Tuberculosis Officers Research Articles

Health Screening Strategies for Artisanal and Small-Scale Miners for Tuberculosis, Human Immunodeficiency Virus and Silicosis: A Case of the USAID-Supported Kunda Nqob'iTB Project in Zimbabwe.

Artisanal and small-scale mining is characterized by excessive exposure to physical, chemical, ergonomic, psychosocial and biological hazards. There is a high burden of tuberculosis (TB), human immunodeficiency virus (HIV) infections and silicosis among artisanal and small-scale miners (ASMs). The aim of this project report is to describe lessons learned from strategies implemented to reach ASMs with screening services for TB, HIV and silicosis in Zimbabwe through the Kunda-Nqob'i TB (KNTB) project supported by the United States Agency for International Development (USAID). The intervention package for screening ASMs for TB, HIV and silicosis included service provision through two occupational health clinics at two provincial hospitals and a mobile workplace-based screening (WBS) facility at the mining sites. From 1 October 2020 to 30 September 2023, 10,668 ASMs were screened, with a high number of cases of silicosis (21%) and TB (7.4%). There was a high burden of HIV (30%) in ASMs attending the occupational health clinics. The two occupational health clinics screened 3453 ASMs, while the mobile WBS activities screened 7215 ASMs during the period. A total of 370 healthcare workers (doctors/clinical officers, nurses, environmental health technicians and district tuberculosis and Leprosy control officers) were trained on TB and the fundamental diagnostic principles of silicosis. The KNTB project has been successful in reaching out to many ASMs operating in remote and hard-to-reach mining areas. The KNTB project has brought to light the positive health-seeking behavior of ASMs operating in remote areas. The project has brought to the fore the effectiveness of multi-stakeholder engagement and collaboration in reaching out to ASMs in remote areas with health screening services. There is a high burden of TB, HIV and silicosis in ASMs. Screening for TB, HIV and silicosis using workplace-based screening and occupational health clinics is an effective strategy and should be rolled out to all areas with high artisanal and small-scale mining activity.

Faktor-Faktor Yang Memengaruhi Kepatuhan Pengobatan Pada Pasien TB

An infectious disease known as tuberculosis (TB) is one of the world's top causes of mortality and a significant contributor to health issues. Until recently, TB—rather than HIV/AIDS—was the most common infectious disease to cause death. Mycobacterium tuberculosis, the bacillus that causes tuberculosis, is released into the air when a person with the disease coughs or removes the bacteria. Without treatment, TB disease has a significant mortality rate (about 50%). Approximately 85% of patients can be treated with the current treatment guidelines (OAT medications for 4-6 months). This study examined the variables affecting TB patients' treatment adherence. A cross-sectional research design and the Fisher Exact test were utilized in this study. This study employed a consecutive, non-random sampling technique. Forty-four people made up the survey's sample size. Based on the analysis's findings, it was discovered that knowledge, side effects, the involvement of the family/PMO, distance, and perceptions of self-medication significantly influenced treatment adherence. There is no relationship between the function of TB officers and accessibility to transportation to treatment adherence.

Using a quality improvement tool, Plan-Do-Study-Act cycle, to boost TB notification in India post-Covid-19 pandemic

