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Kata kunci: hasil pengobatan; pengobatan jangka pendek; TB RO
The case of drug-resistant tuberculosis causes the burden of controlling TB disease to increase. The decline in treatment success rates from 2010 (67.9%) to 51.1% in 2013 and an increase in cases of patients dropped out encouraged Indonesia to apply shortterm treatment to increase the success rate of DR-TB treatment and reduce cases of patients dropped out. This study aims to look the results of DR-TB treatment and factors related to treatment outcomes for short regimens in Indonesia in 2017 using a retrospective cohort study design. Using data on DR-TB patients recorded in the e-TB manager aged ≥15 years who have completed treatment for the maximum short regimen in November 2018. There were 223 cases with 46.6% cured, 26.5% dropped out, 4.9% completed, 14.2 died, 6.3% failed and 1.3% others.. Age, gender, previous treatment history, type of resistance, HIV status, DM status and lung cavity status were not statistically related to the results of treatment of short regimens. Factors related to the results of treatment of short regimens were resistant to amikacin (RR 7.4; 95% CI 4.68-17.29), ofloxacin (RR 28; 95% CI 2.8-279.5), kanamycin (RR 9; 95% CI 4.68- 17.29), and treatment initiation interval >7 days (RR 0.307; CI 0.09-0.98).
Key words: treatment outcomes; short-term treatment; DR-TB
ABSTRAK Nama : Sri Hayanti Program Studi : Magister Epidemiologi Judul : Faktor-Faktor Yang Berhubungan dengan Gagal Pengobatan Pasien Extensive Drug Resistant Tuberculosis (TB-XDR) di Indonesia Tahun 2009 – 2017 (Analisis Data e-TB Manager Subdit Tuberkulosis - Kemenkes RI) TB resistensi obat khususnya TB-XDR pada program pengendalian TB menjadi burden. Berbagai upaya pengendalian TB dilakukan untuk mencapai target global yaitu bebas TB, salah satunya melalui penurunan insiden gagal pengobatan. Penelitian untuk melihat gagal pengobatan TB-XDR belum dilakukan di Indonesia. Penelitian ini untuk mengetahui faktor-faktor yang berhubungan dengan gagal pengobatan pasien TB-XDR di Indonesia tahun 2009 – 2017 dengan menggunakan data sekunder dari aplikasi eTB manager di Subdit Tuberkulosis - Kementerian Kesehatan RI. Sebanyak 151 pasien TB- XDR di Indonesiadianalasis dengan cox regression terdapat 28 (19%) pasien TB-XDR yang sembuh, 2 (1%) pengobatan lengkap, 38 (25%) gagal pengobatan, 4 (3%) lost to follow up, 35 (23%) meninggal dunia dan 44 (29%) tidak dievaluasi. Dari penelitian ini diketahui bahwa pasien yang interupsi pengobatan ≤60 hari berisiko 0,57 kali lebih kecil untuk terjadi gagal pengobatan (HR 0,57; 95%CI -1,29 – 0,15 dan nilai p 0,12) sedangkan pada pasien yang interupsi >60 hari berisiko 0,11 kali lebih kecil untuk terjadi gagal pengobatan dibanding kelompok yang tidak interupsi (HR 0,11; 95% CI -3,67- -0,69 dan nailai p 0,00). Pasien yang memiliki kavitas paru berisiko 3,60 kali lebih besar untuk terjadi gagal pengobatan dibandingkan yang tidak memiliki kavitas paru (HR 3,60; 95% CI 0,50 - 2,06 dan nilai p 0,00). Program pengendalian TB-XDR di Indonesia diharapkan lebih memfokuskan intervensi pada interupsi pengobatan dan kavitas paru. Kata kunci: gagal pengobatan; interupsi pengobatan; kavitas paru; TB-XDR
ABSTRACT Name : Sri Hayanti Study Program: Magister Epidemiologi Title : Influencing Factors for The Failure Treatments of The Extensive Drug Resistant Tuberculosis (XDR-TB) Patients in Indonesia Year 2009-2017 TB drug resistance especially XDR-TB on TB treatment program become a burden. Many programs have been conducted to achieve global target, free of TB, one of strategy is to decrease failed treatment. Study to prove failed treatment on XDR-TB never been conducted in Indonesia. Purpose of this study is to determine the various factors associated with failure treatment on patients with XDR-TB in Indonesia in 2009 – 2017 was conducted using secondary data from the e-TB manager application in Sub Directorate Tuberculosis. Based on analysis by cox regression 151 patients with XDR-TB in which 28 patients (19%) cured, 2 (1%) complete treatment, 38 (25%) failed treatment, 4 (3%) lost to follow up, 35 (23%) died and 44 (29%) do not be evaluated. From this research it is known that patients who are interruption treatment ≤ 60 days have a lower risk 0.57 times more likely to occur as treatment failure (HR 0.57; 95%CI -1.29 – 0.15 and p value 0.12) otherwise patients who are interruption treatment >60 days have a lower risk 0.11 times more likely to occur as treatment failures compared to the group that is no interruption (HR 0.11; 95% CI -3.67- -0.69 and p value 0.00). Patients with lung cavities have 3.60 times greater risk for treatment failure than they who have no lung cavity HR 3.60; 95% CI 0.50 - 2.06 and p value 0.00). Treatment program XDR-TB resistant in Indonesia is expected to be more focused intervention to interruption treatment and lung cavity. Keywords: failure treatment; interruption treatment; cavity pulmonary; XDR-TB
Tuberculosis is still a major cause of health problems and death in the worldwide. The prevalence of DM which continues to increase each year is estimated to be in 2045, there are 629 million people who will suffer from diabetes. This study aims to assess the association DM on TB treatment failure in TB patients in 2017-2019 in Indonesia. Method. This study was conducted using a retrospective cohort study design. The population and sample of this study were all drug-sensitive TB patients in Indonesia who started treatment in 2017-2019 and registered in the Integrated Tuberculosis Information System (SITT) that met the inclusion and exclusion criteria. Data analysis was performed using Cox Regression. Result. A total of 107036 TB patients were included in the analysis of 1,251,525 TB patients registered in 2017- 21019, of which 23388 (21.9%) TB DM patients. The characteristics of the majority of TB patients are aged 15-44 years (51.3%), male 59.8%, live in the district 58.8%, have positive sputum at the time of initial examination 64.8%, history of treatment new TB 94.09%, HIV negative (76.2%). Region of residence, baseline sputum examination, treatment history and HIV status were significantly associated with treatment failure. TBDM patients had 1.72 (95% CI; 1.51-1.95) times the risk of experiencing treatment failure than TBnonDM patients. The proportion of treatment failure of TBDM patients caused by the interaction of DM with treatment history is 50%. Multivariate analysis showed that the risk of treatment failure in TB DM ARR patients was 1.83 (95% CI; 1.6-2.09) compared with nonDM TB patients after being controlled by gender and sputum variables. Conclusion. DM increases the risk of treatment failure in TB patients so controlling blood sugar levels during treatment for TBDM patients is very necessary