Global adoption of 6-month drug-resistant TB regimens: Projected uptake by 2026

BACKGROUND

The WHO has issued a call to action urging countries to accelerate the rollout of new WHO-recommended shorter all-oral treatment regimens for drug-resistant TB (DR-TB), which remains a public-health crisis. The all-oral, 6-month BPaL/M regimen comprises 3-4 drugs: pretomanid used in combination with bedaquiline and linezolid, with or without moxifloxacin. This regimen has been recommended by the WHO for use in DR-TB patients instead of ≥9-month (up to 24-month) regimens. This study aims to project this regimen's use, along with its components bedaquiline, pretomanid and linezolid, and other treatments for DR-TB globally through 2026. It is intended to guide global health stakeholders in planning and budgeting for DR-TB interventions. Projected usage could help estimate cost of the individual components of DR-TB regimens over time.

METHODS

Semi-structured interviews were conducted with national TB programme participants in key countries to gather intelligence on established plans and targets for use of various DR-TB treatment regimens from 2023 to 2026. These data informed development of projections for the global use of regimens and drugs.

RESULTS

Consistent global growth in the use of shorter regimens in DR-TB treatment was shown: BPaLM reaching 126,792 patients, BPaL reaching 43,716 patients, and the 9-11-month all-oral bedaquiline-based regimen reaching 13,119 patients by 2026. By 2026, the longer all-oral regimen is projected to be used by 19,262 patients, and individualised treatment regimens by 15,344 patients.

CONCLUSION

The study shows BPaL/M will be used in majority of DR-TB patients by 2024, reaching 78% by 2026. However, national efforts to scale-up, case-finding, monitoring, drug-susceptibility testing, and implementation of new treatments will be essential for ensuring they are accessible to all eligible patients in the coming years and goals for ending TB are met. There is an urgent need to engage communities in capacity building and demand generation.

Mental Health Status and Its Associated Factors Related to Pulmonary Tuberculosis Patients in Primary Health Care Centre in Surabaya, Indonesia

BACKGROUND

Mental disorders in TB patients are due to long-term treatment, drug side effects, and relapse. This study aimed to analyse the mental health status among TB patients and its associated factors.

METHODS

The study was carried out on 107 Pulmonary TB patients from 5 Primary Healthcare centres in Surabaya, Indonesia. Furthermore, Mental Health Inventory (MHI-18) was used to measure the mental health status. The MHI-18 has four subscales including, anxiety, depression, behaviour control, and positive affection. In addition, the score range of MHI and its subscales is 0-100, where the higher score showed a better mental health status.

RESULTS

The results showed no difference in the score of mental health status, anxiety, depression, and positive affect in all factors. However, behaviour control depicted a significant difference between sex and marital status. In conclusion, mental health problems can occur in all TB patients irrespective of their characteristics.

CONCLUSION

Screening is required for the prevention of severe disease in the early treatment phase and various factors related to mental health should be considered during the implementation of TB management to optimize treatment outcomes.

