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Abstrak :
Latar Belakang: Target angka keberhasilan pengobatan TB MDR/TB RR 2015 adalah ≥ 75 %. Angka keberhasilan pengobatan menurut WHO tahun 2013 adalah 52%. Kesenjangan antara target dan pencapaian masih sangat besar. Metode: Penelitian cross sectional/potong lintang berdasarkan data rekam medis pasien TB MDR yang sudah ada hasil pengobatan sejak Januari 2013 sampai dengan Desember 2016. Hasil: Dari 409 pasien TB MDR di RSUP Persahabatan keberhasilan pengobatan 61,4% dengan hasil akhir pengobatan sembuh 243 subjek (59,4%), pengobatan lengkap 8 subjek (2%), meninggal 44 subjek (10,8%), loss to follow up 106 subjek (25,9%) dan gagal 8 subjek (2%). Pada penelitian ini 243 subjek (59,4%) laki-laki dengan rerata umur 38,79 ± 11,887 tahun, mayoritas gizi kurang dan terdapat pengobatan TB sebelumnya, resistensi terbanyak RHES dan efek samping terbanyak efek samping sedang (kelompok 2). Faktor umur, riwayat penggunaan alkohol dan komorbid DM mempunyai hubungan bermakna terhadap hasil akhir pengobatan (p<0,05). Riwayat penggunaan alkohol merupakan faktor yang paling berpengaruh terhadap hasil akhir pengobatan. Kesimpulan: Keberhasilan pengobatan TB MDR di RSUP Persahabatan adalah sebesar 61,4% dan faktor yang berhubungan bermakna adalah umur, riwayat penggunaan alkohol dan terdapatnya komorbid DM.

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Background: The target of treatment success rate of MDR TB/RR TB in 2015 is ≥ 75 %. The success rate in WHO 2013 is 52%. The gap between target and achievement is still very large. Method: A cross sectional design based on medical record data of MDR TB patients who have been treatment outcomes from January 2013 to December 2016. Result: Of a total 409 MDR TB patients at Persahabatan Hospital succes rate of treatment is 61,4% with the final outcome consist of cured 243 subjects (59,4%), complete treatment 8 subjects (2%), death 44 subjects (10,8%), loss to follow up 106 subjects (25,9%) dan failed 8 subjects (2%). Patients in this study were male 243 subjects (59,4%) with mean age of subjects 38,79 ± 11,887 years old, majority is malnutrition and had previous TB treatment, the most resistance is RHES and the most side effects is moderate. The age, alcohol user and comorbid DM were found to have significant relationship to treatment outcomes (p<0,05). The alcohol user is the most influential factor to the treatment outcomes. Conclusion: The success rate of treatment outcome of MDR TB in Persahabatan hospital is 61,4% and associated factors is the age, alcohol user dan comorbid DM.

Abstrak :
ABSTRAK
Upaya 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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ABSTRACT
Efforts 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.

