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Marlinggom Silitonga; Pembimbing: Bambang Sutrisna
T-863
Depok : FKM UI, 2000
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Ahmad Rozali Namursa; Pembimbing: Sujana Jatiputra
T-847
Depok : FKM UI, 2000
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Ririn Ayudiasari; Pembimbing: Yovsyah; Penguji: Syahrizal, Meilina Farikha
Abstrak:
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Tren angka putus berobat pada pasien TBC RO cenderung fluktuatif. Angka putus berobat TBC RO pada tahun 2020 sebesar 19%, angka ini menurun dibandingkan tahun 2019 sebesar 22% dan 2018 sebesar 27%. Angka putus berobat ini memberikan dampak yang besar bagi indikator program tuberkulosis nasional yang secara tidak langsung memengaruhi keberhasilan pengobatan TBC RO yang belum mencapai target 80%. Penelitian terdahulu menyebutkan kejadian putus berobat ini dipengaruhi oleh faktor karakteristik individu, faktor perilaku, dan faktor lingkungan. Akan tetapi, penyebab pasti dari kejadian putus berobat pasien TBC RO di Indonesia belum banyak diketahui. Penelitian ini bertujuan untuk melihat faktor-faktor apa saja yang berhubungan dengan kejadian putus berobat pada pasien TBC RO di Indonesia Tahun 2022-2023. Sampel penelitian ini adalah semua kasus pasien TBC RO di Indonesia yang memulai pengobatan pada tahun 2022-2023 dan telah memiliki hasil akhir pengobatan dinyatakan sembuh, pengobatan lengkap, dan putus berobat pada Mei 2024. Hasil penelitian menunjukkan terdapat hubungan antara faktor umur, jenis kelamin, status HIV, status DM, jenis resistansi, kategori panduan OAT, dan jenis fasyankes terhadap kejadian putus berobat pada pasien TBC RO. Sedangkan faktor riwayat pengobatan dan wilayah fasyankes tidak menunjukan adanya hubungan yang signifikan dengan kejadian putus berobat. Perluasan fasyankes pelaksana layanan TBC RO dan kolaborasi antara fasyankes dan komunitas TB dalam melakukan pendampingan dan memberikan dukungan psikososial dapat membantu mencegah terjadinya kejadian putus berobat pada pasien TBC RO di Indonesia.
The trend of treatment loss to follow up (LTFU) rates in DR-TB patients tends to fluctuate. The DR-TB treatment LTFU 2020 was 19%, this number decreased compared to 2019 of 22% and 2018 of 27%. LTFU have a major impact on national TB programme indicators, which indirectly affect the success of DR-TB treatment, which has not yet reached the 80% target. Previous studies have found that LTFU is influenced by individual characteristics, behavioural factors, and environmental factors. However, the exact causes of LTFU among DR-TB patients in Indonesia are still unknown. This study aims to find out what factors are associated with the incidence of LTFU in patients with DR-TB in Indonesia in 2022-2023. The sample of this study was all DR-TB patients in Indonesia who started treatment in 2022-2023 and had the final results of treatment declared cured, complete treatment, and LTFU in May 2024. The results showed that there was an association between age, gender, HIV status, DM status, type of resistance, OAT guideline category, and type of health facility with LTFU in patients with DR-TB. Meanwhile, the treatment history and health facility region did not show a significant association with LTFU. Expansion of health facilities providing DR-TB treatment and collaboration between health facilities and TB communities in assisting and providing psychosocial support can help prevent LTFU among patients with DR-TB in Indonesia.
