferon on In-Hospital Mortality.
Shown are Kaplan–Meier graphs of in hospital mortality at any time (the primary outcome), comparing each treatment with
its control without standardization for any initial patient characteristics. Insets show the same data on an expanded y axis.
The rate ratios for death were standardized for age and for ventilation status at entry. Denominators for the few events on
day 0, but not thereafter, include patients with no follow up. Numbers of deaths are by week, and then deaths after day 28.
CI denotes confidence interval.

Figure 3. Rate Ratios for In-Hospital Death, Subdivided by Age and Respiratory Support at Trial Entry.
Analyses in subgroups of age are stratified according to respiratory status at trial entry and vice versa, so each total is
stratified for both factors. The percentages show Kaplan–Meier 28-day mortality. O − E denotes the observed minus
expected number of deaths in patients assigned to active treatment. Diamonds show 95% confidence intervals for treatment
effects. Squares and horizontal lines show treat- ment effects in particular subgroups and their 99% confidence intervals,
with an arrow if the upper 99% confidence limit is outside the range shown. The area of each square is proportional to the
variance of O − E in the subgroup it describes.

status; Figure 3 shows the stratified rate ratios patients receiving lopinavir and in 146 of 1372
ac- cording to age and according to ventilation receiving its control (rate ratio, 1.00; 95% CI,
status. No trial drug had any definite effect on 0.79 to 1.25; P= 0.97), and in 243 of 2050
mortality, either overall (each P>0.10) or in any patients receiving interferon and in 216 of 2050
subgroup defined according to age, ventilation receiving its control (rate ratio, 1.16; 95% CI,
status at entry, other entry characteristics, 0.96 to 1.39; P = 0.11). Unstratified comparisons
geographic region, or glucocorticoid use (Figs. yielded similarly null findings (Fig. 2), as did
S6 through S9). analyses that excluded patients receiving
Death occurred in 301 of 2743 patients receiving glucocorticoids and multivariable sensitivity
remdesivir and in 303 of 2708 receiving its analyses that estimated trial drug effects
control (rate ratio, 0.95; 95% confidence interval simultaneously (Table S3). If mechanical
[CI], 0.81 to 1.11; P = 0.50), in 104 of 947 ventilation prevented oral administration of
patients receiving hydroxychloroquine and in 84 lopinavir or other trial drugs, then this could have
of 906 receiving its control (rate ratio, 1.19; 95% reduced any effects on mortality of assignment
CI, 0.89 to 1.59; P = 0.23), in 148 of 1399 to those drugs, but prespecified analyses of

mortality among patients not already receiving 3). The analyses also (in Figs. S1 through S9)
ventilation at entry also indicated no definite subdivide 28 day mortality graphs according to
protective effect of any trial drug (Fig. 3). ventilation status at entry and give subgroup
analyses of rate ratios for death according to
Secondary Outcomes other characteristics and according to
The prespecified secondary outcomes were glucocorticoid use (with no noteworthy subgroup
ventilation and time to discharge. No trial drug specific or geographic variation).
reduced the initiation of ventilation among All active treatment ended within 14 days, and
patients not already receiving ventilation. the numbers of deaths during this 14-day period
Ventilation was initiated after randomization in with any cardiac cause mentioned on the
295 patients receiving remdesivir and in 284 electronic death record were seven with
receiving its control, in 75 patients receiving remdesivir and eight with its control, four with
hydroxychloroquine and in 66 receiving its hydroxychloroquine and two with its control, six
control, in 126 patients receiving lopinavir and in with lopinavir and three with its control, and six
121 receiving its control, and in 209 patients with interferon and eight with its control (Fig.
receiving interferon and in 210 receiving its S18). Many deaths from Covid-19 involve
control (Table S1). Figure S10 shows the results multiorgan failure, but no death in a patient
for the combined outcome of in hospital death or assigned to a trial drug was attributed
ventilation initiation. specifically by the doctor reporting the death to
In this open label trial, patients who would be renal or hepatic disease.
considered fit for discharge might be kept in the
hospital somewhat longer just because they Meta-Analyses
were being given a trial drug, but information on There are four trials that have compared remde
time to recovery can be obtained by comparing sivir with control: the Solidarity trial (604 deaths
the effects of different drugs on time to in 5451 randomly assigned patients), the
discharge. Each of the three trial treatments that Adaptive Covid-19 Treatment Trial (ACTT-1)
were scheduled to last more than 7 days (136 deaths in 1062 patients; mortality was a
increased the percentage of patients remaining secondary outcome), and two smaller trials (41
in the hospital at day 7 (Table 1). If one of these deaths).6-9 Figure 4 shows the mortality results
three drugs had appreciably accelerated from each trial, stratified according to initial
recovery, then the sizes of these effects should respiratory support. Within each trial, summation
have differed, but they did not. Figures S11 of the observed minus expected numbers of
through S16 plot time to discharge for all deaths with remdesivir in each stratum led to the
patients, those receiving supplemental oxygen, stratified rate ratio for death in that trial.
those not receiving supplemental oxy- gen, Summation of these trial specific observed
those receiving ventilation, those not receiving minus expected subtotals then led to an
ventilation, and those receiving any respiratory appropriately weighted average of the results
support. Each drug delayed discharge by from all trials, which yielded a rate ratio for death
approximately 1 to 3 days while it was being (remdesivir vs. control) of 0.91 (95% CI, 0.79 to
given. Directly randomized comparisons of one 1.05).5 Figures S19 and S20 show the mortality
trial drug with another (Fig. S17) likewise results in the trials of hydroxychloroquine (rate
showed no appreciable differences in discharge ratio, 1.09; 95% CI, 0.98 to 1.21) and
rates while both drug regimens continued or of lopinavir (rate ratio, 1.01; 95% CI, 0.91 to
after both had ended. The supplementary 1.13).
analyses (Tables S2 and S3) tabulate co-
medication (only small absolute differences were DISCUSSION
found between each trial drug and its control) The main outcomes of mortality, initiation of
and provide a multivariable Cox regression ventilation, and hospitalization duration were not
fitting all four treatment effects simultaneously definitely reduced by any trial drug, either overall
(rate ratios for death were similar to those in Fig. or in any particular subgroup. The findings for

mortality and for initiation of ventilation cannot age, or use of ventilation at entry. No trial drug
have been appreciably biased by the open label reduced the initiation of mechanical ventilation.
design without placebos, or by variation in local The similarity of this null effect for all four drugs
care or patient characteristics, and were little is further evidence that none has any material
affected when homogeneity was increased by effect on major disease progression, a
stratification according to geographic region, conclusion

Figure 4. Meta-Analysis of Mortality in Trials of Random Assignment of Remdesivir or Its Control to Hospitalized Patients
with Covid-19
Percentages show Kaplan–Meier 28day mortality. Values for observed minus expected number of deaths (O − E) are log-
rank O − E for the Solidarity trial, O − E from 2-by-2 tables for the Wuhan7 and international8 trials, and w.loge hazard ratio
for each stratum in the Adaptive Covid-19 Treatment Trial (ACTT-1)6 (with the weight w being the inverse of the variance of
the loge hazard ratio, which was calculated from the confidence interval of the hazard ratio). Rate ratios were calculated by
taking the loge rate ratio to be (O − E)/V with a Normal distribution and variance 1/V. Subtotals or totals of (O − E) and of V
yield inverse-variance–weighted averages of the loge rate ratios. For balance, controls in the 2:1 trials were counted twice in
the control totals and subtotals. Diamonds show 95% confidence intervals for treatment effects. Squares and horizontal lines
show treatment effects in particular subgroups and their 99% confidence intervals, with an arrow if the upper 99%
confidence limit is outside the range shown. The area of each square is proportional to the variance of O − E in the
subgroup it describes.

supported by analyses of the combined outcome hospital merely to continue their trial treatment.
of death or ventilation initiation. In all patients and in those not receiving
Although assignment to any of the active trial ventilation, assignment to each active trial drug
treatments in this open label trial somewhat increased the time to discharge by
delayed discharge from the hospital, this could approximately 1 to 3 days while treatment
have been because some recovered patients continued. Because no treatment had much
otherwise fit for discharge were kept in the effect on death or progression to ventilation, the

similarity of these four moderate delays of of a small fraction of all deaths, but it is also
discharge suggests that none of the four compatible with prevention of no deaths.
treatments had a pharmacologic effect that Statistical uncertainties are magnified if at-
substantially reduced time to recovery (i.e., tention is restricted to particular subgroups or
fitness for discharge). In particular, it suggests at time periods.10 If remdesivir has no effect on
most only a small effect of remdesivir on time to mortality, then chance could well produce some-
recovery, a conclusion supported by the directly what favorable findings in a subgroup of the
randomized comparisons between remdesivir results for all trials or striking findings in a
and the other three trial drugs. selected subgroup of a particular trial (as in the
ACTT-1, which examined remdesivir, was unplanned subgroup of ACTT-1 in which the rate
placebo controlled,6 which avoids any bias in ratio for death was 0.30) (Fig. 4). Although both
time to discharge. In that trial, however, the the Solidarity trial and ACTT-1 envisaged sepa-
proportion of lower-risk patients (i.e., those not rate analyses involving lower-risk and higher-
already receiving high flow oxygen or ventilation) risk patients, they did not define how this sub-
happened to be appreciably greater in the division would apply to mortality analyses. The
remdesivir group than in the placebo group. This ACTT-1 protocol prespecified separate analyses
chance imbalance might account for some of the of time to recovery among those with mild-to-
differences in time to recovery between ACTT-1 moderate disease not receiving supplemental
and the Solidarity trial. oxygen, as did the recent Food and Drug Admin-
The chief aim of the Solidarity trial was to help istration reanalyses,11 which categorized
determine whether any of four repurposed anyone receiving even low-flow supplemental
antivirals could at least moderately affect in oxygen as having severe disease. This
hospital mortality. Its results should be subdivision, however, leaves few deaths in the
considered in the context of the evidence on no-supplemental-oxygen category (death in 3 of
mortality from all trials, but for remdesivir and for 75 patients with remde- sivir and in 3 of 63 with
interferon it provides more than three fourths of placebo in ACTT-1, in 11 of 661 patients with
that evidence (Fig. 4). Stratification of the remdesivir and in 13 of 664 with its control in the
findings according to initial respiratory support Solidarity trial, and in 5 of 384 patients with
again facilitates allowance for the remdesivir remdesivir and in 4 of 200 with the standard of
group in ACTT-1 having, by chance, started with care in an international trial with a 2:1
a greater proportion of low-risk patients and a randomization ratio8).
smaller proportion of high-risk patients than the To augment these small numbers of deaths, the
placebo group. The stratified rate ratios for subtotals in Figure 4 include low flow oxygen
death in the Solidarity trial and ACTT-1 are with no supplemental oxygen, which yields a
compatible with each other, and either singly or large lower-risk subgroup and a small higher-
together they are compatible with there being risk subgroup. With this nonprespecified sub
little or no effect of remdesivir on mortality. grouping, there appears to be an absolute
With an appropriately weighted average of the reduction of approximately 1 to 2 percentage
stratified results from each of the four trials,5 the points in mortality among lower-risk inpatients
rate ratio for death with remdesivir as com- and an absolute increase of approximately 5 to 6
pared with control was 0.91 (95% CI, 0.79 to percent age points among higher-risk inpatients.
1.05). Interpretation of this should chiefly reflect These absolute differences in the meta-analysis
not the P value (P= 0.20) or point estimate (rate of all four trials are similar to the absolute
ratio, 0.91) but the confidence interval (0.79 to differences seen when the Solidarity trial is
1.05), which shows the range of rate ratios for subdivided according to ventilation status at
death that are compatible with the weighted entry. Neither subgroup should, however, be
average of the findings from all trials. This does considered in isolation from the other or from the
not sup- port the suggestion that remdesivir can confidence interval for overall mortality.
prevent a substantial fraction of all deaths. The For hydroxychloroquine and lopinavir, the
confidence interval is compatible with prevention Solidarity trial showed no definite effect on

mortality in any subgroup. The only other (95% CI, 0.83 to 1.51) without lopinavir co-
substantial trial is the Randomized Evaluation of administration; these findings suggest no
Covid-19 Therapy (RECOVERY) trial,12,13 mortality reduction. Subcutaneous and
which for these two drugs was larger than the intravenous interferon have different
Solidarity trial and also showed no benefit. pharmacokinetic characteristics,18,19 and
Combination of both trials reinforces these null glucocorticoids could affect interferon
findings (Figs. S19 and S20). signaling,20,21 but the clinical relevance of both
For hydroxychloroquine, the joint rate ratio for issues is unclear. Most interferon was
death (combining the Solidarity and RECOVERY administered subcutaneously, because
trials) was 1.10 (95% CI, 0.98 to 1.23), with no intravenous interferon was used only in patients
apparent benefit whether the patient was receiving high flow oxygen or ventilation, and
receiving ventilation or not. This confidence distribution of it began only in late May, just
interval rules out any material benefit from this before strong evidence emerged of
hydroxyl chloroquine regimen in hospitalized glucocorticoid efficacy in such patients.22,23
patients with Covid-19. It is compatible with Hence, few patients received intravenous
some adverse effect but is not good evidence for interferon without a glucocorticoid.
any adverse effect and is not a safety signal. Approximately half the patients who were
Despite concerns that the loading dose could be assigned to interferon (and half their controls)
temporarily cardio toxic,4 in neither trial was received glucocorticoids, but the rate ratio for
there any excess mortality during the first few death with interferon as compared with its
days, and cardiac deaths were too few to be control seemed unaffected by glucocorticoid
reliably informative. A recent meta analysis use. Randomization to interferon was
identified 15 small, randomized trials with discontinued on October 16, but other trials
nonzero mortality14; combining all 17 continue. A report that nebulized interferon beta
hydroxychloroquine trials yields a rate ratio of 1a might be effective involved only
1.09 (95% CI, 0.98 to 1.21), which still rules out approximately 100 pa- tients with Covid-19
any material benefit. For lopinavir, which was (ClinicalTrials.gov number, NCT04385095), but
always administered with ritonavir, the joint rate the ongoing placebo controlled ACTT-3 of
ratio for death (combining the Solidarity and subcutaneous interferon beta 1a aims to involve
RECOVERY trials and the only informative 1000 patients (NCT04492475), with examination
smaller trial15) was 1.01 (95% CI, 0.91 to 1.13). of time to recovery.
Although lopinavir tablets could not be For each of these four repurposed nonspecific
swallowed by patients receiving ventilation, antivirals, several thousand patients have now
there was no apparent benefit in analyses that undergone randomization in various trials. The
involved only those not already receiving unpromising overall findings from the regimens
ventilation at entry. This confidence interval sug- tested suffice to refute early hopes, based on
gests no material effect on mortality and rules smaller or nonrandomized studies, that any of
out a 10% proportional reduction. An add on these regimens will substantially reduce
study within the Solidarity trial, Discovery, inpatient mortality, the initiation of mechanical
recorded many clinical variables and identified ventilation, or hospitalization duration. Narrower
an unexpected increase in the creatinine level confidence intervals would be helpful
(perhaps because blood lopinavir levels are (particularly for remdesivir), but the main need is
higher than in patients with human for better treatments. The Solidarity trial has
immunodeficiency virus infection receiving been recruiting approximately 2000 patients per
similar doses16,17), but the Solidarity and month, and efficient factorial designs may allow
RECOVERY trials recorded no specifically renal it to assess further treatments, such as immune
or hepatic deaths with lopinavir. For interferon modulators or anti SARS-Cov-2 monoclonal
beta-1a, no other large trials exist. With 4000 antibodies.
patients, the rate ratio for death in the Solidarity
trial was 1.16 (95% CI, 0.96 to 1.39), or 1.12

Manuscript preparation, revision, and submission were controlled by the World Health Organization (WHO) trial team and
writing committee. Any views expressed are those of the writing committee, not necessarily of the WHO. No funder or donor
unduly influenced analyses, manuscript preparation, or submission; their comments merely clarified methods, not changing
analyses or conclusions. Donors of trial drugs were shown the main results for their drug in the last week of September.
Supported by the World Health Organization. Other grants are listed in the Supplementary Appendix. Disclosure forms
provided by the authors are available with the full text of this article at NEJM.org. A data sharing statement provided by the
authors is available with the full text of this article at NEJM.org.
We thank the thousands of patients and their families who participated in this trial and the hundreds of medical staff who
randomly assigned and cared for them. The Ministries of Health of participating member states and national institutions
provided critical support in trial implementation. Derk Arts of Castor EDC donated and managed Castor’s cloud based
clinical data capture and management system, with blinding to trial findings. Anonymized data handling or analysis was
performed at the Universities of Bern, Bristol, and Oxford. Nicholas J. White and colleagues provided unpublished data on
the pharmacokinetic characteristics of hydroxychloroquine to help the WHO select the regimen, the members of the
Discovery data and safety monitoring committee shared clinical variables, the investigators of the Randomized Evaluation of
Covid-19 Therapy (RECOVERY) trial shared log-rank statistics, the investigators of the Adaptive Covid-19 Treatment Trial
(ACTT-1) shared subgroup hazard ratios, and Bin Cao shared details of the Wuhan trial. Collaborators, committee
members, data analysts, and data management systems charged no costs

REFERENCES overview of the randomised trials. Lancet

1. World Health Organization. A coordinated 2005;365:1687-717.

global research roadmap: 2019 novel 6. Beigel JH, Tomashek KM, Dodd LE, et al.

coronavirus. March 2020 Remdesivir for the treatment of Covid-19 —

(https://www.who.int/blueprint/priority- final report. N Engl J Med 2020;383:1813-26.

diseases/keyaction/Coronavirus_Roadmap_ 7. Wang Y, Zhang D, Du G, et al. Remdesivir in

V9.pdf?ua=1). adults with severe Covid-19: a randomised,

2. World Health Organization. R&D blueprint double blind, placebo controlled, multicentre

and Covid-19 trial. Lancet 2020; 395:1569-78.

