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"ABSTRAKMultidrug-resistant tuberculosis (MDR-TB) adalah tuberkulosis yang disebabkan oleh galur Mtb yang resisten setidaknya terhadap rifampisin dan isoniazid (INH). Penelitian ini bertujuan menilai kemampuan AccuPower TB and MDR Real-Time PCR Kit sebagai metode alternatif dalam mendeteksi Mtb serta resistensi terhadap isoniazid dan rifampisin dibandingkan dengan metode kultur dan uji resistensi konvensional. Subjek penelitian terdiri dari 61 pasien tersangka MDR-TB. Sampel sputum dari semua subjek dilakukan pemeriksaan untuk Mtb dan resistensi terhadap INH dan rifampisin dengan Accupower TB and MDR Real-Time PCR Kit dan metode konvensional. 28 dari 52 pasien terdeteksi resisten terhadap INH dan rifampisin. 1 subjek terdeteksi hanya resisten terhadap INH. 1 subjek terdeteksi hanya resisten terhadap rifampisin. Sensitivitas dan PPV kit dalam mendeteksi Mtb diperoleh 98,1% dan 86,7%. Sensitivitas, spesifisitas, PPV, dan NPV kit dalam mendeteksi resistensi Mtb terhadap INH diperoleh 62,1%, 86,9%, 85,7%, dan 64,5%. Sensitivitas, spesifisitas, PPV, dan NPV kit dalam mendeteksi resistensi Mtb terhadap Rifampisin diperoleh 93,1%, 86,9%, 90% dan 90,9%. Accupower TB and MDR Real-Time PCR Kit dalam mendeteksi resistensi ganda Mtb terhadap INH dan Rifampisin (MDR-TB) memperoleh sensitivitas 53,8%, spesifisitas 57,1%, PPV 88,9%, dan NPV 64,7%. Kit ini cukup baik dalam mendeteksi Mtb dan resistensi terhadap rifampisin, tetapi kurang baik untuk mendeteksi resistensi terhadap INH. Deteksi adanya resistensi tunggal diperlukan, karena monoresistensi dapat berkembang menjadi multi-drug dan extended-drug resistant.

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ABSTRACT

Multidrug-resistant tuberculosis (MDR-TB) is caused by mycobacterium that is resistant at least to rifampicin and isoniazid (INH). The aim of this study was to assess the performance of Accupower TB and MDR Real-Time PCR Kit compared to the conventional culture-based drug susceptibility test for Mycobacterium tuberculosis (Mtb). Subject was consisted of 61 patients who were suspected of MDR-TB. Sputum samples from the participants were tested for Mtb and INH and rifampicin resistance by Accupower TB and MDR Real-Time PCR Kit and conventional method. 28 of 52 patients were detected resistance to both INH and rifampicin. 1 subject was detected INH resistance only. 1 subject was detected rifampicin resistance only. Sensitivity and PPV of the kit to detect Mtb were 98,1% and 86,7%, respectively. Sensitivity, specificity, PPV, and NPV of the kit in detecting INH resistance were 62,1%, 86,9%, 85,7%, and 64,5%, respectively. Sensitivity, specificity, PPV, and NPV of the kit in detecting rifampicin resistance were 93,1%, 86,9%, 90%, and 90,9%, respectively. Sensitivity, specificity, PPV, and NPV of the kit in detecting INH and rifampicin resistance (MDR-TB) were 53,8%, 57,1%, 88,9%, and 64,7%, respectively. This kit was good enough to detect Mtb and Rifampisin resistance, but not good to detect INH resistance. Detection of single drug resistance is required as mono resistance might develop further to multi-drug and extended-drug resistant."