Quality improvement tools such as the Plan-Do-Study-Act (PDSA) cycle hold tremendous potential to improve the quality of healthcare in India. The electronic-PDSA tool was previously developed by CETI (Collaboration to Eliminate TB among Indians) and successfully piloted in small groups. In this study the e-PDSA was scaled up across the nation over a brief 10 week period to boost TB notification by training District Tuberculosis Officers (DTOs) virtually post-Covid-19 pandemic. Quality improvement counselors, who were interns from Masters in Public Health Institutions, were liaisons to “hand-hold” and assist the DTOs through the PDSA cycle. The course was voluntary and offered to all DTOs through Central TB Division and State TB Officers from May 2022 to July 2022. Of the 779 Districts in India and nearly equal number of DTOs, 546 (70%) DTOs enrolled in the course and of these 437 (80%) conducted a PDSA while 342 (43%) districts/DTOs did not enroll or did not complete a PDSA. With a baseline notification in February-March-April 2022 and intervention in May-June-July 2022; 55% of the districts in the PDSA group showed improvement in TB Notification compared to 45% in the non-PDSA group. When data was analyzed by population (not district) there was a trend in increase in notification post-pandemic in both PDSA and non-PDSA groups, and the PDSA group had a slightly higher 5.6 per 100,000 population improvement compared to 5.0 per 100,000 in the non-PDSA group. The cost of intervention was $40,000 or $92 per DTO for three months. The course was highly acceptable with DTOs rating 4.3 out of 5 in recommending the course to other DTOs. Our data shows that a large scale-up of the PDSA cycle is feasible, economical and effective with little additional resources. The focus was on increasing the efficiency of the existing processes well within the authority of the DTO. Repeat cycle of PDSA with notification and other measures such as presumptive sputum examination could significantly impact the program and help to achieve TB Free India.

Risk Characterization of Treatment Histories and Comorbidities Regarding Tuberculosis Treatment Status in West Sumatra Province 2020-2021

Background: Tuberculosis (TB) is the leading cause of death among bacterial infectious diseases worldwide, and Indonesia is the second country with the highest TB burden.Objective: The treatment history and comorbidities of TB disease play a significant role in determining the appropriateness of therapy and the duration of treatment for patients. The objective is to identify the factors that influence the incidence of first molar caries.Methods: This study employs an analytic case-control design with a retrospective cohort methodology. 161 RO TB patients and 161 SO TB patients comprised the total sample size. Statistical analysis of this investigation utilizing R and R Studio.Result: In this study, there was a correlation between gender (p-value 0.006 and odds ratio 1.89), contact investigation (p-value 0.001 and odds ratio 0.23), new TB (p-value 0.001 and odds ratio 0.05), TB recurrence (p-value 0.001 and odds ratio 19.0), TB failed treatment (p-value 0.007 and odds ratio 16.4), and pH-saliva (p-value 0.0001 and odds ratio 21.250). In contrast, risk factors such as absenteeism, diabetes, and HIV were not associated with TB treatment status (p-value 0.05). Age, investigation of contact, and TB recurrence were the predominant factors associated with TB treatment status, as determined by multivariate analysis.Conclusions: Several factors, including gender and treatment history (new TB, Relapsed TB, Failed TB), influence the status of TB treatment in West Sumatra Province. These are important factors that must be considered and asked by TB officers at health facilities before the patient undergoes an examination of suspected samples and information to provide appropriate medical therapy to TB patients in health facilities.

Barriers and Facilitators to Implementing a Digital Adherence Technology for Tuberculosis Treatment Supervision in Uganda: Qualitative Study.

Ensuring the completion of treatment for tuberculosis (TB) remains a key challenge in many high-burden countries. 99DOTS is a low-cost digital adherence technology that has emerged as a promising tool for monitoring and supporting TB treatment completion. We aimed to understand the feasibility and acceptability of 99DOTS, a mobile phone-based TB treatment support method, and characterize barriers and facilitators to its implementation during a pragmatic trial in Uganda. Between April 1 and August 31, 2021, we conducted in-depth interviews with people with TB and key informant interviews with health workers and district and regional TB officers involved in the implementation of 99DOTS at 18 health facilities in Uganda. Semistructured interview guides were informed by the capability, opportunity, motivation, and behavior (COM-B) model and explored perceptions of, and experiences with, 99DOTS, including barriers and facilitators to its use. Qualitative analysis was conducted using the framework approach. Interviews were conducted with 30 people with TB, 12 health workers, and 7 TB officers. All people with TB, health workers, and TB officers noted that 99DOTS supported and encouraged people with TB to take their anti-TB medication, facilitated treatment monitoring, and improved relationships between people with TB and health workers. Participants also liked that the platform was free, easy to use, and improved TB treatment outcomes. Barriers to 99DOTS implementation for some people with TB were related to limited literacy, including technology literacy; limited access to electricity to charge their mobile phone to make dosing confirmation calls; and poor network connection. Gender differences in 99DOTS uptake also emerged. Specifically, women with TB were described to be more concerned that 99DOTS use would expose them to TB stigma and to be more likely to have mobile phone-access issues than men with TB. By contrast, men with TB not only had access to mobile phones but also received substantial support from their female partners to take their anti-TB medication and make 99DOTS dosing confirmation calls. Finally, although women with TB were described to face more barriers to 99DOTS use than men with TB, the women's narratives centered on the ways the platform facilitated and improved their adherence, whereas the men's narratives did not. Overall, 99DOTS seems to be a feasible and acceptable strategy to support anti-TB medication adherence in Uganda. However, access to mobile phones, inability to charge mobile phones, and concerns about stigma should be considered and addressed as part of programmatic implementation to maximize uptake among all people with TB, particularly women and those with fewer financial resources.

