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PARTNERSHIPS FOR ENHANCED ENGAGEMENT IN RESEARCH (PEER)
Cycle 5 (2016 Deadline)


Increasing TB notification through one stop clinics and engagement with private healthcare providers in Bandung, Indonesia (INSTEP)


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

Project Overview:

Indonesia has the second highest TB burden globally and ranks among the top 10 for multi-drug resistant tuberculosis (MDR TB). A recent national survey has shown that the TB prevalence rate in Indonesia was previously underestimated. Limitations were identified in the diagnostic algorithms and tools that are currently used. In addition, the survey found that a large proportion of TB cases are diagnosed and managed by private practitioners, without any notification to the National TB Program. In the private healthcare sector, TB cases tend to receive suboptimal diagnostic workup and treatment, compromising TB control in Indonesia. It is crucial that case detection and management be optimized in a way that can work in the Indonesian context. Early detection of TB is important, not only for the patient's own health but also to reduce the period during which he or she is contagious, thereby averting transmission and reducing TB prevalence. The current algorithm for pulmonary TB detection in Indonesia includes sputum microscopy for those with a cough lasting for more than two weeks. The prevalence survey showed that 43% of culture positive cases did meet this criterion and were enrolled into a diagnostic process on the basis of chest x-ray screening. Engagement of private practitioners (PPRs) for TB control is considered necessary by the World Health Organization (WHO) Stop TB Strategy, but ways to achieve optimal engagement have yet to be identified.

The PEER project will address these issues through two new interventions. First, the researchers will establish one-stop TB clinics in one region of Bandung city and second, they will develop and establish a new electronic case notification system. The clinics will provide improved diagnostic services: along with a new algorithm for case detection, the one-stop clinics will utilize chest x-rays (expected to increase by 20-40% the number suspected TB patients having to submit sputum), sputum microscopy, and a molecular diagnostic test (Xpert Mtb/Rif), expected to be 20% more sensitive. The electronic case notification system for recording and reporting (R&R) will be able to be utilized by all healthcare providers, and data will be linked to the national TB notification system. The primary measure of impact of these combine interventions will be the change in number of new TB cases diagnosed and reported within the study area. The research team will evaluate feasibility and acceptability using mixed methods. Results from the project will be shared with policymakers in the Ministry of Health on best practices for TB diagnosis among public and private health providers in Indonesia. Additionally, the integrated information system, which will include previously un-notified cases, will facilitate more accurate monitoring of adherence to treatment standards.


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