The dynamic of tuberculosis case finding in the era of the public–private mix strategy for tuberculosis control in Central Java, Indonesia

Abstract

Background: 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. Objective: We aimed to explore the case detection achievements of the tuberculosis program since PPM implementation in Central Java in 2003. Methods: 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. Results: 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. Conclusions: 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.

Public-private partnerships in primary health care: a scoping review

“…PPPs formed by governments, international donors, and pharmaceutical companies in India and several African countries were also successfully used to control AIDS and provide diagnostic and treatment services to suspects and AIDS patients [ 57 , 61 ]. PPPs were also used for the provision of diagnostic, treatment, and management of TB in Zambia, Vietnam, Indonesia, South India, Nigeria, Kenya, Nepal, Uganda, Korea, Bangladesh, and South Africa [ 4 , 8 , 13 , 20 , 22 , 26 , 29 , 34 , 40 , 41 , 43 , 47 , 50 , 51 , 56 , 58 , 59 , 61 , 66 ]. The following models of partnerships were reported: PPPs, Public-Private Mix (PPM), Public-Private Workplace Partnership (PWP), and Public-NGO Partnership (PNP).…”

“…Treatment. PPM TB case Ramiah I, Reich MR, 2006 [ 57 ] Botswana Analyses the multiple challenges that African Comprehensive HIV/AIDS Partnerships confronted in its first 4 years in the building and managing its relationships with other organisations and among African Comprehensive HIV/AIDS Partnerships partners Qualitative – PPP – Rangan S et al, 2004 [ 58 ] India To develop a ‘model’ partnership between rural private medical practitioners and the revised national TB control program Intervention Diagnosis, treatment PPM TB case Reviono R et al, 2017 [ 59 ] Indonesia To explore the case detection achievements of the tuberculosis program since ppm implementation in central Java, Indonesia in 2003 Retrospective cohort study Case detection, treatment PPM TB case Ribeiro CA et al, 2016 [ 60 ] Brazil Describe public-private partnership in the prevention of influenza amongst industry workers in Ceara state, Brazil Case study Vaccination against influenza PPP Industry workers Sheikh K et al, 2006 [ 61 ] India Review two studies on the private sector in India for TB and HIV, and highlight future policy directions for involving PPM in public health programs Cross-sectional observational Diagnosis, referrals, TB and AIDS treatment PPM Those suspected to have TB and AIDS Sil et al, 2010 [ 62 ] USA To improve access to quality oral health care in central Massachusetts with the central Massachusetts oral health initiative Case study Oral health care PPP Mothers, pregnant women, children Silow-Carroll S, 2008 [ 63 ] USA Describe the implementation of Iowa’s 1st Five Initiative: improving early childhood development services through public-private partnerships Narrative review Screening referrals and follow-up for mental health PPP All young children ages 0 to 5 years and their f...…”

Gridlock from diagnosis to treatment of multidrug-resistant tuberculosis in Tanzania: low accessibility of molecular diagnostic services and lack of healthcare worker empowerment in 28 districts of 5 high burden TB regions with mixed methods evaluation

“…We also propose transfer of molecular diagnostics ownership and maintenance to public-private partnered management as responsibilities for machine maintenance and consumables provisions are borne by the end-users. When this strategy has been used in other TB endemic settings, diagnostic uptake has been increased and sustained [24].…”

Positivity Rate of Pyrosequencing to Diagnose Drug-Resistant Tuberculosis Directly from Sputum with Different Bacterial Load

“…Diagnosing TB is more challenging when the mycobacterial load is low, which can lead to smear-negative result. (19)(20)(21) PSQ is a suitable rapid molecular test for the identification of M. tuberculosis complex as well as for rapid prediction of drug resistance directly from sputum. We showed that smear-negative/culture-positive patients could be detected by PSQ in this study ( Table 1), indicating that sensitivity of PSQ for detecting TB is higher than AFB smear microscopy and comparable to culture method.…”