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TB Epidemic

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:

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TB Epidemic

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  1. DOTS TB Epidemic HIV Epidemic

  2. Average age male/female patients 2003 data (Lowest mean age in provinces with high HIV prevalence)

  3. 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(-)

  4. Health Center Involved DOTS

  5. TrainedHealth Center Staffper Provincemid 2005 Medical Doctors Paramedics LEGEND : % Trained to Standard < 50% 50 – 80% 81 – 100% 100% Lab Technician

  6. Hospital distribution (absolute numbers)

  7. Summary of hospital distribution & involvement TOTAL 213,722,300 1259 297 24

  8. Involving all health facilities and all provider  increasing Case NotificationWarning!!  Treatment Success

  9. 3 Persahabatan Hospital Retrospective Study July 1999 – June 2001 “DOTS” SAT Cured 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

  10. Lung hospital and clinics low success rate Percent of TB-patients who were cured or completed treatment, by province, 2002 Completed 100% Cured 90% 80% 70% 60% proportion of cohort 50% 40% 30% 20% 10% 0% Bali NTT NTB Riau Jambi Babel Aceh Papua Maluku E Java C Java Banten Jakarta BP4-RS W Java N Maluku Bengkulu Lampung Gorontalo N Sumatra S Sumatra W Sumatra N Sulawesi C Sulawesi S Sulawesi Yogyakarta E Kalimantan C Kalimantan S Kalimantan SE Sulawesi W Kalimantan

  11. Lung hospital and clinics low success rate

  12. Proportion of Case Notifiedby Health Clinics & Lung Clinics/Hospital

  13. Treatment-seeking practices of patients with history of TB (Prevalence survey 2004)

  14. Towards 70% case-detection • Indonesians when sick go to Puskesmas (60%-urban and 70% rural) • TB services are available and 'gratis' BUT: • Perception population= “puskemas are for poor” • Treatment seeking to servicesregional differences • Weak ACS capacity at province/ district level We need to build capacity of DOTS teams to promote TB services Health-seeking behaviors:The percentage of people with TB symptoms who have the intention to seek treatment…

  15. Knowledge about TB Source of TB informationUrban-Rural differences

  16. Donor Support to Provinces – phased expansion Q1 - Q3 2003 (GF 8 provs) Q4 2004 (GF 16 provs) Q5 2004 (GF 19 provs) Q9 2005 (GF 21 provs) = GFATM = DUTCH GOVT. = KNCV + + USAID + GF-ATM (Q9) = CIDA + USAID+ GF-ATM (Q9) = TBCTA/ USAID

  17. WHO-Recommended Global Strategy to Stop TBand Reach the 2015 MDGs • 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 Additional components: 2 Addressing TB/HIV and MDR-TB 3. Contributing to health-system strengthening 4. Engaging all care providers 5. Empowering patients and communities 6. Enabling and promoting research Stop TB Department

  18. Budgeting Indonesia’s TB-Control Program propose to the GF-Rnd5

  19. Potential cases by region

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