Effects of Motivation, Knowledge, and Skills of Lung Tuberculosis Officers on Case Detection Rate of Health Centers

Background: One of the main indicators of tuberculosis prevention is the Case Detection Rate (CDR). The CDR of health centers in East Lampung Regency in 2017 was 24.8% which is still below the national standard. Case finding was still being done passively and suspect screening in several health centers was found lacking attention to the patient's medical history. Accordingly, increasing CDR needs improvement efforts to be strongly influenced by tuberculosis officers.Objectives: This study aimed to determine the effects of motivation, knowledge and skills of tuberculosis Officers on CDRs of community health centers in East Lampung Regency.Methods: This study is a cross-sectional quantitative study with total sampling. Data were obtained from questionnaires, checklists and secondary data from community health centers and East Lampung District Health Office. Respondents are 34 community health centers in Lampung Timur represented by 89 officers. Dependent variable was CDR while motivation, knowledge, and skills were the independent variables. The data were analyzed by Rank Spearman tests and multiple linear regression methods.Results: Respondents showed they were lacking in motivation, good knowledge and skills. Rank Spearman correlation coefficient ranged between 0.665 to 0.696 with sig.=0,000. Regression sig values were 0.000 for motivation, 0.0962 for knowledge and 0.001 for skills. Adjusted R square was 0.703, while regression coefficient was 2.872 for motivation and 1.196 for skills.Conclusion: There were significant correlations between motivation, knowledge and skills with CSRs of community health centers in East Lampung Regency. Knowledge had no effect on CSR but motivation and skills have a significant effect partially and simultaneously. Motivation contributed the biggest effect.

Effects of Coronavirus Disease Pandemic on Tuberculosis Notifications, Malawi.

The coronavirus disease (COVID-19) pandemic might affect tuberculosis (TB) diagnosis and patient care. We analyzed a citywide electronic TB register in Blantyre, Malawi and interviewed TB officers. Malawi did not have an official COVID-19 lockdown but closed schools and borders on March 23, 2020. In an interrupted time series analysis, we noted an immediate 35.9% reduction in TB notifications in April 2020; notifications recovered to near prepandemic numbers by December 2020. However, 333 fewer cumulative TB notifications were received than anticipated. Women and girls were affected more (30.7% fewer cases) than men and boys (20.9% fewer cases). Fear of COVID-19 infection, temporary facility closures, inadequate personal protective equipment, and COVID-19 stigma because of similar symptoms to TB were mentioned as reasons for fewer people being diagnosed with TB. Public health measures could benefit control of both TB and COVID-19, but only if TB diagnostic services remain accessible and are considered safe to attend.