"ABSTRAKTelah dilakukan penelitian tentang hasil pengobatan dan variasi biaya TBMDR/XDR di RSUP Persahabatan Jakarta dengan menggunakan strategiProgramatic Management Drug Resistance Tuberculosis (PMDT), yangmemerlukan jangka waktu pengobatan yang lama 18-24 bulan serta memerlukanbiaya yang sangat tinggi.Tujuan umum adalah mengetahui hasil pengobatan dan variabel-variabel biayaTB-MDR/XDR. Penelitian ini adalalah penelitian operasional dengan metodecampuran kuantitatif dan kualitatif. Sampel adalah semua pasien TB-MDR/XDRyang mulai diobati Agustus 2009 sampai 31 Desember 2010, berjumlah 104pasien.Hasil pada penelitian ini lama pengobatan TB-XDR lebih panjang dan angkakeberhasilan (lengkap dan sembuh) lebih rendah yaitu 42,9 % dan 80,9% jikadibandingakan dengan TB-MDR, tetapi angka keberhasilan ini jauh lebih tinggidari angka keberhasilan di dunia.Biaya pasien sampai sembuh dan lengkap pada pasien TB-XDR Rp 91.704.767,33lebih tinggi dari TB-MDR Rp 72.260.081,73. Biaya pasien TB-XDR yangmeninggal Rp 63.246.069,- lebih tinggi dari TB-MDR Rp 34.142.692,44. Hal inijuga terjadi pada total biaya pengobatan TB-XDR dengan efek samping ringanlebih tinggi biayanya dari pada pasien TB-MDR. Penambahan lama pengobatanmempunyai peluang peningkatan biaya sebesar Rp 115.205,- per hariJenis kelamin laki-laki yang bertempat tinggal di Jakarta Timur dengan lamapengobatan kurang dari 569 hari memiliki peluang 1.7 kali lebih tinggimengalami kesembuhan dibandingkan dengan jenis kelamin perempuan, yangbertempat tinggal di daerah dan lama pengobatan yang sama.Kesimpulan : Angka keberhasilan pada TB-MDR dan TB-XDR pada penelitianini lebih tinggi dari angka keberhasilan di dunia . Biaya total pengobatan TBXDRjauh lebih tinggi dari TB-XDR dan terdapat keeratan hubungan antaravariabel biaya pengobatan dengan lama pengobatan

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ABSTRACTThis research captured the Programmatic Management of Drug resistantTuberculosis (PMDT) at Persahabatan Hospital, Jakarta which required longtreatment duration which is 18-24 months and especially the treatment outcomeand variation cost. The study aimed to know regarding the treatment outcomeas well as cost variaties of MDR/XDR-TB patients.This is a operational research using a mixture of quantitative and qualitativemethods. The samples were all treated MDR/XDR-TB patients who startedtreatment from August 2009 until December 31, 2010. Total number of samplewere 104 patients.The results of this study revealed that duration of treatment for XDR-TB patientsis longer than MDR-TB patients with lower success rate which are 42,9% and80,9% respectively and was statistically significant. However this result isrelatively higher than reports from many countries in the world. The cost perpatient for those who cured and completed treatment was US$ 9,357 and US$7,373 for the XDR-TB patients and MDR-TB patients respectively which wasstatistically significant. The cost spent for XDR-TB patients who died duringtreatment was higher compare to MDR-TB ones, US$ 6,453 and US$ 3,484respectively. The same finding was similar higher when comparing the total costof mild side effect for XDR-TB and MDR-TB. Additional time for length oftreatment would give the probability of spending US$ 11,75 per day. Malepatients who live in East Jakarta with length of treatment was less than 569 dayshave the chance to cured 1.7 fold compare to females patient with the samecondition in term of length of stay and residencial.Conclusion: Success Rate of MDR/XDR-TB in this study is higher than thosebeing reported worldwide. Cost for XDR-TB is extremely high than for MDR-TB.There is an association found between cost and length of treatment."

"[ABSTRAKLatar Belakang: Pengobatan TB MDR memiliki hasil yang buruk dengan keberhasilan hanya 48% di dunia. Salah satu indikator keberhasilan pengobatan adalah konversi dini. Identifikasi faktor yang mempengaruhi konversi merupakan hal yang penting. Metode: Penelitian ini dilakukan secara kohort retrospektif dengan menggunakan rekam medik pasien TB MDR di RSUP Persahabatan Jakarta yang berobat selama bulan Agustus 2009 - Desember 2013.Hasil: Dari 436 pasien terdapat 248 pasien laki-laki (56.6%). Sebanyak 256 pasien (58,7%) mengalami konversi biakan dalam dua bulan pengobatan. Nilai tengah waktu konversi adalah 44 hari. Faktor yang memperlambat lama konversi adalah jenis kelamin perempuan (aHR 0,808; [95%CI 0,659-0,991]), IMT pasien kurang (0,792; [0,637-0,983]), ditemukan gambaran kavitas pada foto toraks (0,781;[0,634-0,961]), bacterial load 2+ (0,617;[0,439-0,869]), bacterial load 3+ (0,701;[0,501-0,979]), riwayat pengobatan OAT sebelumnya dengan lini kedua (0,597;[0,415-0,858]), jumlah resisten obat > 2 OAT (0,614;[0,429-0,879]), kelompok pasien Pre XDR dan TB XDR (0,486;[0,305-0,776]), dan jumlah limfosit rendah (0,681;[0,524-0,885]).Kesimpulan: Jenis kelamin perempuan, IMT kurang, gambaran kavitas pada foto toraks, tingginya bacterial load, riwayat pengobatan OAT sebelumnya dengan lini kedua, jumlah resisten obat > 2 OAT, kelompok pasien Pre XDR dan TB XDR serta limpositopenia berhubungan dengan lamanya konversi pada pasien TB MDR.

