Download - TB Epidemic

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National TB Program Indonesia

TB EpidemicTB Epidemic

DOTSDOTS

HIV EpidemicHIV Epidemic

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Aceh

N Sum

atra

W Sum

atra

Riau

Jambi

S Sumatra

Babel

Beng

kulu

Lamp

ung

Banten

Jakarta

W Java

C Java

Yogyakarta

E Java

W K

alimantan

C K

alimantan

S Kalim

antan

E Kalim

antan

N Sulaw

esi

Goron

talo

C Sulaw

esi

S Sulawesi

SE Su

lawesi

Bali

NT

B

NT

T

Maluku

N M

aluku

PapuaAverage age male/female patients 2003 data

(Lowest mean age in provinces with high HIV prevalence)

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Is HIV infection generating more cases among young adults?

0.0

0.1

0.2

0.3

0-14 15-24 25-34 35-44 45-54 55-64 65+

Pro

po

rtio

n m

ale

ca

se

s b

y a

ge

Indonesia

Papua

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AGE DISTRIBUTION OF SMEAR POSITIVE CASES

MERAUKE DISTRICT (Papua Province)

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5

10

15

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25

30

35

40

0-14 15-24 25-34 35-44 45-54 55-64 65+

Age Group (Yrs)

Pro

po

rtio

n (

%)

1998 2001 2002 Indo 2002

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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(-)

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HEALTH CENTER INVOLVED IN DOTS< 60 %60 - 80 %81 - 100 %

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< 50%50 – 80%81 – 100%100%

Medical Doctors

Paramedics

Lab Technician

TrainedHealth Center Staffper Provincemid 2005

LEGEND : % Trained to

Standard

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020406080

100120140160180200

< 70 HOSPITALS

70 - 130 HOSPITALS

> 130 HOSPITALS

Hospital distributionHospital distribution(absolute numbers)(absolute numbers)

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Region Name Population in 2003 Total Hospital Total Hospital DOTS

45,514,800 322 76

128,297,100 656 114

39,910,400 281 107 38

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24SUMATERA

JAVA AND BALI

EASTERN PART

% Hospital DOTS Invlm

Summary of hospital distribution & involvement

TOTAL 213,722,300 1259 297 24

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0

200

400

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800

1000

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1400

Num

ber

of n

ew c

ases

SS+ SS- EP SS+ SS- EP SS+ SS- EP SS+ SS- EP SS+ SS- EP

2000 2001 2002 2003 2004

TB Case Notification Yogyakarta 2000-2004 Chest ClinicHospitalsHealth centers

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Involving all health facilities and all provider increasing Case Notification

Warning!! Treatment Success

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200

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800

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1200

1400

2000 2001 2002 2003 2004

New Smear Positive TB cases Notified, Yogyakarta 2000-2004

Private PractitionersChest ClinicsHospitalsHealth centers

Cure rate service providers compared,

DI Yogyakarta

50%

60%

70%

80%

90%

100%

2000 2001 2002 2003

Health CentersHospitalsChest Clinics

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“DOTS” SATCured 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

Persahabatan Hospital Retrospective Study

July 1999 – June 2001

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Lung hospital and clinicslow success rate

Percent of TB-patients who were cured or completed treatment, by province, 2002

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ace

h

N S

um

atr

a

W S

um

atr

a

Ria

u

Jam

bi

S S

um

atra

Bab

el

Ben

gku

lu

La

mp

ung

Ban

ten

Jaka

rta

W J

ava

C J

ava

Yog

yaka

rta

E J

ava

W K

alim

an

tan

C K

alim

an

tan

S K

alim

an

tan

E K

alim

an

tan

N S

ula

we

si

Gor

on

talo

C S

ula

we

si

S S

ula

we

si

SE

Su

law

esi

Bal

i

NT

B

NT

T

Ma

luku

N M

alu

ku

Pap

ua

BP

4-R

S

pro

po

rtio

n o

f co

ho

rt

Completed

Cured

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Percent of TB-patients who were cured or completed treatment, by province, 2003

0

10

20

30

40

50

60

70

80

90

100

NA

D

SU

MU

T

SU

MB

AR

RIA

U

JAM

BI

SU

MS

EL

BA

BE

L

BE

NG

KU

LU

LAM

PU

NG

BA

NT

EN

DK

I

JAB

AR

JAT

EN

G

D. I . Y

.

