DOTS TB Epidemic HIV Epidemic 1 National TB
DOTS TB Epidemic HIV Epidemic 1 National TB Program Indonesia
Average male/female patients 2003 data (Lowest mean age in provinces with high HIV prevalence) 2 National TB Program Indonesia
3 National TB Program Indonesia
4 National TB Program Indonesia
Urban TB clinic (PPTI) 2004: § TB patient 44 IDU VCT 22 (50%) HIV+ 11 (50%) SS 1 Sep 2004 – 31 Aug 2005: § 641 TB patient VCT 147 (23%) HIV(+) 90% SS(-) 5 National TB Program Indonesia
6 National TB Program Indonesia
Trained Health Center Staff per Province mid 2005 Medical Doctors Paramedics LEGEND : % Trained to Standard Lab Technician < 50% 50 – 80% 81 – 100% 7 National TB Program Indonesia
Hospital distribution (absolute numbers) 8 National TB Program Indonesia
Summary of hospital distribution & involvement TOTAL 213, 722, 300 1259 297 24 9 National TB Program Indonesia
10 National TB Program Indonesia
Involving all health facilities and all provider increasing Case Notification Warning!! Treatment Success 11 National TB Program Indonesia
3 Persahabatan Hospital Retrospective Study July 1999 – June 2001 “DOTS” SAT Cured 47 (19. 75%) 97 (7. 28%) Complete 82 (34. 45%) 470 (35. 26%) Failed 4 (1. 68%) 4 (0. 3%) Drop out 88 (36. 9%) 670 (50. 26%) Move 17 (7. 14%) 67 (5. 03%) Died 0 0 Others 0 25 (1. 88%) Total no of cases 238 1333 12 National TB Program Indonesia
0% BP 4 -RS 90% Papua N Maluku NTT NTB Bali SE Sulawesi S Sulawesi C Sulawesi Gorontalo N Sulawesi E Kalimantan S Kalimantan C Kalimantan W Kalimantan E Java Yogyakarta C Java W Java Jakarta Banten Lampung Bengkulu Babel 100% S Sumatra Jambi Riau W Sumatra N Sumatra Aceh proportion of cohort Lung hospital and clinics low success rate Percent of TB-patients who were cured or completed treatment, by province, 2002 Completed Cured 80% 70% 60% 50% 40% 30% 20% 13 National TB Program Indonesia
Lung hospital and clinics low success rate 14 National TB Program Indonesia
Proportion of Case Notified by Health Clinics & Lung Clinics/Hospital 15 National TB Program Indonesia
16 National TB Program Indonesia
Treatment-seeking practices of patients with history of TB (Prevalence survey 2004) 17 National TB Program Indonesia
Towards 70% case-detection Health-seeking behaviors: The percentage of people with TB symptoms who have the intention to seek treatment… l l Indonesians when sick go to Puskesmas (60%-urban and 70% rural) TB services are available and 'gratis' BUT: BUT l l l Perception population= “puskemas are for poor” Treatment seeking to services regional differences Weak ACS capacity at province/ district level We need to build capacity of DOTS teams to promote TB services 18 National TB Program Indonesia
Knowledge about TB Source of TB information Urban-Rural differences 19 National TB Program Indonesia
Donor Support to Provinces – phased expansion Q 1 - Q 3 2003 (GF 8 Q 4 2004 (GF 16 provs) Q 5 2004 (GF 19 provs) = GFATM = DUTCH GOVT. Q 9 2005 (GF 21 provs) = KNCV + + USAID + GF-ATM (Q 9) = CIDA + = TBCTA/ 20 USAID+ USAID GF-ATM (Q 9) National TB Program Indonesia
WHO-Recommended Global Strategy to Stop TB and Reach the 2015 MDGs 1. Pursuing quality DOTS expansion and enhancement § § § Political commitment Case detection through bacteriology Standardised treatment, with supervision and patient support Effective drug supply system Monitoring system and impact evaluation Additional components: 2 Addressing TB/HIV and MDR-TB 3. Contributing to health-system strengthening 4. Engaging all care providers 5. Empowering patients and communities 6. Enabling and promoting research 21 TB Department National TBStop Program Indonesia
Budgeting Indonesia’s TB-Control Program propose to the GF-Rnd 5 22 National TB Program Indonesia
Potential cases by region Jawa-Bali Sumatra KTI Population 130. 995. 500 46. 984. 300 41. 162. 000 Incidence 107/100. 000 160/100. 000 210/100. 000 Expected Number of SS(+) 140. 165 75. 175 86. 440 Notified Number of SS(+) 58. 050 25. 956 28. 711 Sisa 82. 115 49. 218 57. 729 23 National TB Program Indonesia
- Slides: 23