Tuberkulosis sensitif obat (TB SO) salah satu penyakit infeksius penyebab kematian utama dunia. Terjadi peningkatan kematian pasien TB SO di Provinsi DKI Jakarta. Tujuan : Tujuan penelitian ini adalah untuk mengetahui pengaruh faktor usia, jenis kelamin, status bekerja, klasifikasi lokasi anatomi, klasifikasi riwayat pengobatan, komorbid DM, dan status HIV dengan kematian pasien TB SO selama masa pengobatan di Provinsi DKI Jakarta. Metode : Desain studi penelitian ini adalah kohort retrospektif dengan metode analisis survival Kaplan meier. Hasil : Hasil menunjukkan proporsi kematian pasien sebesar 4,5% dengan probabilitas kesintasan mencapai 90,1%. Faktor yang terbukti berpengaruh terhadap kematian pasien adalah usia >40 tahun (Hazard Ratio (HR) 2,3; 95% Confidence Interval (95% CI) 1,925-2,629), jenis kelamin laki-laki (HR 1,2; 95% CI 1,047-1,396), pasien kambuh dan lainnya (HR 2,8; 95% CI 2,351-3,339), memiliki komorbid DM (HR 1,4; 95% CI 1,159-1,598), dan status positif HIV (HR 4,7; 95% CI 3,879-5,623). Kesimpulan : Faktor usia, jenis kelamin, riwayat pengobatan, komorbid DM, dan status HIV merupakan faktor kematian pasien TB SO di Provinsi DKI Jakarta. Saran berupa dilakukan audit penyebab kematian dan peningkatan standar prosedur layanan oleh pihak Dinas Kesehatan Provinsi direkomendasikan.

Drug-sensitive tuberculosis (TB SO) is one of the world's leading causes of death. There has been an increase in the deaths of TB SO patients in DKI Jakarta Province. Objective: This study aimed to determine the influence of age, gender, work status, anatomical location classification, treatment history classification, DM comorbidities, and HIV status on the death of TB SO patients during the treatment period in DKI Jakarta Province. Methods: The study design of this research was a retrospective cohort with the Kaplan-Meier survival analysis method. Results: The results showed that the proportion of patient deaths was 4.5% with survival probability was 90.1%. Factors of death were age >40 years (Hazard Ratio (HR) 2.3; 95% Confidence Interval (95% CI) 1.925-2.629), male gender (HR 1.2; 95% CI 1.047-1.396), patient relapse and others ( HR 2.8; 95% CI 2.351-3.339), having comorbid DM (HR 1.4; 95% CI 1.159-1.598), and HIV positive (HR 4.7; 95% CI 3.879-5.623). Conclusion: Age, gender, treatment history, comorbid DM, and HIV status are death factors of TB SO patients in DKI Jakarta Province. Suggestions in the form of an audit of the causes of death and improving standard service procedures by the Provincial Health Service are recommended.

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

Provinsi DKI Jakarta merupakan salah satu dari 4 Provinsi di Indonesia yang menjadi tempat implementasi awal dari penerapan penggunaan paduan BPaL (Bedaquiline, Pretomanid, Linezolid) untuk pengobatan TB RO dalam tatanan penelitian operasional. Tujuan penelitian ini adalah membandingkan keberhasilan pengobatan pasien TB RO pada penggunaan Bedaquiline dalam paduan pengobatan dengan keberhasilan pengobatan pasien TB RO tanpa Bedaquiline dalam paduan pengobatan. Penelitian menggunakan rancangan kohort retrospektif dan analisis datanya dengan analisis survival dari data Sistem Informasi Tuberkulosis (SITB) Provinsi DKI Jakarta tahun 2020 – 2023. Hasil penelitian: Pada pola resistansi Monoresistan, Rifampisin Resistan, Poliresistan dan Multidrugs Resistant keberhasilan paduan pengobatan yang menggunakan Bedaquiline tidak menunjukkan perbedaan yang bermakna dengan keberhasilan pengobatan menggunakan paduan tanpa Bedaquiline setelah dikontrol oleh variabel jenis paduan pengobatan (HR 1,01; 95% CI 0,79 -1,29; p-value= 0,939). Pada pola resistansi pre-Extensively Drug Resistant dan Extensively Drug Resistant, keberhasilan paduan pengobatan menggunakan Bedaquiline juga tidak berbeda bermakna bila dibandingkan keberhasilan paduan pengobatan tanpa Bedaquiline dengan mempertimbangkan jenis paduan pengobatan (HR 1,14; 95% CI 0,34 – 3,82; p-value= 0,835). Diharapkan tenaga kesehatan tetap memberikan edukasi pentingnya kepatuhan regimen pengobatan dan dukungan sosial serta psikologis kepada pasien untuk menbantu pasien tetap konsisten menjalani pengobatan.

DKI Jakarta Province is one of 4 Provinces in Indonesia for the initial implementation site of the BPaL (Bedaquiline, Pretomanid, Linezolid) combination for treating DR-TB (Drug Resistant Tuberculosis) in an operational research order. The study aimed to compare the success of treatment of TB RO patients with the use of Bedaquiline in the treatment combination with the success of treatment of TB RO patients without Bedaquiline in the treatment combination. The study used a retrospective cohort design and data analysis with survival analysis from the Tuberculosis Information System (SITB) data of DKI Jakarta Province in 2020 – 2023. Results of the study shows that in Monoresistant, Rifampicin Resistant, Polyresistant and Multidrugs Resistant resistance patterns, the success of treatment combination using Bedaquiline did not show a significant difference with the success of treatment combination without using Bedaquiline after being controlled by treatment combination type variable (HR 1.01; 95% CI 0.79 -1.29; p-value = 0.939). In pre-Extensively Drug Resistant and Extensively Drug Resistant resistance patterns, the success of treatment combination using Bedaquiline was also not significantly different when compared to the success of the treatment combination without Bedaquiline after being controlled by treatment combination type variable (HR 1.14; 95% CI 0.34 – 3.82; p-value = 0.835). Health workers are expected to continue providing education on the importance of compliance with treatment regimens and giving social and psychological support to patients in order to maintain patient’s consistency in undergoing treatment.