Lestari Bony Wiem, Nijman Gerine, Larasmanah Alamanda, Soeroto Arto Yuwono, Santoso Prayudi, Alisjahbana Bachti, Chaidir Lidya, Andriyoko Basti, van Crevel Reinout, Hill Philip C
Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jalan Professor Eyckman No. 38, Kota Bandung, Jawa Barat 40161, Indonesia.
Tuberculosis Working Group, Research Center for Care and Control of Infectious Disease, Faculty of Medicine, Universitas Padjadjaran, Jalan Professor Eyckman No. 38, Kota Bandung, Jawa Barat 40161, Indonesia.
Lancet Reg Health Southeast Asia. 2023 Nov 2;22:100294. doi: 10.1016/j.lansea.2023.100294. eCollection 2024 Mar.
In Indonesia, drug resistance testing for TB largely relies on Xpert MTB/RIF, and it is unknown what proportion of drug-resistant (DR) TB is adequately diagnosed and treated.
We conducted a cascade of care analysis on a cohort of presumptive rifampicin-resistant (RR) TB patients registered in 2015-2018 in a tertiary hospital in Indonesia. Estimated incidences of (presumptive) DR-TB cases were assumption-based using global reports. Data on diagnosis and consecutive cascades steps, including their timing were collected from national electronic registers, and medical records. We described a secondary cascade for patients receiving treatment not supported by phenotypic drug susceptibility testing (pDST). Factors associated with delay and loss between diagnosis and treatment were identified using logistic regression.
Less than a third of estimated incident TB cases at risk of DR-TB were identified as presumptive DR-TB case and tested, and 9.8% (982/10,065) of estimated true DR-TB cases was diagnosed. Of those diagnosed, only 45.1% (443/982) had treatment regimens supported by pDST results, but this did not significantly influence treatment outcomes. Only 25.5% (250/982) of diagnosed patients completed all steps of the cascade including successful treatment. Delays between diagnosis and treatment were substantial, and more common among those referred from a primary healthcare facility, and among those who were employed, living outside of Bandung, and reporting engagement with the private sector.
The DR-TB care cascade in this urban setting in Indonesia is characterized by substantial attrition and delays. Strategies to increase access to DR-TB diagnosis accompanied by optimisation of clinical care could substantially improve outcomes and reduce onward transmission.
Radboud university medical center and University of Otago.
在印度尼西亚，结核病耐药性检测主要依赖于Xpert MTB/RIF，目前尚不清楚耐药结核病（DR-TB）得到充分诊断和治疗的比例。
我们对2015年至2018年在印度尼西亚一家三级医院登记的推定耐利福平（RR）结核病患者队列进行了一系列的医疗分析。（推定）DR-TB病例的估计发病率是根据全球报告基于假设得出的。从国家电子登记册和病历中收集了关于诊断和连续医疗步骤的数据，包括其时间。我们描述了接受非表型药物敏感性试验（pDST）支持治疗的患者的二级医疗流程。使用逻辑回归确定诊断和治疗之间延迟和失访的相关因素。
估计有DR-TB风险的结核病病例中，不到三分之一被确定为推定DR-TB病例并接受检测，估计真正的DR-TB病例中9.8%（982/10,065）得到诊断。在那些被诊断的患者中，只有45.1%（443/982）的治疗方案得到pDST结果的支持，但这对治疗结果没有显著影响。只有25.5%（250/982）的确诊患者完成了包括成功治疗在内的所有医疗步骤。诊断和治疗之间的延迟很大，在从基层医疗机构转诊的患者、就业患者、居住在万隆以外的患者以及报告与私营部门有接触的患者中更为常见。
印度尼西亚这个城市地区的DR-TB医疗流程的特点是大量减员和延迟。增加DR-TB诊断机会并优化临床护理的策略可以显著改善治疗结果并减少进一步传播。
拉德堡德大学医学中心和奥塔哥大学。