Abstrak :
Pendahuluan: Tuberkulosis (TB) adalah penyebab utama kematian akibat infeksi di dunia. Sejak tahun 2008 - 2017 terdapat penurunan angka keberhasilan pengobatan TB di Indonesia (< 90%). Rekomendasi pengobatan TB di Indonesia adalah paduan obat antituberkulosis (OAT) dosis berselang sebagian (2RHZE/4R3H3) atau harian (2RHZE/4RH). Menurut WHO, paduan OAT RHZE/R3H3 mempunyai angka kegagalan dan kekambuhan yang lebih tinggi. Namun, penelitian meta-analisis RCT menyatakan bahwa kedua paduan OAT mempunyai angka kegagalan dan kekambuhan yang sama. Oleh karena itu, dilakukan penelitian untuk membandingkan hasil pengobatan dan efek samping antara paduan OAT 2RHZE/2RH dengan 2RHZE/4R3H3. Metode: Penelitian ini merupakan studi analitik observasional dengan desain cross sectional yang membandingkan hasil pengobatan dan efek samping antara paduan OAT 2RHZE/4RH dengan 2RHZE/4R3H3 pada pasien TB paru kategori I di RSUP Persahabatan periode Januari 2015 sampai Juni 2018. Data sekunder diambil dari rekam medik. Hasil pengobatan dinilai sesuai definisi dalam pedoman nasional penanggulangan TB di Indonesia dan WHO. Efek samping dinilai dari seluruh efek samping terkait OAT yang tercatat dalam rekam medik. Hasil: Terdapat 175 pasien pada masing-masing kelompok. Pada kelompok paduan OAT 2RHZE/4RH terdapat 89.1% pasien berhasil, 13.1% sembuh,76.0% pengobatan lengkap, 10.6% putus berobat, 0.6% gagal, dan tidak ada yang meninggal. Pada kelompok paduan OAT 2RHZE/4R3H3 terdapat 91.4% pasien berhasil, 39.4% sembuh, 52.0% lengkap, 8% putus berobat, tidak ada yang gagal, dan 0.6% meninggal. Tidak ada perbedaan bermakna untuk keberhasilan pengobatan (p=0.470, OR=1.299, IK95%;0.637-2.648), putus berobat (p=0.659 ,OR=0.758, IK95%;0.365-1.577), gagal (p=1.000), dan meninggal (p=1.000) di antara kedua kelompok. Namun, terdapat perbedaan bermakna untuk kesembuhan (p=0.003, OR=2.358, IK95%;1.375-5.206) dan pengobatan lengkap (p=<0.001, OR=0.342, IK95%;0.217-0.540). Sebagian besar pasien mengalami efek samping pengobatan (51.1%) terutama di tahap intensif (73.2%). Pada tahap lanjutan tidak ada perbedaan bermakna kejadian efek samping antara kedua kelompok (p= 0.324, OR=1.386, IK95%; 0.723-2.657). Kesimpulan: Kesembuhan kelompok paduan OAT 2RHZE/4R3H3 lebih baik daripada 2RHZE/4RH, sedangkan pengobatan lengkap sebaliknya. Tidak ada perbedaan bermakna untuk keberhasilan pengobatan, putus berobat, kegagalan, meninggal, dan kejadian efek samping pada tahap lanjutan di antara kedua kelompok. ......Introduction: Tuberculosis (TB) is the main cause of death for infectious disease in the world. Since 2008 - 2017, there was a decline of TB success rate (< 90%) in Indonesia. Treatment of TB in Indonesia are using antituberculosis drugs with part daily dose combination (2RHZE/4R3H3) or daily dose combination (2RHZE/4RH). WHO concluded that 2RHZE/4R3H3 combination had higher failure and recurrence rate. However, a meta-analysis study showed that both combinations had same failure and recurrence rate. Therefore, this study is conducted to compare treatment outcomes and adverse effects between 2RHZE/4RH combination and 2RHZE/4R3H3 combination. Method: This was an observational analytic study with cross sectional design which compared treatment outcomes and adverse effects between 2RHZE/4RH combination and 2RHZE/4R3H3 combination in pulmonary tuberculosis patient at RSUP Persahabatan period January 2015 until June 2018. Secondary data was taken from medical record. Treatment outcomes were assessed using definition in Indonesia National Guideline of TB and WHO. Adverse effects were assessed from all adverse effects that written in medical record. Result: There are 175 patients in each group. In 2RHZE/4RH combination group, there were 89.1% patients succeed, 13.1% cured, 76.0% completed treatment, 10.6% lost to follow up, 0.6% failed and no one died. In 2RHZE/4R3H3 combination group, there were 91.4% patients succeed, 39.4% cured, 52.0% completed treatment, 8% lost to follow up, no one failed, and 0.6% died. There was no significant difference for success (p=0.470, OR=1.299, IK95%;0.637-2.648), loss to follow up (p=0.659, OR=0.758, IK95%;0.365-1.577), failure (p=1.000), and death rate (p=1.000) between two groups. However, there was a significant difference for cure (p=0.003, OR=2.358, IK95%;1.375-5.206) and complete treatment rate (p=<0.001, OR=0.342, IK95%;0.217-0.540) between two groups. Most patients had adverse effects (51,5%), especially in intensive phase (73,2%). In continuation phase, there was no significant difference of adverse effects event between two groups (p = 0.324, OR= 1.386, IK95%; 0.723-2.657). Conclusion: Cure rate was better in 2RHZE/4R3H3 group than 2RHZE/4RH group, for completed treatment on the contrary. There was no significant difference for success rate, loss to follow up rate, failure rate, death rate, and adverse effects event in continuation phase between two groups.