JAT

IM

KA

LBA

R

KA

LTE

NG

KA

LSE

L

KA

LTIM

SU

LUT

GO

RO

NT

ALO

SU

LTE

NG

SU

LSE

L

SU

LTR

A

BA

LI

NT

B

N T

T

MA

LUK

U

MA

LUT

PA

PU

A

IND

ON

ES

IA

BP

4+R

S

compl

cure

Lung hospital and clinics low success rate

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Proportion of Case Notifiedby Health Clinics & Lung Clinics/Hospital

84.698.6 96.5 95

76

44

85.4

15.41.4 3.5 5

24

56

14.6

0102030405060708090

100

Hospital/ Lung Clinics

Health Center

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Initiation of treatment

0%

10%

20%

30%

40%

50%

60%

SUMATRA KTI JAVA

Initiation of treatmentHospital & BP4

Initiation of treatmentPrimary Health Care

Initiation of treatment PrivatePracticioners

Hospital & BP4 Primary Health Care Private PracticionersSUMATRA 44% 43% 12%KTI 31% 53% 16%JAVA 49% 21% 29%

Initiation of treatment

Treatment-seeking practices of patients with history of TB (Prevalence

survey 2004)

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Towards 70% case-detection

Indonesians when sick go to Puskesmas (60%-urban and 70% rural) TB services are available and 'gratis'

BUTBUT: Perception population= “puskemas are for poor” Treatment seeking to servicesregional differences Weak ACS capacity at province/ district level

We need to build capacity of DOTS teams to promote TB services

66.1

49.4

41.9

14.310.7 8.9

0

10

20

30

40

50

60

70

80

Puskesmas Priv Pract Gov Hosp Priv Hosp Midwife Self-treatm

Sumatra

Java-Bali

KTI

National

Health-seeking behaviors:

The percentage of people with TB

symptoms who have the intention to seek

treatment…

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Knowledge about TBKnowledge about TB

0

10

20

30

40

50

60

70

80

90

Heard/TB TB Curable TB/ secret Free srvcs

62.6

51.1

43.4

12.6 15.6

1.1 1.1

0

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20

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60

70

Food/Drinks TB cough Airpollution Inherited Other Spell/magic Hit chest

Sumatra

Java-Bali

KTI

National

58.1

66.1

35.7

1620.5

11.414.2

9.9

3.6

9.713

8.1

13.8

35.6

46

56.2

0

10

20

30

40

50

60

70

Friend/family

TV Healthofficer

Radio Magz/newsp

Relig/ commleader

Teacher Poster/leaflet

National

Urban

Rural

Source of TB informationSource of TB informationUrban-Rural differencesUrban-Rural differences

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= GFATM = DUTCH GOVT. = KNCV + + USAID + GF-ATM (Q9)

= CIDA + USAID+ GF-ATM (Q9)

= TBCTA/ USAID

Donor Support to Provinces – phased expansion

Q5 2004 (GF 19 provs)

Q4 2004 (GF 16 provs)

Q9 2005 (GF 21 provs)

Q1 - Q3 2003 (GF 8 provs)

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WHO-Recommended Global Strategy to Stop TBWHO-Recommended Global Strategy to Stop TBand Reach the 2015 MDGsand Reach the 2015 MDGs

1. 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

Stop TB DepartmentStop TB Department

Additional components:2 Addressing TB/HIV and MDR-TB3. Contributing to health-system strengthening4. Engaging all care providers5. Empowering patients and communities6. Enabling and promoting research

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0%

20%

40%

60%

80%

100%

2002 2003 2004 2005 2006

Budgeting Indonesia’s Budgeting Indonesia’s TB-Control ProgramTB-Control Program

Budgeting Indonesia’s Budgeting Indonesia’s TB-Control ProgramTB-Control Program

Budget Requirement for TB Program 2005-2010

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2005 2006 2007 2008 2009 2010

Year

Budget (USD Million)

Govt (excl loans) Grant (excl. GF ATM) GF-ATM R1 Gap

propose to the GF-Rnd5

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Jawa-Bali Sumatra KTI

Population 130.995.500 46.984.300 41.162.000

Incidence 107/100.000 160/100.000 210/100.000

Expected Number

of SS(+)

140.165 75.175 86.440

Notified Number of SS(+)

58.050 25.956 28.711

Sisa 82.115 49.218 57.729

Potential cases by region