Risk Factors Analysis and Mapping of Pulmonary Tuberculosis in Community Health Centre Tamalatea of Jeneponto District

BACKGROUND: Tuberculosis (TB) remains a global health problem, and in Indonesia, although TB control efforts have been carried out since 1995. TB is ranked 9th as the leading cause of death worldwide. The increase in the number of TB cases caused by risk factors triggering include a decrease in the immune system caused by HIV infection, nutritional status, education, sex, occupation, air humidity, house ventilation, temperature, occupancy density lighting, and contact history.
 AIM: This study aimed to analyze the relationship of nutritional status, contact history, and smoking to the incidence of pulmonary TB in Community Health Centre Tamalatea of Jeneponto District.
 METOHDS: This type of research is analytic observational with a case–control design with a total sample of 147 samples consisting of 49 cases and 98 controls. Data collection was conducted from August to October 2019. Data analysis used in the study was univariate and bivariate analysis with Chi-square test.
 RESULTS: The results showed that nutritional status (OR=5.403 95% CI: 2.547–11.461), contact history (OR=13.971 95% CI: 3.807–51.262), and smoking (OR=2.782 95% CI: 1.370–5.648) are related to the incidence of pulmonary in Community Health Centre Tamalatea of Jeneponto District. TB officers are expected to intensify the home visit program, especially for pulmonary TB sufferers with a considerable distance from the community health center, with transportation constraints and relatively poor economic conditions so that the health status of pulmonary TB sufferers can be monitored properly.
 CONCLUSION: TB officers are expected to intensify the home visit program, especially for pulmonary TB sufferers with a considerable distance from the Puskesmas, with transportation constraints and relatively poor economic conditions so that the health status of pulmonary TB sufferers can be monitored properly.

Analysis of tuberculosis program management in primary health care.

BackgroundThis study discusses the analysis of Tuberculosis (TB) program management at the Perak Timur Primary Health Care (PHC) and the Sawahan PHC in Surabaya. Early detection and adequate treatment can prevent transmission and improve control programs.ObjectiveThis study aims to analyze management of the tuberculosis program at PHCs in Surabaya.MethodsThe research method used is qualitative research. Data collection was done by interviewing tuberculosis officers about TB program and carrying out observations at the PHCs.ResultsThe study showed that case finding in the Perak Timur PHC and the Sawahan PHC was passive-active. The Perak Timur PHC has facilities for rapid molecular testing, while the Sawahan PHC have to go to a center for Health Laboratory if rapid molecular testing is needed. In terms of treatment, patients at the Perak Timur PHC would come according to an agreement with TB officer, while at the Sawahan PHC, patients have to come every Monday. Officer at the Perak Timur PHC tended to accommodate the needs of TB patients compared to officer at the Sawahan PHC. The level of adherence to taking medication in two PHCs is good but there are a number of patients who have not really understood the frequency of taking medication.ConclusionGenerally, both PHCs have good TB program management but the Perak Timur PHC tends to be more flexible towards patients while the Sawahan PHC tends to be stricter towards patients.

<p>Geographic Accessibility, Readiness, and Barriers of Health Facilities to Offer Tuberculosis Services in East Gojjam Zone, Ethiopia: A Convergent Parallel Design</p>