Abstrak :
Tuberkulosis Resisten Obat (TB RO) merupakan penyakit yang disebabkan oleh bakteri Mycobacterium tuberculosis yang sudah resisten terhadap obat lini pertama. Penyakit ini masih menjadi masalah kesehatan di dunia karena penularannya sangat cepat dan morbiditasnya cukup tinggi. Banyaknya obat yang digunakan dalam pengobatan TB RO menyebabkan kemungkinan munculnya reaksi obat tidak diinginkan (ROTD). ROTD dapat menjadi salah satu faktor penyebab ketidakpatuhan pasien dan pada akhirnya dapat mempengaruhi hasil pengobatan. Tujuan penelitian ini adalah menganalisis hubungan antara ROTD dengan kepatuhan dan hasil pengobatan TB RO. Desain studi yang digunakan adalah cross sectional dengan data dari rekam medis pasien di RS UI periode 1 April 2022–28 Februari 2023. Analisis data menggunakan uji Chi Square. Dari 65 pasien ditemukan pasien yang mengalami ROTD sebanyak 62 pasien yang didominasi oleh pasien laki-laki, usia produktif, tidak memiliki penyakit penyerta, serta pasien yang menggunakan paduan pengobatan jangka panjang. Hasil Uji Chi Square untuk ROTD dengan kepatuhan menunjukkan nilai p=0.373 (p>0.05) dan untuk ROTD dengan hasil pengobatan didapatkan nilai p=0.120 (p>0.05). Dari penelitian ini dapat disimpulkan bahwa tidak ada hubungan antara ROTD dengan kepatuhan dan hasil pengobatan pasien tuberkulosis resisten obat di Rumah Sakit Universitas Indonesia. ......Drug Resistant Tuberculosis is a disease caused by Mycobacterium tuberculosis which is resistant to the first-line drugs. This disease is still a health problem worldwide because of its fast transmission and high morbidity rate. The large number of drugs used to treat Drug Resistant Tuberculosis causes the possibility of Adverse Drug Reactions (ADRs). ADRs can be one of the factors causing patient non-compliance and can ultimately affect treatment outcomes. This study aimed to analyze the relationship between ADRs with adherence and treatment results of Drug Resistant Tuberculosis. The research design used was cross sectional with medical record data of Drug Resistant Tuberculosis patients at University Indonesia Hospital from April 1, 2022, until February 28, 2023. Data analysis used the Chi Square test. From 65 patients, 62 patients with ADRs were found, dominated by male patients, adult patients with no comorbidities, and patients who used long-term combination medication. The results of the Chi Square Test ADRs with adherence showed a value of p=0.373 (p>0.05) and for ROTD with treatment results obtained p=0.120 (p>0.05). From this study, it can be concluded that there is no relationship between ADRs with Adherence and Treatment Result of Drug Resistant Tuberculosis Patients at University of Indonesia Hospital.

Abstrak :
Anak merupakan populasi yang memiliki risiko lebih tinggi untuk terjadinya tuberkulosis ekstraparu (TBC-EP). Namun demikian, sampai saat ini data mengenai keberhasilan pengobatan TBC ekstraparu pada anak dan faktor yang memengaruhinya di Indonesia masih sangat terbatas. Penelitian ini bertujuan untuk mengetahui keberhasilan pengobatan TBC-EP pada anak dan mengidentifikasi faktor-faktor yang memengaruhinya. Pengambilan data dilakukan di Rumah Sakit Cipto Mangunkusumo Kiara dengan metode kohor retrospektif pada populasi anak terdiagnosis TBC ekstraparu. Dari 953 pasien anak usia 0 bulan-17 tahun yang terdiagnosis TBC, 458 (48%) anak mengalami TBC-EP dengan tiga bentuk yang paling sering bertutur-turut adalah TBC osteoartikular (21,7%), limfadenitis (21,1%) dan sistem saraf pusat (16,3%). Sebanyak 70,6% pasien TBC ekstraparu anak dinyatakan sembuh selama 2015-2021. Mayoritas pasien TBC-EP berusia 11-18 tahun (46%) dengan sebaran jenis kelamin yang seimbang, laki-laki (49,3%) dan perempuan (50,7%). Riwayat kontak dengan pasien TBC ditemukan pada 41,1% dan jaringan parut BCG ditemukan pada 34,7% kasus. Komorbiditas TBC ekstraparu dan TBC paru ditemukan pada 45,7% pasien. Analisis multivariat pada faktor prediktor keberhasilan pengobatan TBC ekstraparu mendapati hasil yang bermakna pada status gizi baik (RR 1,285, IK 95% 1,135-1,456) dan jenis TBC ekstraparu yang dialami bukanlah TBC ekstraparu berat (RR 1,330, IK 95% 1,094-1,616). ......Children is highly susceptible to extrapulmonary tuberculosis (EPTB). However, knowledge about childhood EPTB in Indonesia and its treatment success is limited. This study aimed to determine treatment success rate of EPTB and factors affecting successful treatment outcome in children. We conducted a retrospective cohort study in Cipto-Mangunkusumo Kiara Hospital. A total of 953 pediatric patients below 18 years old were diagnosed with TBC. Extrapulmonary TB was found in 458 children (48%), with the most prevalent type: bone and joint (21.7%), lymph node (21.1%), and central nervous system (16.3%). There were 70.6% EPTB pediatric patients successfully treated during 2015-2021. The majority of patient with EPTB were in the age group of 11-18 years (46%) with balanced sex distribution, male (49.3%) and female (50.7%). Comorbidity of pulmonary TBC and EPTB was found in 45.7% patients. Multivariate analysis in factors predicting successful treatment outcome with significant results were good nutritional status (RR 1.285, 95% CI 1.135-1.456) and suffered from non-severe EPTB form (RR     1.330, 95% CI 1.094-1.616).

