The co-management of tuberculosis-diabetes co-morbidities in Indonesia under the National Tuberculosis Control Program: results from a cross-sectional study from 2017 to 2019

Abstract

Background Indonesia suffers from a high burden of tuberculosis (TB) and diabetes (DM). The government initiated national TB-DM co-management activities under the National TB Control Program in 2017. This study investigates the detection and treatment outcomes of TB-DM in Jakarta after implementing these activities, and identifies the main factors associated with these outcomes. Methods A cross-sectional study was conducted using TB registry data in two districts of Jakarta, East Jakarta (low-income) and South Jakarta (high-income). A 5-step cascade analysis was used: diagnosed TB patients; TB patients tested for DM; diagnosed TB-DM patients; and patients received and completed TB treatment/cured. We conducted descriptive analyses to understand the characteristics of TB and TB-DM patients, and used a two-level mixed-effect logistic regression to explore factors associated with having a DM test and completing TB treatment/being cured. Results Over the study period (2017–2019) 50.8% of the new pulmonary TB patients aged over 15 were tested for DM. The percentage increased from 41.7% in 2017–2018 to 60.1% in 2019. Of the TB patients tested for DM, 20.8% were diagnosed with DM. Over 90% of the detected TB-DM patients received standard TB treatment, 86.3% of whom completed treatment/were cured. Patients in East Jakarta were more likely to be tested for DM and to complete standard TB treatment/be cured than patients in South Jakarta (P < 0.001). Bacteriologically positive TB patients were more likely to be tested for DM (OR = 1.37, 95% CIs 1.17,1.60). Patients diagnosed in sub-district level healthcare centers had a higher likelihood of being tested for DM than those in government and private hospitals (P < 0.05). Receiving DM treatment was associated with a higher likelihood of completing TB treatment/being cured (OR = 1.82, 95% CIs 1.20, 2.77). Conclusions TB-DM case detection significantly improved in 2019 after introducing TB-DM co-management activities in Jakarta, while gaps in TB-DM co-management existed between bacteriologically positive and clinically diagnosed TB patients, and across different types of health facilities. Collaboration between TB and DM departments should be strengthened, and more resources need to be mobilized to further improve the co-management of TB-DM in Indonesia.

Modifiable and Non-Modifiable Risk Factors for Tuberculosis Among Adults in Indonesia: A Systematic Review and Meta-Analysis

“…Additionally, the current study found a favorable relationship between tobacco usage and smoking for TB among adults (Khaliq et al, 2015). One of the highest smoking rates in the world is found in Indonesia (Jiang et al, 2022). Therefore, the task is not just to reduce the number of smokers but also to reduce the number of TB cases among smokers.…”

“…To help Indonesia reach its 2030 TB elimination target, the central and local governments' roles in TB control must be increased. One of them is the health reform, which highlights the value of sustainable implementation in Indonesia at the regional level (Nindrea et al, 2020;Jiang et al, 2022;Nindrea et al, 2023).…”

“…More than 1 million annual deaths are recorded from TB. TB illness continues to be a serious public health issue that affects people of all ages (Jiang et al, 2022). The action plans have already established a new aim to eliminate TB epidemics by 2030, in which endemic nations must make further efforts to stop or lessen the effect of TB (Jeremiah et al, 2021).…”

“…In a World Health Organization (WHO) report from 2020, Indonesia had the second-highest percentage of worldwide TB incidence (8.5%) (Jiang et al, 2022). A strategy was created by the Indonesian government to eradicate TB (Jeremiah et al, 2021).…”