BackgroundTuberculosis (TB) remains a foremost global public health threat. Active TB control needs geographically accessible health facilities that have quality diagnostics, equipment, supplies, medicines, and staff.ObjectiveThis study aimed at assessing the geographic distribution, physical accessibility, readiness and barriers of health facilities for TB services in East Gojjam zone, Ethiopia.MethodsA convergent parallel design was applied using health facility and geographic data. Data on facility attributes, service availability and readiness were collected by inteviewing TB officers, laboratory heads and onsite facility visits. Coordinates of health facilities and kebele centroids were collected by GPS. We used ArcGIS 10.6 to measure Euclidean distance from each kebele centroids to the nearest health facility. Descriptive statistics were computed by using SPSS version 25. Barriers to TB service readiness were explored by in-depth interviews. NVivo12 was used to thematically analyze the qualitative data.ResultsThe overall TB health service coverage (THSC) was 23% (ranging: 10–85%). The mean distance from the nearest health facility was 8km (ranging: 0.5–16km). About 132 (32%) kebeles had poor geographic accessibility to TB services (over 10km distance from the nearest health facility) and had poor facility readiness. Although 114 (95%) health facilities offered at least one TB service, 44 (38.6%) of them had no sputum smear microscopy. The overall TB readiness index was 63.5%: first-line anti-TB drugs (97%), diagnostics (63%), trained staffs, diagnostic and treatment guidelines (53%) and laboratory supplies (41%). Lack of health workers (laboratory personnel), inadequate budget, poor management practice and TB program support, inadequate TB commodity suppliers, and less accessible geographic locations of health facilities were identified as barriers to TB service readiness distribution.ConclusionConsiderable proportion of the population in the study area have poor access to quality TB diagnostic services due to low THSC and poor facility readiness. Barriers to TB service availability and readiness were health system related. Regular refresher training of health workers on TB, creating mechanisms to attract laboratory personnel to work in the study area and scaling up of sputum smear microscopy services, establishing an efficient mechanism for procurement, distribution, utilization and reporting of TB commodity supplies, and good management practices are crucial to enhance TB service readiness in the study zone.

Implementasi Penanggulangan Tuberkulosis di Puskesmas Glugur Darat Kota Medan

This study aims to determine the implementation of tuberculosis control policies at Puskesmas Glugur Darat. This research design uses quantitative and qualitative approaches, where the method is a qualitative approach. The results showed that the implementation of the tuberculosis control policy at the Glugur Darat Community Health Center had not run as well as possible. The cure rate for tuberculosis patients at Puskesmas Glugur Darat was 46.15% and less than the national target of> 85% and the treatment success rate of 65.38% was also less than the national target of 85%. In conclusion, the head of the puskesmas, tuberculosis officers, and cadres have used the national tuberculosis guidelines and the DOTS strategy well, but implementation has not gone well because there are still people who do not participate in health promotion activities.
 
 Keywords: Land Glug, Implementation, Countermeasures for Tuberculosis Policy

PENERAPAN APLIKASI SISTEM INFORMASI SPASIAL UNTUK PENGELOLAAN PROGRAM TUBERKULOSIS DI PUSKESMAS GATAK DAN KARTASURA KABUPATEN SUKOHARJO

The proportion of smear positive in 2013-2016 in Sukoharjo District was reported still high in case in 2015 where the cases was 63%. . The purpose this community engagement was to implement the surveillance information system of tuberculosis (TB) using online-spatial in order to support the health officers in community health care (Puskesmas) organizing the spatial TB data integrated better and precisely The decision maker in Puskesmas and health district would be assisted by this activity where it could provide the data base to support TB eradication programs. Method of activities involved the implementation to supervise and train how to apply the information system getting the reporting and recording of data as the national guideline written. The training program conducted were introducing of the software, training of the basic of system applied, and dissemination of data and their analysis from software used. and review of pr-test and post-test activities. Results of service are in the form of material delivery during implementation and training, namely; 1). The spatial database of TB is available in survey application 2). TB officers at the puskesmas, the head of the puskesmas and the head of the sub-sector of TB in the health department who attended greatly appreciated and accepted the activities and use of the survey application. 3).Presentation of data and analysis obtained from the use of the software used as well as the results of the improvement in the ability of success after training that is 66.67% and which is quite successful 33.33%

Disparities in access to diagnosis and care in Blantyre, Malawi, identified through enhanced tuberculosis surveillance and spatial analysis