S-11668
Depok : FKM-UI, 2024
S1 - Skripsi Pusat Informasi Kesehatan Masyarakat
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Al Khoirul Idrus Muhammad Fitri; Pembimbing: Tri Yunis Miko Wahyono; Penguji: Yovsyah, Sulistyo, Muhammad Bal`an Kamali Rangkuti
Abstrak:
Program penanggulangan TB nasional menggunakan strategi DOTS (Directly Observed Treatment Shortcourse) telah dilaksanakan sejak tahun 1995. Secara nasional strategi DOTS telah memberikan perubahan meskipun belum secara komprehensif. Kondisi diatas diperparah dengan munculnya masalah baru, diantaranya adalah kejadian TB-HIV. Tipe penderita dan ko-infeksi TB-HIV menjadi faktor risiko terjadinya putus berobat OAT pada penderita TB Paru BTA Positif. Tujuan penelitian ini untuk mengetahui hubungan tipe penderita dan ko- infeksi TB-HIV dengan kejadian putus berobat penderita TB Paru BTA positif di Kota Jakarta Timur. Desain penelitian kasus kontrol, dilakukan pengamatan pada penderita TB Paru BTA positif di Kota Jakarta Timur. Analisis multivariat dengan regresi logistic. Hasil penelitian didapatkan hubungan yang signifikan antara ko-infeksi TB-HIV dengan kejadian putus berobat pada penderita TB Paru BTA positif di Kota Jakarta Timur dengan aOR 19,27 setelah dikontrol jenis kelamin dan status PMO (p value=0,006; 95% CI: 2,36-157,21). Keberadaan infeksi HIV secara bersamaan dengan infeksi TB semakin mengancam kelangsungan hidup sehingga diperlukan terapi yang adekuat untuk mengendalikan virus dan membunuh kuman mycobacterium tuberculosis. Skrining HIV pada penderita TB harus dilakukan secara intensif untuk tata laksana pengobatan yang adekuat melalui program kolaborasi TB-HIV sehingga penderita bisa sembuh dari infeksi TB. Kata Kunci : penderita, TB-HIV, BTA positif
A national TB control program using the DOTS strategy (Directly Observed Treatment Shortcourse) has been implemented since 1995. Nationally, the DOTS strategy has provided changes although not yet comprehensively. The above conditions are exacerbated by the emergence of new problem, such as the incidence of TB-HIV. Type of patient and TB-HIV co-infection is a risk factor to default of anti tuberculosis drugs on positive smear pulmonary tuberculosis patient. The purpose research is to know relation between patient type and TB- HIV co-infection default of treatment for positive smear pulmonary tuberculosis patients in East Jakarta. The design of case control research, conducted observation on the patient of smear positive pulmonary tuberculosis in East Jakarta. Multivariate analysis with logistic regression. The result of anti tuberculosis drugs of the research showed significant correlation between TB-HIV co-infection with default with smear positive pulmonary tuberculosis patient with aOR 19,27 after controlled sex and drug administer superviser statue (p value = 0,006; 95% CI: 2,36-157.21). The presence of HIV infection simultaneously with TB infection is increasingly threatening survival so that adequate therapy is needed to control the virus and kill the bacteria mycobacterium tuberculosis. HIV screening of tuberculosis patients should be intensified for an adequate treatment regimen through a TB-HIV collaboration program so that people can recover from TB infection. Key Word : patient, co-infection TB-HIV, positive BTA
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A national TB control program using the DOTS strategy (Directly Observed Treatment Shortcourse) has been implemented since 1995. Nationally, the DOTS strategy has provided changes although not yet comprehensively. The above conditions are exacerbated by the emergence of new problem, such as the incidence of TB-HIV. Type of patient and TB-HIV co-infection is a risk factor to default of anti tuberculosis drugs on positive smear pulmonary tuberculosis patient. The purpose research is to know relation between patient type and TB- HIV co-infection default of treatment for positive smear pulmonary tuberculosis patients in East Jakarta. The design of case control research, conducted observation on the patient of smear positive pulmonary