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ABSTRACTIntroduction: Treatment for MDR-TB has a poor outcomes, success rate was only 48% worldwide. One indicator of treatment success is early culture conversion. Identification of potential factors associated with culture conversion are important.Methods: A cohort rectrospective study using medical records of MDR-TB patients of Persahabatan Hospital during August 2009 until December 2013. Data were analyzed using multivariate analysis.Results : Of a total 436 patients, there are 248 patients (56.6%) were males. Two hundred fifty six patients (58,7%) had sputum culture conversion at two months. The median time to culture conversion was 44 days. The factors for longer sputum culture conversion were female (aHR 0,808; [95%CI 0,659-0,991]), underweight patients (0,792; [0,637-0,983]), cavitaty on chest radiograph (0,781;[0,634-0,961]), bacterial load 2+ (0,617;[0,439-0,869]), bacterial load 3+ (0,701;[0,501-0,979]), previous TB treatment with second line drugs (0,597;[0,415-0,858]), resistance to more 2 TB drugs (0,614;[0,429-0,879]), pre XDR and XDR-TB (0,486;[0,305-0,776]), and lower lymphocites count (0,681;[0,524-0,885]).Conclusion: Female, underweight patients, cavitaty, high bacterial load, previous TB treatment with second line drugs, resistance to more 2 TB drugs, resistance to rifampicine, isoniazid and other second line drugs, and lower lymphocites count were associated with longer time culture conversion in MDR-TB patients.;Introduction: Treatment for MDR-TB has a poor outcomes, success rate was only 48% worldwide. One indicator of treatment success is early culture conversion. Identification of potential factors associated with culture conversion are important.Methods: A cohort rectrospective study using medical records of MDR-TB patients of Persahabatan Hospital during August 2009 until December 2013. Data were analyzed using multivariate analysis.Results : Of a total 436 patients, there are 248 patients (56.6%) were males. Two hundred fifty six patients (58,7%) had sputum culture conversion at two months. The median time to culture conversion was 44 days. The factors for longer sputum culture conversion were female (aHR 0,808; [95%CI 0,659-0,991]), underweight patients (0,792; [0,637-0,983]), cavitaty on chest radiograph (0,781;[0,634-0,961]), bacterial load 2+ (0,617;[0,439-0,869]), bacterial load 3+ (0,701;[0,501-0,979]), previous TB treatment with second line drugs (0,597;[0,415-0,858]), resistance to more 2 TB drugs (0,614;[0,429-0,879]), pre XDR and XDR-TB (0,486;[0,305-0,776]), and lower lymphocites count (0,681;[0,524-0,885]).Conclusion: Female, underweight patients, cavitaty, high bacterial load, previous TB treatment with second line drugs, resistance to more 2 TB drugs, resistance to rifampicine, isoniazid and other second line drugs, and lower lymphocites count were associated with longer time culture conversion in MDR-TB patients., Introduction: Treatment for MDR-TB has a poor outcomes, success rate was only 48% worldwide. One indicator of treatment success is early culture conversion. Identification of potential factors associated with culture conversion are important.Methods: A cohort rectrospective study using medical records of MDR-TB patients of Persahabatan Hospital during August 2009 until December 2013. Data were analyzed using multivariate analysis.Results : Of a total 436 patients, there are 248 patients (56.6%) were males. Two hundred fifty six patients (58,7%) had sputum culture conversion at two months. The median time to culture conversion was 44 days. The factors for longer sputum culture conversion were female (aHR 0,808; [95%CI 0,659-0,991]), underweight patients (0,792; [0,637-0,983]), cavitaty on chest radiograph (0,781;[0,634-0,961]), bacterial load 2+ (0,617;[0,439-0,869]), bacterial load 3+ (0,701;[0,501-0,979]), previous TB treatment with second line drugs (0,597;[0,415-0,858]), resistance to more 2 TB drugs (0,614;[0,429-0,879]), pre XDR and XDR-TB (0,486;[0,305-0,776]), and lower lymphocites count (0,681;[0,524-0,885]).Conclusion: Female, underweight patients, cavitaty, high bacterial load, previous TB treatment with second line drugs, resistance to more 2 TB drugs, resistance to rifampicine, isoniazid and other second line drugs, and lower lymphocites count were associated with longer time culture conversion in MDR-TB patients.]"