BackgroundA sizeable fraction of tuberculosis (TB) cases go undiagnosed. By analysing data from enhanced demographic, microbiological and geospatial surveillance of TB registrations, we aimed to identify modifiable predictors of inequitable access to diagnosis and care.MethodsGovernmental community health workers (CHW) enumerated all households in 315 catchment areas during October–December 2015. From January 2015, government TB Officers routinely implemented enhanced TB surveillance at all public and private TB treatment registration centres within Blantyre (18 clinics in total). This included collection from registering TB patients of demographic and clinical characteristics, a single sputum sample for TB microscopy and culture, and geolocation of place of residence using an electronic satellite map application. We estimated catchment area annual TB case notification rates (CNRs), stratified by microbiological status. To identify population and area-level factors predictive of CHW catchment area TB case notification rates, we constructed Bayesian spatially autocorrelated regression models with Poisson response distributions. Worldpop data were used to estimate poverty.ResultsIn total, the 315 CHW catchment areas comprised 753,489 people (range 162 to 13,066 people/catchment area). Between 2015 and 2017, 6077 TB cases (61% male; 99% HIV tested; 67% HIV positive; 55% culture confirmed) were geolocated, with 3723 (61%) resident within a CHW catchment area. In adjusted models, greater distance to the nearest TB registration clinic was negatively correlated with TB CNRs, which halved for every 3.2-fold (95% CI 2.24–5.21) increase in distance. Poverty, which increased with distance from clinics, was negatively correlated with TB CNRs; a 23% increase (95% CI 17–34%) in the mean percentage of the population living on less than US$2 per day corresponded to a halving of the TB case notification rates.ConclusionsUsing enhanced surveillance of TB cases in Blantyre, we show an ecological relationship consistent with an ‘inverse care law’ whereby poorer neighbourhoods and those furthest from TB clinics have lower relative CNRs. If confirmed as low case detection, then pro-poor strategies to facilitate equitable access to TB diagnosis and treatment are required.

Factors affecting tuberculosis health message recall 2 years after active case finding in Blantyre, Malawi.

SETTING:Urban slums, Blantyre, Malawi.OBJECTIVE:To explore tuberculosis (TB) community-wide active case finding (cwACF) recall and accompanying messaging 2 years after the intervention.DESIGN:This mixed-methods study used population-weighted random cluster sampling to select three cwACF-receiving and three non-cwACF-receiving neighbourhoods in Blantyre. Qualitative data were collected using 12 focus group discussions (community peer-group members) and five in-depth interviews (TB officers) with script guides based on the concepts of the Health Belief Model (HBM). Thematic analysis was used to explore transcripts employing deductive coding. Questionnaires completed by focus group participants were used to collect quantitative data, providing a ‘knowledge score’ evaluated through univariate/multivariate analysis, analysis of variance and multiple linear regression.RESULTS:Community peer-group participants (n = 118) retained high awareness and positive opinions of cwACF and recognised the relationship between early diagnosis and reduced transmission, considering cwACF to have prompted subsequent health-seeking behaviour. TB-affected individuals (personal/family: 47.5%) had significantly higher knowledge scores than unaffected individuals (P = 0.039), but only if resident in cwACF-receiving neighbourhoods (P = 0.005 vs. P = 0.582), implying effect modification between exposures, albeit statistically under-powered (P = 0.229).CONCLUSION:Consistent with epidemiological evidence and HBM theory, cwACF may have a permanent impact on knowledge and behaviour, particularly in communities with a high prevalence of TB-affected individuals. Behaviour change strategies should be explicitly included in cwACF planning and evaluation.

RELATIONSHIP OF ATTITUDES AND PERCEPTIONS WITH ADHERENCE IN TREATMENT OF PULMONARY TUBERCULOSIS PATIENTS IN MEDAN

Objective: This study aimed to analyze the relationship of attitudes and perceptions about tuberculosis (TB) with adherence to the treatment of TB patients in Medan.Methods: A quantitative cross-sectional design. The target population was all patients who admitted to seven primary health centers (PHCs) in Medan. Samples were new TB patients aged >18 years old, with the result of acid-fast bacilli (+) (n=100). Assessment of behavioral adherence, attitudes, and perceptions of treatment were done based on treatment behavior instruments that had been validated and analyzed by the Chi-square test and logistic regression.Results: The results showed that 55% of the patients adhered to their medication. There was a relationship between attitude and adherence of TB treatment (p<0.05). However, there is no wrong perception correlation with treatment adherence (p>0.05). A good attitude increased 3.7 (95% confidence interval 1624; 8549) times for adherence to TB treatment.Conclusions: The positive attitude of the TB patients improved TB treatment behavior. Structured education provided by doctors and TB officers in PHC should be done to improve the knowledge and attitude of TB patients.