(https://www.who.int/teams/blueprint/covid- 8. Spinner CD, Gottlieb RL, Criner GJ, et al.

19). Effect of remdesivir vs standard care on

3. World Health Organization. An international clinical status at 11 days in patients with

randomised trial of additional treatments for moderate Covid-19: a randomized clinical

Covid-19 in hospitalised patients who are all trial. JAMA 2020;324:1048-57.

receiving the local standard of care 9. Goldman JD, Lye DCB, Hui DS, et al.

(https://www.who.int/publications/m/item/an- Remdesivir for 5 or 10 days in patients with

international-randomised-trial-of-additional- severe Covid-19. N Engl J Med 2020;

treatments-for-covid-19-in-hospitalised- 383:1827-37.

patients-who-are-all-receiving-the-local- 10.Peto R. Current misconception 3: that

standard-of-care). subgroup specific trial mortality results often

4. White NJ, Watson JA, Hoglund RM, Chan provide a good basis for individualising

XHS, Cheah PY, Tarning J. Covid-19 patient care. Br J Cancer 2011;104: 1057-8.

prevention and treatment: a critical analysis 11.FDA Center for Drug Evaluation and

of chloroquine and hydroxylchloroquine Research. FDA’s approval of Veklury

clinical pharmacology. PLoS Med (remdesivir) for the treatment of Covid-19:

2020;17(9):e1003252. summary review

5. Early Breast Cancer Trialists’ Collaborative (https://www.accessdata.fda.gov/drugsatfda_

Group (EBCTCG). Effects of chemotherapy docs/nda/2020/ 214787Orig1s000Sumr.pdf ).

and hormonal therapy for early breast cancer 12.Horby P, Mafham M, Linsell L, et al. Effect of

on recurrence and 15 year survival: an hydroxychloroquine in hospitalized patients

with Covid-19. N Engl J Med 2020;383:2030- 18.Buchwalder PA, Buclin T, Trinchard I,
40. Munafo A, Biollaz J. Pharmacokinetics and
13.RECOVERY Collaborative Group. pharmacodynamics of IFN-beta 1a in healthy
Lopinavirritonavir in patients admitted to volunteers. J Interferon Cytokine Res
hospital with Covid-19 (RECOVERY): a 2000;20:857-66.
randomised, controlled, open-label, platform
trial. Lancet 2020;396:1345-52. 19.Jalkanen J, Hollmén M, Jalkanen S.
14.Axfors C, Schmitt AM, Janiaud P, et al. Interferon beta-1a for COVID-19: critical
Mortality outcomes with hydroxylchloroquine importance of the administration route. Crit
and chloroquine in Covid-19: an international Care 2020;24:335.
collaborative meta analysis of randomized
trials. October 22, 2020 20.Jalkanen J, Pettilä V, Huttunen T, Hollmén
(https://www.medrxiv.org/content/10.1101/ M, Jalkanen S. Glucocorticoids inhibit type I
2020.09.16.20194571v2). preprint. IFN beta signaling and the upregulation of
15.Cao B, Wang Y, Wen D, et al. A trial of CD73 in human lung. Intensive Care Med
lopinavir ritonavir in adults hospitalized with 2020;46:1937-40.
severe Covid-19. N Engl J Med 2020;
382:1787-99. 21.Flammer JR, Dobrovolna J, Kennedy MA, et
16.Venisse N, Peytavin G, Bouchet S, et al. al. The type I interferon signaling pathway is
Concerns about pharmacokinetic (PK) and a target for glucocorticoid inhibition. Mol Cell
pharmacokinetic pharmacodynamic (PK-PD) Biol 2010;30:4564-74.
studies in the new therapeutic area of Covid-
19 infection. Antiviral Res 2020;181:104866. 22.The RECOVERY Collaborative Group.
17.Gregoire M, Le Turnier P, Gaborit BJ, et al. Dexamethasone in hospitalized patients with
Lopinavir pharmacokinetics in Co-vid-19 Covid-19 — preliminary report. N Engl J
patients. J Antimicrob Chemother Med. DOI: 10.1056/NEJMoa2021436.
2020;75:2702-4.
23.World Health Organization. Corticosteroids
. for Covid-19: living guidance, 2 September
2020(https://apps.who.int/iris/
handle/10665/334125).

COMPOSITION OF THE WHO SOLIDARITY TRIAL CONSORTIUM

Writing Committee WHO trial coordination team
Hongchao Pan, Ph.D., Richard Peto, F.R.S., AM Henao-Restrepo, P Lydon, MC Miranda-
Quarraisha Abdool Karim, Ph.D., Marissa Montoya, M-P Preziosi, KK Salami, V
Alejandria M.D., M.Sc., Ana Maria Henao- Sathiyamoorthy, S Swaminathan.
Restrepo, M.D., M.Sc., César Hernández García
M.D., Ph.D., Marie Paule Kieny Ph.D., Reza International Steering Committee
Malekzadeh M.D., Srinivas Murthy M.D. C.M., *National Principal Investigators; National
Marie-Pierre Preziosi M.D., Ph.D., K. Srinath Coordinators; Members of the Executive Group.
Reddy M.D., D.M., Mirta Roses Periago M.D., Albania: University Hospital Centre Mother
MPH, Vasee Sathiyamoorthy B.M.B.Ch., Ph.D., Theresa, Tirana N Como*; National Agency for
John-Arne Røttingen M.D., Ph.D., Soumya Medicines and Medical Devices N Sinani.
Swaminathan M.D. Nuffield Department of Argentina: Fundación del Centro de Estudios
Population Health, University of Oxford, Oxford, Infectológicos G Lopardo*; National Academy of
United Kingdom (H.P. and R.P.), Centre for the Sciences of Buenos Aires M Roses Periago.
AIDS Programme of Research In South Africa Brazil: Oswaldo Cruz Foundation EP Nunes*,
(CAPRISA), Durban, South Africa (Q.A.K.), PPS Reges. Canada: University of British
National Institutes of Health, University of the Columbia S Murthy*; Public Health Agency of
Philippines, Manila, Philippines (M.M.A.), Canada M Salvadori. Colombia: Universidad
Agency of Medicine and Medical Devices, Nacional de Colombia and Clinica Colsanitas
Madrid, Spain (C.H.G), Institut National de la CA Alvarez- Moreno*; Ministry of Health ML
Santé Et de la Recherche Médicale (INSERM), Mesa Rubio. Egypt: National Hepatology and
Paris, France (M.P.K.), Digestive Disease Tropical Medicine Research Institute M
Research Institute, Teheran University of Hassany*; Ministry of Health and population H
Medical Sciences,Tehran, Iran (R.M.), University Zaid. Finland: Helsinki University Hospital,
of British Columbia, Vancouver, Canada (S.M), Helsinki and South Karelian Central Hospital,
Public Health Foundation of India, New Delhi, Lappeenranta KAO Tikkinen*; Finnish Institute
India (K.S.R.), National Academy of Sciences of for Health and Welfare and University of Finland,
Buenos Aires, Buenos Aires, Argentina (M.R.P.), Helsinki M Perola. France: Hospices Civils de
Research Council of Norway, Oslo, Norway (J- Lyon, Lyon F Ader*; Institut National de la Santé
A.R.), World Health Organization, Geneva, Et de la Recherche Médicale, Paris MP Kieny.
Switzerland (A-M.H-R., M-P.P., V.S.M., S.S.). Honduras: National Autonomous University of
Honduras MT Medina*; Secretaria de Salud de
Data and Safety Monitoring Committee Honduras N Cerrato.
(DSMC) India: ICMR, National AIDS Research Institute,
Aldo Maggioni (chair), Abdel Babiker, Deborah Pune S Godbole*; Public Health Foundation of
Cook, Arjen Dondorp, Gagandeep Kang. India KS Reddy. Indonesia: National Institute of
Health Research and Development I
Global monitoring and data management Irmansyah*; RSUP Persahabatan, Jakarta MR
support teams Rasmin. Iran (Islamic Republic of): Digestive
University of Bern, Switzerland: S Trelle, S Disease Research Institute, Teheran University
McGinty, M Branca, S Appadoo. of Medical Sciences, Tehran R Malekzadeh*.
University of Bristol, United Kingdom: JAC Ireland: HRB Clinical Research Facility,
Sterne, CA Rogers, HBC Cappel-Porter, D University College Cork J Eustace*; Department
Hutton, S Bellani, E Allum, J Kirwan. of Health P Lennon, T Maguire. Italy: University
of Verona E Tacconelli*; Italian Medicines
Statistical analysts Agency (AIFA) N Magrini. Kuwait: Infectious
University of Oxford, United Kingdom: Hongchao Diseases Hospital A Alhasawi*; Ministry of
Pan, Richard Peto.

Health A Al-Bader. Lebanon: Rafic Hariri Argentina: Health Ministry JB Balbuena, JM
University Hospital P Abi Hanna*; Ministry of Castelli, A Mykietiuk, C Vizzotti; Hospital de
Public Health R Hamra. Lithuania: Vilnius Infecciosas Francisco J Muñiz, Buenos Aires V
University, Institute of Clinical Medicine; Vilnius Chediack, E Cunto, L de Vedia, C Domínguez, J
University Hospital Santaros klinikos L Fernández, N Lista, A Rodríguez; Hospital
Jancoriene*, L Griskevicius. Luxembourg: General de Agudos José Ramos Mejía, Buenos
Through DISCOVERY add-on study. Malaysia: Aires S Caimi, C Delgado, M Losso, F
Penang Hospital TS Chow*; Hospital Sungai Masciottra, V Pachioli, J Toibaro; Hospital
Buloh, Jalan Hospital S Kumar. North General de Agudos Juan A Fernández, Buenos
Macedonia: University Clinic of Infectious Aires J Barletta, J Carrillo, N D’Amico, L
Diseases and Febrile Conditions M Stevanovikj*; Hermida, M Jaume, C Luna, M Padilla, J
Ministry of Health S Manevska. Norway: Oslo Patroso, L Perez Blanco, J Presas, MJ Rolon,
University Hospital P Aukrust*, A Barratt-Due; AL Sisto, S Themines; Hospital Julio C
Research Council of Norway JA Rottingen. Perrando, Resistencia, Chaco V Arce, P
Pakistan: Shaukat Khanum Memorial Cancer Arribillaga, RA Ferreyra, ML Lescano, F Tito, L
Hospital and Research Centre A Raza*, M Verón; Hospital Mariano y Luciano de la Vega,
Hassan. Peru: Universidad Peruana Cayetano Moreno A Chalco, J Farina, M Provenzano;
Heredia PJ García*, E Gotuzzo. Philippines: Hospital Nacional Profesor Alejandro Posadas,
National Institutes of Health, University of the Palomar I Alonso, R Alzola, M Benedetti, D Di
Philippines, Manila MM Alejandria*. Saudi Pilla, P Díaz Aguiar, Y Cervellino, C Giudiche, M
Arabia: Ministry for Preventive Health AO Athari Golikow, M Jacobo, D Laplume, F Loiacono, A
Alotaibi*, López, L Ellero, C Pallavicini, F Riveros, G
A Asiri. South Africa: University of the Torales; Hospital Prof. Bernado Houssay,
Witwatersrand J Nel*; Wits Reproductive Health Vicente López M Altamirano, L Barcelona, V
and HIV Institute H Rees; Centre for the AIDS Berdiñas, C Fogar, A Martin; Hospital Provincial
Programme of Research In South Africa Q Dr José María Cullen, Santa Fé RA Avila, J
Abdool Karim. Spain: Hospital Clínico San Burgui, N Carrizo, M Filippi, M Gomez, V
Carlos, UCM, SCREN, IdISSC, Madrid A Reichert; Hospital Rawson, Córdoba M Alvarez,
Portoles*; Agency of Medicine and Medical AC Cazaux, M Díaz, HM Hurtado, LR Lorena,
Devices C Hernández-Garcia. Switzerland: ML Marianelli, L Orellano,
Lausanne University Hospital O Manuel*. C Salvay, M Simonetta.
*National PI; National Coordinator; Executive Austria: Through DISCOVERY add-on study.
Group; § Representing Discovery add-on study Paracelsus Medical University Salzburg, SCRI-
in France, Belgium, Austria and Luxembourg. CCCIT and AGMT A Egle, R Greil; Medizinische
Universität Innsbruck, Innsbruck M Joannidis.
Executive Group of the International Steering Belgium: Through DISCOVERY add-on study.
Committee CHR de la Citadelle, Liège A Altdorfer, V
John-Arne Røttingen (chair), Quarraisha Abdool Fraipont; Cliniques Universitaires de Saint Luc,
Karim, Marissa Alejandria, César Hernández Bruxelles L Belkhir; Cliniques Universitaires de
García, Marie Paule Kieny, Reza Malekzadeh, Bruxelles- Hôpital Erasme, Université Libre de
Srinivas Murthy, Richard Peto (independent Bruxelles, Bruxelles M Hites.
DSMC statistician), K. Srinath Reddy, Mirta Brazil:Fundação Universidade de Pernambuco
Roses Periago, Soumya Swaminathan. DB Miranda Filho, P Monteiro; Hospital Couto
Maia VPS Almeida, CX Nunes; Hospital das
National investigators and researchers Clínicas da Universidade Federal de Minas
This does not include members of the Gerais H Duani; Hospital das Clínicas,
International Steering Committee or its Universidade Federal do Paraná GL Breda, SM
Executive Group. Raboni; Hospital Estadual de Sumaré AJS
Albania: University Hospital Centre Mother Colussi, MC Ramos, LF Ruffing; Hospital
Theresa, Tirana NGJ Gjermeni, E Meta. Federal do Estado do Rio de Janeiro EC João;