"Tuberkulosis multidrug resistant (TB MDR) merupakan penyakit infeksi yang terus mengalami peningkatan jumlah kasus setiap tahunnya. Indonesia menempati peringkat ke-delapan dari 27 negara dengan kasus TB MDR paling banyak di dunia (WHO, 2013). Pengobatan yang lebih kompleks dengan durasi yang lebih lama, menjadikan pasien TB MDR seringkali mengalami kegagalan konversi sputum. Kegagalan konversi sputum ini dipengaruhi oleh banyak faktor (multifaktorial). Penelitian ini bertujuan untuk mengetahui hubungan antara faktor demografi (usia dan jenis kelamin), riwayat merokok serta penyakit komorbid (diabetes melitus dan HIV/AIDS) terhadap kejadian gagal konversi sputum pasien TB MDR di RSUP Persahabatan Jakarta tahun 2014-2016. Penelitian ini tergolong penelitian potong lintang dengan data sekunder yang diperoleh dari 51 rekam medis di Poli TB MDR RSUP Persahabatan. Hasil penelitian ini menunjukkan prevalensi pasien TB MDR dengan gagal konversi sputum sebesar 5.6%. Hasil analisis univariat menunjukkan pasien TB MDR dengan gagal konversi sputum didominasi oleh laki-laki (62.7%); usia dewasa (80.4%); memiliki kebiasaan merokok (58.8%); tidak memiliki riwayat diabetes melitus (82.4%); dan tidak memiliki riwayat HIV/AIDS (100%). Hasil analisis bivariat menunjukkan hubungan yang tidak bermakna antara usia (p=0.084); jenis kelamin (p=0.421); kebiasaan merokok (p=0.550); riwayat diabetes melitus (p=0.799) dengan kegagalan konversi sputum pasien TB MDR. Dari hasil tersebut, dapat disimpulkan bahwa usia, jenis kelamin, riwayat merokok, diabetes melitus, dan HIV/AIDS tidak memiliki hubungan yang bermakna dengan kejadian gagal konversi sputum pasien TB MDR di RSUP Persahabatan Jakarta tahun 2014-2016.

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Multidrug resistant tuberculosis (MDR TB) is an infectious disease that continues to increase in the number of cases every year. Indonesia is on 8th rank among 27 countries with the most cases of MDR TB in the world (WHO, 2013). More complex treatment with longer duration, makes MDR TB patients often have sputum conversion failure. This sputum conversion failure is influenced by many factors (multifactorial). The aim of this study is to determine the relationship between demographic factors (age and gender), smoking habit, comorbid diseases (diabetes mellitus and HIV/AIDS) with sputum conversion failure of MDR TB patients at RSUP Persahabatan Jakarta in 2014-2016. The design of this study is a cross-sectional study with secondary data obtained from 51 medical records in MDR TB Polyclinic at Persahabatan Hospital.

The results of this study showed the prevalence of MDR TB patients with sputum conversion failure is 5.6%. The results of univariate analysis showed that MDR TB patients with sputum conversion failure were dominated by men (62.7%); adult age (80.4%); have a smoking habit (58.8%); have no history of diabetes mellitus (82.4%); and have no history of HIV/AIDS (100%). The results of bivariate analysis showed an insignificant relationship between age (p=0.084); gender (p=0.421); smoking habits (p=0.550); history of diabetes mellitus (p=0.799) with sputum conversion failure of MDR TB patients. From these results, it can be concluded that age, gender, smoking habit, diabetes mellitus, and HIV/AIDS do not have significant relationships with sputum conversion failure of MDR TB patients at RSUP Persahabatan Jakarta in 2014-2016."

"ABSTRACTDi Indonesia, angka keberhasilan pengobatan pasien TB resistan obat sejak tahun 2013-2015 masih rendah yaitu sebesar 52,4%. Upaya yang dilakukan adalah dengan diterapkannya metode baru yaitu metode standar jangka pendek pada tahun 2107. Seiring diterapkannya metode baru, metode standar konvensional tetap terus dilakukan. Penelitian ini menggunakan desain cross sectional bertujuan untuk mengetahui perbedaan hasil pengobatan antara metode standar standar konvensional dan metode standar jangka pendek. Data yang digunakan adalah data pasien TB MDR yang memulai pengobatan antara Januari-Desember 2017 yang teregister dalam e-TB Manager. Hasil pengobatan yang baik pada metode standar konvensional adalah 39,8% dan pada metode standar jangka pendek adalah 48,9%. Hasil analisis uji chi square terhadap perbedaan hasil antara metode konvensional dan jangka pendek adalah tidak terdapat perbedaan yang signifikan (p-value = 0,067). Dan hanya faktor umur 45 tahun dan interval inisiasi pengobatan 30 hari yang perbedaan hasil pengobatannya signifikan (p-value = 0,005 dan 0,047).

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ABSTRACTIn Indonesia, the success rate of treatment of drug-resistant TB patients from 2013-2015 is still low at 52.4%. The efforts made were to implement a new method, namely the standard short-term method in 2107. As new methods were implemented, conventional standard methods continued. This study used a cross sectional design aimed to determine differences in treatment outcomes between conventional standard standard methods and short-term standard methods. The data used is data on MDR TB patients who started treatment between January-December 2017 registered in e-TB Manager. The good treatment results in the conventional standard method are 39.8% and in the standard short term method is 48.9%. The results of the chi square test analysis of the differences in results between conventional and short-term methods there is no significant difference (p-value = 0.067). And only age factors 45 years and treatment initiation intervals 30 days for which the difference in results was significantly different (p-value = 0.005 and 0.047)."