tuberculosis in East Jakarta. Multivariate analysis with logistic regression. The result of anti tuberculosis drugs of the research showed significant correlation between TB-HIV co-infection with default with smear positive pulmonary tuberculosis patient with aOR 19,27 after controlled sex and drug administer superviser statue (p value = 0,006; 95% CI: 2,36-157.21). The presence of HIV infection simultaneously with TB infection is increasingly threatening survival so that adequate therapy is needed to control the virus and kill the bacteria mycobacterium tuberculosis. HIV screening of tuberculosis patients should be intensified for an adequate treatment regimen through a TB-HIV collaboration program so that people can recover from TB infection. Key Word : patient, co-infection TB-HIV, positive BTA
T-4942
Depok : FKM UI, 2017
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Dora Herdiana; Pembimbing: Nurhayati Prihartono; Penguji: Ratna Djuwita, Heidy Agustin, Sulistyo
Abstrak:
Tingginya angka putus berobat merupakan masalah serius dalampengobatan TB karena memunculkan resistensi obat, meningkatkan kekambuhan,gagal pengobatan,dan berpotensi penularan yang menyebabkan peningkatanbeban dan transmisi TB. Sistem skoring faktor risiko untuk memprediksikesintasan putus berobat pada penderita TB belum banyak diteliti. Studi inibertujuan untuk mengetahui sistem skoring faktor prediktor kesintasan putusberobat penderita TB paru.Studi dilakukan pada April-Mei 2015 di poli DOTS RSUP Persahabatan,menggunakan desain cohort retrospective yang bersumber dari form TB 01 danrekam medis. Sampel sebanyak 370 dengan penderita putus berobat sebagai event,70 orang, penderita sembuh dan pengobatan lengkap sebagai sensor, 300 orang.Probabilitas kumulatif kesintasan putus berobat penderita TB adalah 81%. Hasilanalisis multivariat menemukan prediktor jenis kelamin, diagnosis TB, dan ambilobat sesuai jadwal yang berinteraksi dengan waktu mempunyai nilai p 0,043,0,008, 0,0001 berturut-turut, berisiko terhadap kesintasan putus berobat denganHR 1,7 (95%CI:1,02-2,99), 1,9 (95%CI:1,18-3,05) dan 32,7 (95%CI:14,78-72,18).Variabel mengambil obat sesuai jadwal semakin meningkat HR nya seiringmeningkatnya waktu pengamatan. Hasil skoring model akhir mampu memprediksikesintasan kejadian putus berobat penderita TB paru sebesar 92%, dan nilai cut-off untuk skor model skoring ≥21.Perlu meningkatkan KIE pada penderita secara efektif khususnyapenderita yang laki-laki, diagnosis TB BTA negatif dan mengambil obat tidaksesuai jadwal, meningkatkan jejaring internal maupun eksternal rumah sakit,untuk mengendalikan angka putus berobat TB.Kata Kunci: tuberculosis, putus berobat, kesintasan, skoring
Treatment default is a serious problem in tuberculosis control because itimplies resistance, increased relaps, failure, persistence of infectious source andfurther increased burden and transmission tuberculosis. Scoring system of defaultrisk factors to predict survival patients have been not studied yet, particularly inIndonesia. The aim of this study to determine the predictors scouring system ofsurvival defaulting treatment for tuberculosis patients.This retrospective cohort study was conducted from April to Mei 2013 atpoli DOTS RSUP Persahabatan. were identified from TB 01 forms and medicalrecords. Patients defaulting from treatment were considered as event and thosecure and completing treatment as censors. 370 tuberculosis patients wereincluded, 70 events and 300 censors. Overall patients survival rate was 81%.Survival defaulting associated significanly to sex, smear diagnosis and taking drugaccording to guideline with p value are 0,043, 0,008, 0,0001 respectively, found tobe risk factors for survival defaulting HR 1,7 (95%CI:1,02-2,99), HR 1,9;(95%CI:1,18-3.05), dan HR 32,7 (95%CI:14,78-72,18) respectively. IncreasingHR of taking drug according to guideline followed with increased alteration oftime observation. Scoring results are obtained predicting survival patientsdefaulting by 92%, and a cut-off point for the scoring model is ≥21.Communication, information and education must be increased das well asincreased internal and external hospital linkage to decrease default outcome.Keywords: tuberculosis, default, survival, scouring