Hospital Regional de Mato Grosso do Sul JHC J Papenburg, M Semret; McMaster university E
Croda; Hospital Regional de São José GA Pinto; Duan; Memorial University of Newfoundland T
Hospital São José de Doenças Infecciosas EAG Azher; North York General Hospital, Toronto A
Arruda; Hospital Sírio Libanês MFDB Corradi; Geagea; Ottawa Hospital S English; Queen's
Hospital Universitário Clementino Fraga Filho University S Perez-Patrigeon; Queensway
ES Machado, FCQ Mello; Instituto de Carleton Hospital M Rushton; Royal Alexandra
Infectologia Emilio Ribas LC Pereira Junior, TNL Hospital A Singh; Royal Victoria Regional Health
Souza, ALCC Toscano; Oswaldo Cruz Centre G DiDiodato; Sinai Health System,
Foundation VGV Santos. Toronto M Fralick; St Paul’s Hospital N Press;
Canada: Centre Hospitalier de l'Universite de Sunnybrook Hospital N Daneman, R Fowler, A
Montreal FM Carrier, M Durand; Centre Rishu; Trillium Health Partners C Graham;
Hospitalier Universitaire de Sherbrooke F University Health Network, Toronto I Bogocj;
Lamontagne; CHU de Quebec-Universite Laval University of Alberta N Lee, C O'Neil; University
D Bellemare, E Cloutier, O Costerousse, TV of British Columbia D Ovakim; University of
Tran, A Turgeon; Grand River Hospital S Giilck; Calgary, Calgary J Conly, CD Fell, R Lim, R
Grey Nuns Community Hospital H Hoang; Somayaji, A Tremblay, E Vakil; University of
Hopital Montfort N Chagnon; IUCPQ F Manitoba Y Keynan, R Zarychanski; Vancouver
Lellouche; Lions Gate Hospital J Douglas; General Hospital A Mah; Western University S
Markham Stouffville Hospital, E Fera; McGill Parvathy, M Silverman; William Osler Health
University, Montreal MP Cheng, C Costiniuk, L System A Binnie, S Borgia.
Harrison, K Khwaja, M Klein, N Kronfli, TC Lee,
Colombia: Clínica Colsanitas, Sede Clínica Finland: Helsinki University Hospital, Helsinki M
Iberomérica I Zuluaga; Clínica Colsanitas, Sede Myllärniemi, J Paajanen, A Renner; Tampere
Clínica Reina Sofia J Chacón, D Garzón, F University Hospital, Tampere J Rutanen, MU
Guevara; Clínica Colsanitas, Sede Clinica Santa Sinisalo.
Maria del Lago JS Bravo; Clínica Colsanitas, France: Through DISCOVERY add-on study.
Sede Clínica Sebastian de Belalcazar JM Amiens University, Amiens C Andrejak, JP
Oñate; Clínica Colsanitas, Sede Clínica Lanoix, Y Zerbib; ANRS, Paris A Diallo, N
Universitaria Colombia S Lozano-González; JA Mercier; Centre hospitalier Andrée Rosemon,
Rojas-Murrugarra, CH Saavedra; Fundación Cayenne, Guyane F Djossou; Centre Hospitalier
Cardioinfantil-Instituto de Cardiología E Váquiro- Annecy Genevois, Annecy D Bougon, V Tolsma;
Herrera, F Varón-Vega; Fundación Hospital Centre Hospitalier Universitaire de Besançon,
Universidad del Norte H Macareno; Fundación Besançon K Bouiller, JC Navellou; Centre
Santa Fe de Bogotá M Caicedo; Fundación Hospitalier Universitaire de Nantes, Nantes B
Valle de Lili F Rosso; Hospital Universitario San Gaborit, F Raffi, J Reignier; Centre Hospitalier
Ignacio, Pontificia Universidad Javeriana SL Universitaire Dijon-Bourgogne, Dijon P Andreu,
Valderrama. L Piroth, JP Quenot; Centre Hospitalier
Egypt: Ain Shams University G Elassal; AL- Universitaire Grenoble Alpes, Grenoble O
Azhar University S Zaky; Assuit University S Epaulard, N Terzi; Centre Régional Universitaire
Hassany, E Moustafa; Cairo University A de Nancy, Vandoeuvre Lés Nancy F
Abdalmohsen, A Abdelbary, N Asem, H Goehringer, A Kimmoun; Centre Régional
Masoud, A Said; Ministry of Health and Universitaire de Nice, Nice J Courjon, J
Population, W Amin, M Elshesheny, M Fathy, N Dellamonica, S Leroy, CH Marquette; Centre
Fathy, N Fayed, A Hammam, H Ibrahim, M Régional Universitaire de Rennes, Rennes F
Solyman Kabyl, M Mohamed, A Mohamed Laine, B Laviolle, Georges Pompidou European
Gouda, S Okasha, A Rafik, A Sedky, S Tarek, A Hospital, Paris D Lebeaux, A Buffet, A Fayol, JS
Tharwat; National Hepatology and Tropical Hulot, M Livrozet; Groupe Hospitalier de la
Medicine Research Institute A Abdel Baki; région Mulhouse Sud Alsace, Mulhouse O
National Liver Institute W Abdel-Razek; National Hinschberger, Y Mootien; Groupe hospitalier La
Research Center E Kamal. Pitié-Salpêtrière, Paris J Mayaux, V Pourcher;

Groupe Hospitalier Paris Saint Joseph, Paris C Hospital, Montpellier K Klouche; Lille University
Bruel, B Pilmis; Henri-Mondor Hospital, Créteil S Hospital, Lille K Faure, E Faure, J Poissy; Metz-
Gallien, A Mekontso Dessap; Hôpital Bichat, Thionville hospital, Ars-Laquenexy R Gaci, C
Paris T Alfaiate, A Dechanet, A Dupont, S Laribi, Robert; Montpellier University Hospital,
MC Tellier, S Tubiana; Hôpital Bichat, Université Montpellier V Le Moing, A Makinson;
de Paris, IAME, Inserm, Paris D Belhadi, L Pontchaillou University Hospital, Rennes F
Bouadma, C Burdet, FX Lescure, F Mentre, N Benezit; Reims University Hospital, B
Peiffer-Smadja, G Peytavin, JF Timsit, Y Mourvillier; Sorbonne Université , Inserm, Paris
Yazdanpanah; Hôpital Cochin, Paris D Costagliola; Strasbourg University Hospital,
S Kerneis, M Lachatre, O Launay; Hôpital de Strasbourg R Clere-Jehl, F Danion , F Meziani,
Bicêtre, Le Kremlin Bicêtre S Figueiredo, S V Poindron; Toulouse University Hospital,
Jauréguiberry; Hôpital Delafontaine, Saint Denis Toulouse F Bounes, G Martin-Blondel;
J Aboab, F Crockett, N Sayre; Hôpital Tourcoing Hospital, Tourcoing V Jean-Michel, E
d'instruction des armées Bégin, Saint Mandé C Senneville; Tours University Hospital, Tours D
Dubost); Hôpital Marie Lannelongue, Le Plessis Garot; University Hospital Centre of Bordeaux,
Robinson J Le Pavec, F Stefan; Hôpital Saint- Bordeaux, A Boyer, C Cazanave, D Gruson, D
Antoine, Paris K Lacombe; Hôpital Saint-Louis, Malvy; University Hospital of Martinique, Fort-
Paris JM Molina, M Noret; Hôpital Tenon, Paris de-France C Chabartier; University Hospital of
G Pialoux; Hospices Civils de Lyon, Lyon JC Saint- Etienne, Saint-Etienne E Botelho-Nevers,
Richard, J Textoris, F Wallet; Institut National de A Gagneux-Brunon, G Thiery; University
la Santé Et de la Recherche Médicale, Paris C Hospital, Rennes C Fougerou.
Delmas, J Saillard; Lapeyronie University
Honduras: Hospital Atlantida, la Ceiba AA Iyer, K Reddy, S Rege, J Shah; BYL Nair
Fiallos; Hospital Leonardo Martinez, San Pedro Hospital, Mumbai R Bhadade, R de Souza, M
Sula L Erazo; Hospital Militar, Tegucigalpa R Harde; Chirayu Medical College & Hospital,
Figueroa; Hospital San Felipe, Tegucigalpa JJ Bhopal A Goenka, A Mangalgiri, M Maurya, R
Flores, L Melendez; Instituto Cardiopulmonar, Parate, K Singh, A Tiwari, R Verma; Christian
Tegucigalpa C Aguilar, W Moncada. Medical College, Vellore OC Abraham, A
India: AIIMS, Bhopal S Atal, R Joshi, S Balachandran, TD Sudarsanam; Gandhi
Khadanga, A Ray, S Saigal, S Sharma; AIIMS, Hospital, Hyderabad (V Aedula, T C Bingi, V
Jodhpur A Avinash, P Bhardwaj, P Bhatia, J Jamalapuram, H Kalakuntla, A K Maurya, K
Charan, N Chauhan, N Dutt, M Garg, V Nag, B Nagmani, K Padma Malini, M Rajarao, KT Rao,
Shadrach; AIIMS, New Delhi R Aggarwal, DK R Sudarsi, M D Suleman; GMERS Medical
Baidya, , R Guleria, CA Kayina, A Mittal, N College & Hospital, Gotri, Vadodara K Mehta, P
Nischal, M Soneja, KD Soni, S Maitra, A Trikha, Patel, C Rathod; Government Medical College
N Wig; AIIMS, Rishikesh G Chikara, P Gupta, R and New Civil Hospital, Surat C Acharya, K
Kant, V Krishnan, B Mohan, P Panda; Apollo Bhatt, M Chaudhari, V Chaudhary, B Divakar, A
Hospitals, Greams Lane, Chennai N Gamit, S Gamit, B Kantharia, A Kavishvar, M
Ramakrishnan, BK Tirupakuzhi Vijayaraghavan, Momin, C Patel, V Patel, S Patel, H Patel, A
R Venkatasubramanian; Apollo Speciality Vasava, M Verma; Government Medical
Hospitals, Vanagaram, Chennai R Ebenezer, S College, Nagpur S Khandare, D Chand, M
Krishnamoorthy, D Suresh Kumar; Army Kalikar, S Mitra, U Narlawar; Government.
Institute of Cardio Thoracic Sciences, Pune G Siddhartha Medical College, Vijayawada B
Bhati, V Marwah, D Peter, TVSVGK Tilak; B. J. Bhargavi, G Chakradhararao, D Durgaprasad,
Government Medical College & Sassoon K Seshaiah; ICMR- National AIDS Research
General Hospital, Pune R Borse, B Daswani, S Institute, Pune S Chidrawar, A Kadam, S Kalme,
Divhare, D Ogale, S Sangale, M Tambe, R S Kamble, M Mamulwar, S Panda, S Sane;
Waghmare; B.J. Medical College& New Civil Indian Council of Medical Research, New Delhi
Hospital, Ahmedabad C Desai, D Raval, K B Bhargava, R Gangakhedkar, N Gupta; Madras
Upadhyay; Bharati hospital, Pune N Agrawal, S Medical College & Rajiv Gandhi Government

General Hospital, Chennai T Banu, V AA Pradana, Y Risniati, RI Sugiyono, NH
Damodaran, L Narasimhan, G Natarajan, V Susanto, AK Syarif, A Yulianto; RS University
Rajendran, KM Sudha, S Sudharshini, E Airlangga, Surabaya M Amin; RS University
Therani; Rajan Omandurar Medical College & Udayana Bali IKA Somia, RS YARSI, Jakarta I
Hospital, Chennai R Jayanthi, J Komathi, KP Kusuma; RSJ Prof. Dr. Soerojo, Magelang HA
Manimaran, T Ramesh Kumar, A Revathi; Mahmudji; RSPAU Dr. Esnawan Antariksa,
Pandit Deendayal Upadhyay Government Jakarta FE Sari; RSPI Prof. Dr. Sulianto Saroso,
Medical College, Rajkot M Bhapal, S Misra, A Jakarta PA Sitompul; RSUD Dr. Achmad
Singh, A Trivedi); PD Hinduja National Hospital Mochtar, Bukittinggi D Herman; RSUD Dr.
and Medical Research Centre, Mumbai U Moewardi, Solo H Harsini; RSUD Dr. Saiful
Agrawal, Z Udwadia; RCSM GMC CPRH, Anwar, Malang YJ Sugiri; RSUD Dr. Soetomo,
Kolhapur A Paritekar, G Patil, A Waikar; Sardar Surabaya S Soedarsono; RSUP Dr. Hasan
Vallabhbhai Patel Institute of Medical Sciences Sadikin, Bandung Y Hartantri; RSUP Dr. Kariadi,
and Research, Ahmedabad S Malhotra, D Roy; Semarang SB Raharjo; RSUP Dr. M. Djamil,
SMS Medical College & Hospital, Jaipur A Padang I Medison; RSUP Dr. Sardjito,
Agrawal, S Bhandari, S Mahavar, R Sharma, S Yogyakarta BS Riyanto; RSUP Dr. Wahidin
Sharma, A Singh; Voluntary Health Services- Sudirohusodo, Makassar I Djaharuddin; RSUP
Infectious Diseases Medical Centre, Chennai N Fatmawati, Jakarta AY Djojo; RSUP H. Adam
Kumarasamy, P Selvamuthu; WHO-India, New Malik, Medan A Rahmaini; RSUP Persahabatan,
Delhi M Ahmad, M Gupta, V Purohit. Jakarta F Isbaniah; RSUP Prof. Dr. R. D Kandou
Indonesia: National Institute of Health Research Manado A Nugroho; RSUP Sanglah, Bali GK
and Development AR Afrilia, D Arlinda, R Sajinadiyasa; RSUPN Dr. Cipto
Avrina, LE Bang, SL Driyah, M Erastuti, T Mangunkusumo, Jakarta CW Pitoyo.
Fajarwati, M Karyana, N Nurhayati, C Opitasari,
Iran (Islamic Republic of): Ahvaz Jundishapur Medical Sciences, Sari F Baba Mahmoodi, F
University of Medical Sciences, Ahvaz F Amini, Fallahpoor Golmaee; National Institute for
S Moogahi, M Varnasseri, MJ Yadyad, F Medical Research Development, Tehran B
Yousefi; Alborz University of Medical Sciences, Mesgarpour; Qazvin University of Medical
Karaj Z Siami, A Soleimani; Arak University of Sciences, Qazvin A Karampour, S Kiani Majd, R
Medical Sciences, Arak A Kamali, B Najafipour, H Najari, E Zare Hoseinzade; Qom
Mahmoodiyeh, H Sarmadian, D Shojaei, S University of Medical Sciences, Qom SY Foroghi
Soltanmohammad; Babol University of Medical Ghomi, MR Ghadir, M Gheitani, SS Hashemi
Sciences, Babol M Bayani, S Ebrahimpour, M Madani, A Hormati, J Khodadadi; Saveh
Javanian, M Sadeghi Haddad Zavareh, M University of Medical Sciences, Saveh A Akhavi
Shokri; Golestan University of Medical Sciences, Mirab, M Mesri, H Mozaffar; Shahid Beheshti
Gorgan B Khodabakhshi, A Norouzi, S University of Medical Sciences, Tehran P
Tavassoli; Guilan University of Medical Baghaei, F Dastan, P Tabarsi; Shahid Sadoughi
Sciences, Rasht F Joukar, L Mahfoozi, F University of Medical Sciences, Yazd SA
Mansour-Ghanaei, A Pourkazemi; Isfahan Mousavi Anari; Shiraz University of Medical
University of Medical Sciences, Isfahan A Sciences, Shiraz MJ Fallahi, M Moghadami, S
Hakamifard, M Salahi, K Shirani; Kermanshah Yaghoubi, F Zand; Tabriz University of Medical
University of Medical Sciences, Kermanshah M Sciences, Tabriz K Ansarin, H Mikaeili, M
Afsharian, A Janbakhsh, F Mansouri, R Miladi, P Nazemiyeh, A Taghizadieh; Tehran University of
Mohamadi, Z Mohseni Afshar, B Sayad, M Medical Sciences, Tehran S Eghtesad, F
Shirvani, S Vaziri, MH Zamanian; Mashhad Ghiasvand, H Hosseini, N Khajavirad, M
University of Medical Sciences, Mashhad M Mohraz, H Poustchi, A Sadeghi, MA Sahraian,
Amini, F Barazandeh, S Hafizi Lotfabadi, R MR Salehi, AR Sima.
Khodashahi, M Mozdourian, SN Saberhosseini, Ireland: Beaumont Hospital and Royal College
M Saberi, N Saber-Moghaddam, Y of Surgeons in Ireland E deBarra; Mater
Yazdanpanah; Mazandaran University of Misericordiae University Hospital E Muldoon;