"ABSTRAKUpaya pengendalian TB-MDR telah dilakukan, namun hasil akhir pengobatan pasien TB-MDR masih menjadi permasalahan terkini yang perlu diselesaikan. Di Indonesia, terjadi penurunan success rate pasien TB RO sejak lima tahun terakhir, yaitu kisaran 68-46, sedangkan hasil pengobatan buruk lebih fluktuatif dan masih tinggi yaitu kisaran 28-47. Penelitian ini menggunakan desain kohort retrospektif yang bertujuan untuk mengetahui gambaran dan faktor yang berhubungan dengan hasil pengobatan pasien TB-MDR di Indonesia. Data yang digunakan adalah data pasien TB-MDR yang berusia 15 tahun yangmemulai pengobatan antara Januari 2013-Desember 2015 dan teregister dalam e-TB Manager. Didapatkan 1.683 kasus dengan 49,7 pasien sembuh, 2,7 lengkap, 14,1 meninggal, 4,4 gagal, dan 29,1 loss to follow up.Analisis bivariat dilakukan untuk mengidentifikasi faktor yang berhubungandenganhasil pengobatan buruk kematian, gagal, atau loss to follow up. Faktor risiko terhadap hasil pengobatan buruk adalah usia 45 tahun RR 1.32; 95 CI 1.20-1.46, resistansi OAT lini 1 RR 34.1; 95 CI 8.24-141.0, resistansi OAT lini 1 lini 2 dan/atau florokuinolon RR 32; 95 CI 7.9-134.0, kavitas paru RR 1.21; 95 CI 1.00-1.44, interval inisiasi pengobatan >30 hari RR 1.11; 95 CI 1.00-1.24, dan tempat tinggal di desa RR 1.15; 95 CI 1.02-1.30. Sedangkan faktor protektor terhadap hasil pengobatan buruk adalah paduan standar RR 0.73; 95 CI 0.59-0.91.

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ABSTRACTEfforts to control MDR TB have been done, but treatment outcome of MDR TB patients remains a current issue that needs to be resolved. In Indonesia, success rate was declining in the last five years, from 68 46 , whereas poor treatment results are more fluctuate and still high at 28 47. This cohort retrospective study was conducted to analyze the characteristics and factors influencing treatment outcomes of MDR TB patients in Indonesia. This research was use data from e TB Manager and included all MDR TB patients who were ge 15 years and starting treatment between January 2013 and December 2015. Overall, 1.683 MDR TB patientswere included,49.7 recovered, 2.7 complete treatment, 14.1 died, 4.4 treatment failure, and 29.1 loss to follow up. A bivariate analysis was used to identify risk factors for poor treatment outcomes, which were defined as death, treatment failure, or loss to follow up. The risk factors for poor treatment outcome were age above 45 years RR 1.32, 95 CI 1.20 1.46, patients who are resistant first lines TB drugs RR 34.1 95 CI 8.24 141.0 and first lines TB drugs 2nd lines injection and or fluoroquinolone RR 32 95 CI 7.9 134.0, lung cavity RR 1.21, 95 CI 1.00 1.44, treatment initiation interval 30 days RR 1.11 95 CI 1.00 1.24, and residence in rural areas RR 1.15 95 CI 1.02 1.30. While the protector factor for poor treatment outcome is standardized regimen RR 0.73 95 CI 0.59 0.91."

"Tuberculosis Multidrug resistant TB MDR adalah salah satu jenis resistensituberkulosis terhadap minimal dua obat anti tuberkulosis lini pertama, yaituIsoniazid INH dan Rifampicin R dengan atau tanpa resisten terhadap obat antituberkulosis lain. Prevalensi TB MDR di dunia menurut WHO tahun 2012 sebesar 12 dari kasus TB baru dan 20 dari kasus TB dengan pengobatan ulang. Hal ini masihmerupakan masalah kesehatan masyarakat dunia, termasuk di Indonesia. Penelitian inibertujuan untuk mengetahui besarnya pengaruh faktor puskesmas yang dapatmempengaruhi individu terhadap kejadian TB MDR, serta menggali faktor levelpuskesmas yang dapat menjelaskan kejadian TB MDR. Desain penelitian inimenggunakan kasus kontrol dengan mixed methods. Pengumpulan data dilakukandengan wawancara menggunakan kuesioner, diskusi terarah, wawancara mendalam danobservasi. Analisis data menggunakan regresi logistik multilevel. Hasil penelitianmenunjukkan bahwa ada variasi risiko antar puskesmas/ fasilitas kesehatan tingkatpertama yang dapat mempengaruhi individu terhadap kejadian TB MDR. Faktor-faktorpada level individu yaitu pendidikan, riwayat hasil pengobatan, kepatuhan menelanobat, dan pengetahuan, PMO dan level puskesmas yaitu penjaringan suspek dan kotakerat pasien TB/TB MDR, pengobatan TB sesuai ISTC berpengaruh terhadap prevalensiTB MDR di Provinsi Sumatera Selatan. Faktor kontekstual puskesmas dapatmenurunkan variasi risiko antar puskesmas terhadap kejadianTB MDR sebesar 18 Pengembangan strategi intervensi pengendalian TB MDR yang sesuai dengan kondisiProvinsi Sumatera Selatan adalah mengkolaborasikan penjaringan suspek TB/TBMDR, pengobatan TB/TB MDR sesuai ISTC dan jejaring eksternal ISTC.