Spatial variation of tuberculosis risk in Indonesia 2010-2019

Background: As the second-highest country in tuberculosis (TB) cases globally, Indonesia has experienced an increasing trend of notification rate in the last ten years; however, the 34 provinces may have different risks. This study aims to examine TB risk variation across Indonesia in 2010-2019. Methods: A descriptive analysis was conducted on TB routine data of 2010-2019 from the Ministry of Health. Cases included all types of TB patients. Total cases, incidence rate (IR), and standardized morbidity ratio (SMR) were calculated for each province and national level during the period. Distributions of IRs and SMRs were displayed on maps. Results: During 2010-2019, 3,866,447 TB cases occurred in Indonesia, and the national IR was 1,523 per 100,000 populations. The highest proportion of cases and IR were in West Java (20.6%, 314 per 100,000); while the lowest was in North Kalimantan (0.2%, 3 per 100,000). Higher risks of TB occurred in DKI Jakarta (SMR 1.9), Papua (1.7), North Sulawesi (1.7), Maluku (1.5) and West Papua (1.5) among others. The smallest SMRs were found in Bali and Yogyakarta (0.5). Conclusion: TB risk varied across Indonesia in 2010-2019, with a higher risk in DKI Jakarta and several provinces in eastern Indonesia. Given the underreporting nature of routine data, validation is required when using the finding of this study in the local-level intervention. Keywords: tuberculosis, TB, standardized morbidity ratio, spatial variation, risk   Abstrak Latar belakang: Sebagai negara dengan jumlah kasus tuberkulosis (TB) terbesar kedua di dunia, Indonesia menunjukkan tren peningkatan notification rate di sepuluh tahun terakhir. Akan tetapi, risiko TB di 34 provinsi bisa saja berbeda-beda. Artikel ini bertujuan mengkaji variasi risiko TB di Indonesia pada tahun 2010-2019. Metode: Data rutin TB tahun 2010-2019 dari Kementerian Kesehatan dianalisis secara deskriptif. Kasus TB didefinisikan sebagai semua tipe pasien TB. Total jumlah kasus, incidence rate (IR), dan standardized morbidity ratio (SMR) dihitung untuk tiap provinsi dan tingkat nasional selama periode tersebut. Sebaran IR dan SMR diplot di atas peta. Hasil: Selama 2010-2019, terdapat 3.866.447 kasus TB dan IR nasional 1.523 per 100.000 populasi. Proporsi kasus dan IR terbesar ada di Jawa Barat (20,6%, 314 per 100.000) dan terkecil di Kalimantan Utara (0,2%, 3 per 100.000). Risiko TB lebih tinggi di antaranya terjadi di DKI Jakarta (SMR 1,9), Papua (1,7), Sulawesi Utara (1,7), Maluku (1,5) dan Papua Barat (1,5). Standardized Morbidity Ratio terendah ditemukan di Bali dan Yogyakarta (0,5). Kesimpulan: Dapat disimpulkan bahwa risiko TB beragam di seluruh Indonesia selama 2010-2019, di mana DKI Jakarta dan beberapa provinsi di timur Indonesia memiliki risiko lebih tinggi. Mengingat adanya kurang lapor dalam data rutin, validasi diperlukan jika menggunakan temuan studi ini dalam intervensi di tingkat lokal. Kata kunci: tuberkulosis, TB, standardized morbidity ratio, variasi spasial, risiko  

Studi Ekologi Hubungan Kejadian Demam Berdarah Dengue (DBD) dengan Faktor Iklim di Kota Administrasi Jakarta Pusat, Indonesia Tahun 1999-2018

Demam Berdarah Dengue (DBD) merupakan vector-borne disease dengan tingkat prevalensi tertinggi di dunia. Jumlah kasus DBD telah meningkat di sejumlah negara dalam 10 tahun terakhir. Tujuan dari penelitian ini adalah untuk mengetahui hubungan faktor iklim dengan kejadian DBD di Kota Administrasi Jakarta Pusat dalam periode 20 tahun, dari Januari 1999-Desember 2018. Penelitian ini menggunakan data sekunder dari Direktorat Pencegahan dan Pengendalian Penyakit Tular Vektor dan Zoonosis (P2PTVZ) Kementerian Kesehatan Republik Indonesia dan Badan Meteorologi, Klimatologi dan Geofisika (BMKG). Penelitian ini menggunakan disain studi ekologi dan dianalisis bivariat dengan uji korelasi Spearman. Hasil analisis bivariat menunjukkan bahwa variabel curah hujan (Pv=0,0001; r=0,448) dengan lag 2 bulan, suhu udara (Pv=0,0001; r=-0,27) dengan lag 1 bulan, dan kelembaban relatif (Pv=0,0001; r=0,329) dengan lag 2 bulan, secara signifikan berhubungan positif dengan kasus DBD. Kasus DBD secara signifikan dipengaruhi curah hujan, suhu udara, dan kelembaban relatif dengan lag bulan tertentu, oleh karena itu upaya pencegahan dan mitigasi epidemi DBD di Kota Administrasi Jakarta Pusat dapat dilakukan sejak bulan Januari dalam rangka mengantisipasi puncak kasus DBD di periode bulan Maret-April.