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DOTS. TB Epidemic. HIV Epidemic. Average age male/female patients 2003 data (Lowest mean age in provinces with high HIV prevalence). Urban TB clinic (PPTI). 2004: TB patient 44 IDU VCT 22 (50%) HIV+ 11 (50%) SS-. 1 Sep 2004 – 31 Aug 2005: - PowerPoint PPT Presentation
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1
National TB Program Indonesia
TB EpidemicTB Epidemic
DOTSDOTS
HIV EpidemicHIV Epidemic
2
National TB Program Indonesia
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
40.00
45.00
50.00
55.00
60.00
65.00
Aceh
N Sum
atra
W Sum
atra
Riau
Jambi
S Sumatra
Babel
Beng
kulu
Lamp
ung
Banten
Jakarta
W Java
C Java
Yogyakarta
E Java
W K
alimantan
C K
alimantan
S Kalim
antan
E Kalim
antan
N Sulaw
esi
Goron
talo
C Sulaw
esi
S Sulawesi
SE Su
lawesi
Bali
NT
B
NT
T
Maluku
N M
aluku
PapuaAverage age male/female patients 2003 data
(Lowest mean age in provinces with high HIV prevalence)
3
National TB Program Indonesia
Is HIV infection generating more cases among young adults?
0.0
0.1
0.2
0.3
0-14 15-24 25-34 35-44 45-54 55-64 65+
Pro
po
rtio
n m
ale
ca
se
s b
y a
ge
Indonesia
Papua
4
National TB Program Indonesia
AGE DISTRIBUTION OF SMEAR POSITIVE CASES
MERAUKE DISTRICT (Papua Province)
0
5
10
15
20
25
30
35
40
0-14 15-24 25-34 35-44 45-54 55-64 65+
Age Group (Yrs)
Pro
po
rtio
n (
%)
1998 2001 2002 Indo 2002
5
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(-)
6
National TB Program Indonesia
HEALTH CENTER INVOLVED IN DOTS< 60 %60 - 80 %81 - 100 %
7
National TB Program Indonesia
< 50%50 – 80%81 – 100%100%
Medical Doctors
Paramedics
Lab Technician
TrainedHealth Center Staffper Provincemid 2005
LEGEND : % Trained to
Standard
8
National TB Program Indonesia
020406080
100120140160180200
< 70 HOSPITALS
70 - 130 HOSPITALS
> 130 HOSPITALS
Hospital distributionHospital distribution(absolute numbers)(absolute numbers)
9
National TB Program Indonesia
Region Name Population in 2003 Total Hospital Total Hospital DOTS
45,514,800 322 76
128,297,100 656 114
39,910,400 281 107 38
17
24SUMATERA
JAVA AND BALI
EASTERN PART
% Hospital DOTS Invlm
Summary of hospital distribution & involvement
TOTAL 213,722,300 1259 297 24
10
National TB Program Indonesia
0
200
400
600
800
1000
1200
1400
Num
ber
of n
ew c
ases
SS+ SS- EP SS+ SS- EP SS+ SS- EP SS+ SS- EP SS+ SS- EP
2000 2001 2002 2003 2004
TB Case Notification Yogyakarta 2000-2004 Chest ClinicHospitalsHealth centers
11
National TB Program Indonesia
Involving all health facilities and all provider increasing Case Notification
Warning!! Treatment Success
0
200
400
600
800
1000
1200
1400
2000 2001 2002 2003 2004
New Smear Positive TB cases Notified, Yogyakarta 2000-2004
Private PractitionersChest ClinicsHospitalsHealth centers
Cure rate service providers compared,
DI Yogyakarta
50%
60%
70%
80%
90%
100%
2000 2001 2002 2003
Health CentersHospitalsChest Clinics
12
National TB Program Indonesia
“DOTS” SATCured 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
Persahabatan Hospital Retrospective Study
July 1999 – June 2001
3
13
National TB Program Indonesia
Lung hospital and clinicslow success rate
Percent of TB-patients who were cured or completed treatment, by province, 2002
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Ace
h
N S
um
atr
a
W S
um
atr
a
Ria
u
Jam
bi
S S
um
atra
Bab
el
Ben
gku
lu
La
mp
ung
Ban
ten
Jaka
rta
W J
ava
C J
ava
Yog
yaka
rta
E J
ava
W K
alim
an
tan
C K
alim
an
tan
S K
alim
an
tan
E K
alim
an
tan
N S
ula
we
si
Gor
on
talo
C S
ula
we
si
S S
ula
we
si
SE
Su
law
esi
Bal
i
NT
B
NT
T
Ma
luku
N M
alu
ku
Pap
ua
BP
4-R
S
pro
po
rtio
n o
f co
ho
rt
Completed
Cured
14
National TB Program Indonesia
Percent of TB-patients who were cured or completed treatment, by province, 2003
0
10
20
30
40
50
60
70
80
90
100
NA
D
SU
MU
T
SU
MB
AR
RIA
U
JAM
BI
SU
MS
EL
BA
BE
L
BE
NG
KU
LU
LAM
PU
NG
BA
NT
EN
DK
I
JAB
AR
JAT
EN
G
D. I . Y
.