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Multidrug resistant tuberculosis MDR TB is one type of tuberculosis resistance to atleast two first line anti tuberculosis drugs, Isoniazid INH and Rifampicin R with orwithout resistance to other anti tuberculosis drugs. World prevalence of MDR TBaccording to WHO 2012 is 12 of new TB cases and 20 of TB cases with retreatment.This is still a public health problem of the world, including in Indonesia. Thisstudy aims to determine the magnitude of the influence of puskesmas factors that canaffect the individual to the incidence of MDR TB, as well as to explore the level factorof puskesmas that can explain the incidence of MDR TB. This research design use casecontrol with mixed methods. The data were collected through interviews usingquestionnaires, directional discussions, in depth interviews and observations. Dataanalysis using multilevel logistic regression. The results showed that there werevariations in risk among puskesmas that could affect individuals against MDR TBincidence. Factors at the individual level of education, history of treatment outcomes,medication adherence, and knowledge, PMO and Puskesmas levels are suspect and tightsquares of TB TB MDR patients, TB treatment according to ISTC has an effect on theprevalence of MDR TB in South Sumatera Province. Contraceptive factors puskesmas first level health facilities can reduce risk variation among puskesmas to the incidenceof MDR TD by 18 . Development of MDR TB control intervention strategyappropriate to South Sumatera Province condition is to collaborate on suspected TB TB MDR screening, TB TB MDR treatment according ISTC and ISTC externalnetwork."

"ABSTRAKPrevalensi DO pada pasien TB MDR terus meningkat setiap tahunnya di Provinsi DKI Jakarta. Penelitian ini bertujuan untuk menganalisis kejadian DO pada pasien TB MDR di Provinsi DKI Jakarta tahun 2011-2015 berdasarkan faktor risiko umur, jenis kelamin, status HIV, masa pengobatan, kepatuhan berdasarkan tipe pasien, riwayat pengobatan TB sebelumnya, dan jumlah resistansi OAT. Data yang digunakan adalah data sekunder data register kohort e-TB Manager dengan jumlah sampel sebanyak 516 pasien. Desain penelitian studi kuantitatif observational cross sectional. Prevalensi DO pasien TB MDR pada penelitian ini 44.6 yang merupakan prevalensi kasar. Tren prevalensi DO pada penelitian ini cenderung mengalami peningkatan dari tahun 2011 hingga 2015 dan selalu melebihi angka 10 setiap tahunnya. Oleh karena itu, perlu adanya upaya untuk dapat mengurangi jumlah kasus DO pada pasien TB MDR. Diharapkan penelitian ini dapat menjadi acuan bagi Dinas Kesehatan Provinsi DKI Jakarta dalam menjalankan program P2TB yang lebih baik dan tepat sasaran.

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ABSTRACTThe prevalence of DO among MDR TB patients increases every year in DKI Jakarta Province. This research aims to analyse DO among MDR TB patients in DKI Jakarta Province in 2011 2015 based on risk factors of age, sex, HIV status, treatment periode, adherence based on type of patients, history of TB treatment, and number of OAT resistance. The data used is secondary data cohort registration e TB Manager with sample of 516 patients. The design study is an observational cross sectional quantitative study. The crude prevalence of DO among MDR TB patients was 44.6. Prevalence tren of DO among MDR TB increases since 2011 untill 2015 and always more than 10 in every year. Therefore, it is necessary efforts that can decrease DO cases among MDR TB patients. This study expected to be a reference for DKI Jakarta Province Health Office in implement P2TB Program and reach target precisely. "