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Treatment default is a serious problem in tuberculosis control because itimplies resistance, increased relaps, failure, persistence of infectious source andfurther increased burden and transmission tuberculosis. Scoring system of defaultrisk factors to predict survival patients have been not studied yet, particularly inIndonesia. The aim of this study to determine the predictors scouring system ofsurvival defaulting treatment for tuberculosis patients.This retrospective cohort study was conducted from April to Mei 2013 atpoli DOTS RSUP Persahabatan. were identified from TB 01 forms and medicalrecords. Patients defaulting from treatment were considered as event and thosecure and completing treatment as censors. 370 tuberculosis patients wereincluded, 70 events and 300 censors. Overall patients survival rate was 81%.Survival defaulting associated significanly to sex, smear diagnosis and taking drugaccording to guideline with p value are 0,043, 0,008, 0,0001 respectively, found tobe risk factors for survival defaulting HR 1,7 (95%CI:1,02-2,99), HR 1,9;(95%CI:1,18-3.05), dan HR 32,7 (95%CI:14,78-72,18) respectively. IncreasingHR of taking drug according to guideline followed with increased alteration oftime observation. Scoring results are obtained predicting survival patientsdefaulting by 92%, and a cut-off point for the scoring model is ≥21.Communication, information and education must be increased das well asincreased internal and external hospital linkage to decrease default outcome.Keywords: tuberculosis, default, survival, scouring
T4472
Depok : FKM-UI, 2015
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Indah Mediana; Pembimbing: Syahrizal Syarif; Penguji: Yovsyah, Rina Handayani
S-10413
Depok : FKM-UI, 2020
S1 - Skripsi Pusat Informasi Kesehatan Masyarakat
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Rojali; Pembimbing: Krisnawat Bantas; Penguji: Yovsyah, Tri Yunis Miko Wahyono, Suwandi, Iman Soehendar
Abstrak:
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Pengobatan yang tidak tuntas menyebabkah penyakit tidak akan sembuh, Masalah putus berohar tubedrulosis adalah suatu yang universal, pengobatan tuberkulosis relatif panjang, jika dibandingkan dengan penyakit infeksi lain. Penderila tubedrulosis bila tidak diobati dengan baik akan menyebabkan terjadinya kekebalan pada kesehatan dan dapat menularkan penyak.it pada orang lain. Desain penelilian: Desain penelitian Kohort Retprospektif. Sampel sebanyak 652 orang pasien tuberkolosis yang Ielah menyelesaikan pengobatan tahun 2005 sd. 2006 di wilayah Suku Dinas Kesebatan Masyarakat Kota Jakarta timur. Sampel yang didapatkan 652 ornng dengan menggunakan random sampling yeng didapat dari kelompek tipe penderita baik penderita hero maupun penderita lama. Hasil dan Diskusi: Ditemukan penderita tuberkulosis yang pernah berobat selama tahun 2005-2006 sebesar 24 orang (3,1!6%). Probabilitas kesehatan berobat pasien tuberkolosis adalah sebesar 99,69"/o (hari ke II), 99,38% {hari ke 60), 97,01 {hari ke 90), 96,19% {hari ke 190) dan 96,19% (hari ke 249). Pada analisis Cox regression PMO dan Yankes metupalam varibel indepent pada penderita tuberlrulosis yang PMO bemsal dari non keluarga memiliki resiko pntus berobat 11,75 kali lebih besar dibandingken pasien tubekolosis yang PMOnya hemsa1 dari keluarga (HR :ll,754 95% CI:3,'177-34,737). Demikian juga pasien tuberkulosis pada Runtah Sakit memHiki resiko putus herobat 2,4 kali lebih tinggi dihandingkan pasien tuberkolosis yang di Puskesmas (2,369 95% Cl : 1,011-5,547). Kesimpulan dan saran: Faktor-fuktor yang berpengaruh terhadap survival kelanjutan berobat penderita tuberkulosis adalah Pengawas Minum Obat (PMO) dan Yankes dengan keseluruhan probabilitas survival kelanjutan berobat penderita tuberkulusis adalah 99,38% {hari ke 60 bari}, 97,01% (bari ke 90) dangan median probabilltas kesintasan oads hari ke 191· hari.
