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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 Dates: May 2017 - November 2019

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.

5-497 Standardized Patient Training
Standardized Patient Training (Photo courtesy of Dr. Alisjahbana).

Summary of Recent Updates:

As of March 2019, the team conducted the preparation of Sub-study 3 and the data collection of Sub-study 1 and Sub-study 2. The research team disseminated the results of the mapping of private practitioners to stakeholders and discussed several strategic follow-up plans of sharing the mapping data and the necessity of TB DOTS training for private healthcare providers in Bandung.

The team finished about 80% of overall data collection for sub-study 1. They have been started the recruitment of patients in private healthcare facilities and faced some challenges since the majority of the private doctors (in clinics or solo practices) referred the patients diagnosed with TB to public healthcare facilities. They interviewed 24 patients (13 newly diagnosed TB patients, 7 patients who underwent 2nd-month TB treatment and 4 patients who underwent 6th-month TB treatment). In regard to Sub-study 2, they conducted focus group discussion with three specialists contributing to TB-related practice to re-assess the clinical scenarios and the supporting materials. In addition to weekly study evaluation, they conducted a two-day meeting with the Standardized Patients to evaluate and refresh them about clinical scenarios and standard operating procedures of Sub-study 2. The piloting of Sub-study 3 has been started to validate the question guideline and the other research instruments.

In order to disseminate the results of mapping of private practitioners, we conducted a meeting with Bandung Health Office, 30 selected CHCs (out of 73 CHCs in Bandung), Indonesian Medical Association and Indonesian Clinical Association on October 3, 2018. At the end of this event, we discussed several strategic issues regarding public-private mix in and the follow-up plan such as the possibility of sharing of the mapping data and the necessity of TB DOTS training for private healthcare providers in Bandung.

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