WHAT IS TBC ?

infection

Bacterial

Difficult diagnosis, especially in children

Multiple drug, no new drugs

Long term therapy - adherence

MDR, XDR, HIV, … etc

TB MANAGEMENT IN INDONESIA

PHC

Government Private

PHCGovernme

nt hospital

GP

dots

strateg

y

Private

hospital

Private

clinic

Specialist,

assisted by GP

GP &

Specialis

t

Guidelines: PDPI, PAPDI,

IDAI: PNTA

SUB-STANDARD TB CARE IMPACT

mis-diagnosis (over / under) and mis-

treatment (over / under),

many severe pediatric TB cases

poor patient outcomes,

continued infectiousness with transmission

of M. tuberculosis to family & other

community members,

generation & propagation of drug resistance

(MDR, XDR)

4

DOTS

DOTS strategy

WHAT IS DOTS ??

DOTS STRATEGY

• early 1990, WHO & IUATLD developed a strategy to combat world TB problem DOTS! (Directly Observe Treatment Short-course)

• proven as a cost effective strategy

• based on: many studies, clinical trial, best practices, & program implementation for more than 2 decade

THE DEVELOPMENT OF DOTS

Long-course drug treatment

Short-course drug treatment

The Styblo-IUATLD model of TB control

In Tanzania in the 1970s, Dr Karel Styblo of IUATLD pioneered the development of a model of TB control based on a managerial approach to case finding & treatment.

WHO & the DOTS Strategy

In 1993, WHO's Global Tuberculosis Programme (GTB) began promoting Styblo's strategy in a technical & management package known by the brand-name DOTS.

DOTS STRATEGY COMPONENTS

1. Government commitment to sustained TB control activities.

2. Case detection by sputum smear microscopy among symptomatic patients

3. Standardized treatment regimen of 6-8 mo for at least all confirmed sputum smear positive cases, with DOT for at least the initial 2 month

4. A standardized recording & reporting system

5. A regular, uninterrupted supply of all essential anti-TB drugs

the

achievem

ents

people treated for TB since 199556 million

Reduction in TB mortalitySince 199045%

Lives savedSince 199522 million

PASIEN TB BANYAK YANG BEROBAT KE PRAKTIK

SWASTA*

*Riskesdas 2010, Balitbangkes (2011)

12/1/2014 15God only knows Wallahu A’lam