Treatment for T8 patients who are not complete will affect the disease will not recover.TB treatment not come to compliance is a universal and this condition base on TB drugs intake is needed few months (6 - 9 months), when to be comprised by other infectious diseases. The happening of impenetrability at germ (germ resistance) and can be contagious of disease at others, and it was affected by TB patients were not received a good case management including drugs management. Research Design: Designing of research was Retrospective cohort Sampling was amounting 652 TB patients who have been done on treatment compliance by the year 2005 10 2006 at East Jakarta Health Region of Health Community of Sub Services. Number of sampling 652 people by using sampling random that getting from new case detection (new TB patients), and also old case detection (old TB patients). Result and Discussion: Found by patient of tuberculosis broken medicines during year 2005-2006 equal to 24 people (3,86%). Probability survival of continuation medicines patient of tuberculosis is equal10 99,69% (day to 11), 97,38% (day10 60), 97,01(day 10 90),96,19% ( day10 190) and 96,19% (day 10 249). At analysis of Cox PMO regression and of health services represent indepent variable at patient of tuberculosis which is PMO come from non family have broken risk medicines 11,75 bigger limes compared 10 patient of tuberculosis which its this come from family (HR:11,754 95% Cl: 3,977-34,737). And so do 10 patient of tuberculosis at Hospital have broken risk medicines 2,4 higher times compared to patient of tuberculosis which in Health Center (2,369 95% Cl: 1,011-5,547). Conclusion and Suggestions: Factors having an effect on to survival of continuation treatment of tuberculosis patients was supervisor of drugs intake (PMO) and Health Services with overall of probability survival of continuation treatment of tuberculosis patients was 99,38% (day to 60 day), 97,01% (day to 90) with probability median survival on 191 days after drugs intake. It will be suggersted that should be taken step for increasing quality of Health Services in strategy of DOTS which are: diagnoses, counceling (health education) to the TB patients and Supervisor of Drugs Intake (PMO).
T-2825
Depok : FKM-UI, 2008
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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R. A. Della Patrisia Pramesti; Pembimbing: Trisari Anggondowati; Penguji: Syahrizal Syarif, Sulistyo
Abstrak:
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Ketidakberhasilan pengobatan TBC masih berada di atas ambang batas 10% yaitu 13% pada tahun 2023 di Indonesia. Komponen terbesar yang menyumbang angka ketidakberhasilan pengobatan TBC ini adalah kejadian putus berobat. Pasien TBC yang putus berobat pada tahun 2023 menempati angka tertinggi sepanjang periode pelaporan TBC pada tahun 1996-2023 dan meningkat secara berturut-turut dalam tiga tahun terakhir. Penelitian ini bertujuan untuk mengidentifikasi prediktor kejadian putus berobat pada pasien TBC sensitif obat (SO) dan mengetahui gambaran waktu terjadinya putus berobat di Indonesia. Penelitian ini menggunakan desain studi kohort retrospektif dengan melibatkan seluruh pasien TBC SO yang memulai pengobatan pada Januari-Desember 2023 di Indonesia yang memenuhi kriteria penelitian dan tercatat pada sistem informasi tuberkulosis (SITB). Analisis data mencakup analisis deskriptif sampai analisis multivariat untuk memperoleh model prediksi terbaik dalam penelitian ini. Hasil menunjukkan bahwa 17% dari populasi dalam penelitian ini putus pengobatan dengan median waktu putus berobat pada hari ke-56. Pasien ≥45 tahun, laki-laki, koinfeksi HIV, memiliki riwayat pernah putus berobat, diobati di rumah sakit (RS) pemerintah, RS swasta dan klinik/praktik mandiri swasta, lokasi fasyankes dan tempat tinggalnya berbeda kabupaten/kota, serta berobat di wilayah Kawasan Timur Indonesia dan Sumatera merupakan kelompok risiko tinggi putus berobat. Oleh karena itu, perlu dilakukan upaya peningkatan pengetahuan, kesadaran, dan persepsi pasien, penguatan dukungan sosial dan keluarga, perluasan akses pelayanan dan pendampingan pasien TBC di seluruh fasilitas pelayanan kesehatan, serta penguatan sistem pelayanan kesehatan dan sistem deteksi dini untuk mencegah kejadian putus berobat.