Challenges in management of tuberculosis under programmatic conditions: Perceptions of health care providers from four states of India

Background: Among the global estimation of 10.4 million new cases of Tuberculosis (TB) in 2015, 27% of cases are contributed by India. Revised national TB control program (RNTCP) started in 1993, and now heading towards for universal access. Despite its achievements, the program faces number of implementation challenges. This qualitative study explored ‘what is healthcare providers take on it?’. Material & Methods: A total of 28 in-depth interviews were conducted in Uttarakhand, Chhattisgarh, Delhi and Maharashtra from October 2014 to January 2015, under the thematic areas of finance, human resource, and communications. Participants included senior level policy makers like principal secretaries of health, National Health Mission Directors, Director Health Services, state TB officers and district TB officers, medical officers, community volunteers and TB consultants from international agencies. Analytic induction method was used for data analysis. Results: Participants identified many barriers in the overall management and implementation of RNTCP. Convergence of RNTCP needs to be more effective. Inadequate Human resources, issues in public private partnership, insufficient budget allocation and interrupted fund flow, inefficient Information Education and Communication strategy are a few. Conclusion: This study could gather the perspectives of senior health officials, implementers and other stakeholders on challenges in implementation of TB control programme in four states. Challenges perceived by them are vital in strategic revisions of RNTCP.

Voluntary Counselling and Testing (VCT) Visit among Tuberculosis Patients in Pulogadung Sub-district Primary Health Centre

Background: Based on Indonesian Ministry of Health Regulation no. 74 year 2014, Voluntary Counseling and Testing (VCT) is an obligatory national program for all lung tuberculosis (TB) patients. However, according to annual report year 2016 of Pulogadung Sub-District Primary Health Care, East Jakarta, Indonesia; there were only 175 out of 237 (73.8%) TB patients who have been checked for their Human Immunodeficiency Virus (HIV) status, but the target of the program was 100%. However, a community diagnosis to investigate this shortage for about two years has not been done before. Objective: To explore related-factors that causes the low number of VCT among TB patients in Pulogadung Sub-District Primary Health Care. Methods: In-depth individual interviews were performed on twenty TB patients that had not done VCT along with Focus Group Discussion (FGD) on eight TB officers from seven villages under Pulogadung Primary Health Care. Thematic keywords were found and analyzed qualitatively. Results: From the TB patients, it was found that the majority of them knew about TB but only some of them knew about HIV. Most of them did not know the correlation between TB and HIV. Patients were not willing to take VCT because they felt that they were not in the risk of HIV. Meanwhile, there were still TB officers who only gave HIV education to risky TB patients. Conclusion: In conclusion, TB patients who had not done VCT felt they did not have risky behaviors to HIV. This was also because of lack of HIV counseling from TB officers to TB patients.

Post-2015, why delay to seek healthcare? Perceptions and field experiences from TB healthcare providers in northern Malawi: a qualitative study

BackgroundMalawi is a low-income country with high Tuberculosis (TB) burden. TB diagnosis delay and untimely initiation of treatment is still a major problem in Malawi which could increase the risk of tuberculosis transmission in the communities. This study investigated factors related to the diagnostic delay of tuberculosis from TB healthcare providers in the northern region of Malawi.MethodsNine focus group discussions were conducted with 57 participants in total. The participants were healthcare cadres including district TB officers, clinical officers, TB nurses, laboratory technicians and Health Surveillance Assistants (HSAs). NVivo (11.0) software was used for data analysis.ResultsThe factors related to diagnostic delay were categorized into three themes: client factors, institutional factors and healthcare provider related factors. Client’s stigma and fear for HIV test, resource shortage within healthcare institutions and the healthcare workers’ poor attitude against potential patients were among the most influential factors behind the TB diagnostic delay.ConclusionsThe TB control strategies should aim to reduce HIV stigma, improve resource supply and improve TB healthcare workers’ morale in order to achieve timely TB diagnosis.