Abstrak :
As healthcare costs rise in the United States, debate is ongoing over how to obtain better value for dollars spent. In this context, the use of cost-effectiveness analysis (CEA) is more compelling than ever. This book, written by the Second Panel on Cost-Effectiveness in Health and Medicine, reviews key concepts and analytic challenges in CEA. The authors endorse the original Panels concept of a reference case and support its recommendation that analysts take a broad societal perspective; in addition, they recommend a healthcare sector perspective for a second reference case, as well as an important new framework, the Impact Inventory, for detailing costs and effects. The revisions draw on advances in the field and include three new chapters that capture research on decision modeling, methods for evidence synthesis, and ethical considerations. The volume also includes two new worked examples (Appendix A and Appendix B) to illustrate ways to implement the authors recommendations.

Abstrak :
Tuberkulosis (TB) menjadi salah satu penyebab kematian tertinggi di dunia, dimana Indonesia pada tahun 2019 menjadi negara penyumbang kasus Tuberkulosis terbanyak kedua di dunia. Pengaruh pandemi COVID-19 dikhawatirkan akan mempersulit penanggulangan TB yang dapat dievaluasi melalui tingkat keberhasilan pengobatan. Studi potong lintang ini dilakukan untuk menganalisis pengaruh pandemi COVID-19 terhadap keberhasilan pengobatan TB di Puskesmas. Sejumlah 418 pasien TB yang menerima OAT KDT Kategori 1 sebelum dan selama pandemi COVID-19 di tiga Puskesmas Wilayah Kota Depok diikutsertakan dengan metode total sampling. Observasi dilakukan terhadap data sekunder dari sistem informasi TB, kartu pengobatan pasien, rekam medis, dan catatan pasien lainnya. Keberhasilan pengobatan ditentukan melalui kategori hasil pengobatan pasien berdasarkan Kementerian Kesehatan RI. Hasil pengobatan sembuh atau pengobatan lengkap dikategorikan sebagai berhasil, sedangkan hasil pengobatan lainnya dimasukkan dalam kategori tidak berhasil. Angka keberhasilan pengobatan selama pandemi meningkat sebesar 10,3% dibandingkan pada periode sebelum COVID-19, dengan nilai berturut-turut sebesar 90,3% dan 80%. Pandemi COVID-19 ditemukan berpengaruh signifikan (p = 0,005) secara statistik terhadap keberhasilan pengobatan pasien TB di tiga puskesmas. Hanya ditemukan 5 pasien TB (1,8%) yang mengalami koinfeksi COVID-19. Faktor yang mempengaruhi keberhasilan pengobatan meliputi usia dan komorbid selama pandemi COVID-19 serta lama pengobatan pasien pada kedua periode. ......Tuberculosis (TB) is one of the highest causes of death in the world, where Indonesia in 2019 became country that contributed second most Tuberculosis cases in the world. The impact of the COVID-19 pandemic feared to complicate TB management which can be evaluated through success rate of treatment. This cross-sectional study was conducted to analyze the effect of COVID-19 pandemic on TB success treatment in public health centers. A total of 418 TB patients who received anti-TB FDC Category I before and during COVID-19 pandemic in three Puskesmas Depok city region were included with total sampling method. Observations were made on secondary data from TB information systems, patient treatment cards, medical records, and other patient records. Success treatment are determined through category of patient treatment outcomes based on the Health Ministry of the Republic of Indonesia. The results of cured treatment or complete treatment are categorized as successful, while other treatment results are included in the category of unsuccessful. The success rate of treatment during the pandemic increased by 10.3% compared to the period before COVID-19, with successive values of 90.3% and 80%. The COVID19 pandemic was found to have a significant effect (p = 0.005) statistically on the successful treatment of TB patients in three health centers. Only 5 TB patients (1.8%) were found to have COVID-19 co-infection. Factors influencing treatment success include age and comorbidities during the COVID-19 pandemic as well as the length of treatment of patients in both periods.