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Implementing TB Elimination Approaches in Indonesia: Operational Research on Case...
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Implementing TB Elimination Approaches in Indonesia: Operational Research on Case Finding, Treatment and Prevention of TB in Yogyakarta and Timika

A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366).

Deadline for manuscript submissions: closed (31 July 2023) | Viewed by 6163

Special Issue Editors

Dr. Bachti Alisjahbana

E-Mail Website
Guest Editor
Research Center for Care and Control of Infectious Diseases (RC3ID), Universitas Padjadjaran, Bandung, Indonesia
Interests: tuberculosis; diagnostic; acute undifferentiated fever; biomarkers
Dr. Mikaela Coleman

E-Mail Website
Guest Editor
The Centenary Institute, University of Sydney, Sydney, Australia
Interests: tuberculosis; epidemiology; leprosy; immunology; systematic screening

Special Issue Information

Dear Colleagues,

This Special Issue focuses on the implementation of tuberculosis (TB) elimination approaches in Indonesia. It showcases the results and operational challenges and successes in implementing the active case finding, prevention and treatment of TB.

Indonesia has the second highest burden of TB in the world, but its TB response was set back by the COVID-19 pandemic. Progress towards national and global targets in Indonesia will require increased case finding and prevention, and answering questions on how best to implement these will be critical.

In Yogyakarta and Timika, programs have been implementing active case finding, providing TB preventive therapy and working to improve TB treatment. A cohort of TB implementers was selected from these programs to participate in a structured operational research initiative training (SORT-IT) course. Through the course, participants conducted studies on population screening, contact investigation, TB preventive therapy, facility-based case finding, and sub-clinical TB. It is hoped that the results from their research will help to inform policy and practice in Indonesia and elsewhere as (elements of) comprehensive strategies for TB elimination are implemented.

Dr. Bachti Alisjahbana
Dr. Mikaela Coleman
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Tropical Medicine and Infectious Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • tuberculosis
  • TB preventive therapy
  • PLHIV
  • screening
  • active case finding
  • contact investigation
  • treatment
  • Indonesia
  • patient-centered care
  • X-ray

Published Papers (4 papers)

