Background: The public–private mix (PPM) strategy has strengthened tuberculosis care and control in many countries. Indonesia, a country with a high tuberculosis burden, has a low tuberculosis case detection rate (CDR), despite PPM implementation in 2003. The PPM in Indonesia involves primary healthcare centers, hospitals, and specialized chest clinics. The long-term impact of the strategy is unknown. Objective: We aimed to explore the case detection achievements of the tuberculosis program since PPM implementation in Central Java in 2003. Methods: This retrospective cohort study covered the period 1 January 2000 to 31 December 2014. The data from tuberculosis patients treated in all health facilities in Central Java implementing directly observed treatment short-course, recorded via a standardized form, were analyzed after being validated by the Office of Health of Central Java Province. We evaluated the CDR, case notification rate, and total number of cases, using linear regression to analyze the temporal trends of those indicators in the phases of PPM implementation. Results: The CDR increased during the initial phase (2000–2005), decreased during the mid-phase (2006–2009), and increased slightly during the late phase (2010–2014), ranging from 13 to 61.72. These trends were observed despite a steady increase in the number of participating healthcare facilities. The regression analysis showed that the CDR of referral institutions contributed the most to the total CDR of Central Java Province. Many of the smear-negative tuberculosis cases recorded at primary healthcare centers may have been smear positive; this probable misclassification could have been partially avoided if more specific and sensitive diagnostic tools were available. Conclusions: The CDR remains below the national target (70%). Early awareness of a negative trend in certain program indicators is important to ensure program sustainability. Careful observation of the indicator pattern will secure the long-term success of the program.

Background: Tuberculosis (TB) is a major health problem throughout the world. Hospitals and pulmonary clinics contribute significantly to the number of patients from all positive smear cases. Hospital performance in TB control is assessed using treatment success rates. The purpose of this study is to find out an overview of hospital performance factors that influence the success of hospitals in TB control in Central Java. Subjects and Method:The study design was descriptive analytical epidemiology with a retrospective cohort design. The samples were taken in total sampling. The subjects were 158 hospitals in Central Java Province that used the DOTS strategy. The variable assessment instrument from the 2010 TB Sub-Directorate of Ministry of Health's checklist was taken in January-February 2018. The data were linked to TB data from the Central Java Provincial Health Office in 2013 and 2016. Treatment success rates were stated to be good if the value was %85% Results: There were 110 hospitals with complete data in 2013 and 2016. Good success rates (>85%) in 2013 were achieved by 59 (53.60%) hospitals in 2013, in 2016 it decreased, only 43 (39.10%) hospitals were achieved. There was no significant relationship between the commitment and organization of the DOTS Hospital team, treatment, medical supervision, internal / external networks, and health facilities with the success rate of TB treatment,in which in this study, the value of p > 0.05. The type of hospital was significantly associated with treatment success rates in 2013, in which the lower type of hospital, the better the success rate of TB treatment. Conclusion: Because of the low number of hospitals that achieve good success rates (>85%), more detailed identification of risk factors is needed.

BackgroundLatent tuberculosis infection is a condition where there is a persistent immune response to Mycobacterium tuberculosis without clinical manifestations of tuberculosis. Currently, there is no gold standard to diagnose latent tuberculosis infection. The tuberculin skin test and interferon-gamma release assay are currently used to diagnose latent tuberculosis infection. However, studies have shown inconsistencies regarding the level of agreement between these tests in different settings. In this study, we aimed to evaluate the agreement between these two tests for diagnosing latent tuberculosis infection in human immunodeficiency virus (HIV)-infected individuals.MethodsWe screened HIV patients with no clinical symptoms of tuberculosis, a normal chest X-ray, and no history of tuberculosis or use of antituberculous drugs. Participants were tested with tuberculin skin test (TST) and T-SPOT.TB (an interferon gamma release assay) simultaneously. Participants' HIV stage was determined by measuring the level of CD4+ T-lymphocytes. Tuberculosis status was confirmed by sputum examination using GeneXpert. The level of agreement between the TST and T-SPOT.TB results was measured using Cohen's κ coefficient.ResultsOf the 112 participants, 20 had a positive T-SPOT.TB test result, and 21 had a positive TST result. The TST and T-SPOT.TB test results showed a high level of agreement (κ = 0.648, P < 0.001). Performance of the tests did not vary with CD4+ level. However, in participants with CD4+ < 200 cells/mm3, T-SPOT.TB detected more latent tuberculosis infections than the TST.ConclusionThere was good agreement between the TST and T-SPOT.TB results of latent tuberculosis infection in participants. TST is the preferred test for diagnosing latent tuberculosis infection in HIV-infected patients, especially in resource-limited settings, because it is simple and cost-effective. However, T-SPOT.TB may be useful to rule out latent tuberculosis infection in patients with severe immunodeficiency.