Pengembangan Sistem Pendukung Keputusan Untuk Mendukung Penegakkan Diagnosa TB Dots Di Rumah Sakit Aisyiyah Muntilan

Tuberculosis (TB) disease intervention is a national program and being a target of MDGs. Therefore, a government determined minimum service standards of a hospital that had to be implemented in all health service units and hospitals in Indonesia. A strategy of DOTS at Aisyiyah Hospital in Muntilan had been available particularly in terms of case finding. Notwithstanding, a process of patient diagnosis had not been implemented in accordance with a standard of human resource. Number of medical officers at a TB DOTS unit was not sufficient. In addition, quality of information like completeness, accurateness in diagnosis, and timeliness in reporting TB cases had not achieved a target. The aim of this study was to develop decision support system of TB as an effort to systematically diagnose and manage data of TB based on the standard. This was qualitative-quantitative research. A qualitative method was used to identify each step of information system development. Meanwhile, a quantitative method was used to assess quality of information between before and after developing information system using pre-experimental design (the one group pre and posttest design). Qualitative data were collected by conducting indepth interview, whereas quantitative data were collected using checklist. Data were analysed using T test. Research object was decision support system before and after applying at TB unit at Aisyiyah Hospital in Muntilan. Research subjects consisted of four TB officers as main informants. Informants for triangulation purpose consisted of head of SIMRS and head of medical services. The results of T test showed that variables of completeness, accurateness, and preciseness after developing the decision support system were better than that of before developing the system (p-value = 0.000). As suggestions, head of SIMRS needs to conduct further development of decision support system of TB in another unit particularly in inpatient unit. The decision support system needs to be evaluated and adjusted with the standard.

Evaluation the Pulmonary Tuberculosis Control Program with Strategy DOTS in Puskesmas Tanah Kalikedinding Surabaya

ABSTRACTStrategy DOTS is the tuberculosis control programs. The program has implemented in Tanah Kalikedinding Health Center and has expected to reach CDR ≥ 70% and SR ≥ 85%, which closely related to the management of health centers. This study aimed to evaluate the implementation of the DOTS program in health center whose the results associated with indicators of tuberculosis. This was a descriptive design study with the population was all pulmonary specialist, tuberculosis officers and laboratory personnel and pulmonary tuberculosis patients. The number of Tuberculosis patient respondents was 32 respondents. Samples were chosen using purposive sampling. Data collected by interview questionnaire and checklist. The variables were the finding case, the TB treatment, the enabling factor and inhibiting factor, recording and reporting, and result of tuberculosis indicators. This study resulted that CDR in 2013 was 112% already reached the national target ≥ 70%. This success related to the finding case almost all patients > 2 weeks of cought and all (100%) patients were examinated sputum and diagnosed according to the steps of tuberculosis diagnosis in Indonesia Department of Health guidelines. While SR in 2013 was 65.5% did not reach the target ≥ 85%. It was caused of there are patients who did not have a taking drug observer (PMO). All (100%) patients ever forgot taking anti tuberculosis drugs. Change in schedule of visit to the continuation phase be 2×/month caused patients to forget taking anti tuberculosis drugs. The enabling factor was counseling routinely by health care workers in health center. Inhibiting factor was distance to health center by majority (65,5%) patients were > 1 km. So they needed vehicle to go to the health center. Recording and reporting using electronic systems and being reported by online. So it is expected all TB patients were expected have a taking drug observer and optimizing the role of the a taking drug observer to increase success rate.Keywords: DOTS strategy, Case Detection Rate, Success Rate, evaluation, Tuberculosis