Mercy University Hospital A Jackson; St James's Bandera, A Gori; Fondazione Policlinico
Hospital and Trinity College, Dublin C Bergin; St Universitario A. Gemelli IRCCS, Roma R Cauda,
Vincent's University Hospital and School of A Cingolani, K de Gaetano Donati, S Lamonica;
Medicine University College Dublin C McCarthy; IRCSS Ospedale Sacro Cuore – Don Calabria,
University Hospital Galway and National Negrar Di Valpolicella (Verona) A Agheben, N
University of Ireland Galway JG Laffey. Riccardi, P Rodari; Ospedale Cardinal Massaia,
Italy: AOU Citta della Salute e Scienza, Torino S Asti M Degioanni, T Lupia;
Corcione, FG De Rosa, S Scabini; ASST di Ospedale Maggiore, Trieste S Di Bella, D
Monza, Ospedale San Gerardo, Monza L Bisi, P Giacomazzi, R Luzzati; Ospedale Policlinico San
Bonfanti, G Gustinetti, F Iannuzzi; ASST Martino– IRCCS, Genova A Di Biagio, M
Fatebenefratelli Sacco, Milano A Capetti, M Bassetti; Ospedale SM Goretti, Latina B
Galli, S Rusconi; ASST Santi Paolo e Carlo, Kertusha, M Lichtner, P Zuccalá; Policlinico di S.
Milano F Bai, A d’Arminio Monforte, E Merlini; Orsola, Bologna C Campoli, P Viale; ULSS9
ASST Valtellina e Alto Lario, Ospedale di Scaligera, Legnago (Verona) P Rovere, M
Sondalo E Menatti, P Zucchi; Azienda Vincenzi; University of Campania, Luigi
Ospedaliera Ospedali Riuniti Marche Nord, Vanvitelli, Napoli F Calò, N Coppola, M Macera,
Pesaro F Barchiesi, B Canovari; Azienda C Monari; University of Verona E Cremonini, P
Sanitaria Universitaria Friuli Centrale, Udine D De Nardo, MD Pezzani.
Pecori, C Tascini, P Della Siega, M Merelli; Kuwait: Infectious Diseases Hospital M Al-
Azienda Socio Sanitaria Territoriale di Cremona Roomi, S Kelly; Kuwait University S Al-Sabah.
N Cocco, B Drera, C Fornabaio, A Pan; Brescia Lebanon: Centre Hospitalier Universitaire, Notre
Spedali Civili General Hospital F Castelli, E Dame des Secours M Matar; Rafic Hariri
Focà, E Quiros-Roldan; Fondazione IRCCS Ca' University Hospital M Hassoun, M Saliba.
Granda Ospedale Maggiore Policlinico, Milano A
Lithuania: Vilnius University, Institute of Clinical og Romsdal Hospital DAL Hoff; Oslo University
Medicine; Vilnius University Hospital Santaros Hospital AM Dyrhol-Riise, AR Holten, T Kåsine,
klinikos, Vilnius B Zablockiene. K Nezvalova-Henriksen, IC Olsen , M Trøseid;
Luxembourg: Through DISCOVERY add-on Østfold Hospital S Aballi; Sorlandet Hospital,
study. Centre Hospitalier de Luxembourg J Arendal RB Olsen; Sorlandet Hospital,
Reuter, T Staub. Kristiansand M Haugli; Stavanger University
Malaysia: Queen Elizabeth Hospital HG Lee; Hospital B Berg; Telemark Hospital HK Skudal;
Institute for Clinical Research, National Institute Trondheim University Hospital R Hannula;
of Health CK Chew, PP Goh, WY Mak; Kuala University Hospital of North Norway AB Kildal;
Lumpur Hospital CL Leong; Melaka Hospital NZ Vesfold Hospital A Johannessen; Vestre Viken
Zaidan; Sarawak General Hospital HH Chua; Hospital Trust, Bærum AA Tveita; Vestre Viken
Sultanah Bahiyah Hospital LL Low; Sungai Hospital Trust, Drammen L Heggelund; Vestre
Buloh Hospital YG Mohamed Gani; Tengku Viken Hospital Trust, Kongsberg G Ernst; Vestre
Ampuan Afzan Hospital D Muhamad; Tuanku Viken Hospital Trust, Ringerike L Thoresen.
Fauziah Hospital S Ab Wahab. Pakistan: Agha Khan University Hospital,
North Macedonia: University Clinic of Infectious Karachi D Begum, F Mahmood, N Nasir;
Diseases and Febrile Condition IS Demiri, S Pakistan Institute of Medical Sciences,
Marinkovikj, B Petreska, K Spasovska. Islamabad N Akhtar, U Walayat; Shaukat
Norway: Akershus University Hospital O Khanum Memorial Cancer Hospital and
Dalgard; Diakonhjemmet Hospital L Vinge; Research Centre A Raza; The Indus Hospital,
Haraldsplass Deaconess Hospital BR Kittang; Karachi S Bhatti, F Herekar, M Hussain, S
Haukeland University Hospital B Blomberg; Mustafa, A Rahim, A Rehman, S Sarfaraz, Q
Innlandet Hospital, Elverum CM Ystrøm; Shaikh.
Innlandet Hospital, Lillehammer R Eiken; Nord- Peru: Centro Médico Naval KH Bernal-Málaga,
Trondelag Hospital Trust NV Skei; Lovisenberg KCM Del-Aguila-Torres, DY Gastiaburú-
Hospital H Hoel; Molde Hospital B Tholin; Møre Rodriguez, AA Gomero-Lopez, M Laca-Barrera,

CX Peña-Mayorga, J Pro, JM Samanez-Pérez, Chacaltana-Huarcaya, E Díaz-Chipana, CM
GM Sotomayor-Woolcott; Clínica Ricardo Palma Quispe-Nolazco, ME Ramos-Samanez, JG
GE Gianella-Malca, OJ Ponce, KM Rojas- Vásquez-Cerro, RM Yauri-Lazo; Hospital
Murrugarra, RKA Tapia-Orihuela; Clínica San Nacional Dos de Mayo HC Arbañil-Huamán, CV
Pablo CV Luna-Wilson, FJ Ortega-Monasterios, Ibarcena-Llerena, GF Miranda-Manrique, G
A Peña-Villalobos; Hospital Cayetano Heredia Santos-Revilla, VF Terrones-Levano, CE
CR Cornejo-Valdivia, G Málaga, F Mejía- Ticona- Huaroto, DY Ugarte-Mercado; Hospital
Cordero; Hospital de la Amistad Perú Corea Nacional Hipólito Unanue A Soto; Hospital
Santa Rosa II JA Juárez-Eyzaguirre, F León- Nacional Hipólito Unanue AM Alcantara-Díaz,
Jiménez; Hospital III Daniel Alcides Carrión- JA Azañero-Haro, RJ Carazas-Chavarry, A
ESSALUD LG Barreto-Rocchetti, N Flores- Cruz-Chereque, RM Sánchez-Sevillano;
Valdez, MA Hueda-Zavaleta, MA Inquilla- Hospital Nacional Sergio E. Bernales IC
Castillo, JA Mendoza-Laredo, JP Otazú-Ybáñez, Casimiro-Porras, ODC Peña- Vásquez, E
KE Ponte-Fernandez, OJ Vargas- Anahua; Sánchez-Garavito, H Sandoval-Manrique, JA
Hospital María Auxiliadora AM Alva-Correa, B Silva-Ramos, OM Torres-Ruiz; Hospital
Ángeles-Padilla, RA Franco-Vásquez, RC Regional Lambayeque ED Meregildo-Rodríguez;
Gallegos-López, M Olivera-Chaupis, MA Hospital Regional Lambayeque JG Alvarado-
Paredes-Moreno, W Torres-Ninapayta, RD Moreno, PC Ávila-Reyes, JMA Benitez-Peche,
Vásquez- Becerra; Hospital Nacional Alberto LN Cabrera-Portillo, HC Sánchez-Carrillo, MA
Sabogal Sologuren EC Agurto-Lescano, LE Solano-Ico, M Villegas-Chiroque; Universidad
Hercilla-Vásquez, CA Iberico-Barrera, CS Peruana Cayetano Heredia PM Cárcamo, AL
Terrazas-Obregón; Hospital Nacional Daniel Williams).
Alcides Carrión J Castillo- Espinoza, JN
Philippines: Asian Hospital and Medical Center University of the East Ramon Magsaysay
L Fernandez, M Kwek; Baguio General Hospital Memorial Medical Center J Cabrera, V
TPT Cajulao; Batangas Medical Center RJ Catambing, MC Rosario; University of the
Javier; Cardinal Santos Medical Center MSA Philippines, Philippine General Hospital MS
Ramos, LEG Santos; Cebu Doctors' University Arcegono, SV Buno, A David-Wang, AF
Hospital MM Chua, G Garcia; Chinese General Malundo, RE Villalobos; Vicente Sotto Memorial
Hospital KL Li; Diliman Doctors Hospital GM Medical Center MV Bala, OK Macadato; World
Europa, D Tagarda; Fe Del Mundo Medical Citi Medical Center SM Reyes, IR Tang.
Center KL Ngo- Sanchez; Lung Center of the Saudi Arabia: Al Noor Specialist Hospital
Philippines V De los Reyes, MC Orden; Makati Mekkah M Al Gethamy, A Naji; Dammam
Medical Center J Caoili, MT Gler; Manila Central Hospital MS AL-Mulaify; King Faisal
Doctors Hospital SMA Andales-Bacolcol, MJ Specialist Hospital and Research Centre,
Nepomuceno, D Teo; ManilaMed, Medical Riyadh A Alrajhi, R Al Maghraby; King Khaled
Center Manila EA Roxas, BM Te; Perpetual University Hospital, Riyadh N Alotaibi, F
Succor Hospital, Cebu P Blanco, MB Chua, MC AlShaharani, A Al Sharidi, M Barry, L Ghonem;
Mujeres; Research Institute for Tropical Ohud Hospital Al Madinah A Khalel AM
Medicine JU Garcia, ADE Roman; San Juan de Kharaba; Prince Mohammed Bin Abdulaziz
Dios Educational Foundation Hospital RD Paez, Hospital, Riyadh L Alabdan, MS AlAbdullah;
C Ramos; San Lazaro Hospital JT Arches, AG Qatif Central Hospital A Al Shabib.
Awing, R Solante, DR Ymbong; Southern South Africa: Chris Hani Baragwanath
Philippines Medical Center I Chin, A Lee, K Roa; Academic Hospital C Menezes, SA van
St. Luke's Medical Center Global M Panaligan; Blydenstein, M Venter; Groote Schuur Hospital
St. Lukes Medical Center Quezon City RM M Mendelson, B Sossen; Sefako Makgatho
Llorin, JMA Quinivista-Yoon, JJ Suaco, CJ Health Sciences University VL Maluleke, AN
Tibayan; St. Luke's Medical Center Quezon City Mdladla, M Nchabeleng; Wits Health Consortium
GMA Zabat; The Medical City CLR Abad, EA University of the Witwatersrand J Bennet, N
Aventura, J Bello, J Francisco, MA Lansang; Mbhele, N Mwelase, V Parker, M Rassool; Wits

Reproductive Health and HIV Institute T Baraiaetxaburu Artetxe, M De La Peña
Palanee-Phillips. Trigueros, J De Miguel Landiribar, OL Ferrero
Spain: Complejo Asistencial de Segovia EM Beneitez, S Ibarra Ugarte, M Intxausti
Ferreira Pasos; Complejo Hospitalario de Urrutibeaskoa, I Lombide Aguirre, I Lopez
Toledo J González Moraleja, MP Toledano; Azkarreta, M López Martínez, P Muñoz
Hospital Clínic-IDIBAPS, University of Sanchez, V Polo San Ricardo, A Sagarna
Barcelona, Barcelona A Carrillo, M Chumbita, L Aguirrezabala, MZ Zubero Sulibarria; Hospital
De la Mora, F Etcheverry, F Garcia, M Universitario de Badajoz FF Rodríguez Vidigal;
Hernández, A Inciarte, L Leal, O Miró, A Hospital Universitario de Ceuta D García Muñiz,
Moreno, P Puerta, M Solà, A Soriano, A Tomé; E Laza Laza, M Sangüesa Jareño; Hospital
Hospital Clinico San Carlos, UCM, IdISSC, Universitario de Cruces A Basterretxea Ozamiz,
Madrid A Ascaso, I Burruezo, N Cabello-Clotet, MJ Blanco Vidal, M Del Alamo Martinez, A
V Estrada, A Leone, D Lozano-Martin, FJ García de Vicuña Melendez, AJ Goikoetxea
Martin-Sanchez, MJ Nuñez Orantos, AB Rivas Agirre, M Ibarrola Hierro, I Isasi Otaolea, J Nieto
Paterna, I Sagastagoitia, R Sandoval, E Vargas; Arana; Hospital Universitario de Getafe DAP
Hospital Clínico Universitario Lozano Blesa IIS Abad Pérez, EAR Aranda Rife, MBR Balado
Aragón, Zaragoza MJ Esquillor-Rodrigo, J Rico, ECS Conde Senovilla, MCS Del Cerro
Guzmán, JR Paño-Pardo, C Toyas-Miazza; Saélices, LFO Fernández de Orueta, AHR
Hospital Comarcal Sant Jaume de Calella A Herrera Rodríguez, NLP López Muñoz, MLL
Juan Arribas, J Algarra Vento, O Del Rio Pérez, Luengo López, EM Manzone, BMC Martínez
A Macias Paredes, D Pelleja Munné, S Valero Cifre, MMF Muñoz Flores, SOS Odeh Santana,
Rovira; Hospital Consorcio General Universitario GPC Pérez Caballero; Hospital Universitario de
Valencia M García Deltoro, P Ortega, F Jaén C Alarcón-Payer, MJ Barbero Hernández,
Puchades, F Sanz, J Tamarit; Hospital de C Herrero Rodríguez, F Horno Ureña, FJ La
Manises K Jerusalem; Hospital de Mérida AM Rosa Salas, G Pérez Chica; Hospital
Pérez Fernández; Hospital General de Universitario de Salamanca JA Martín Oterino;
Tomelloso MI Elices-Calzón, J González- Hospital Universitario Donostia Instituto de
Cervera, G López-Larramona, AJ Lucendo, MM Investigación BioDonostia E Agirre, I Alvarez, A
Maestre-Muñiz, M Martín-Toledano, S Berroeta, MJ Bustinduy, X Camino, A Couto, A
Masegosa-Casanova, AM Ruiz-Chicote; Fuertes, MA Goenaga, M Ibarguren, JA
Hospital General Universitario de Alicante I Iribarren, X Kortajarena, MA Von Wichmann, JJ
Agea, V Boix, R García, J Gil, P Llorens, E Zubeldia, B Zubeltzu, A Zufiaurre; Hospital
Merino, S Reus, R Sánchez, D Torrús-Tendero; Universitario Fundación Alcorcón MA Abreu-
Hospital General Universitario de Elche, Alicante Galan, O Devora-Ruano, M Galan de Juana, C
F Gutierrez, M Masiá , S Padilla; Hospital Guijarro, J Hernandez-Nuñez, JJ Martínez-
General Universitario Gregorio Marañón J Simón, O Martin-Segarra, A Pablo-Esteban, JM
Berenguer, P Diez, C Diez, C Fanciulli, I Parra-Ramirez, JT Pérez-Hopkins, MP Pozo-
Gutiérrez, I Miguens, L Pérez-Latorre, M Peña, G Sierra-Torres, A Vegas-Serrano, M
Ramirez; Hospital La Paz.IdIPAZ JR Arribas, F Velasco; Hospital Universitario Infanta Leonor
de la Calle, B Díaz Pollán, MR Torres; Hospital EA Alvaro-Alonso, P Ryan, J Valencia; Hospital
Puerta de Hierro AFCB Caballero Bermejo, GAC Universitario Infanta Sofía P Ruiz-Seco; Hospital
Adolfo Centeno, ADS Diaz De Santiago, AFC Universitario Río Hortega de Valladolid J Gómez
Fernandez Cruz, EMR Muñez Rubio, IPP Pintos Barquero; Hospital Universitario San Pedro de
Pascual, A Ramos Martinez; Hospital Regional Alcántara JF Masa; Hospital Universitario Son
Universitario de Malaga R Gomez-Huelgas, MD Espases J Asensio, F Fanjul, A Ferre, M I
Lopez-Carmona, I Perez-Camacho; Hospital Fullana, M Peñaranda, L Ramon; Hospital
Universitari Sagrat Cor R Salas; Hospital Universitario Virgen de la Victoria, Málaga R
Universitario Araba JC Gainzarain, MA Moran, Z Jiménez-López, E Nuño, C Pérez-López, J
Ortiz De Zarate, J Portu, E Saez De Adana; Sánchez-Lora, E Sánchez-Yáñez; Hospital
Hospital Universitario Basurto JM Universitario Virgen Macarena MD Del Toro, M