The unsuccessful outcome of tuberculosis (TB) treatment in Indonesia remains high, at 13% in 2023, exceeding the 10% threshold. The largest contributing factor to this outcome is the rate of loss to follow-up (LTFU). In 2023, the number of LTFU cases reached the highest level recorded in the TB information system from 1996 to 2023, showing a consecutive increase over the past three years. This study aims to identify the predictive factors for occurrence of LTFU among drug-sensitive tuberculosis (DS-TB) cases and to determine the predicted time before the LTFU in Indonesia. This study utilizes a retrospective cohort design, involving all DS-TB cases who initiated treatment between January and December 2023 in Indonesia, met the study criteria, and were recorded in the TB information system. The analysis performed includes descriptive and multivariate analysis to identify the most accurate model in this study. The findings indicate that 17% of the population experienced LTFU, with the median time on day 56. Patients aged 45 years and older, male patients, those with HIV status, a prior history of treatment interruption, those receiving treatment at private hospitals, public hospitals and private clinics/general practitioners, those treated at facilities located in districts or cities different from their registered addresses, and those treated in Eastern Region of Indonesia and Sumatera were identified as having the highest risk compared to other groups. Accordingly, it is imperative to enhance patient knowledge and awareness, strengthen social and family support systems, expand service access and patient support across all facilities, and strengthen the healthcare system and early detection mechanisms to prevent the occurance of LTFU.
T-7461
Depok : FKM-UI, 2025
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Tuti Alawiyah; Pembimbing: Helda; Penguji: Renti Mahkota, Tengku Yenni Febrina, Sulistyo
Abstrak:
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Latar belakang: Tuberkulosis Sensitif Obat (TBC SO) masih menjadi tantangan program kesehatan di Kota Bogor, di mana angka putus berobat melebihi rata-rata nasional dan treatment success rate baru mencapai 79,2%, jauh di bawah target nasional 90%. Setiap pasien yang putus berobat berisiko berkembang menjadi TBC resistan obat sekaligus menjadi sumber penularan aktif di komunitas. Hingga saat ini, upaya pencegahan putus berobat masih bersifat reaktif karena belum tersedianya bukti ilmiah yang spesifik tentang prediktor kejadian putus berobat pada konteks Kota Bogor sebagai wilayah urban dengan distribusi fasilitas pelayanan kesehatan yang beragam. Penelitian ini bertujuan mengidentifikasi determinan kejadian putus berobat pada pasien TBC SO di Kota Bogor tahun 2024 sebagai landasan intervensi program yang berbasis bukti. Metode: Penelitian kuantitatif dengan desain kohort retrospektif menggunakan total populasi pasien TBC SO yang memulai pengobatan di Kota Bogor tahun 2024 (n=3.562) dari data SITB dan SiGeulis. Analisis multivariat menggunakan Cox Extended regression dengan Heaviside split pada bulan ke-2 untuk mengakomodasi variabel yang melanggar asumsi proportional hazard. Data tidak lengkap pada variabel HIV, DM, riwayat pengobatan, dan pekerjaan dianalisis menggunakan pendekatan informative missingness dengan menjadikan kategori "tidak diketahui" sebagai kategori analitik tersendiri yang bermakna secara programatik. Hasil: Proporsi putus berobat sebesar 8,37% (n=298) dengan median waktu kejadian bulan ke-3. Hampir separuh kejadian (49,0%) terkonsentrasi pada fase intensif dua bulan pertama pengobatan. Terdapat lima prediktor independen: jenis fasyankes rumah sakit (aHR fase awal=6,95; 95% CI: 4,05–11,94), jenis kelamin laki-laki (aHR=1,90; 95% CI: 1,49–2,41), status HIV tidak diketahui (aHR fase awal=2,01; fase lanjutan=2,73), riwayat pengobatan tidak diketahui (aHR fase awal=1,82; 95% CI: 1,21–2,75), serta komorbid DM yang signifikan hanya pada fase lanjutan (ada DM: aHR=2,05; tidak diketahui: aHR=2,17). Kesimpulan: Risiko putus berobat bersifat dinamis dan berbeda antar fase pengobatan. Jenis fasyankes dan riwayat pengobatan tidak diketahui dominan pada fase awal, sementara DM dan status HIV tidak diketahui menguat di fase lanjutan. Pola konsisten pada tiga kategori "tidak diketahui" mencerminkan fenomena informative missingness (ketidaklengkapan) data klinis sebagai sinyal lemahnya keterlibatan pasien dengan sistem kesehatan. Intervensi perlu bersifat diferensial berdasarkan fase pengobatan seperti pemantauan intensif di rumah sakit pada dua bulan pertama, dan penguatan skrining serta tindak lanjut HIV dan DM sepanjang fase lanjutan pengobatan.
Background: Drug-susceptible tuberculosis (DS-TB) remains a persistent challenge for health programs in Bogor City, where the loss to follow-up (LTFU) rate exceeds the national average and the treatment success rate stands at only 79.2%, well below the national target of 90%. Each patient who discontinues treatment risks developing drug-resistant TB while simultaneously becoming an active source of transmission in the community. To date, prevention efforts remain reactive due to the absence of context-specific evidence on predictors of LTFU in Bogor City as an urban area with a heterogeneous distribution of health facilities. This study aims to identify the determinants of LTFU among DS-TB patients in Bogor City in 2024 as an evidence-based foundation for program intervention. Methods: A quantitative study with a retrospective cohort design was conducted using the total population of DS-TB patients who initiated treatment in Bogor City in 2024 (n=3,562), sourced from SITB and SiGeulis. Multivariate analysis used Cox Extended regression with a Heaviside split at month 2 to accommodate variables violating the proportional hazard assumption. Incomplete data on HIV status, diabetes mellitus (DM), treatment history, and occupation were analyzed using an informative missingness approach, treating the "unknown" category as a distinct analytical category with programmatic significance. Results: The proportion of LTFU was 8.37% (n=298), with a median time to event of month 3. Nearly half of all events (49.0%) were concentrated in the intensive phase of the first two months of treatment. Five independent predictors were identified: hospital-based care (aHR early phase=6.95; 95% CI: 4.05–11.94), male sex (aHR=1.90; 95% CI: 1.49–2.41), unknown HIV status (aHR early phase=2.01; late phase=2.73), unknown treatment history (aHR early phase=1.82; 95% CI: 1.21–2.75), and comorbid DM which was significant only in the late phase (known DM: aHR=2.05; unknown DM: aHR=2.17). Conclusion: The risk of LTFU is dynamic and differs across treatment phases. Health facility type and unknown treatment history were dominant predictors in the early phase, while DM and unknown HIV status emerged as stronger predictors in the late phase. The consistent pattern across three "unknown" categories reflects the phenomenon of informative missingness incomplete clinical data as a signal of weak patient engagement with the health system. Interventions should be phase-specific: intensive monitoring at hospitals during the first two months, and strengthened HIV and DM screening and follow-up throughout the late treatment phase.
T-7619
Depok : FKM-UI, 2026
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Angga Berliana Dewi; Pembimbing: Nuning MK Masjkuri; Penguji: Lukman Hakim Tarigan, Soedjono
S-5519
Depok : FKM-UI, 2008
S1 - Skripsi Pusat Informasi Kesehatan Masyarakat
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