BackgroundTuberculosis (TB) is the fourth leading cause of death in Indonesia. In 2015, the World Health Organization estimated that nearly two-thirds of the TB patients in Indonesia had not been notified, and the status of their care remained unknown. As such, Indonesia is home to nearly 20% of the world’s “missing” TB patients. Understanding where patients go for care may enable strategic planning of services to better reach them.MethodsA patient pathway analysis (PPA) was conducted to assess the alignment between patient care seeking and the availability of TB diagnostic and treatment services at the national and subnational level in Indonesia.ResultsThe PPA results revealed that only 20% of patients encountered diagnostic capacity at the location where they first sought care. Most initial care seeking occurred in the private sector and case notification lagged behind diagnostic confirmation in the public sector.ConclusionsThe PPA results emphasize the role that the private sector plays in TB patient care seeking and suggested a need for differentiated approaches, by province, to respond to variances in care-seeking patterns and the capacities of public and private providers.

Introduction Tuberculosis (TB) remains a highly stigmatised disease that can cause or exacerbate mental health disorders. Despite increased awareness of the importance of reducing TB stigma, validated tools to measure TB stigma remain scarce. This study aimed to culturally adapt and validate the Van Rie TB Stigma Scale in Indonesia, a country with the second largest TB incidence worldwide. Methods We validated the scale in three phases: translation, cultural adaptation, and psychometric evaluation. We invited diverse experts to an interdisciplinary panel for the cross-cultural adaptation, then performed a psychometric evaluation of the scale: exploratory and confirmatory factor analyses, reliability analysis, and correlation analysis with Patient Health Questionnaire 9 [PHQ-9]. Results We culturally adapted the original scale's language and content during the translation and cultural adaptation phases. After psychometric evaluation with 401 participants in seven provinces of Indonesia, we removed two items. The new scale had two forms: (A) patient and (B) community perspective forms. Both forms had good internal consistency, with respective Cronbach's alpha values of 0.738 and 0.807. We identified three loading factors in Form A (disclosure, isolation, and guilty) and two loading factors in Form B (isolation and distancing). The scale showed correlation with PHQ-9 (Form A, rs = 0.347, p < 0.001; Form B, rs = 0). Conclusions The culturally adapted Indonesian version of Van Rie's TB Stigma Scale is comprehensive, reliable, internally consistent, and valid. The scale is now ready for applied scale-up in research and practice to measure TB-stigma and evaluate the impact of TB-stigma reduction interventions in Indonesia.

Background: Tuberculosis (TB)-related stigma remains a key barrier for people with TB to access and engage with TB services and can contribute to the development of mental illnesses. This study aims to characterise stigmatisation towards people with TB and its psychosocial impact in Indonesia. Methods: This study will apply a sequential mixed method in two main settings: TB services-based population (setting 1) and workplace-based population (setting 2). In setting 1, we will interview 770 adults with TB who undergo sensitive-drug TB treatment in seven provinces of Indonesia. The interview will use the validated TB Stigma Scale questionnaire, Patient Health Questionnaire-9, and EQ-5D-5L to assess stigma, mental illness, and quality of life. In Setting 2, we will deploy an online questionnaire to 640 adult employees in 12 public and private companies. The quantitative data will be followed by in-depth interview to TB-related stakeholders. Results: CAPITA will not only characterise the enacted stigma which are directly experienced by people with TB, but also self-stigma felt by people with TB, secondary stigma faced by their family members, and structural stigma related to the law and policy. The qualitative analyses will strengthen the quantitative findings to formulate the potential policy direction for zero TB stigma in health service facilities and workplaces. Involving all stakeholders, i.e., people with TB, healthcare workers, National Tuberculosis Program officers, The Ministry of Health Workforce, company managers, and employees, will enhance the policy formulation. The validated tool to measure TB-related stigma will also be promoted for scaling up to be implemented at the national level. Conclusions: To improve patient-centered TB control strategy policy, it is essential to characterise and address TB-related stigma and mental illness and explore the needs for psychosocial support for an effective intervention to mitigate the psychosocial impact of TB.

Tuberkulosis tidak hanya menjadi masalah di tingkat global dan Indonesia tetapi juga di Provinsi Jambi. Penularan TB dapat membentuk klaster baik secara tempat maupun waktu. Penelitian ini bertujuan untuk mengidentifikasi klaster atau autokorelasi spasial TB di Kabupaten Muaro Jambi tahun 2018-2020. Data sekunder berupa jumlah agregat semua kasus TB yang memulai pengobatan di tahun 2018-2020 diperoleh dari Sistem Informasi Tuberkulosis Terpadu (SITB) berbasis pelaporan online.Unit analisis adalah desa/kelurahan. Analisis Getis Ord G* dilakukan untuk mengidentifikasi wilayah klaster TB. Jumlah semua kasus TB selama tiga tahun adalah 1.194 kasus. Kasus TB terlihat mengelompok baik di wilayah yang padat penduduk maupun tidak. Karena angka cakupan pengobatan yang masih rendah maka analisis spasial berdasarkan notifikasi akan berbeda dengan analisis spasial berdasarkan insiden. Selain peningkatan penemuan kasus TB baik secara pasif maupun aktif, diperlukan juga penguatan sistem surveilans TB.  Penelitian spasial lain yang memasukkan variable sosio-demografi, ekonomi, lingkungan, dan lain sebagainya dengan menggunakan analisis lebih lanjut seperti Geographically Weighted Regression (GWR) juga diperlukan.

Background: Indonesia was ranked third in 2018 for tuberculosis (TB) incidence among other countries in the world. Indonesia is also facing non-communicable diseases (NCDs) and re-emerging disease. One of the NCDs problems in Indonesia is diabetes mellitus. These two diseases are interrelated. The prevalence of TB and diabetes mellitus in the elderly is much higher than in the other age groups. The purpose of this study was to determine the proportion of TB and diabetes mellitus and risk factors associated with each of these diseases in the elderly. Methods: The research was conducted at the Budi Luhur Nursing Home. The number population and sample is 70 people. The research design was cross-sectional. Univariate analysis was shown in the distribution of frequencies and proportions and bivariate analysis was performed using a chi-square test. Results: The proportion of TB was 2.4% while the proportion of diabetes mellitus was 14.6%. History of diabetes mellitus was associated with diabetes mellitus (p-value=0.015 and POR 7.11 (95% CI 1.543 - 32.764)). Age, gender, nutritional status, stress, physical activity, and history of TB were not associated with diabetes mellitus. Conclusion: : It is recommended to conduct other studies with a better design and to consider a research method that is suitable for the elderly.