IMPLEMENTATION OF DIRECTLY OBSERVED TREATMENT SHORTCOURSE STRATEGY IN HOSPITALS IN YOGYAKARTA CITY: A COMPARATIVE ANALYSIS OF 2005 AND 2009 DATA

• Main Authors: , Madeleine Zoughbi, , Prof. dr. Adi Utarini, M.Sc., MPH., Ph.D.
• Format: Theses and Dissertations NonPeerReviewed
• Published: [Yogyakarta] : Universitas Gadjah Mada 2012
• Subjects: ETD
• Online Access: https://repository.ugm.ac.id/97701/; http://etd.ugm.ac.id/index.php?mod=penelitian_detail&sub=PenelitianDetail&act=view&typ=html&buku_id=54337
• Institution: Universitas Gadjah Mada

Background: Indonesia adopted the Directly Observed Treatment Shortcourse (DOTS) strategy since 1995, and further scaled it up by introducing the DOTS regimen into hospitals, through the Hospital DOTS Linkage. The DOTS strategy expanded rapidly, allowing space to question the efficacy and quality of the services delivered to the public under the health care system status quo circumstances, a situation that provides the fertile soil for the evolution and proliferation of the Drug-Resistant TB strains (DR-TB). In general, DR-TB surveillance and management has only been recently introduced in the Indonesian NTP. Documentation and follow up are suboptimal to get the exact estimations of the DR-TB problem, and henceforth, allow for missed cases to be efficiently treated. The efficient referral and management of TB patients, via the adherence to the globally advocated DOTS strategy, should enhance TB control and prevent the occurrence of DR-TB cases. Objective: This study aims to compare the progress on DOTS strategy implementation and the potential of DR-TB within the seven hospitals in the years 2005 and 2009, in Yogyakarta City. Method: The study is a comparative cross-sectional analysis of TB patient (TB03) registers, besides Laboratory registers (TB04) and aggregated provincial TB registers (TB07, TB08, TB11), from the hospitals in Yogyakarta City that implement the DOTS strategy. Potentials of DR-TB will be quantified using estimations and odds ratios from previous studies and WHO TB report. Result: The treatment success rate declined and mortality rate increased between the two years. Defaults and failed therapy cases remained stable while transfer cases increased. We observed progress in process indicators between the years of comparison. There were more adherences to sputum smear testing standards, and Child TB was introduced to the TB control system. The improved case management, follow up and documentation can be detected through the declined number of Regimen 2 patient and completeness of documentation especially from the year 2009, although the improvements are still suboptimal to the required level. The study showed a potential for MDR-TB. The estimates show a stable burden of DR-TB from 2005 to 2009, and not as a significant threat to hurdle TB control. Conclusion: Continuous monitoring is of major importance to maintain the TB control system in the hospitals. Follow up and update to the contemporary guidelines for TB care is crucial to enhance DOTS strategy implementation, besides the need to improve internal and external linkages in the hospitals. DR-TB needs to be introduced in the TB management system in the hospitals and the overall NTP monitoring system. This study provided a mere estimation to the load of DR-TB in the study cohorts, but to get the real load of DR-TB an epidemiological study is more convenient. Laboratory culture and drug susceptibility testing are essential for DR-TB detection and follow up, thus enhancing laboratory role in TB control is crucial to maintain and enhance TB management in hospitals.