Gutiérrez-Moreno, I Jiménez-Varo, Z Palacios- de Sumaré (MJ Moraes), Oswaldo Cruz
Baena, N Palazón-Carrión, P Retamar, J Foundation (BGJ Grinsztejn, MA Krieger),
Rodríguez-Baño, E Salamanca-Rivera, M Hospital Hospital Federal do Rio de Janeiro
Sevillano, A Valiente-Méndez, D Vicente-Baz; (ALM Oliveira), Hospital Regional de São José
Hospital Universitario y Politécnico La Fe, (M Vieira), and Hospital São José de Doenças
Valencia PBG Pablo Berrocal Gil, M Salavert Infecciosas (CFV Takeda);
Lletí; Hospital Universitario12 de Octubre, Canada: Eastern Regional Health Authority (P
Madrid A Lalueza IIS Aragón M de la Rica, L Daley), Hôpital Charles-Le Moyne (G Poirier), Dr
Diez-Galán; Ramón y Cajal Hospital, Madrid Y Evert Chalmers Hospital (Z Aslam), Montfort
Aranda García, P Borque, S Chamorro Tojeiro , Hospital (N Chagnon), Centre Hospitalier de
B Comeche, N Diaz Garcia, R Escudero- l'Université de Montréal (S Matte), Hôpital du
Sanchez, F Gioia, B Monge Maillo, S Moreno Sacré-Cœur de Montréal (YA Cavayas), Saint
Guillen, R Ron Gonzalez, P Vizcarra. Paul’s Hospital Vancouver (W Connora),
Switzerland: Campus SLB, Lindenhofgruppe Humber River Hospital (K Mandelzweig),
Bern A Bosshard, J Wiegand; Clinic of Sunnybrook Hospital (C Downey, P Kiiza, E
Infectiology and Infection Control, Kantonsspital Shadowitz), Thunder Bay Regional Health
Baden M Greiner; Department of Internal Sciences Centre (G Gamble), University of
Medicine, Kantonsspital Frauenfeld S Alberta (A Singh), University of British Columbia
Gastberger; Hôpital du Valais Sion N (V Chaubey, J Grant), University Health Network
Desbaillets, S Emonet, PA Petignat, E Toronto (B Coburn, SM Poutanen), University of
Stavropoulou; Hôpital fribourgeois Fribourg V Manitoba (A Heendeniya, LE Kelly), McMaster
Erard; Hôpital Riviera-Chablais Rennaz F Duss, University (J Tsang), and Unity Health Toronto
N Garin; Hôpitaux universitaires de Genève A (KL Schwartz, D Tan);
Calmy, Y Flammer, A Marinosci, V Prendki; Colombia: Clínica Reina Sofia, (M Choconta, L
Kantonsspital Aarau A Conen, S Haubitz, B Martínez), Clínica Universitaria Colombia (Y Gil,
Jakopp, E West; Kantonsspital Baden B Wiggli; M Jiménez, A Montañez, O Córdoba), Clínica
Lausanne University Hospital F Desgranges, D Santa María del Lago (O Agudelo, J de La Hoz,
Haefliger, V Suttels, L van den Bogaart; Réseau M Salazar, A Valencia), Clínica Sebastián de
hospitalier neuchâtelois Neuchâtel O Clerc; Belalcázar (A Muriel, J Villabon), Clínica
Spital Thurgau AG, Kantonsspital Münsterlingen iberoamerica (C Arévalo, C Rebolledo),
R Fulchini, Universitätsspital Basel M Stoeckle. Fundación Cardioinfantil-Instituto de Cardiología
(LD Sáenz, JC Villar), Fundación Santa fe de
Other collaborators in participating countries Bogotá (S Bello), Fundación Valle del Lili (K
Special recognition to all the research staff and Gómez, A Martínez, A Sotomayor, J Yara),
medical teams in each participating hospitals in Fundación Universitaria Sanitas (C Aristizábal,
Argentina: Hospital Ramos Mejía Buenos Aires D Castro, M Isaza, P Marín, C Orjuela), Hospital
(SA Arrigorriaga, RF Fernandez Deu, AG Universitario San Ignacio (V Méndez, C
Guida), and Hospital Rawson Córdoba (LK Gómez), Hospital Universidad del Norte (S
Lassen, SF Silva, CT Toledo, AZ Zamora, LZ Aguilera, F Torres), Ministry of Health (A
Zappia); Moscoso, F Ruiz), PAHO (L. Ramírez, G
Austria: AGMT Arbeitsgemeinschaft Tambini), INVIMA (J Aldana, P Pulgarín);
Medikamentöse Tumortherapie, Salzsburg (S National University of Colombia (M Jimenez, O
Esmaeilzadeh- leithner, B Lamprecht, D Cordoba, A Montañez);
Wolkersdorfer); Finland: Helsinki University Hospital (P
Belgium: Cliniques Universitaires de Bruxelles- Järvinen, I Kalliala, TP Kilpeläinen),
Hôpital Erasme, Université Libre de Bruxelles, Occupational Health Helsinki (JMJ Mustonen) &
Bruxelles (Z Khalil) Tampere University Hospital (RH Hankkio, GM
Brazil: Ministry of Health (CG Sachetti, FF Määttä, VK Virtanen);
Soares), Hospital Universitário Clementino France: Hôpital Avicenne Paris (O Bouchad),
Fraga Filho (RA Medronho), Hospital Estadual Hôpital d'Instruction des Armées Bégin (C

Ficko), Hôpital Bichat Paris (B Basli, A Chair, J Omandurar Medical College Chennai (C R
Level, M Schneider, J Guedj, C Laouenan, V Anuradha, R Pravin Kumar, S Sai Vishal, C
Godard), Hôpital de Bicêtre (X Monnet), Praveen Kumar), VHS Infectious Diseases
Hospices Civils de Lyon (B Leveau), Centre Medical Centre Chennai (F Beulah, S Ramu, G
hospitalier universitaire de Martinique (A Cabie), Narayanan), Gandhi Hospital Hyderabad (B
Pontchaillou University Hospital (M Revest), Sheshadri, MD Iqbal Ahmed), SMS Medical
Reims University Hospital (F Bani-Sadr, Rennes College & Hospital Jaipur (B Goyal), BYL Nair
University Hospital (A Caro, C Cameli, MJ Ngo Hospital Mumbai (R Singh, A Bhamare), PD
Um Tegue); Georges Pompidou European Hinduja National Hospital and Medical Research
Hospital, Paris (JL Diehl), Tours University Centre Mumbai (A Sunavala, S Mehendale, RS
Hospital (L Bernard), ANRS (V Petrov-Sanchez, Raju), Government Medical College Nagpur (M
S Le Mestre, C Cagnot, D Lebrasseur, C Birkle, Faisal, P Gomase, P Gosavi, S Bhelekar, P
C Moins, S Gibowski, C Paul, E Landry, E Agrawal, N Agrawal, R Sabu), AIIMS New Delhi
Balssa, L Wadouachi, A le Goff, L Moachon), (R Subramaniam, A Anant, S Bhatnagar, L Dar,
ANSES (C Semaille), Imagine Institute Paris (L S Bhoi, P Mathur, A Kumar, M Ved Prakash, P
Abel), Inserm (H Esperou, S Couffin- Tiwari), Indian Council of Medical Research New
Cadiergues, E D'Ortenzio, B Hamze, O Delhi (M Murhekar, S Agrawal, B John), the
Puechal), Inserm ANRS Villejuif (Y Riault, E Army Institute of Cardio Thoracic Sciences Pune
Netzer), Infective Agents Institute Lyon (M (V Mangal), Bharati hospital Pune (S Palkar),
Bouscambert- Duchamp, V Icard, B Lina, F ICMR- National AIDS Research Institute Pune
Morfin-Sherpa, A Gaymard), Toulouse (S Krishnan, R Bangar, P Kerkar, K Chaudhari,
University Hospital (Delobel, C. Thalamas, M. P Kokate, A Kashikar), AIIMS Rishikesh (M
Murris) Université Bordeaux Inserm (L Wittkop, Singh, A Chauhan), Government Medical
L Moinot, A Gelley), Université Paris Saclay College Surat (A Patel, K Chauhan), and
Inserm (A Essat, M Ghislain, M Brossard), and Christian Medical College Vellore (T George, L
Université Sorbonne Inserm Audrin, G Karthik, GM Varghese, P Rupali, T
(L Beniguel, M Genin); Balamugesh, V Surekha, B Chacko, M Moorthy,
Honduras: Hospital Atlantida la Ceiba (M K P P Abhilash, SC Nair, S Chandy, R Charles,
Juarez); Instituto Cardiopulmonar Tegucigalpa A Jacob, D Mathew, E Inbarani, R Moses, N
(N Maradiaga), Hospital Leonardo Martinez San Stanely);
Pedro Sula (J Samara), Hospital Militar Indonesia: RSUP Dr. Wahidin Sudirohusodo,
Tegucigalpa (JS Jerez), Hospital San Felipe Makassar (A Nurulita, M Ilyas, N Lihawa, NA
Tegucigalpa (E Cruz, H Rodriguez), Agencia de Tabri, N Mayasari); RSUP Sanglah, Bali (IAJD
Regulación Sanitaria (F Contreras), National Kusumawardani, NW Candrawati, NLPE
Autonomous University of Honduras (F Herrera, Arisanti, IMS Utama); RSUP Dr. Kariadi,
S Moncada, W Murillo), Secretaria de Salud de Semarang (MAU Sofro, FN Kholis, N
Honduras (A Flores, R Aplicano), and PAHO (P Farkhanah, T Handoyo); RSUD Dr. Achmad
Huerta); India: AIIMS, Jodhpur (S Misra, D Mochtar, Bukittinggi (S Suyastri, T Hidayat, D
Mathur), SVP Institute of Medical Sciences and Oktafia); RSJ Prof. Dr. Soerojo, Magelang (V
Research Ahmedabad (N Suthar, S Shah, P Otifa, W Sabaan, S Sumawan, I Nopiasardani);
Palat, A Chandwani, A Pandya,V Buch, S Talati, RS Univ. Udayana, Bali (CAW Purnamasidhi, IW
D Patel), AIIMS Bhopal (V Ingle, A Singhai, N Aryabiantara, IK Suyasa, DPGP Samatra); RS
Shrivastava), Apollo Hospitals Greams Lane Univ. Airlangga, Surabaya (HW Setiawan, PA
Chennai (S Pavithra, E Elvira, G Parthasarathy, Wulaningrum, AN Rosyid, NA Ramadhan); RS
Y Arun Chander, A Afsal, NK Hilda), Apollo YARSI, Jakarta (D Bachtiar, E Sastria, M
Speciality Hospitals Vanagaram Chennai (J Rusmana, E Yuliana); RSUD Moewardi, Solo
Krishnan, S Hilda, K Kirubanandam, C (YF Dewi, J Aphridasari, A Adhiputri. E
Poongavanam, J Swaminathan), Madras Pramudyaningsih); RSUP Dr. M. Djamil, Padang
Medical College Chennai (G Arathi, G (R Russilawati, A Anggrainy, S Ermayanti, O
Jayashree, T Meenakshi, S Gomathi), Khairsyaf); RSUP Persahabatan, Jakarta (AC

Byantoro, R Sutarto, AS Asmara, T Kusumaeni); Italy: Azienda Ospedaliera Integrata of Verona
RSUPN Dr. Cipto Mangunkusumo, Jakarta (A and the Servizio di Farmacia, Azienda
Susilo, G Singh); RSUD Dr. Saiful Anwar, Ospedaliera Integrata, Verona (P Marini, M
Malang (R Tantular, U Agus, A Christanto, N Cesca, I Bolcato, L Scardoni);
Ichsan); RSUP Fatmawati, Jakarta (LT Lebanon: Ministry of Public Health (R Hamra);
Yudhorini, J Nasarudin, MA Taufik, L Utami); Lithuania: Vilnius University, Institute of Clinical
RSUP Dr. Hasan Sadikin (AY Soeroto, B Medicine; Vilnius University Hospital Santaros
Andriyoko, R Winarni, NH Chairunnisa); RSUD klinikos, Vilnius, (M Paulauskas, U
Dr. Soetomo, Surabaya (T Kusmiati, M Qibtiyah, Sakalauskiene)
A Bachtiar, A Febriani); RSPAU Dr. Esnawan Luxembourg: Clinical and Epidemiological
Antariksa, Jakarta R (Sitepu, R Pratama, S Investigation Center, Strassen (M Alexandre),
Siswandi, P Parman); RSUP Prof. Dr. R.D. Hôpitaux Robert Schuman, Luxembourg (M
Kandou, Manado (E Prasetyo, FNK Fujiyanto, R Berna)
Adiwinate, E Kristanto); RSUP H. Adam Malik, Pakistan: Hayatabad Medical Complex
Medan (M Muntasir, A Agustina, D Panjaitan, Peshawar (S Jamal), Shaukat Khanum
FR Ananda); RSUP Dr. Sardjito, Yogyakarta (F Memorial Cancer Hospital (S Hassan, S Abbas,
Dayi, A Riswiyanti, I Trisnawati, NR Ananda); S Khan, MR Khan), and Shifa International
RSPI Prof. Sulianti Saroso, Jakarta (N Mariana, Hospital (E Khan, S Azam);
A Rusli, T Sundari, R Rosamarlina);
Philippines: Asian Hospital and Medical Center Villavicencio, DD Ona, S Unson, JD Gargar, BM
(MIL Fernandez), Baguio General Hospital (MLF Samonte), University of the East Ramon
de Leon, RG Dagwasi), Batangas Medical Magsaysay Memorial Medical Center (MTF
Center (ML Almero, M Mercado), Cardinal Sumagaysay), University of the Philippines (FM
Santos Medical Center (A Vergara), Cebu Climacosa, ME Mercado, CDA Rozul, P Tagle,
Doctors' University Hospital (F Repunte), M Recana), World Citi Medical Center (DJD
Chinese General Hospital (SO Tan, MK Ong- Reotita), Philippine Clinical Research
Tantuco, RC Reyes, PLG Co, ALG Gabriel- Professionals (G Mendoza, J Arellano, AR
Chan, AO Reyes-Addatu, JT Li-Yu, SA Ang), Baniqued), Department of Health Philippines (FT
Diliman Doctors Hospital (KI Del Ayre), Fe Del Duque III, MR Vergeire), Food and Drug
Mundo Medical Center (SMA Santos, A Torrico), Administration Philippines (RE Domingo), and
Lung Center of the Philippines (H Basobas, Z WHO WPRO (JP Tonolete);
Del rosario), Makati Medical Center (KM Saudi Arabia: King Faisal Specialist Hospital
Taladua, HF Ricaforte-Docuyanan), Manila and Research Centre, Riyadh (N Alorayyidh, R
Doctors Hospital (JS Ramos- Precilla, SA Moslmani), King Khaled University Hospital,
Limson), Medical Center Manila (TAE Nunez), Riyadh (A Abdurrahman, D Bintaleb);
The Medical City (A Santiago), Perpetual Succor Spain: Complejo Asistencial de Segovia (M.T.
Hospital, Cebu (TR Cuevas), Philippine Council Criado Illana, P. Bachiller Luque, A. Carrero
for Health Research and Development (JC Gras, Lydia Iglesias Gómez, Paula Goicoechea
Montoya ), Philippine General Hospital (JP Núñez); Hospital Clinico San Carlos, UCM,
Benedicto, M Llanes, G Astudillo, P Nala, R IdISSC, Madrid (V Alvarez, C Perez-Ingidua, N
Abaya), Research Institute for Tropical Medicine Pérez Macias, O Bueno, MJ Tellez), Hospital La
(A Yabut), San Juan de Dios Educational Paz, Madrid (A Borobia), Instituto de
Foundation Hospital (JD Cruz), San Lazaro Investigación Biomédica de Málaga, Málaga (J
Hospital (SM Ligutan), St. Lukes Medical Center Sanabria-Cabrera);
Quezon City (AR Cumpas), Vicente Sotto South Africa: Chris Hani Baragwanath
Memorial Medical Center (M Bagano, MP Pablo- Academic Hospital (D Kalambay, WBT Lechuti),
Villamor, GM Aquino Jr, JD Bancat), Southern Groote Schuur Hospital (S Koekemoer, S
Philippines Medical Center (MYC Barez, LL Moosa, T Morar), Sefako Makgatho Health
Torno, P Ferrer, EA Sibal),St. Lukes Medical Sciences University (SC Shaku, VM
Center Global (G Dy-Arga, R Enecilla, CE Ramothwala), Wits Health Consortium (C

