Abstrak Proporsi keberhasilan pengobatan pasien TBC di Jakarta Barat trend-nya mengalami penurunan dari tahun 2020 hingga 2022. Penelitian ini bertujuan untuk mengetahui hubungan kepatuhan pengobatan, co-infeksi HIV, dan riwayat pengobatan dengan ketidakberhasilan pengobatan TBC SO di Kota Jakarta Barat tahun 2022. Desain studi penelitian yaitu kohort retrospektif, bersumber dari laporan TB03.SO Sistem Informasi Tuberkulosis (SITB) Kota Jakarta Barat tahun 2022. Analisis penelitian meliputi analisis deskriptif, survival dengan Kaplan Meier, dan multivariat (cox regression). Dari 2116 pasien yang terdapat 1846 pasien menjadi sampel penelitian. Hasil penelitian menunjukkan insiden rate kumulatif: 4,9/1000 orang-minggu; probabilitas survival kumulatif: 70,5%. Pada kelompok negatif DM, tidak patuh minum obat HR: 47,78 kali (95% CI: 32,59-70,03; p-value: <0,001). Pada kelompok ada riwayat pengobatan, tidak patuh minum obat HR: 26,28 (95% CI: 12,54-55,03; p-value: <0,001) setelah dikontrol variabel jenis kelamin. Pada kelompok patuh pengobatan, pada saat pasien TBC SO memiliki riwayat pengobatan sebelumnya memiliki HR: 2,3 (95% CI: 1,06-5,01; p-value: 0,035). Diharapkan menguatkan koordinasi dengan poli lainnya (Poli HIV/PDP atau Poli Penyakit Dalam) untuk memantau keteraturan minum OAT dan juga obat untuk penyakit penyerta lainnya untuk kasus TBC dengan komorbid. Perlu dilakukan pemantauan efek samping, konsultasi, tatalaksana efek samping sesuai standar, dan juga follow up pengobatan pasien. Kata kunci: Ketidakberhasilan Pengobatan, TBC Sensitif Obat, Analisis Survival

Abstract The proportion of successful treatment for TB patients treated in West Jakarta has decreased by 83.40% (2020), 79.36% (2021), and 77.18% (2022) (22.82% failure) . This study aims to determine the relationship between treatment adherence, HIV co-infection, and previous treatment history with TB SO patient survival and treatment failure in West Jakarta City in 2022. The study design of this research is a retrospective cohort with data sourced from the TB03.SO System report. Information on Tuberculosis (TBC SO) for West Jakarta City for the period January-December 2022. The analysis used in this research is descriptive analysis, survival using Kaplan Meier, and multivariate using cox regression. Of the 2116 eligible patients in this study, 1846 patients were included in the research sample. The results showed that the cumulative incidence rate was 4.9/1000 person-weeks with a cumulative survival probability of 70.5%. in the DM negative group, when TB SO patients were non-compliant with taking medication HR: 47.78 times (95% CI: 32.59-70.03; p-value: <0.001) after controlling for the gender variable. The results of the multivariate analysis showed that in the group with no history of treatment, when TB patients did not adhere to taking medication, the HR was: 65.65 times (95% CI: 43.09-100.03; p-value: <0.001) after controlling for variables gender. In the group with a history of treatment, when TB patients did not comply with taking medication, the HR was 26.28 times (95% CI: 12.54-55.03; p-value: <0.001) after controlling for the gender variable. in the treatment adherent group, when TB SO patients had a history of previous treatment, the HR was: 2.3 times (95% CI: 1.06-5.01; p-value: 0.035). It is hoped that coordination with other polyclinics (HIV/PDP Polyclinic or Internal Medicine Polyclinic) will be strengthened to monitor the regularity of taking OAT and also medication for other comorbidities for TB cases with comorbidities, for example ARVs for HIV patients and DM therapy for DM patients. It is necessary to monitor side effects, consult, manage side effects according to standards, and also follow up on patient treatment so as to increase treatment compliance and reduce the rate of treatment failure. Key words: Treatment Unsuccessful, Drug-Sensitive Tuberculosis, Survival Analysis

