ISTCThe Indonesian Experience

Erlina BurhanIndonesian Society of Respirology

ISTC Task ForceIndonesian Medical Association

Contents

• Background

• Initiating ISTC

• Endorsement

• Key events

• Roll out of ISTC

• Conclusions

Back ground - Present practices & Back ground - Present practices & need for ISTCneed for ISTC

• TB care is standardized & implemented in the public TB care is standardized & implemented in the public sector mainly through the network of Primary Health sector mainly through the network of Primary Health Center’s and some hospitalsCenter’s and some hospitals

• CXR is the commonly used diagnostic tool in hospitals & CXR is the commonly used diagnostic tool in hospitals & private practiceprivate practice

• Sputum smear is very much underutilized in hospitals & Sputum smear is very much underutilized in hospitals & private practice & sputum culture is uncommonprivate practice & sputum culture is uncommon

• Many doctors are using other tests (serology test, PCR) Many doctors are using other tests (serology test, PCR) instead of sputum testinginstead of sputum testing

• Treatment regimens vary considerably in private practiceTreatment regimens vary considerably in private practice• Hence the need for a tool to bridge the NTP with Hence the need for a tool to bridge the NTP with

Professional societies, Private sector & HospitalsProfessional societies, Private sector & Hospitals• The Tool - ISTCThe Tool - ISTC

Process of introducing ISTCProcess of introducing ISTC• March 2005 : Sensitization of key opinion leader during

JEMM• July 2005: Introduction of ISTC draft to key opinion

leaders (WHO/ KNCV)

• August 2005: Introduce ISTC to professional organization • September 2005: Workshop for professional organization

to develop a plan to endorse, socialize, disseminate and implement ISTC

• September 2005: appoint ISTC team led by Indonesian Society of Respirology

• October 2005: Various professional organization Meetings• November 2005: First National TB Congress with

presentations on ISTC • December 2005: Finalizing Work Plan for socialization• Supported closely by the ATS with several visits from Dr Phil

Hopewell and Ms Fran Du Melle

Process of EndorsementProcess of Endorsement

• January 2006: – First formal Endorsement Letter from Indonesian Society of

Respirology– Introducing ISTC to the President of the Indonesian Medical

Association and other Specialist Organizations (organized by Indonesian Society of Respirology)

• February 2006: – Follow up meeting

and Discussion with Indonesian Medical Association

– Indonesian Medical Association endorse the standards in February 2006

Launch of ISTC

• World TB Day 2006 : IDI (Indonesian Medical Association) formally endorsed the standards & launched by Minister of Health

Endorsement and Key Events

• ISTC Task force at IMA was established

• ISTC short version in Bahasa (incl addendum) Indonesia was published and disseminated

• ISTC is included in various scientific meetings of professional organization

Roll Out ISTCWith support from NTP, WHO, and KNCV; • Indonesian Society of Respirology has

implemented:– Two days Workshops in 13 provinces in

coordination with local chapters of professional societies & Provincial/District health authorities

– ISTC Short version were delivered to all participants

– All the topics were delivered as a CD and handout to participants

• Indonesian Medical Association– Develop National Task Force– Socialization and establishment of Provincial

TF in 12 provinces to ensure sustainability & local ownership

– Development guideline for implementation TB in Private Practitioner

– Piloting TB in PP through certification and accreditation scheme

TOPICS

• Why & What of ISTC • Epidemiology of TB • Standard diagnosis • Standard treatment • Standard Public Health Responsibility • MDR TB • TB-HIV• The Role of Chest X Ray• Group work & discussions

The Role of Professional Organizations

• Socialization and dissemination• Having ISTC as a topic in their annual meetings,

scientific sessions and seminars• Meetings to socialize and dissemination the

standards ( Hands on )• ISTC articles in Journals

Conclusions

• Professional society members relate more easily to ISTC than NTP guidelines since it is evidence based & more clinical oriented

• ISTC can act as the bridge between the NTP, Professional societies & Private sector

• NTP’s can outsource the socialization & roll out of ISTC to Professional organizations

• Involvement of key professional opinion leaders/champions, right from introduction is important for buy in, acceptance & endorsement

• A Hospital assessment study done on DOTS practices in 2007/8 in Public & Private hospitals acts as baseline data to evaluate the impact of ISTC in future.