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Cycle 5 (2016 Deadline)

Investigation of services delivered for TB by external care system - especially the private sector (INSTEP)

PI: Bachti Alisjahbana (, TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran
U.S. Partner: Megan Murray, Harvard Medical School

Project Overview:

The PEER project will be comprised of three studies that will cover the whole assessment of services delivered for TB patients in the private sector in Bandung Municipality, Indonesia. The overall study objective is to describe the health care pathways of patients seeking treatment for TB, and describe the behavior, and reasons behind the behavior, of Private Practitioners who diagnose and initiate treatment of TB patients. Specifically, the team will investigate health care pathways of newly diagnosed TB patients according to their socio-demographic characteristics and type of healthcare facility (sub-study 1). The PEER project will also assess the quality of TB case management by private health care providers, including their diagnostic, referral, and treatment practices, by using standardized patients (sub-study 2); and to understand which factors and reasons are associated with the choice of diagnostic, referral and treatment practices among private practitioners (sub-study 3). Cross-sectional, observational, and qualitative study designs will be used to reach the stated objectives.

The study will provide the national TB program a better understanding about the current practices of TB care and management, especially in the private sector. This information is vital since a large proportion of TB cases in Indonesia come to private providers as the first point of care when they first experience sickness. The proposed study method in evaluating the performance of private providers will be different from previous studies conducted in Indonesia by employing an approach which allow the team to investigate real practices performed by private providers.

Summary of Recent Updates:

Within the reporting period (October to December 2017), the team performed some preparatory activities and initial data collection for mapping of private providers. The team presented the study to the 30 selected Community Health Centers (CHCs) to ensure all stakeholders were aware of the activities. Field enumerators have conducted data collection for the mapping of private practitioners by using an Android-based questionnaire developed for sub-study 1. They randomly selected 10 CHCs out of 30 CHCs and purposely chose 5 hospitals within the study area to be the site for subject recruitment for sub-study 1. The team decided against including informed consent procedure for doctors to avoid bias and low participation rate (sub-study 2). An updated ethical approval was obtained for this alteration from The Health Research Ethics Committee Faculty of Medicine Universitas Padjadjaran Bandung. In December 2017, they conducted a Focused Group Discussion with two pulmonologists and one specialist of tropical infection and medicine to develop the clinical scenarios and scripts.

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