As Indonesia’s rifampin resistance testing rates are lower than global testing rates per the 2020 WHO global tuberculosis (TB) report, prevalence of multidrug-resistant TB may be underestimated. Our study aimed to evaluate prevalence and patterns of TB drug resistance (DR) within Indonesia. We conducted a cross-sectional analysis of baseline data collected from 2017–2018 as part of a cohort study of adults with presumed pulmonary TB at 7 DR-TB referral hospitals in Indonesia. Bacteriological examinations (acid-fast bacilli, GeneXpert, sputum culture) and drug-susceptibility testing were performed following the guidelines of the National TB Program. Of 447 participants with complete bacteriological examinations, 312 (69.8%) had positive sputum cultures for Mycobacterium tuberculosis. The proportion of MDR and pre-extensively drug-resistant was higher in previously treated compared with newly diagnosed participants (52.5% [73/139] versus 15% [26/173]). Compared with drug-sensitive case, drug-resistant TB was associated with cavities. Given the difference between rates of DR in TB referral hospitals from our study compared with the WHO survey in 2019 that showed 17.7% and 3.3% DR among previously treated and newly diagnosed participants globally, further characterization of Indonesia’s TB epidemiology in the general population is needed. Strategies, including public policies to optimize case finding, strengthen capacity for resistance testing, and prevent loss to follow-up will be critical to reduce the burden of TB in Indonesia.

Background : The negative conversion duration of SARS-CoV-2 RNA was related to disease progression, and a prolonged negative conversion could provide early warning signal for poor prognosis in patients with COVID-19. The objectives of this study was to identify the factors influencing the delay in negative conversion of PCR swab test results in patients with COVID-19 as a consideration in determining the COVID-19 prevention policy in the community Methods : A retrospective cross-sectional study involving 68 patients diagnosed with COVID-19 that was treated in Dr. Kariadi General Hospital Medical Center Semarang from June 1st to December 30th 2020. Negative conversion was evaluated based on the results of the RT-PCR swab test on day 7, 14 and 21. Results : Mean negative conversion time for all patients was 11.63±5.08 days. Thirty-one factors were evaluated in the initial univariate Cox and Kaplan-Meier analysis. Older age (>59 years), overweight (>25 kg/m2), fever (>38°C), shortness of breath, diabetes mellitus, neutrophilia, hypoalbuminemia, CRP and antiviral treatment showed significant association with negative conversion time. These factors were then included in a multivariate regression analysis. Hypoalbuminemia or albumin level of <3.0 g/dL was found as an independent factor associated with negative conversion time of viral RNA (HR:1.986; 95%CI:1.098–3.594), and hypoalbuminemia was presumed to cause prolonged viral clearance time in patients with COVID-19. Conclusion : The factors influencing the prolong in negative conversion of viral RNA in patients with COVID-19 were older age, overweight, fever, shortness of breath, diabetes mellitus, neutrophilia, hypoalbuminemia, CRP and antiviral treatment. Hypoalbuminemia was an independent predictor for prolonged negative conversion of viral RNA in patients with COVID-19.

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BackgroundThe numbers of patients with drug resistance TB (DR-TB) increased annually by over 20% globally in the last decade. However, data on the prevalence of DR-TB in Indonesia are limited. The objective of this study to estimate the proportion of DR-TB in new and previously treated TB cases, and to identify comorbidities and risk factors.MethodsThis study has been conducted at seven hospitals throughout Indonesia since March 2017. Clinically TB patients ≥18-year-old were enrolled and followed until 6 months after treatment completed. Demography and clinical data were recorded; sputum, blood, urine, and PBMC were collected at several time points. AFB smear, sputum culture, Xpert MTB/RIF, and drug sensitivity tests were performed. Drug resistance TB is determined by Xpert MTB/RIF.ResultsOf 151 enrolled patients, 103 (68%) were confirmed M. tuberculosis by Xpert MTB/RIF, and 47 (46%) were confirmed rifampicin resistance. The distribution of DR-TB in each study site is shown in Figure 1. Among those with comorbidities (38%), comorbidity with diabetes (based on HbA1c level and diabetes history), HIV, and cancer was 9%, 26%, and 7%. Demography, nutrition status, contact and treatment history, and comorbidities are shown in Table 1. DR-TB primary infection contributes to 23% of DR-TB cases. Biomarkers that may predict treatment failure and TB-genotyping are underway.ConclusionThe proportion of DR-TB in both new and previously treated patients in our cohort was significantly higher than the estimated number from the WHO and Ministry of Health. TB is a serious threat for public health and mitigation plan must be implemented at all levels.Table 1: Demography, Nutrition Status, Contact History, TB Treatment History and Comorbid Status520560570580590AllDemography Age (Median, IQR)38 (20)41 (21)42 (25)37 (45)22 (3)40 (25) Male (n, %)9 (75)16 (47)26 (67)9 (82)4 (57)64 (62)BMI <18.57 (58)17 (50)20 (51)5 (45)5 (71)54 (52) 18.5 to <255 (42)13 (38)13 (33)5 (45)2 (29)38 (37) ≥2504 (12)6 (15)1 (10)011 (11)Contact history with TB patients2 (17)1 (3)8 (21)2 (18)2 (29)15 (15)TB treatment history New10 (83)12 (35)13 (33)10 (91)5 (71)50 (49) Previously treated2 (17)22 (65)26 (67)1 (9)2 (29)53 (51)Comorbid HIV2 (18)002 (18)04 (4) DM1 (9)14 (41)13 (33)01 (14)29 (28) Disclosures All authors: No reported disclosures.