Reviono Reviono, Setianingsih Wahyu, Damayanti Kusmadewi Eka, Ekasari Ratna
a Faculty of Medicine , Universitas Sebelas Maret , Surakarta , Indonesia.
b Dr Moewardi Hospital, Surakarta , Central Java , Indonesia.
Glob Health Action. 2017;10(1):1353777. doi: 10.1080/16549716.2017.1353777.
The public-private mix (PPM) strategy has strengthened tuberculosis care and control in many countries. Indonesia, a country with a high tuberculosis burden, has a low tuberculosis case detection rate (CDR), despite PPM implementation in 2003. The PPM in Indonesia involves primary healthcare centers, hospitals, and specialized chest clinics. The long-term impact of the strategy is unknown.
We aimed to explore the case detection achievements of the tuberculosis program since PPM implementation in Central Java in 2003.
This retrospective cohort study covered the period 1 January 2000 to 31 December 2014. The data from tuberculosis patients treated in all health facilities in Central Java implementing directly observed treatment short-course, recorded via a standardized form, were analyzed after being validated by the Office of Health of Central Java Province. We evaluated the CDR, case notification rate, and total number of cases, using linear regression to analyze the temporal trends of those indicators in the phases of PPM implementation.
The CDR increased during the initial phase (2000-2005), decreased during the mid-phase (2006-2009), and increased slightly during the late phase (2010-2014), ranging from 13 to 61.72. These trends were observed despite a steady increase in the number of participating healthcare facilities. The regression analysis showed that the CDR of referral institutions contributed the most to the total CDR of Central Java Province. Many of the smear-negative tuberculosis cases recorded at primary healthcare centers may have been smear positive; this probable misclassification could have been partially avoided if more specific and sensitive diagnostic tools were available.
The CDR remains below the national target (70%). Early awareness of a negative trend in certain program indicators is important to ensure program sustainability. Careful observation of the indicator pattern will secure the long-term success of the program.
公私混合（PPM）策略已在许多国家加强了结核病的防治工作。印度尼西亚是一个结核病负担较重的国家，尽管在2003年实施了PPM策略，但其结核病病例发现率（CDR）仍然较低。印度尼西亚的PPM涉及初级卫生保健中心、医院和专门的胸科诊所。该策略的长期影响尚不清楚。
我们旨在探讨自2003年在中爪哇实施PPM以来结核病项目的病例发现成果。
这项回顾性队列研究涵盖了2000年1月1日至2014年12月31日期间。中爪哇所有实施直接观察短程治疗的卫生设施中接受治疗的结核病患者的数据，通过标准化表格记录，并经中爪哇省卫生厅验证后进行分析。我们评估了CDR、病例报告率和病例总数，使用线性回归分析这些指标在PPM实施阶段的时间趋势。
CDR在初始阶段（2000 - 2005年）有所上升，在中期阶段（2006 - 2009年）有所下降，在后期阶段（2010 - 201年）略有上升，范围在13至61.72之间。尽管参与的卫生设施数量稳步增加，但仍观察到了这些趋势。回归分析表明，转诊机构的CDR对中爪哇省的总CDR贡献最大。在初级卫生保健中心记录的许多涂片阴性结核病病例可能原本是涂片阳性；如果有更特异和敏感的诊断工具，这种可能的错误分类本可以部分避免。
CDR仍低于国家目标（70%）。尽早认识到某些项目指标的负面趋势对于确保项目的可持续性很重要。仔细观察指标模式将确保项目的长期成功。