Background: Multidrug-resistant tuberculosis (MDR-TB) is a serious threat to global TB control programs. According to WHO, there are 23,000 cases of TB multidrug-/rifampicinresistant (MDR/RR-TB) in Indonesia. In 2017, there were 442,000 of TB cases. There were 8,600 -15,000 MDR/RR-TB cases, of which 2.4% were new cases and 13% were previously treated TB cases. This study aims to determine the factors that influence the delay in diagnosis and treatment of MDR-TB patients. Subjects and Method: This study was a cross-sectional study conducted at Dr. Moewardi hospital, from September to October 2017, Surakarta, Central Java. A sample of 73 MDR-TB patients with disabilities on medical records was selected for this study. The dependent variables were delay in diagnosis and delay in therapy of MDR-TB cases. The independent variables were age, gender, distance to health facilities, and type of health facilities. Data were collected from medical records of MDR-TB patients who were treated from March 2012 to March 2017. Data were analyzed using the chi-square model. Results: Median delay in diagnosis = 4 days. Median treatment delay = 12 days. The average patient who had delayed MDR-TB therapy (≥4 days) was 44 years old (Mean= 44.19; SD= 12.64). Delay in MDR-TB diagnosis was not significantly associated with gender (OR= 0.53; 95% CI= 0.18 to 1.57; p= 0.264), distance to health facility (OR= 1.56; 95% CI= 0.58 to 4.21; p= 0.389), and type of health facility (OR= 0.60; 95% CI= 0.26 to 1.41; p= 0.983). The average of patient who had delayed MDR-TB therapy (≥12 days) was 41 years old (Mean= 41.39; SD= 12.69). Treatment delay was not significantly related to gender (OR= 0.45; 95% CI= 0.16 to 1.26; p= 0.137), distance to health facility (OR=1.44; 95% CI= 0.55 to 3.78; p= 0.466), and type of health facility (OR= 2.31; 95% CI= 1.03 to 5.21; p= 2.967). Conclusion:There was no statistically significant relationship between gender, distance from the patient's home to health facilities, and type of health facility with the delay in diagnosis and treatment of MDR-TB patients.

Introduction: Multidrug resistance tuberculosis (MDR-TB) is a continuing threat because the treatment is rather toxic. One of the causes of poor treatment outcome is due to the adverse events, especially the occurrence of psychiatric adverse events. Methodology: The two cases presented in this paper are MDR-TB patients with psychiatric adverse events related to depression spectrum. The diagnosis of psychiatric adverse events was done by psychiatrist in the referral hospital. Results: The treatment of MDR-TB and psychiatric adverse event was carried out simultaneously. One of the patients was able to manage the adverse events, but the other was not. The management of psychiatric adverse events need to be performed carefully. Social support of family and friends was received by the successful patient, while the other was not fully supported, thus failed the treatment. Conclusion: The social support provided by the family and friends are precious for the successful treatment of MDR-TB psychiatric adverse events. The availability of healthcare personnel who is able to recognize the symptoms early is needed in the community healthcare service in order to properly detect and manage the psychiatric adverse events on MDR-TB patients.