WSMP Barliana

PARTNERSHIPS FOR ENHANCED ENGAGEMENT IN RESEARCH (PEER)
Women in Science Mentoring Program (2020)

Association between burden of medicine and therapy adherence among multi-drug resistant tuberculosis patients in West Java, Indonesia

PI: Melisa Barliana, Universitas Padjadjaran, Sumedang, West Java, Indonesia
Project Dates: February 2022 - July 2023

Project Overview

PI Prof. Dr. Med.Sc. Melisa Intan Barliana (middle) with her students, February 2023. Photo credit NAS

The project aims to: (a) understand the factors that perceived as barrier toward therapy adherence among MDR TB patients in West Java (b) analyze the burden of medicine among MDR TB patients in West Java, (c) analyze the association of burden of medicine and therapeutics adherence among MDR TB patients in West Java.

The expected outcomes of this research will obtain an existing condition of burden medicine as barrier toward therapy adherence among MDR TB patients in West Java,

Indonesia. The team aims to identify the obstacles, gaps, and problems that underline the nonadherence or compliance of MDR TB patients. The result of this study will provide

data that will help government to make policies, especially about the role of pharmacist in Indonesia in health care facilities regarding efficacy of MDR TB therapy. The result

of this study will also determine base line of MDR TB management in health care facilities/primary health care. Then, it can be used as basis for making new programs that may improve patient’s compliance to increase the efficacy of therapy. Therefore, this research is expected to be a reference of healthcare worker in performing a better healthcare service owing to improve QoL of MDR TB patients. The research plan is potential to propose in a grant aid from Ministry of Education and Research Republic of Indonesia.

Currently, pharmacists' role in health care facilities to manage the therapy of MDR TB patients is limited. Government policy has not regulated the role pharmacists in healthcare facilities to involve them in management of MDR TB therapy. Therefore, this research is intended as a preliminary study to describe baseline condition in primary health care in West Java. New programs or modules can be develop and embedded to ongoing program about monitoring of drug effect and related problems. According to the PI, evidence-based recommendations can then be made to the government to improve the efficacy of MDR TB therapy and to increase the role of pharmacists in Indonesia.

This study will become the first study to investigate the burden medicine and correlate with therapy adherence in MDR TB patients. By improving the management of MDR TB therapy and optimizing the role of pharmacist in health care facilities will improve the cost effectiveness of MDR TB therapy.

Potential Development Impacts

As the second-highest tuberculosis burden country in the world, Indonesia needs rigorous research and effort in tuberculosis care, drug surveillance, drug development, diagnostic, and prevention. This research may give a contribution in tuberculosis care improvement in Indonesia, especially MDR TB. The findings of this project need to be summarized with other corresponding research to produce more comprehensive recommendations. The recommendations could be disseminated to healthcare professionals through seminars or workshops.

According to Dr. Barliana, the role of the pharmacists in clinical practices, especially in TB care, remains scarce in Indonesia. The existing national regulation on management of tuberculosis did not highlight the role the pharmacists in MDR TB care. Therefore, pharmacists do not take a substantial part in this effort. On the other hand, pharmacists have a potential to provide a meaningful contribution towards MDR TB patients' care. Delivering drug information, monitoring, and counseling patients who take long-term medication is the standard of pharmacy care in Indonesia that should be performed by pharmacists in healthcare facilities, according to Dr. Barliana. She noted that eradication of MDR TB requires inter-professional collaborative effort.

Activities and outcomes

In the course of the project, the team conducted a mixed-method research about burden of medication in multi-drug resistant tuberculosis (MDR TB) in West Java, Indonesia. The study observed a major burden due to MDR TB medication, even in adherent patient. Side effects were the most frequently encountered issues. Yet, lack of autonomy was assessed as a dominant burden since it reached the highest score. The project team recommend that the healthcare workers, especially pharmacists in a role of medicine specialists, to deliver better patient-centered care. The team published one peer reviewed article and another research article still under review. The results were disseminated during the stakeholder seminar. The PI anticipates that their findings will be beneficial for the implementation of TB care, especially in Indonesia.

Mentorship

In the course of the project, women mentees also achieved a number of accomplishments, including:

- Publication of an article in Frontiers in Pharmacology (IF 5.988; Top 10%): Transporter and metabolizer gene polymorphisms affect fluoroquinolone pharmacokinetic parameters (DOI: 10.3389/fphar.2022.1063413)

- Finalizing the moxifloxacin manuscript and planning to submitted to International Journal.

- Completion of Master's Degree in Clinical Pharmacy

- Completion of Undergraduate Degree in Pharmacy

In the meantime, the PI reports that in 2022 she In 2022, she also achieved several academic career accomplishments, including promotion to Professor. She reports publishing 12 articles in International journals (Q1-Q3 journals, Scopus indexing and last but not least, she supervised five students who completed their final project in 2022.

Publications

Barliana, Melisa Intan, Nadiya Nurul Afifah, Vycke Yunivita, and Rovina Ruslami. “Genetic Polymorphism Related to Ethambutol Outcomes and Susceptibility to Toxicity.” Frontiers in Genetics 14 (April 20, 2023). https://doi.org/10.3389/fgene.2023.1118102.

Annisa, Nurul, Melisa I. Barliana, Prayudi Santoso, and Rovina Ruslami. “Transporter and Metabolizer Gene Polymorphisms Affect Fluoroquinolone Pharmacokinetic Parameters.” Frontiers in Pharmacology 13 (December 12, 2022). https://doi.org/10.3389/fphar.2022.1063413.

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