"ABSTRAKLatar belakang dan tujuan: Gangguan elektrolit merupakan salah satu efek samping yang spaling sering ditemukan pada pasien tuberkulosis multidrug-resistant TB MDR yang mendapatkan obat anti tuberkulosis OAT mengandung obat suntik lini kedua. Tujuan penelitian ini adalah untuk mengetahui proporsi gangguan elektrolit pada pasien yang mendapatkan OAT suntik lini kedua serta faktor-faktor yang berhubungan dengan gangguan tersebut.Metode: Penelitian ini merupakan penelitian potong lintang, retrospektif, berbasis rekam medis pada pasien TB MDR di RSUP Persahabatan selama pengobatan fase intensif dari Juli 2015-Juni 2016 dan mendapatkan OAT dengan regimen kanamisin ataukapreomisin, pirazinamid, etambutol, levofloksacin,sikloserin dan etionamid. Hasil: Sebanyak 121 pasien ikut pada penelitian ini. Gangguan elektrolit didapatkan pada 114 pasien 94,2. Rerata waktu terjadinya gangguan elektrolit setelah pengobatan adalah 2,0 bulan. Hipokalemia merupakan jenis gangguan elektrolit yang paling banyak ditemukan 57,9. Hipokalemia berhubungan dengan jenis kelamin dan jenis OAT suntik yang digunakan. Insidens hipokalemia lebih banyak ditemukan pada pasien perempuan 72 dibandingkan dengan laki-laki 47,9 dengan OR 2,8 KI 95 : 1,3-6,1 dan pada pasien yang mendapatkan kapreomisin 68,5 dibandingkan yang mendapatkan kanamisin 49,2 dengan OR 2,2 KI 95 : 1,1-4,7 . Hasil ini bermakna secara statistik. Faktor usia, status gizi, diabetes melitus, gangguan fungsi ginjal dan infeksi HIV tidak berhubungan dengan hipokalemia pada penelitian ini. Kesimpulan: Hipokalemia merupakan gangguan elektrolit yang paling sering terjadi pada pasien TB MDR yang mendapatkan OAT MDR mengandung obat suntik lini kedua. Jenis kelamin perempuan dan kapreomisin merupakan faktor risiko terjadinya hipokalemia namun diperlukan penelitian lebih lanjut untuk mengidentifikasi faktor risiko lainnya yang dapat mempengaruhi kejadian hipokalemia pada pasin TB MDR.

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ABSTRACT<>br>Background: Electrolyte imbalance is one of the adverse reactions mostly found in patients with multidrugs resistant tuberculosis MDR TB who treated by injectable agent. The aim of this study is to know the proportion of electrolyte imbalance in MDR TB patients receiving second line injection of antituberculosis drugs and the contributing factors. Methods: This study is a cross sectional, retrospective, medical record based study among MDR TB patients in Persahabatan Hospital during intensive phase from July 2015 to June 2016 who received intensive phase treatment consist of kanamycin or capreomycin, pirazinamid, ethambutol, levofloxacin, cycloserine and ethionamide.Results One hundred and twenty one patients were included in this study. The proportion of electrolyte imbalance was found in 114 patients 94.2. The mean duration of therapy at the time incidence of electrolyte imbalance was 2.0 months. Hypokalemia 57,9 were the most electrolyte imbalance frequently found. Hypokalemia was associated with gender and type of antituberculosis injection drugs. The incidence of hypokalemia significantly high among female 72.0 patients than male 47.9 with OR 2.8 CI 95 1.3 6.1 and also in patients receiving capreomysin 68.5 than kanamycin 49.2 with OR 2.2 CI 95 1.1 4.7. Age, nutrition status, diabetes melitus, renal disfunction and HIV have no association with hypokalemiain our study. Conclusion: Hypokalemia was the most frequent electrolyte imbalance found among patient receiving MDR antituberculosis regimen. Female gender and capreomycin injection using were associated with the incidence of hypokalemia. However, more clinical researchs are needed to identify other risk factors contributing of hypokalemia state in MDR TB patients."