JAT
IM
KA
LBA
R
KA
LTE
NG
KA
LSE
L
KA
LTIM
SU
LUT
GO
RO
NT
ALO
SU
LTE
NG
SU
LSE
L
SU
LTR
A
BA
LI
NT
B
N T
T
MA
LUK
U
MA
LUT
PA
PU
A
IND
ON
ES
IA
BP
4+R
S
compl
cure
Lung hospital and clinics low success rate
15
National TB Program Indonesia
Proportion of Case Notifiedby Health Clinics & Lung Clinics/Hospital
84.698.6 96.5 95
76
44
85.4
15.41.4 3.5 5
24
56
14.6
0102030405060708090
100
Hospital/ Lung Clinics
Health Center
16
National TB Program Indonesia
17
National TB Program Indonesia
Initiation of treatment
0%
10%
20%
30%
40%
50%
60%
SUMATRA KTI JAVA
Initiation of treatmentHospital & BP4
Initiation of treatmentPrimary Health Care
Initiation of treatment PrivatePracticioners
Hospital & BP4 Primary Health Care Private PracticionersSUMATRA 44% 43% 12%KTI 31% 53% 16%JAVA 49% 21% 29%
Initiation of treatment
Treatment-seeking practices of patients with history of TB (Prevalence
survey 2004)
18
National TB Program Indonesia
Towards 70% case-detection
Indonesians when sick go to Puskesmas (60%-urban and 70% rural) TB services are available and 'gratis'
BUTBUT: Perception population= “puskemas are for poor” Treatment seeking to servicesregional differences Weak ACS capacity at province/ district level
We need to build capacity of DOTS teams to promote TB services
66.1
49.4
41.9
14.310.7 8.9
0
10
20
30
40
50
60
70
80
Puskesmas Priv Pract Gov Hosp Priv Hosp Midwife Self-treatm
Sumatra
Java-Bali
KTI
National
Health-seeking behaviors:
The percentage of people with TB
symptoms who have the intention to seek
treatment…
19
National TB Program Indonesia
Knowledge about TBKnowledge about TB
0
10
20
30
40
50
60
70
80
90
Heard/TB TB Curable TB/ secret Free srvcs
62.6
51.1
43.4
12.6 15.6
1.1 1.1
0
10
20
30
40
50
60
70
Food/Drinks TB cough Airpollution Inherited Other Spell/magic Hit chest
Sumatra
Java-Bali
KTI
National
58.1
66.1
35.7
1620.5
11.414.2
9.9
3.6
9.713
8.1
13.8
35.6
46
56.2
0
10
20
30
40
50
60
70
Friend/family
TV Healthofficer
Radio Magz/newsp
Relig/ commleader
Teacher Poster/leaflet
National
Urban
Rural
Source of TB informationSource of TB informationUrban-Rural differencesUrban-Rural differences
20
National TB Program Indonesia
= GFATM = DUTCH GOVT. = KNCV + + USAID + GF-ATM (Q9)
= CIDA + USAID+ GF-ATM (Q9)
= TBCTA/ USAID
Donor Support to Provinces – phased expansion
Q5 2004 (GF 19 provs)
Q4 2004 (GF 16 provs)
Q9 2005 (GF 21 provs)
Q1 - Q3 2003 (GF 8 provs)
21
National TB Program Indonesia
WHO-Recommended Global Strategy to Stop TBWHO-Recommended Global Strategy to Stop TBand Reach the 2015 MDGsand 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
Stop TB DepartmentStop TB Department
Additional components:2 Addressing TB/HIV and MDR-TB3. Contributing to health-system strengthening4. Engaging all care providers5. Empowering patients and communities6. Enabling and promoting research
22
National TB Program Indonesia
0%
20%
40%
60%
80%
100%
2002 2003 2004 2005 2006
Budgeting Indonesia’s Budgeting Indonesia’s TB-Control ProgramTB-Control Program
Budgeting Indonesia’s Budgeting Indonesia’s TB-Control ProgramTB-Control Program
Budget Requirement for TB Program 2005-2010
0
10
20
30
40
50
60
70
2005 2006 2007 2008 2009 2010
Year
Budget (USD Million)
Govt (excl loans) Grant (excl. GF ATM) GF-ATM R1 Gap
propose to the GF-Rnd5
23
National TB Program Indonesia
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
Potential cases by region