Barker, J Chelliah, J Ferreira, M Knight, LI and Interferon β-1a by Merck KGaA
Koeberg, Y Kilian, A Rama, D Strydom, S (subcutaneous) and Faron (intravenous). Add-
Naidoo), and Wits Reproductive Health and HIV on studies were conducted in Canada, France,
Institute (F Docrat, A Jacques, K Moodley, T India and Norway.
Msomi, R Boikanya, S Cornell);
Switzerland: Kantonsspital Baden (A Friedl, J Supported by: Canada: the Canadian Institutes
Rutishauser, F Rutz), Campus SLB of Health Research (WST-171496); the London
Lindenhofgruppe Bern (C Groen, J Evison), Health Sciences Foundation, London, Ontario;
Kantonsspital Frauenfeld (P Rochat, P the Calgary Health Trust and Calgary Centre for
Hackman, P Wiesli, A Kistler, R Ursprung, S Clinical Research COVID-19 Fund, and the
Danioth, R Werner, S Dias, M Schuster), Covenant Health Research Centre; the McGill
Hôpitaux universitaires de Genève (P Vazquez, University Health Centre was supported by a
Y Gosmain), Lausanne University Hospital (M grant from the McGill Interdisciplinary Initiative in
Cavassini, A Fayet-Mello, L Vallotton, L Infection and Immunity (MI4) with funding from
Warpelin-Decrausaz, V Sormani, D Niksch), and the MUHC Foundation; France: EU-
Hôpital du Valais Sion (M Eyer, E Schaefer, S RESPONSE has received funding support from
Schwery, MSavet, A Luyet), Hôpitaux the European Union’s Horizon 2020 research
universitaires de Genève et Faculté de and innovation programme under grant
médecine (the Clinical Research Center and the agreement No 101015736; India: the Indian
HIV research team); Council of Medical Research under RFC No
WHO teams: AFRO (C Garapo, JP Okeibunor), ECD/NTF-1-20-21; HETERO LABS Limited
EMRO (A Hashish, C Kodama, A Mandil), Hyderabad donated Remdesivir; Finland:
EURO (C Butu, M Dara, A Kuli, A Mesi, N funding support from the Academy of Finland;
Mamulashvili, I Zurlyte), PAHO/AMRO (L Iran: funding from the Iran Ministry of Health and
Reveiz), SEARO (T Azim, M Gupta, R Medical Education; Italy: funding and in kind
Takahashi), WPRO (A Cawthorne, YR Lo, JP support from the Azienda Ospedaliera Integrata
Tonolette) and Headquarters (V Benassi, S of Verona and the Servizio di Farmacia, Azienda
Benitez, A Borges, T Bouquet, S Chuffart, E Ospedaliera Integrata, Verona; Malaysia:
Egorova, R Embaye, S Kone, C Merle, P funding support from the Ministry of Health NIH
Molinaro, R La Rotta, MJ Ryan, N Mafunga, A Research Grant; Norway: funding support from
Mazur, G Queyras). the Clinical Therapy Research in the Specialist
Health Services (KLINBEFORSK); Philippines:
Acknowledgments the Department of Science and Technology,
The chief acknowledgement is to the thousands Philippine Council for Health Research and
of patients and their families who participated in Development; South Africa: the South African
this trial and made it possible, and the hundreds Medical Research Council; Spain: the Spanish
of medical staff who randomized and cared for Clinical Research Network (SCReN, Institute of
the patients. Health Carlos III, through PT17/0017/0018 -
integrated in the State Plan I+D+I 2013-2016
The Ministries of Health of the participating and co-financed by FEDER-), Research Project
Member States and their institutions provided COV20/00612 (CTE-COVID-19, ISCIII), and the
critical support in the implementation of the trial. Agencia Española de Medicamentos y
Productos Sanitarios (AEMPS); Hospital
Castor EDC donated and managed their cloud- Universitario Virgen Macarena, Sevilla, Spain,
based clinical data capture and management has received funding support from the Instituto
system. Anonymized data handling and analysis de Salud Carlos III, Spanish Network for
was at the Universities of Berne, Bristol and Research in Infectious Diseases (REIPI;
Oxford. Remdesivir was donated by Gilead RD16/0016/0001), co‐financed by European
Sciences, Hydroxychloroquine by Mylan, Development Regional Fund “A way to achieve
Lopinavir-Ritonavir by Abbvie, Cipla and Mylan Europe”, Operative program Intelligent Growth

2014‐2020; Switzerland: the Swiss National Development Office (FCDO); the German
Science Foundation (NSF) in collaboration with Federal Ministry of Health (BMG); the Ministry of
the Federal Office of Public Health (FOPH). Foreign Affairs of Denmark; the Kingdom of
WHO: supported through its COVID-19 Strategic Saudi Arabia (the King Salman Humanitarian
Preparedness and Response Plan, including Aid and Relief Center); and the Government of
funding from the United Kingdom’s Department the State of Kuwait.
for International Development (DFID, now
replaced by the Foreign, Commonwealth &

TABLE S1. TREATMENT ALLOCATION VS INITIATION OF VENTILATION IN THOSE NOT

ALREADY BEING VENTILATED AT THE TIME OF RANDOMIZATION

Ventilation includes invasive or non-invasive mechanical ventilation or extra-corporeal membrane oxygenation.

* Ventilation can be reported in patients who have not yet died or been discharged.

† More complete follow-up will increase the numbers known to have been ventilated or died, but not the
Kaplan-Meier (K-M) estimate of the 28-day percentage risk of death (in hospital) or ventilation initiation.

TABLE S2. USE OF CORTICOSTEROIDS AND OTHER NON-STUDY DRUGS

Numbers and percentages are tabulated

TABLE S3. MULTIVARIATE ANALYSIS stratified by the set of study drugs that was
SIMULTANEOUSLY ESTIMATING ALL 4 locally available at randomization (13 occupied
strata). Hence, no reduction of the dataset was
EFFECTS needed to ensure that comparisons were only
The pre-planned primary analyses in the main between concurrently randomized treatments,
text involved 4 pairwise comparisons, one and that they were not subject to any selective
between each treatment group and its controls, biases. It was adjusted for several of the
as indicated in the flowchart (Figure 1). These 4 prognostic factors listed in Table 1: age (<40,
primary analyses were stratified by age and by 40-49, 50-59, 60-69, 70-79, 80+ years), sex,
whether the patient was already ventilated at the diabetes, bilateral lung lesions at entry (no, yes,
time of randomization, and found no definitely not imaged at entry), and respiratory support at
favorable or definitely unfavorable effect of any entry (no oxygen, oxygen but no ventilation,
of the 4 study drugs on all-cause in-hospital ventilation). This multivariate sensitivity analysis
mortality (Figure 3). The RRs in these 4 pre- had not been pre-planned as a primary or a
planned pairwise comparisons were: secondary analysis. For each of the 4 study
drugs it yielded mortality rate ratios (RRs) for
Remdesivir vs its control (pre-planned analysis) active treatment vs local standard of care (SoC)
RR=0.95 (95% CI 0.81-1.11), that were similar to those in the pre-planned
Hydroxychloroquine vs its control (pre-planned primary pairwise comparisons, again finding no
analysis) RR=1.19 (0.89-1.59), definitely favorable or unfavorable effect of any
Lopinavir vs its control (pre-planned analysis) of the 4 study drugs:
RR=1.00 (0.79-1.25), and
Interferon vs its control (pre-planned analysis) Remdesivir vs local SoC (in multivariate
RR=1.16 (0.96-1.39). analysis) RR=0.95 (95% CI 0.81-1.11),
Hydroxychloroquine vs local SoC (in multivariate
As there was some overlap between the 4 analysis) RR=1.14 (0.89-1.46),
control groups, an exploratory sensitivity Lopinavir vs local SoC (in multivariate analysis)
analysis used multivariate Cox regression to fit RR=0.94 (0.76-1.16), and
all 4 treatment effects simultaneously, assuming Interferon vs local SoC (in multivariate analysis)
the independence of any effects of lopinavir and RR=1.14 (0.96-1.35).
of interferon. This multivariate analysis was

Figure S1. Effects on in-hospital mortality of (a) remdesivir, (b) hydroxychloroquine, (c) lopinavir, and
(d) interferon

Figure S2. Subdivision by ventilation at randomization of the apparent effects of remdesivir on the
probability of death in hospital from any cause

Figure S3. Subdivision by ventilation at randomization of the apparent effects of hydroxychloroquine on
the probability of death in hospital from any cause

Figure S4. Subdivision by ventilation at randomization of the apparent effects of lopinavir on the
probability of death in hospital from any cause

Figure S5. Subdivision by ventilation at randomization of the apparent effects of interferon on the
probability of death in hospital from any cause

Figure S6. In-hospital mortality rate ratios, stratified by age and respiratory support at entry, remdesivir
vs its control, by entry characteristics and by steroid use at any time*

Figure S7. In-hospital mortality rate ratios, stratified by age and respiratory support at entry,
hydroxychloroquine vs its control, by entry characteristics and by steroid use at any time*

Figure S8. In-hospital mortality rate ratios, stratified by age and respiratory support at entry, lopinavir vs
its control, by entry characteristics and by steroid use at any time*

Figure S9. In-hospital mortality rate ratios, stratified by age and respiratory support at entry, interferon
vs its control, by entry characteristics and by steroid use at any time*

Figure S10. RRs for the composite of death in hospital or initiation of ventilation: effects of (a)
remdesivir, (b) hydroxychloroquine, (c) lopinavir, (d) interferon, each vs its control

Figure S11. Remdesivir, Hydroxychloroquine, Lopinavir & Interferon, each vs its own control - effects
on time to discharge alive in patients NOT being ventilated (no O2, or getting low-flow / high-flow O2) at
entry Those who die in hospital remain in the analyses until after day 28.

Figure S12. Remdesivir, hydroxychloroquine, lopinavir & interferon, each vs its own control - effects on
time to discharge alive in patients already being ventilated at entry Those who die in hospital remain in the
analyses until after day 28.

Figure S13. Remdesivir, hydroxychloroquine, lopinavir & interferon, each vs its own controls - effects on
time to discharge alive in patients being given low-flow O2 / high-flow O2 at entry Those who die in hospital

remain in the analyses until after day 28.

Figure S14. Remdesivir, hydroxychloroquine, lopinavir & interferon, each vs its own controls - effects on
time to discharge alive in patients being given no O2 at entry (Approximates “mild-to-moderate” in ACTT-1/FDA
reports) Those who die in hospital remain in the analyses until after day 28.

Figure S15. Remdesivir, hydroxychloroquine, lopinavir & interferon, each vs its own controls - effects on
time to discharge alive in patients on low-/high-flow O2 or ventilated (Approximates “severe” in ACTT-1/FDA

reports.) Those who die in hospital remain in the analyses until after day 28.

Figure S16. Remdesivir, hydroxychloroquine, lopinavir & interferon, each vs its own controls - effects on
time to discharge alive in all patients, regardless of respiratory support at entry Those who die in hospital

remain in the analyses until after day 28.

Figure S17. Pairwise randomized comparisons between pairs of study drugs - effects on time to

discharge alive, restricted to patients randomized when and where both of the two drugs were available

Those who die in hospital remain in the analyses until after day 28.

Figure S18. Effects of (a) remdesivir, (b) hydroxychloroquine, (c) lopinavir, (d) interferon on cardiac
death in hospital (any death in hospital for which the trial’s electronic death report included a
cardiaccause)

Figure S19. Hydroxychloroquine vs its control in hospitalized COVID – Meta-analysis of mortality in the
Solidarity, Recovery and other trials

* Log-rank O-E for Solidarity and Recovery, and sum of O-E from 2x2 tables for small trials. RR is got
by taking logeRR to be (O-E)/V with Normal variance 1/V. Similar use of subtotals or of totals of (O-E)
and of V yield inverse-variance-weighted averages of the logeRR values. † For balance, only half the
control numbers in Recovery are added into totals and subtotals.

Figure S20. Lopinavir versus its control in hospitalized COVID – Meta-analysis of mortality in the
Solidarity, Recovery & Wuhan trials

*Log-rank O-E for Solidarity and Recovery, and O-E from a 2x2 table for the Wuhan trial. RR is got by
taking logeRR to be (O-E)/V with Normal variance 1/V. Similar use of subtotals or of totals of (O-E) and
of V yield inverse variance weighted averages of the logeRR values. † For balance, only half the control
numbers in Recovery are added into totals and subtotals.

Figure S21. Remdesivir vs control – Meta-analysis of mortality in trials of random allocation of
hospitalised COVID-19 patients between remdesivir and its control

*Log-rank O-E for Solidarity, O-E from 2x2 tables for Wuhan and SIMPLE, and w.logeHR for ACTT
strata (with the weight w being the inverse of the variance of logeHR, which is got from the HR’s CI).
RR is got by taking logeRR to be (O-E)/V with Normal variance 1/V. Subtotals or totals of (O-E) and of
V yield inverse-variance-weighted averages of the logeRR values. † For balance, controls in the 2:1
studies count twice in the control totals and subtotals.



GAMBARAN KEPATUHAN PENGGUNAAN MASKER PADA PASIEN GANGGUAN
JIWA YANG DIRAWAT DI RUANG RAWAT INAP PSIKIATRI RS JIWA DR. H.
MARZOEKI MAHDI BOGOR TAHUN 2021

1. Ns. Sri Redjeki Julianingsih, S.Kep, M.Kep, 2. Ns. I Wayan Suartana, S.Kep, 3. Ida Faridah, S.Kp, 4.
Ns. I Wayan Kustiko saputra, S. Kep, 5. Alriwati, AMd.Kep, 6. Ns. Wawan Setiawan, S.Kep, 7. Dr. Puji

Triastuti, MARS, 8. Dr. Faroland Dedi K, Sp, PK
9.Miranty Novia Wardhani, S.Psi,

ABSTRAK
Kepatuhan penggunaan masker merupakan salah satu komponen penting dalam pelaksanaan protocol
Kesehatan yang berguna untuk pencegahan penularan. Pencegahan dan pengendalian infeksi virus
Covid-19 wajib dikerjakan di semua tatanan layanan Kesehatan, termasuk pada ODGJ di Rumah Sakit
Jiwa. Hierarki pengendalian infeksi menempatkan penggunaan alat pelindung diri sebagai upaya
terakhir yang harus dikerjakan di layanan Kesehatan. RS Jiwa dr. H. Marzoeki Mahdi Bogor sebagai
Rumah Sakit yang ditunjuk untuk melayani perawatan Covid-19 melakukan upaya untuk mengedukasi
pada pasien baik pasien psikiatri maupun non Psikiatri tentang perlunya penggunaan alat pelindung diri
selama masa Pandemi Covid-19. Penelitian ini bertujuan untuk memberikan gambaran nyata mengenai
kepatuhan penggunaan masker pada pasien gangguan jiwa yang di rawat di ruang rawat inap Psikiatri
RS. Jiwa dr. H. Marzoeki Mahdi Bogor. Penelitian ini merupakan penelitian eksperimental, deskriptif
dan analitik dengan pendekatan Cross Sectional. Populasi dalam penelitian ini adalah seluruh pasien
gangguan jiwa yang di rawat pada saat observasi dilakukan. Teknik pengambilan sampel menggunakan
purposive sampling yang dilaksanakan pada pasien gangguan jiwa anak remaja, dewasa dan lansia
dengan menggunakan rumus slovin sejumlah 91 responden. Analisis data dalam penelitian ini
menggunakan Analisis Univariat dan Analisis Bivariat. Berdasarkan hasil analisis menunjukkan adanya
hubungan signifikan antara kepatuhan penggunaan masker dengan variabel usia (p Value = 0.002).
Adanya hubungan signifikan antara kepatuhan penggunaan masker dengan variabel jenis kelamin (p
Value = 0.001). Adanya hubungan signifikan antara kepatuhan penggunaan masker dengan variabel
keluhan (p Value = 0.000). Tidak ada hubungan signifikan antara pemberian edukasi dengan
kepatuhan penggunaan masker pada pasien gangguan jiwa di RS. Jiwa dr. H. Marzoeki Mahdi Bogor
(p Value = 0.630). Tidak ada hubungan antara jenis masker dengan kepatuhan penggunaan masker
pada pasien dengan gangguan jiwa di RS Jiwa dr. H. Marzoeki mahdi Bogor (p Value = 0.220). Saran
dalam penelitian ini yaitu, pasien gangguan jiwa selama masa perawatan tetap harus melaksanakan
protocol Kesehatan salah satunya dengan menggunakan masker. Kepatuhan penggunaan masker pada
pasien gangguan jiwa dapat tetap dilakukan dengan menitikberatkan pada monitoring atau supervisi
penggunaan masker selain edukasi.

Kata Kunci : Kepatuhan, Pasien gangguan jiwa, APD, Masker.