"ABSTRAKTingginya angka insidens TB MDR di Indonesia, dibarengi dengan tingginya tingkatLost to Follow-up LTFU pada pengobatan pasien TB MDR. Pasien TB resisten obatmemiliki kemungkinan LTFU lebih besar dibandingkan pasien TB sensitif obatdikarenakan durasi pengobatan yang lebih lama. Selain itu, pasien TB MDR yang tidakmelanjutkan pengobatannya sampai tuntas memiliki peningkatan risiko kematian akibatTB. Studi ini bertujuan untuk mengetahui pengaruh rujuk balik dan tipe pasien terhadapkejadian LTFU pada pasien Multidrug-Resistant Tuberculosis TB MDR di Indonesia.Studi dilakukan pada Mei-Juni 2018 di Subdit TB ndash; Direktorat P2PML, Ditjen P2PKementerian Kesehatan RI. Desain studi yang digunakan adalah desain studi kohortretrospektif. Jumlah sampel pada studi ini adalah 961 pasien. Sampel diambil secaratotal sampling. Berdasarkan status rujuk baliknya, 86,3 pasien dilakukan rujuk balikdan 13,97 pasien tidak dirujuk balik. Berdasarkan kategori tipe pasien, 35,17 kasuskambuh, 5,52 pasien baru, 13,94 pasien pernah LTFU, 23,10 kasus gagalpengobatan kategori 1, 20,29 kasus gagal pengobatan kategori 2, 1,9 lain-lain pasien tidak diketahui riwayat pengobatan TB sebelumnya . Dari studi ini, diketahuibahwa proporsi kejadian LTFU sebesar 28,40 dengan kumulatif hazard LTFU sebesarsebesar 1,12 selama 39 bulan pengamatan, sehingga didapatkan hazard rate sebesar2,88/100 orang-bulan. Hasil analisis multivariabel dengan regresi cox time-dependentmenunjukkan bahwa rujuk balik menurunkan peluang terjadinya LTFU sebesar 46 HR 0,54; 95 CI 0,35-0,84 pada kondisi variabel tipe pasien dan umur sama adjusted . Untuk tipe pasien, tipe pernah LTFU, gagal pengobatan kategori 2 dan tidakdiketahui riwayat pengobatan TB sebelumnya meningkatkan peluang terjadinya LTFUmasing-masing sebesar 50 HR 2,02; 95 CI 1,18-3,45 , 53 HR 2,13; 95 CI1,240-3,66 , dan 74 HR 3,80; 95 CI 1,54-9,36 dibandingkan dengan tipe pasienkambuh baseline pada kondisi variabel rujuk balik, jenis kelamin, dan umur sama adjusted . Pada laki-laki, efek tipe gagal pengobatan kategori 2 lebih rendah 0,26 kalidibandingkan dengan pasien wanita dengan tipe gagal pengobatan kategori 2. Petugaskesehatan perlu meluangkan waktu yang lebih banyak untuk memberikan komunikasi,informasi, dan edukasi mengenai pengobatan TB serta mengenai manfaat rujuk balikkepada pasien TB MDR. Risiko LTFU meningkat pada pasien yang bertipe pernahLTFU, gagal pengobatan kategori 2, dan tidak diketahui riwayat pengobatan TBsebelumnya dibandingkan pasien dengan tipe kambuh, karena tipe kambuh sudah terujikepatuhannya terhadap pengobatan sebelumnya. Perlunya skrinning tipe pasien denganbaik untuk mengidentifikasi risiko LTFU berdasarkan tipe pasien sejak awal pasienmemulai pengobatan.Kata kunci: LTFU, rujuk balik, tipe pasien, TB MDR

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ABSTRACTThe high incidence rate of MDR TB in Indonesia is accompanied by high rate of lost tofollow up LTFU in the treatment of MDR TB patients. Drug resistant TB patients havea greater risk of LTFU than drug sensitive TB patients due to longer treatmentduration. In addition, MDR TB patients who did not continue treatment completely hadan increased risk of dying from TB. The aims of this study were to determine thedecentralization influence and patient type on the incidence of LTFU in Multidrug Resistant Tuberculosis MDR TB patients in Indonesia. This study was conducted inMay June 2018 at Subdirectorate of TB Directorate of Prevention and CommunicableDisease Control, Directorate General of Prevention and Disease Control Ministry ofHealth of the Republic of Indonesia. The study design was retrospective cohort. Thenumber of samples in this study was 961 patients. Samples were taken in total sampling.Based on the decentralization status, 86.3 of patients were decentralized. Based onthe type of patient category, 35.17 of relapse, 5.52 of new, 13.94 of after LTFU,23.10 of failure category 1, 20.29 of failure category 2, 1.9 of other patients unknown history of previous TB treatment . The proportion of incidence of LTFU is28.40 with cumulative hazard of LTFU equal to 1.12 during 39 months ofobservation, so hazard rate is 2.88 100 person month. In multivariable analysis withcox regression time dependent revealed that decentralization reduced the probability ofLTFU up to 46 HR 0.54, 95 CI 0.35 0.84 after controlled by type of patient andage. For patient type, treatment after LTFU, failure category 2 and unknown history ofprevious TB treatment increased the probability of LTFU by 50 HR 2,02 95 CI1,18 3,45 , 53 HR 2,13 95 CI 1,240 3,66 , and 74 HR 3,80 95 CI 1,54 9,36 consecutively compared with the type of relapse patients baseline after controlled bythe decentralization, gender, and age. In male patients with failure treatment category2, the effect was 0.26 times lower compared with failure category 2 in female patients.Health workers need to spend more time in communicating, informing and educatingabout TB treatment and the benefits of decentralization to MDR TB patients. The risk ofLTFU increased in type of patient after LTFU, treatment failure category 2, andunknown history of previous TB treatment compared with patients with relapse types.The need for good patient type screening to identify the risk of LTFU by type of patientfrom the initial of treatment.Keywords LTFU, decentralization, type of patient, MDR TB"