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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 11884

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

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Keywords

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

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Published Papers (6 papers)

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Research

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9 pages, 807 KiB  
Article
Comprehensive Tuberculosis Screening and Treatment at a Prison in Central Papua Province, Indonesia
by Aurelia, Kamaludin, Cahya Muslimin, Yetty Balik, Trisasi Lestari, Firdaus Hafidz, Christa Dewi, Christopher Lowbridge and Ari Probandari
Trop. Med. Infect. Dis. 2024, 9(10), 241; https://doi.org/10.3390/tropicalmed9100241 (registering DOI) - 12 Oct 2024
Viewed by 774
Abstract
Incarcerated people have been reported to have higher rates of tuberculosis (TB) than the general population. However, TB is rarely reported among incarcerated people in correctional facilities in Mimika District, in Central Papua Province of Indonesia. This study aims to describe the outcomes [...] Read more.
Incarcerated people have been reported to have higher rates of tuberculosis (TB) than the general population. However, TB is rarely reported among incarcerated people in correctional facilities in Mimika District, in Central Papua Province of Indonesia. This study aims to describe the outcomes of comprehensive screening and treatment of TB disease and latent TB infection (LTBI) within a prison in Mimika. In response to a newly reported case of TB within a prison, a facility-wide comprehensive screening and treatment program was carried out for both TB disease and LTBI between September 2021 and June 2022. We evaluated the outcomes of the screening intervention, including the number of people found to have TB and LTBI and the number and proportion of people who started and completed TB-preventive treatment at the facility. A total of 403 incarcerated people and facility staff participated in the comprehensive screening program. Ten participants were found to have TB disease, all of whom commenced treatment. LTBI was detected in 256 (64%) participants, 251 (98%) of whom completed TB-preventive treatment. Comprehensive screening revealed a high prevalence of TB disease and LTBI in this prison. Completion of treatment for TB disease and latent TB infection was high. These outcomes suggest a role for routine search–treat–prevent strategies for TB in this setting. 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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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 1434
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 2615
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 2 | Viewed by 2526
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 2 | Viewed by 2550
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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Review

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14 pages, 311 KiB  
Review
Community-Wide Active Case Finding for Tuberculosis: Time to Use the Evidence We Have
by Mikaela Coleman, Chris Lowbridge, Philipp du Cros and Ben J. Marais
Trop. Med. Infect. Dis. 2024, 9(9), 214; https://doi.org/10.3390/tropicalmed9090214 - 14 Sep 2024
Viewed by 1069
Abstract
Tuberculosis, caused by the Mycobacterium tuberculosis (Mtb) bacteria, is one of the world’s deadliest infectious diseases. Despite being the world’s oldest pandemic, tuberculosis is very much a challenge of the modern era. In high-incidence settings, all people are at risk, irrespective [...] Read more.
Tuberculosis, caused by the Mycobacterium tuberculosis (Mtb) bacteria, is one of the world’s deadliest infectious diseases. Despite being the world’s oldest pandemic, tuberculosis is very much a challenge of the modern era. In high-incidence settings, all people are at risk, irrespective of whether they have common vulnerabilities to the disease warranting the current WHO recommendations for community-wide tuberculosis active case finding in these settings. Despite good evidence of effectiveness in reducing tuberculosis transmission, uptake of this strategy has been lacking in the communities that would derive greatest benefit. We consider the various complexities in eliminating tuberculosis from the first principles of the disease, including diagnostic and other challenges that must be navigated under an elimination agenda. We make the case that community-wide tuberculosis active case finding is the best strategy currently available to drive elimination forward in high-incidence settings and that no time should be lost in its implementation. Recognizing that high-incidence communities vary in their epidemiology and spatiosocial characteristics, tuberculosis research and funding must now shift towards radically supporting local implementation and operational research in communities. This “preparing of the ground” for scaling up to community-wide intervention centers the local knowledge and local experience of community epidemiology to optimize implementation practices and accelerate reductions in community-level tuberculosis transmission. 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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