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Research

11 pages, 1737 KiB  
Article
Tuberculosis Case Finding in Kulon Progo District, Yogyakarta, Indonesia: Passive versus Active Case Finding Using Mobile Chest X-ray
by John Silwanus Kaku, Riris Andono Ahmad, Stephanie Main, Dwi Oktofiana, Bintari Dwihardiani, Rina Triasih, Philipp du Cros and Geoffrey Chan
Trop. Med. Infect. Dis. 2024, 9(4), 75; https://doi.org/10.3390/tropicalmed9040075 - 4 Apr 2024
Viewed by 638
Abstract
Active-case finding (ACF) using chest X-ray is an essential method of finding and diagnosing Tuberculosis (TB) cases that may be missed in Indonesia’s routine TB case finding. This study compares active and passive TB case-finding strategies. A retrospective study of TB case notification [...] Read more.
Active-case finding (ACF) using chest X-ray is an essential method of finding and diagnosing Tuberculosis (TB) cases that may be missed in Indonesia’s routine TB case finding. This study compares active and passive TB case-finding strategies. A retrospective study of TB case notification was conducted. Data between 1 January and 31 December 2021, was used. The population in this study were TB cases notified from Kulon Progo District health facilities, including those found through routine activities or active-case findings. A total of 249 TB cases were diagnosed in Kulon Progo in 2021, and 102 (41%) were bacteriologically confirmed. The TB patients’ ages ranged from 0 to 85 years (median 52, IQR 31–61). The majority of cases were male (59%, 147/249) and mostly among people aged 15–59 (61.4%, 153/249). The proportion of clinical TB diagnoses among cases found from active-case findings was 74.7% (68/91) while the proportion among passive-case findings was 50% (79/158). Active-case finding contributed 91 (36.5%) TB cases to the total cases detected in Kulon Progo in 2021. The use of chest X-rays in active-case findings likely contributed to the detection of a higher proportion of clinical TB than in passive-case findings. Full article
(This article belongs to the Special Issue Implementing TB Elimination Approaches in Indonesia: Operational Research on Case Finding, Treatment and Prevention of TB in Yogyakarta and Timika)
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10 pages, 551 KiB  
Article
The Yield of Active Tuberculosis Disease and Latent Tuberculosis Infection in Tuberculosis Household Contacts Investigated Using Chest X-ray in Yogyakarta Province, Indonesia
by Betty Nababan, Rina Triasih, Geoffrey Chan, Bintari Dwihardiani, Arif Hidayat, Setyogati C. Dewi, Lana Unwanah, Arif Mustofa and Philipp du Cros
Trop. Med. Infect. Dis. 2024, 9(2), 34; https://doi.org/10.3390/tropicalmed9020034 - 31 Jan 2024
Viewed by 1537
Abstract
In Indonesia, the implementation of tuberculosis (TB) contact investigation is limited, with low detection rates. We report the yield of and risk factors for TB disease and infection for household contacts (HHCs) investigated using chest X-ray (CXR) screening. We identified HHCs aged five [...] Read more.
In Indonesia, the implementation of tuberculosis (TB) contact investigation is limited, with low detection rates. We report the yield of and risk factors for TB disease and infection for household contacts (HHCs) investigated using chest X-ray (CXR) screening. We identified HHCs aged five years and above of bacteriologically confirmed index cases from 2018 to 2022 in Yogyakarta City and Kulon Progo. All HHCs were offered screening for TB symptoms; TB infection testing with either tuberculin skin testing or interferon gamma release assay; and referral for CXR. Sputum from those with symptoms or CXR suggestive of TB was tested with Xpert MTB/RIF. Risk factors for active TB disease and latent TB infection (LTBI) were identified by logistic regression models. We screened 2857 HHCs for TB between June 2020 and December 2022, with 68 (2.4%) diagnosed with active TB. Of 2621 HHCs eligible for LTBI investigation, 1083 (45.7%) were diagnosed with LTBI. The factors associated with active TB were age, being underweight, diabetes mellitus, urban living, and sleeping in the same house as an index case. Factors associated with LTBI were increasing age and male gender. Conclusions: Screening for HHC including CXR and TST/IGRA yielded a moderate prevalence of TB disease and infection. Full article
(This article belongs to the Special Issue Implementing TB Elimination Approaches in Indonesia: Operational Research on Case Finding, Treatment and Prevention of TB in Yogyakarta and Timika)
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10 pages, 1134 KiB  
Article
High Tuberculosis Preventive Treatment Uptake and Completion Rates Using a Person-Centered Approach among Tuberculosis Household Contact in Yogyakarta
by Felisia Felisia, Rina Triasih, Betty Weri Yolanda Nababan, Guardian Yoki Sanjaya, Setyogati Candra Dewi, Endang Sri Rahayu, Lana Unwanah, Philipp du Cros and Geoffrey Chan
Trop. Med. Infect. Dis. 2023, 8(12), 520; https://doi.org/10.3390/tropicalmed8120520 - 14 Dec 2023
Cited by 1 | Viewed by 1664
Abstract
Coverage of tuberculosis preventive treatment (TPT) in Indonesia is inadequate, and persons who start TPT often do not complete treatment. In 2020, Zero TB Yogyakarta implemented person-centered contact investigation and shorter TPT regimen provision in collaboration with primary health care centers. Between 1 [...] Read more.
Coverage of tuberculosis preventive treatment (TPT) in Indonesia is inadequate, and persons who start TPT often do not complete treatment. In 2020, Zero TB Yogyakarta implemented person-centered contact investigation and shorter TPT regimen provision in collaboration with primary health care centers. Between 1 January 2020 and 31 August 2022, we assessed eligibility for TPT among household contacts of persons with bacteriologically confirmed TB (index cases) and offered them a 3-month TPT regimen (3RH or 3HP). A dedicated nurse monitored contacts on TPT for treatment adherence and side effects every week in the first month and every two weeks in the next months. Contacts were also able to contact a nurse by phone or ask for home visits at any point if they had any concerns. A total of 1016 contacts were eligible for TPT: 772 (78.8%) started short regimen TPT with 706 (91.5%) completing their TPT. Side effects were reported in 26 (39%) of the non-completion group. We conclude that high rates of TPT uptake and completion among contacts assessed as eligible for TPT can be achieved through person-centered care and the use of shorter regimens. Side-effect monitoring and management while on TPT is vital for improving TPT completion. Full article
(This article belongs to the Special Issue Implementing TB Elimination Approaches in Indonesia: Operational Research on Case Finding, Treatment and Prevention of TB in Yogyakarta and Timika)
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9 pages, 642 KiB  
Article
Spectrum of TB Disease and Treatment Outcomes in a Mobile Community Based Active Case Finding Program in Yogyakarta Province, Indonesia
by Nur Rahmi Ananda, Rina Triasih, Bintari Dwihardiani, Betty Nababan, Arif Hidayat, Geoff Chan and Philipp du Cros
Trop. Med. Infect. Dis. 2023, 8(9), 447; https://doi.org/10.3390/tropicalmed8090447 - 15 Sep 2023
Cited by 1 | Viewed by 1797
Abstract
The World Health Organization recommends using chest X-ray (CXR) in active case finding (ACF) to improve case detection. This study aimed to describe the spectrum and outcomes of TB disease diagnosed through a mobile community based ACF program in Yogyakarta. This prospective cohort [...] Read more.
The World Health Organization recommends using chest X-ray (CXR) in active case finding (ACF) to improve case detection. This study aimed to describe the spectrum and outcomes of TB disease diagnosed through a mobile community based ACF program in Yogyakarta. This prospective cohort study included people attending a TB ACF program in Yogyakarta between 1 January 2021 to 30 June 2022. Participants ≥10 years old underwent CXR, symptom screening, and Xpert MTB/RIF testing of sputum. Subclinical TB was defined as asymptomatic active TB, whether bacteriologically confirmed or not. Treatment outcome data were obtained from the national program TB database. 47,735 people attended the ACF program; the yield of TB disease was 0.86% (393/45,938). There were 217 symptomatic cases, of whom 72 (33.2%) were bacteriologically confirmed, and 176 asymptomatic cases, with 52 (29.5%) bacteriologically confirmed. Treatment success was 70.7% with high loss to follow up (9%) and not evaluated (17.1%). Multivariate analysis demonstrated weak evidence for lower unsuccessful outcomes in symptomatic versus subclinical TB (aOR 0.6, 95% CI 0.36–0.998). TB ACF programs utilizing CXR may diagnose a high proportion of subclinical TB. Linkage to care in ACF program is important to increase successful treatment outcomes. Full article
(This article belongs to the Special Issue Implementing TB Elimination Approaches in Indonesia: Operational Research on Case Finding, Treatment and Prevention of TB in Yogyakarta and Timika)
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