Untuk menjamin keteraturan pengobatan tuberkulosis diperlukan Pengawas Menelan Obat. Seorang PMO sebaiknya seseorang yang dikenal, dipercaya dan disetujui baik oleh petugas kesehatan maupun penderita. PMO juga seseorang yang tinggal dekat dengan penderita, bersedia membantu penderita dengan sukarela dan bersedia dilatih dan atau mendapat penyuluhan bersama-sama dengan penderita. PMO bertugas untuk mengawasi penderita menelan obat secara teratur, memberi dorongan pada penderita agar mau berobat teratur, mengingatkan penderita untuk periksa ulang dahak, memberikan penyuluhan pada anggota keluarga penderita tuberkulosis yang mempunyai gejala-gejala tuberkulosis untuk memeriksakan diri ke unit pelayanan kesehatan. Beberapa penelitian mernperlihatkan bahwa peran PMO dalam pengobatan penyakit tuberkulosis paru meningkatkan keteraturan berobat. Pada Tahun 2005 di Kabupaten Sanggau 53% PMO berasal dari tenaga kesehatan, dan penelitian ini bertujuan untuk rnenilai kekuatan hubungan Status Pengawas Menelan Obat dengan keteraturan pengambilan obat penderita tuberkulosis paru di Kabupaten Sanggau - Kalimantan Barat tahun 2005 yang belum pernah diteliti. Untuk mengetahui gambaran besar variabel Status PMO mempengaruhi keteraturan pengambilan obat di Kabupaten Sanggau, rnaka digunakan desain historical cohort dengan jumlah responden sebanyak 270 orang. Responden merupakan penderita tuberkulosis paru tahun 2005 di Kabupaten Sanggau. Hasil penelitian rnenunjukkan perbedaan keteraturan pengambilan obat pada penderita tuberkulosis paru yang memiliki PMO berasal dari tenaga kesehatan dengan PMO bukan tenaga kesehatan. Besarnya nilai RR = 0,659 yang menunjukkan efek protektif, berarti penderita tuberkulosis paru yang mernilild PMO yang berasal bukan dari tenaga kesehatan lebih teratur mengarnbil obat dibandingkan penderita tuberkulosis yang memilild PMO tenaga kesehatan. Model akhir yang menerangkan hubungan status PMO dengan keteraturan mengarnbil obat = -7,074 - 0,435 (status PMO) + 2,587 {Pengetahuan Mengenai Ancarnan Tuberkulosis Paru) + 1,074 (Penyuluhan Mengenai Pengobatan Tuberkulosis Paru + 0,451 (Penyuluhan Mengenai Penularan Tuberkulosis Paru). Pengetahuan mengenai ancaman tuberkulosis paru, penyuluhan mengenai pengobatan tuberkulosis paru dan penyuluhan mengenai penularan tuberkulosis paru akan meningkatkan keteraturan mengambil obat. Pendekatan sosial budaya untuk menginterpensi pengobatan penyaldt tuberkulosis paru, dapat dilakukan dengan mernilih PMO yang berasal dari tokoh masyarakat maupun ketua adat mengingat masyarakat sangat patuh akan hukum adat Dayak dan hukum adat Melayu yang ada di Kabupaten Sanggau.

To ensure a good regulated tuberculosis treatment, a treatment observer must be needed. People who have access to TB Patients on a daily basis and who are accountable to the health services are the most appropriate persons to provide directly observed treatment. Treatment observer must be the persons who are accessible to the patients, take responsibilities of helping the patients and get proper health education with the patients. Treatment observer have duty to observe and disseminating messages to the patients to complete a full course of anti-TB treatment. Treatment observer must advice the patients and their families to checked their sputums to the health centre. Some researches showed that good treatment observers could increased good regulates took medicine. In Sanggau Distric, 2005 there were 53% of treatment observer recruired from health care workers, and the objective of this research is to acces the relationship between health care worker treatment observers and non health care worker treatment observers with the regulate took medicine for the lung tuberculosis patients in Sanggau District, West Kalimantan, 2005. It's use a historical cohort study design and 270 total samples. The respondens were the lung tuberculosis sufferers in Sanggau District, 2005. The result of this research showed that there was relationship between the regulate in taking medicine for health care worker treatment observers and non health care worker treatment observers. RR=0.659 show a protective effect, it means that the tuberculosis patient with non health care worker treatment observers more regulate took medicine then the health care workers treatment observer. The last model to showed the relationship of the treatmentohserver status with the regulate took medicine is: -7.074-0.435 (Treatment Observers Status) + 2.587 (knowledge of tuberculosis threat) + 1.074 (promotion of lung tuberculosis infection)+ 0.451 (promotion of the uncomplete drugs) Knowledge of the lung tuberculosis threat, the desseminating messages of uncomplete drugs and desseminating messages of lung tuberculosis infection will increase the regulate of took medicine. The conduction. of soc. ial cultur for interperated the cureness of lung tuberculosis could be used by recruit community base approach and social elits as treatment observers, however the strong culture of Dayak and Melayu has been integrated the community in Sanggau District.