PENDAHULUAN keterbatasan dalam berbicara (alogia), serta
Pandemik Covid-19 belum berakhir hingga keterbatasan dalam maksud dan tujuan perilaku.
tahun 2021 saat ini. Pencegahan dan Berdasarkan penelitian ilmiah, Covid-19
pengendalian infeksi wajib dikerjakan di semua ditularkan melalui kontak erat dan droplet,
tatanan layanan Kesehatan termasuk di RS Jiwa kecuali jika ada tindakan medis yang memicu
yang menangani pasien dengan gangguan terjadinya aerosol dimana memicu terjadinya
kejiwaan. Sebagai salah satu RS yang ditunjuk resiko penularan melalui airborne. Pasien
untuk melayani perawatan covid-19, RS. Jiwa dr. gangguan jiwa yang di rawat di ruang rawat inap
H. Marzoeki Mahdi Bogor telah melaksanakan psikiatri untuk jangka waktu tertentu merupakan
hierarki pengendalian infeksi dengan indivividu yang beresiko terinfeksi karena
menempatkan penggunaan alat pelindung diri mengalami kontak erat dengan petugas
sebagai upaya terakhir yang harus dikerjakan di Kesehatan maupun pasien lain yang berpeluang
Layanan Kesehatan tidak hanya untuk pasien tinggi terpapar virus Covid-19. Mereka dapat
non psikiatri namun juga pada pasien psikiatri melindungi diri dengan memenuhi praktik
yang mengalami gangguan kejiwaan. pencegahan dan pengendalian infeksi yang
Kepatuhan penggunaan masker pada pasien mencakup pengendalian administrative,
gangguan jiwa menjadi hal penting yang perlu lingkungan dan engineering serta penggunaan
diupayakan untuk pencegahan dan Alat pelindung Diri (APD) yang tepat. Edukasi
pengendalian virus Covid-19. Tingkat kepatuhan untuk pasien gangguan jiwa tentang pentingnya
penggunaan masker pada pasien gangguan jiwa penggunaan APD merupakan salah satu aspek
berbeda dengan pasien lain pada umumnya. dari Langkah pencegahan dan pengendalian
Karakteristik ODGJ (Orang Dengan Gangguan infeksi dengan berbasis asesmen resiko.
Jiwa) yang mengalami kehilangan orientasi Kepatuhan penggunaan masker pada pasien
waktu, tempat dan orang akan menjadi faktor gangguan jiwa merupakan salah satu aspek dari
penyulit dalam pemberian edukasi penggunaan asesmen resiko yang perlu dipikirkan untuk
masker di masa pandemik saat ini. mengontrol pencegahan dan pengendalian
infeksi virus Covid-19 di Rumah Sakit Jiwa.
Kepatuhan adalah suatu perubahan perilaku dari Gangguan jiwa dapat disebabkan oleh banyak
perilaku yang tidak mentaati peraturan ke faktor yang berinteraksi satu sama lain. Koping
perilaku yang mentaati peraturan (Green dalam yang tidak konstruktif merupakan salah satu
Notoatmodjo, 2012). Kepatuhan merupakan faktor yang akan menjadi penyulit dalam
suatu tahap awal perilaku, maka semua faktor pemberian edukasi penggunaan masker.
yang mendukung atau mempengaruhi perilaku
juga akan mempengaruhi kepatuhan (Sacket Penelitian mengenai gambaran kepatuhan
dalam Sahayu, 2011). Kondisi psikiatrik yang penggunaan masker pada pasien gangguan jiwa
dialami oleh pasien gangguan jiwa adalah salah di RS Jiwa dr. H. Marzoeki Mahdi Bogor menjadi
satu faktor yang akan mempengaruhi perilaku salah satu aspek penting yang perlu dielaborasi
dan mempengaruhi kepatuhan. Sejumlah tanda untuk dapat memberikan rekomendasi tentang
dan gejala dari gangguan jiwa menurut DSM IV cara atau metode yang paling efektif dalam
adalah ; 1) Gejala positif, sekumpulan gejala meningkatkan kepatuhan penggunaan masker
perilaku tambahan yang menyimpang dari pada masa pandemi. Berdasarkan beberapa
perilaku normal seseorang termasuk distorsi data ataupun permasalahan yang telah
persepsi (halusinasi), distorsi isi pikir (waham), diungkapkan di latar belakang dan juga karena
distorsi dalam proses berpikir dan Bahasa serta belum pernah dilakukannya penelitian mengenai
distorsi perilaku dan pengontrolan diri. 2) Gejala kepatuhan penggunaan masker pada pasien
negative, yaitu sekumpulan gejala gangguan jiwa di RS. Jiwa. dr. H. Marzoeki
penyimpangan berupa hilangnya Sebagian Mahdi Bogor, maka tim peneliti tertarik untuk
fungsi normal dari individu termasuk lebih memfokuskan pada gambaran kepatuhan
keterbatasan dalam ekspresi emosi, penggunaan masker dan aspek apa saja yang
keterbatasan dalam produktivitas berpikir,

berhubungan dengan hal tersebut pada pasien ini variabel dependen yaitu kepatuhan
gangguan jiwa sebagai suatu bentuk upaya penggunaan masker pada pasien gangguan
pencegahan dan pengendalian infeksi virus jiwa, sedangkan variabel independennya yaitu
Covid-19 di Rumah sakit Jiwa dr. H. Marzoeki usia, pemberian edukasi dan jenis masker.
Mahdi Bogor. Penelitian ini menggunakan purposive sampling,
sampel diambil dari seluruh pasien dengan
METODOLOGI gangguan jiwa menggunakan metode Slovin
Penelitian ini merupakan penelitian kuantitatif sebanyak 91 pasien.
yang bersifat deskriptif analitik. Dalam penelitian

HASIL DAN PEMBAHASAN
Diagram 1. Diagram karakteristik responden berdasar umur

Berdasarkan diagram 1 umur termuda adalah 10 tahun dan umur dewasa antara 20 – 40 tahun, umur
lansia adalah 60 tahun. Rata-rata umur responden adalah 39 tahun.

Tabel 1. Tabel Jenis Masker

Jenis Masker

Frequency Percent Valid Percent Cumulative Percent

Valid Masker Bedah 89 97.8 97.8 97.8
Masker Kain 2 2.2 2.2 100.0
Total
91 100.0 100.0

Sebanyak 97.8 % menggunakan masker bedah dan 2.2% menggunakan masker kain.

Tabel 2. Tabel Pemberian Edukasi Pada Responden

Edukasi

Frequency Percent Valid Percent Cumulative Percent

Valid Tidak 6 6.6 6.6 6.6
Ya 85 93.4 93.4 100.0
Total 91 100.0 100.0

Sebanyak 93.4% pasien teredukasi terhadap penggunaan masker dan 6.6% yang tidak mendapatkan
edukasi penggunaan masker.

Tabel 3. Tabel Kepatuhan Penggunaan Masker (Lamanya Menggunakan Masker)

Pemakaian

Frequency Percent Valid Percent Cumulative Percent

Valid kurang dari 1 jam 52 57.1 57.1 57.1
lebih dari 1 jam 39 42.9 42.9 100.0
Total
91 100.0 100.0

Sebanyak 57.1% responden yang menggunakan masker kurang dari 1 jam dan 42.9% menggunakan
masker lebih dari 1 jam.

Tabel 4. Tabel Mengenai Keluhan Penggunaan Masker

Keluhan

Frequency Percent Valid Percent Cumulative Percent

Valid tidak ada keluhan 24 26.4 26.4 26.4
sesak,pusing,Lelah 8 8.8 8.8 35.2
bingung halusinasi 32 35.2 35.2 70.3
lepas pasang,digantung
dileher dan dahi 27 29.7 29.7 100.0
Total
91 100.0 100.0

Sebanyak 26.4% pasien tidak mengalami keluhan dan 8.8% pasien mengalami keluhan sesak, pusing
dan kelelahan, 35.2% pasien Nampak bingung dan mengalami halusinasi. Sejumlah 29.7% pasien
sering melepas dan memasang Kembali masker, masker diposisikan menggantung di dahi dan
digantungkan di leher.

Tabel 5. Tabel Hasil Uji Korelasi

Correlations

Umur JK Pemakaian
.022 -.320**
Umur Pearson Correlation 1 .834 .002
JK Sig. (2-tailed) 91 91 91
Pemakaian N -.355**
1 .001
Pearson Correlation .022 91
Sig. (2-tailed) .834 91 1
N 91 -.355**
.001 91
Pearson Correlation -.320**
Sig. (2-tailed) .002 91
N 91

**. Correlation is significant at the 0.01 level (2-tailed).

Model Summaryb

Model R R Square Adjusted R Square Std. Error of the Estimate
1 .320a .102 .092 14.76539

a. Predictors: (Constant), Pemakaian antara keluhan dengan kepatuhan penggunaan
b. Dependent Variable: Umur masker dengan p value sebesar 0.000. Untuk
variabel pemberian edukasi terhadap kepatuhan
Dari tabel di atas diperoleh hasil adanya penggunaan masker tidak ada hubungan yang
hubungan signifikan antara umur dan kepatuhan signifikan dengan p value = 0.630. Demikian
penggunaan masker pada pasien gangguan jiwa pula dengan variabel jenis masker terhadap
di RS Jiwa dr. H. Marzoeki Mahdi Bogor dengan kepatuhan penggunaan masker tidak memiliki
tingkat signifikansi p value = 0.002, adanya hubungan yang signifikan (p Value = 0.220).
hubungan signifikan antara jenis kelamin dan kesehatan di ruang rawat inap. Untuk
kepatuhan penggunaan masker dengan p value melengkapi hasil penelitian perlu
sebesar 0.001, adanya hubungan signifikan

KESIMPULAN
Berdasarkan data hasil penelitian mengenai
kepatuhan penggunaan masker pada pasien
gangguan jiwa di RS. Jiwa dr H Marzoeki Mahdi
Bogor, diketahui bahwa jenis kelamin, usia dan
keluhan pasien berkontribusi pada kepatuhan
penggunaan masker. Aspek yang tidak
signifikan berkontribusi terhadap kepatuhan
penggunaan masker pada pasien gangguan jiwa
adalah pemberian edukasi dan pemilihan jenis
masker. Dengan demikian, untuk kepatuhan
penggunaan masker pada pasien gangguan
jiwa, selain diberikan edukasi perlu dilakukan
monitoring secara intens oleh petugas

dilakukan studi lanjutan mengenai aspek usia https://www.suara.com/news/2020/04/09/11
dan jenis kelamin secara detail sehingga faktor- 5044/dirjen-yankes-ketersediaan-apd-
faktor pendukung yang memberi kontribusi pada sangat-terbatas
kepatuhan penggunaan masker pada pasien 10. Gladys Apriluana , Laily Khairiyati RS.
gangguan jiwa dapat lebih dielaborasi dan Hubungan Antara Usia, Jenis Kelamin,
digambarkan dengan lebih tepat. Selain itu Lama Kerja, Pengetahuan, Sikap dan
pemilihan jenis masker pun menjadi hal penting Ketersediaan Alat Pelindung Diri (APD)
yang dapat diteliti lebih lanjut untuk mengetahui dengan Perilaku Penggunaan APD pada
jenis masker apa yang lebih nyaman digunakan Tenaga Kesehatan. J Publ Kesehat Masy
untuk mendukung kepatuhan penggunaan Indones. 2016;3(3):82–7
masker bagi pasien gangguan jiwa di RS Jiwa 11. Yánez Benítez C, Güemes A, Aranda J,
dr. H. Marzoeki Mahdi Bogor. Ribeiro M, Ottolino P, Di Saverio S, et al.
Impact of Personal Protective Equipment
DAFTAR PUSTAKA on Surgical Performance During the
1. Kemenkes RI. Peraturan Menteri COVID-19 Pandemic. World J Surg.
2020;44(9):2842–7
Kesehatan RI No 1087 Tentang Standar 12. Kang JH, Kim EJ, Choi JH, Hong HK, Han
Kesehatan dan Keselamatan Kerja SH, Choi IS, et al. Difficulties in using
diRumah Sakit. Standar Kesehat Dan personal protective equipment: Training
Keselam Kerja diRumah Sakit. 2010; experiences with the 2015 outbreak of
2. Kementerian Kesehatan RI Tentang Middle East respiratory syndrome in
Petunjuk Teknis Alat Pelindung Diri (APD) Korea. Am J Infect Control [Internet].
Dalam menghadapi Wabah Covid 19, 2018;46(2):235–7. Available from:
Tahun 2020 https://doi.org/10.1016/j.ajic.2017.08.041
3. Kementrian Kesehatan RI Tentang 13. Piché-Renaud P-P, Groves H, Kitano T,
Pedoman Pencegahan Covid 19,Juli 2020 Arnold C, Thomas A, Streitenberger L, et
4. Susilo A, Rumende CM, Pitoyo CW, al. Healthcare workers’ perception of a
Santoso WD, Yulianti M, Sinto R, et al. global outbreak of novel coronavirus
Coronavirus Disease 2019 : Tinjauan (COVID-19) and personal protective
Literatur Terkini Coronavirus Disease 2019 equipment: Survey of a pediatric tertiary
: Review of Current Literatures. J Penyakit care hospital. Infect Control Hosp
Dalam Indones. 2020;7(1):45–67 Epidemiol [Internet]. 2020;1–25. Available
5. WHO. Water , sanitation , hygiene and from:http://www.ncbi.nlm.nih.gov/pubmed/3
waste management for the COVID-19 virus. 2782038
World Heal Organ. 2020;(March):1–9 14. Ahmed N, Shakoor M, Vohra F, Abduljabbar
6. Idhom AM. Update Corona 8 April 2020 T, Mariam Q, Rehman MA. Knowledge,
Indonesia dan Data Covid-19 Dunia Hari awareness and practice of health care
Ini. tirto.id [Internet]. 2020 May 12; professionals amid sars-cov-2, corona virus
Available from: https://tirto.id/update- disease outbreak. Pakistan J Med Sci.
corona-8-april-2020-indonesia- data-covid- 2020;36(COVID19-S4):S49–56
19-dunia-hari-ini-eLSN 15. Chughtai AA, Seale H, Dung TC, Hayen A,
7. McNeil DG. Saudi Arabia: MERS toll Rahman B, Raina MacIntyre C. Compliance
revised. New York Times June. 2014;4 with the use of medical and cloth masks
8. Black JRM, Bailey C, Przewrocka J, among healthcare workers in Vietnam. Ann
Dijkstra KK, Swanton C. COVID-19: the Occup Hyg. 2016;60(5):619–30
case for health- care worker screening to 16. Chersich MF, Gray G, Fairlie L, Eichbaum
prevent hospital transmission. Lancet. Q, Mayhew S, Allwood B, et al. COVID-19 in
2020;395(10234):1418–20 Africa: care and protection for frontline
9. Ariefana P. Dirjen Yankes: Ketersediaan healthcare workers. Global Health.
APD Sangat Terbatas. www.suara.com 2020;16(1):46
[Internet]. 2020; Available from:

IMPLEMENTATION OF COMPLIANCE WITH THE USE OF PERSONAL PROTECTIVE
EQUIPMENT (APD) IN HOSPITALS DURING THE COVID 19 PANDEMIC

1. Risca Yuniadewi Irawan Email : [email protected]

ABSTRACT

Health Workers are the spearhead of the government in handling Covid 19 patients so it is necessary to get special
attention in handling Covid 19 patients. In handling Covid-19, the use of APD by health workers directly involved in the
handling of patients, especially those who have been confirmed by Covid-19, is very important. APD used is APD that
has met the standards so that it is effective to prevent the spread of the virus or contract Covid-19. The purpose of the
research is to identify the application of Personal Protective Equipment (APD) by Health Workers who handle directly
or indirectly Covid 19 patients. This type of research is observational with cross -sectional research design that is
conducting direct observations on the application of APD in Government Hospitals in Bogor and then analyzed based
on the standards of APD use applicable in the hospital. The study population is doctors, nurses, radiographers, health
analysts who handle covid 19 patients either directly or indirectly who are in the treatment room and hospital support
room of 87 people. Data collection is done by observation when doing care to patients. The research was conducted
from September to October 2020. The collected APD usage data is then processed manually, analyzed descriptively,
and compared to standards related to research. Compliance of health workers is carried out by analyzing the
observation data and then compared with the standards of hospitals on the use of APD in each room. Types of APD
refer to the Ministry of Health Guidelines. The results of the study obtained a percentage in the use of APD where the
respondents who obeyed was 10% (9 people) Doctors/general practitioners, 60% (60 people) nurses, 9% (8 people)
Radiographers, 18% (16 people) health analysts. The respondents who did not comply were 2% (2 people) nurses.
Most of the respondents of health workers as much as 98% in the hospital already have a high level of vigilance to
wear APD by following the standards. While only 2% of respondents still do not follow the standard of APD usage.

