Abstrak: abstrak Indonesia saat ini menempati peringkat ke-2 sebagai negara dengan beban kasus TB terbesar di dunia, termasuk TB resistan obat. Pengobatan TB resistan obat memiliki periode yang lebih lama dan efek samping yang lebih berat. Keberhasilan pengobatan TB resistan obat di Indonesia juga masih belum optimal yaitu 51% pada tahun 2016. Penelitian ini bertujuan untuk mengetahui determinan keberhasilan pengobatan TB resistan obat di DKI Jakarta tahun 2014-2015. Desain studi penelitian ini adalah kohort retrospektif dengan sumber data utama yaitu e-TB manager Dinas Kesehatan DKI Jakarta. Hasil penelitian menunjukkan bahwa jenis fasilitas layanan kesehatan dan keteraturan pengobatan merupakan determinan keberhasilan pengobatan TB resistan obat di DKI Jakarta. Upaya peningkatan keberhasilan pengobatan TB resistan obat perlu didukung dengan memperluas layanan pengobatan dan memperkuat kordinasi antara fasyankes rujukan dan satelit. Kata kunci: tuberkulosis; tuberkulosis resistan obat; keberhasilan pengobatan. ABSTRACT Indonesia is currently at 2nd rank as the country with the largest burden of TB cases in the world, including drug-resistant TB. Treatment of drug resistant TB has a longer period and more severe side effects. The success rate of drug-resistant TB treatment also still quite low (51%) in 2016. This study aims to determine the determinants of successful treatment of drug resistant TB in Jakarta in 2014-2015. The study design of this study is a retrospective cohort with the main data source is e-TB manager of DKI Jakarta Health Office. The results showed that the type of health care facility and the regularity of treatment is the determinant of the success of drug resistant TB treatment in DKI Jakarta. Efforts to improve the success of TB drug resistant treatment should be supported by expanding treatment services and strengthening coordination between referral and satellite facilities. Key words: tuberculosis; drug-resistant tuberculosis; successful treatment

Abstrak: Resistensi obat merupakan masalah baru dalam program eliminasi TB yang disebut TB resisten obat. Pengobatan TB resisten obat di Indonesia dilakukan di fasilitas pelayanan kesehatan rujukan dan fasilitas pelayanan kesehatan satelit. Penelitian ini bertujuan untuk mengetahui pengaruh fasilitas pelayanan kesehatan terhadap keberhasilan pengobatan pasien TB resisten obat di Indonesia. Penelitian ini dilaksanakan pada bulan Mei 2019 di Subdit-TB, Direktorat P2PML, Kementerian Kesehatan RI. Desain studi penelitian ini adalah kohort restrospektif. Jumlah sampel sebanyak 4288 orang, diseleksi menggunakan teknik total sampling. Hasil penelitian menunjukkan bahwa pasien yang menyelesaikan pengobatan di fasilitas pelayanan kesehatan satelit sebanyak 97,20% dan di fasilitas pelayanan kesehatan rujukan sebanyak 2,8%. Proporsi keberhasilan pengobatan sebesar 53,2% dengan kumulatif hazard keberhasilan pengobatan sebesar 5,43 di akhir pengamatan selama 36 bulan pengamatan

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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.

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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.

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The tuberculosis treatment success rate in Indonesia in 2023 did not reach the 90% target. Treatment success impacts the reduction of infection spread and drug resistance cases, making early prediction of treatment success crucial. This study aims to develop a machine-learning model to predict treatment success. Data from Indonesia's Tuberculosis Information System (SITB) cohort was used. The study included productive-age patients (15-64 years) diagnosed with drug-sensitive tuberculosis who received treatment from January 1, 2020, to December 31, 2023. Data was randomly split into training (80%) and testing (20%) sets for model validation, with cross-validation performed. The algorithms used include decision tree, random forest, multilayer perception, extreme gradient boosting, and logistic regression. A consensus was reached for decision-making variables required in performing machine learning-based modeling of SITB data to predict treatment success using modeling of SITB data to predict treatment success using the Delphi method. The results of the study show that the random forest machine learning algorithm had the best performance and highest accuracy in predicting treatment success. This machine learning–based prediction tool can provide early predictions with SHAP (SHapley Additive ExPlanations) interpretation, helping healthcare workers make informed decisions more easily.