Keywords: Personal Protective Equipment (APD), Compliance, Health Workers, Pandemic Covid 19

ABSTRAK

Tenaga Kesehatan merupakan ujung tombak pemerintah dalam penanganan terhadap pasien Covid-19 sehingga
perlu mendapatkan perhatian yang khusus dalam menangani pasien Covid 19. Dalam penanganan Covid-19,
penggunaan APD oleh tenaga kesehatan yang terlibat langsung dalam penanganan pasien terutama yang telah
terkonfirmasi Covid-19 merupakan hal yang sangat penting. APD yang digunakan adalah APD yang telah memenuhi
standar sehingga efektif untuk mencegah penyebaran virus atau tertular Covid-19. Tujuan Penelitian adalah untuk
mengidentifikasi penerapan Alat Pelindung Diri oleh Tenaga Kesehatan yang menangani secara langsung maupun
tidak langsung pasien Covid 19. Jenis penelitian adalah observasional dengan desain penelitian cross sectional yaitu
melakukan pengamatan langsung mengenai penerapan APD di Rumah Sakit Pemerintah di Bogor kemudian
dianalisis berdasarkan standar penggunaan APD yang berlaku di Rumah Sakit tersebut. Populasi penelitian adalah
dokter, perawat, radiografer, analis kesehatan yang melakukan penanganan pasien covid 19 baik langsung maupun
tidak langsung yang berada di ruang perawatan dan ruang penunjang rumah sakit sejumlah 87 orang. Pengambilan
data dilakukan dengan cara observasi ketika melakukan asuhan kepada pasien.Penelitian dilakukan selama bulan
September sampai dengan Oktober 2020. Data pemakaian APD yang telah terkumpul kemudian diolah secara
manual, dianalisis secara deskriptif dan dibandingkan dengan standar yang berhubungan dengan penelitian.
Kepatuhan tenaga kesehatan dilakukan dengan menganalisis data hasil observasi lalu dibandingkan dengan standar
dari Rumah Sakit tentang pemakaian APD di tiap Ruangan. Jenis-jenis APD mengacu kepada Pedoman Kementrian
Kesehatan. Hasil penelitian didapatkan prosentase dalam penggunaan APD dimana responden yang patuh adalah
sebesar 10% (9 orang) dokter umum, 60% (60 orang) perawat, 9% (8 orang) Radiografer, 18% (16 orang) analis
kesehatan. Adapun responden yang tidak patuh adalah sebesar 2% (2 orang) perawat. Hampir sebagian besar
responden tenaga kesehatan sebesar 98% di Rumah Sakit tersebut sudah memiliki tingkat kewaspadaan yang tinggi
untuk memakai Alat Pelindung Diri (APD) yang sesuai dengan standar. Sedangkan hanya 2% saja responden yang
masih belum mengikuti standar pemakaian APD.

Kata Kunci : Alat Pelindung Diri, Kepatuhan, Tenaga Kesehatan, Pandemi Covid 19

PENDAHULUAN deskriptif. Populasi penelitian adalah semua
Tenaga Kesehatan merupakan ujung tombak dokter, perawat, radiografer, analis kesehatan
pemerintah dalam penanganan terhadap pasien yang melakukan penanganan pasien covid 19
Covid 19 sehingga perlu mendapatkan perhatian baik langsung maupun tidak langsung yang
yang khusus dalam menangani pasien Covid 19. berada di ruang perawatan dan ruang
Coronavirus Disease 2019 (COVID-19) adalah penunjang rumah sakit sejumlah 87 orang.
penyakit menular yang disebabkan oleh Severe Penelitian dilakukan selama bulan Oktober
Acute Respiratory Syndrome Coronavirus 2 sampai dengan November 2020. Dalam
(SARSCoV-2). Berdasarkan Keputusan Menteri penelitian ini proses pengumpulan data
Kesehatan Republik Indonesia nomor dilakukan dengan cara melakukan observasi
hk.01.07/menkes/104/2020 bahwa Pemerintah pada perawat di ruang perawatan dan tenaga
telah menetapkan infeksi novel coronavirus penunjang di ruang penunjang di rumah sakit
(infeksi 2019-ncov) sebagai penyakit yang dapat tempat penelitian.
menimbulkan wabah.
Pengambilan dilakukan dengan cara observasi
Pemerintah juga telah membuat suatu perawat dan tenaga kesehatan lainnya yang
“Pedoman Pencegahan dan Pengendalian dilakukan pada saat peneliti sedang berdinas
Coronavirus Disease (COVID-19) Revisi ke-4”. sehingga mempertahankan kealamian proses
Penerapan kewaspadaan harus dipatuhi oleh observasi responden. Metode analisis yang
Tenaga Kesehatan. Oleh sebab itu penting digunakan analisis univariat. Data pemakaian
sekali pemahaman dan kepatuhan Tenaga APD yang telah terkumpul kemudian diolah
Kesehatan untuk menerapkan Kewaspadaan secara manual, dianalisis secara deskriptif dan
standar agar tidak terinfeksi. Untuk dibandingkan dengan standar yang
meningkatkan kewaspadaan terhadap Penyakit berhubungan dengan penelitian. Kepatuhan
Covid-19, Tenaga kesehatan khususnya yang tenaga kesehatan dilakukan dengan
langsung menangani pasien Covid 19 harus menganalisis data hasil observasi lalu
menerapkan pemakaian Alat Pelindung Diri dibandingkan dengan standar dari Rumah Sakit
(APD) lengkap yang sudah distandarkan. Hal ini tentang pemakaian APD di tiap Ruangan. Jenis-
juga dijelaskan di dalam Peraturan menteri jenis APD mengacu kepada Standar APD
kesehatan republik indonesia nomor 27 tahun Rumah Sakit tersebut dan Pedoman
2017 tentang pedoman pencegahan dan Kementerian Kesehatan.
pengendalian infeksi di fasilitas pelayanan
kesehatan bahwa penerapan kewaspadaan HASIL DAN PEMBAHASAN
standar salah satunya adalah melalui
penggunaan alat pelindung diri. A. Standarisasi Pemakaian Alat Pelindung
Diri di Ruangan.
Alat pelindung diri adalah pakaian khusus atau
peralatan yang di pakai petugas untuk Berdasarkan hasil observasi di Ruangan
memproteksi diri dari bahaya fisik, kimia, Perawatan dan Ruangan Penunjang untuk
biologi/bahan infeksius. Tujuan Penelitian penanganan pasien Covid, didapatkan hasil
adalah untuk mengidentifikasi penerapan Alat bahwa Alat Pelindung Diri yang dipakai oleh
Pelindung Diri oleh Tenaga Kesehatan yang Tenaga Perawat, Radiografer dan Analis
menangani secara langsung maupun tidak Kesehatan adalah sesuai dengan standar yang
langsung pasien Covid 19. telah ditetapkan oleh Rumah Sakit untuk tiap
Ruangan. Standar yang telah ditetapkan Rumah
METODE Sakit mengacu juga kepada Buku Standar Alat
Penelitian ini mengambil tempat di sebuah Pelindung Diri Dalam Manajemen Penanganan
Rumah Sakit Jiwa Marzoeki Mahdi Bogor. Covid-19 Dirjen Kefarmasian dan Alat
Penelitian menggunakan metode kualitatif Kesehatan, Kementerian Kesehatan Republik
dengan menggunakan desain penelitian Indonesia Tahun 2020. Jenis Alat Pelindung Diri
dalam Penanganan pasien Covid 19 kepada

adalah sebagai berikut : bagian tepi wajah) dari percikan cairan
1. Masker Bedah (Surgical Mask) atau darah atau droplet.
• Material:Plastik bening yang dapat
• Kegunaan:Melindungi pengguna dari memberikan visibilitas yang baik bagi
partikel yang dibawa melalui udara pemakainya maupun pasien.
(airborne particle), droplet, cairan, virus • Frekuensi penggunaan:Sekali pakai
atau bakteri. (Single Use) atau dapat dipergunakan
kembali setelah dilakukan desinfeksi /
• Material:Non woven, spunbond dekontaminasi.
meltblown, spunbond (sms) dan
spunbond meltblown, meltblown 5. Sarung tangan pemeriksaan (Examination
spunbond (smms). Gloves)
• Kegunaan:Melindungi tangan pengguna
Masker bedah tidak direkomendasikan untuk atau tenaga medis dari penyebaran
penanganan langsung pasien terkonfirmasi infeksi atau penyakit selama pelaksanaan
Covid-19. Masker dapat menahan dengan pemeriksaan atau prosedur medis.
baik terhadap penetrasi cairan, darah dan • Material:Nitrile, latex, isoprene.
droplet. • Frekuensi penggunaan:Sekali pakai
(Single Use).
2. Masker N-95
6. Sarung tangan bedah (Surgical Gloves)
• Kegunaan:Melindungi pengguna atau • Kegunaan:Melindungi tangan pengguna
tenaga kesehatan dengan menyaring atau tenaga kesehatan dari penyebaran
atau menahan cairan, darah, aerosol infeksi atau penyakit dalam pelaksanaan
(partikel padat di udara), bakteri atau tindakan bedah.
virus. • Material:Nitrile, latex, isoprene.
• Frekuensi penggunaan:Sekali pakai
• Material:Terbuat dari 4-5 lapisan (lapisan (Single Use).
luar polypropilen, lapisan tengah electrete
(charged polypropylene). Memiliki 7. Gaun sekali pakai
efisiensi filtrasi yang baik dan mampu • Kegunaan:Melindungi pengguna atau
menyaring sedikitnya 95% partikel kecil tenaga kesehatan dari penyebaran infeksi
(0,3 micron). Kemampuan filtrasi lebih atau penyakit, hanya melindungi bagian
baik dari masker bedah. depan, lengan dan setengah kaki.
• Material:Non woven, Serat Sintetik
Direkomendasikan dalam penanganan (Polypropilen, polyester, polyetilen,
langsung pasien terkonfirmasi Covid-19. dupont tyvex). Frekuensi penggunaan:
Frekuensi penggunaan: Sekali pakai (Single Sekali pakai (Single Use).
Use).
8. Coverall Medis
3. Pelindung mata (Kacamata Goggles) • Kegunaan:Melindungi pengguna atau
tenaga kesehatan dari penyebaran infeksi
• Kegunaan:Melindungi mata dan area di atau penyakit secara menyeluruh dimana
seluruh tubuh termasuk kepala,
sekitar mata pengguna atau tenaga medis punggung, dan tungkai bawah tertutup.
• Material:Non woven, Serat Sintetik
dari percikan cairan atau darah atau (Polypropilen, polyester, polyetilen,
dupont tyvex) dengan pori-pori 0.2-0.54
droplet. mikron (microphorous).

• Frekuensi penggunaan:Sekali pakai

(Single Use) atau dapat dipergunakan

kembali setelah dilakukan

desinfeksi/dekontaminasi.

Goggle tidak diperbolehkan untuk

dipergunakan kembali jika ada bagian yang

rusak.

4. Pelindung wajah (Face Shields)

• Kegunaan:Melindungi mata dan wajah
pengguna/tenaga medis (termasuk

• Frekuensi penggunaan:Sekali pakai cairan atau darah.
(Single Use).
• Frekuensi penggunaan:Sekali pakai
9. Heavy Duty Apron (Single Use) atau dapat dipergunakan
kembali setelah dilakukan desinfeksi atau
• Kegunaan:Melindungi pengguna atau dekontaminasi.
tenaga kesehatan terhadap penyebaran
infeksi atau penyakit. • Material:Latex dan PVC.

• Material:100% polyester dengan lapisan 11.Penutup sepatu (Shoe Cover)
PVC, atau 100% PVC, atau 100% karet,
atau bahan tahan air lainnya. • Kegunaan:Melindungi sepatu

• Frekuensi penggunaan:Sekali pakai pengguna/tenaga kesehatan dari percikan
(Single Use) atau dapat dipergunakan
kembali setelah dilakukan desinfeksi atau cairan/darah. Material: Non Woven Spun
dekontaminasi.
Bond.

• Frekuensi penggunaan:Sekali pakai

(Single Use).

10.Sepatu boots anti air ( Waterproof Boots)

• Kegunaan:Melindungi kaki

pengguna/tenaga kesehatan dari percikan

Berikut adalah tabel beserta uraian hasil penelitian terhadap
Tabel 1.Standarisasi Jenis Pemakaian Alat Pelindung Diri (APD) Berdasarkan Ruangan Penanganan
Covid 19

Standar APD di Ruangan

No Jenis APD Sesuai Standar Isolasi IGD Radiologi Area Laboratorium
Screening

1 Shoe Cover √ √√ √
2 Face Shields √ √√ √
3 Kacamata Goggle √
4 Masker Bedah √ √√ √ √
5 Sepatu Boots √ √√ √
6 Masker N95 √ √√ √ √
7 Hazmat √ √√ √ √
8 Sarung tangan Gynekolog √ √√ √
9 Sarung tangan pemeriksaan ( Examination Glove ) √ √√ √
10 Nurse Cap √ √√ √
11 Baju khusus pegawai √√ √

Berdasarkan tabel 1 telah diidentifikasi jenis- pasien Covid 19 petugas kesehatan diharuskan
jenis Alat Pelindung Diri (APD) yang harus ada memakai APD lengkap yaitu shoe cover, face
dan dikenakan oleh petugas kesehatan di shields, kacamata goggle, masker bedah,
ruangan perawatan dan ruangan penunjang masker N95, sepatu boots, baju hazmat, sarung
untuk penanganan terhadap pasien Covid 19 tangan Gynekolog, sarung tangan pemeriksaan,
menurut standar yang telah ditetapkan Rumah nurse cap.
Sakit tersebut. Untuk penanganan terhadap

B. Implementasi Kepatuhan Tenaga Kesehatan Memakai Alat Pelindung Diri (APD )
Tabel 2. Kepatuhan Berdasarkan Jenis Profesi di Ruangan Perawatan dan Ruangan Penunjang Untuk
Penanganan Terhadap pasien Covid 19

Kepatuhan sesuai Standar Jumlah

No Jenis Profesi Isolasi IGD Radiologi Laboratorium Screening Tiap

Patuh Tidak Patuh Tidak Patuh Tidak Patuh Tidak Patuh Tidak Profesi

1 Dokter Umum 9- ---- ---- 9

2 Perawat 22 - 30 - - - - - - 2 54

3 Radiografer -- --8- ---- 8

4 Analis Kesehatan - - - - - - 16 - - - 16

Jumlah Tiap Ruangan 31 0 30 0 8 0 16 0 0 2 87

Tabel 3. Prosentase Kepatuhan Berdasarkan Jenis Profesi di Ruangan Perawatan dan Ruangan
Penunjang Untuk Penanganan Terhadap pasien Covid 19

Prosentase Kepatuhan sesuai Standar Jumlah

No Jenis Profesi Isolasi IGD Radiologi Laboratorium Screening Tiap

Patuh Tidak Patuh Tidak Patuh Tidak Patuh Tidak Patuh Tidak Profesi

1 Dokter Umum 10% - - - - - - - - - 10%

2 Perawat 25% - 34% - - - - - - 2% 62%

3 Radiografer - - - - 9% - - - - - 9%

4 Analis Kesehatan - - - - - - 18% - - - 18%

Jumlah Tiap Ruangan 36% 34% 9% 18% 2% 100%

Dari tabel 2 dan 3 didapatkan prosentase hasil tersebut tidak memakai sarung tangan
penelitian dalam penggunaan APD dimana pemeriksaan. Penelitian ini tidak mengkaji faktor
responden yang patuh adalah sebesar 10% (9 yang menyebabkan responden tidak
orang) dokter umum, 60% (60 orang) perawat, menggunakan sesuai standar, apakah karena
9% (8 orang) Radiografer, 18% (16 orang) alasan faktor preferensi seseorang atau karena
analis kesehatan. Adapun responden yang tidak alasan yang tidak tercantum dalam ketentuan
patuh adalah sebesar 2% (2 orang) perawat. Rumah Sakit, yang mana perlu diteliti lebih
lanjut.Implementasi kepatuhan pemakaian Alat
Hampir sebagian besar responden tenaga Pelindung Diri (APD) terbesar adalah pada
kesehatan sebesar 98% di Rumah Sakit Tenaga Kesehatan yang langsung berinteraksi
tersebut sudah memiliki tingkat kewaspadaan dengan pasien Covid 19.
yang tinggi untuk memakai Alat Pelindung Diri
(APD) yang sesuai dengan standar. Sedangkan Kasus kematian yang semakin bertambah
hanya 2% saja responden yang masih belum diakibatkan oleh virus covid 19 semakin
mengikuti standar pemakaian APD. meningkatkan kewaspadaan para Tenaga
Berdasarkan observasi bahwa responden Kesehatan terhadap virus Covid 19 terutama