Influence of Diabetes Mellitus on the Development of Multi Drug Resistant-Tuberculosis in Yogyakarta

Background: the correlation between diabetes mellitus (DM) and Multi-Drug-Resistant Tuberculosis (MDR-TB) has never been studied among patients with tuberculosis (TB) in Indonesia, while DM has been identified to alter immune response and pharmacokinetics of TB medications that may lead to a failure of TB treatment and develop MDR-TB. Our study aimed to analyze the influence of diabetes mellitus on the development of MDR-TB. Methods: a retrospective cohort study was carried out on 356 TB patients at the Provincial Lung Clinics and Sardjito Hospital, Yogyakarta, Indonesia between 2010 and 2014. Diagnosis of MDR-TB was established based on GeneXpert or drug sensitivity testing, while DM was determined based on the criteria in the National Guidelines. Demographic, epidemiological and outcome variables were collected. Odds ratios and 95% confidence intervals (95% CI) were analyzed using simple logistic regression. Results: among 356 TB patients, 23 patients were with binomial TB-DM, while 333 patients did not suffered from DM. Patients with TB-DM presented a 6.8-fold (95% CI:2.0-23.7, p=0.003) higher risk of developing MDR-TB. Individuals with TB-DM had a 4.4-fold (95% CI:1.5-12.9, p=0.008) greater chance to have positive sputum smear by the second month of treatment indicating a delay in the resolution of the tuberculosis infection. Conclusion: there was a significant correlation between diabetes mellitus and MDR-TB development. Therefore, it is suggested that clinicians at all levels of health care service should conduct any kind of screening test for MDR-TB in such group of patients. Further prospective cohort study is needed to confirm the findings of this preliminary study

Persistent lymphopenia in septic patients at Dr. Sardjito General Hospital, Yogyakarta

Sepsis triggers immune responseboth pro-inflammatory and anti-inflammatory. Lymphocytes play an important role in the regulation of the inflammatory response. The decrease in lymphocyte numbers due to continuous apoptosis by sepsiscan suppress the immune system and failure to resolve inflammation. Persistent lymphopenia is also associated with a poor prognosis of sepsis. Currently, there are limited studies about persistent lymphopenia in sepsis patients in low- and middle-income countries, including Indonesia. This study aimed to describe the sociodemographic, clinical, and laboratory patterns of sepsis patients with persistent lymphopenia. This was a descriptive study that analyzed patients’ medical records who were treated at the Department of Internal Medicine, Dr. Sardjito General Hospital, Yogyakarta from January 1st, 2016, to December 31th, 2017. Patients diagnosed with clinical sepsis and persistent lymphopenia were included in the study. The status of persistent lymphopenia was described as lymphocyte counts that remained low or lower (<1.62x103/L) on day 4± 24 h compared to the initial value at the time of sepsis diagnosis (day one). Information of patients’ individual and clinical characteristics, complete blood cell count profiles and culture results were included. The outcomes of interest were the survival status and length of stay of the patients. A total of 101 patients with sepsis and persistent lymphopenia were involved in this study. The average increase in lymphocyte numbers was 73.63 ± 426.86/µL. The main source of infection was pulmonary infection, with a mortality rate of 43.6% and a median survival of 19 days. The average length of stay was 13.1±6.8. Persistent lymphopenia in patients with sepsis has a high mortality. Further research is needed to determine the clinical ramifications of persistent lymphopenia

Analisis Stakeholder dalam Penanggulangan HIV dan AIDS di Kabupaten Grobogan

HIV-AIDS is one of the world's health problems. Grobogan regency is one of the districts in Central Java with HIV number 4 and the discovery of new cases of HIV-AIDS number 3 in Central Java by 2015. Until 2017, HIV-AIDS cases are still fluctuating and tend to increase. Efforts were made to garner support and political commitment from the Grobogan Government and other stakeholders. The continuity of the program depends on political commitment and stakeholder policy support in the region. Conducting stakeholder analysis becomes important for the development of future strategic HIV / AIDS prevention plans. Objective this research to describe how local government strategic planning in HIV and AIDS prevention in Grobogan District. This research is descriptive research with qualitative approach. There were 20 informants in the study: Executive and Legislative officials, HIV / AIDS Caring NGO, VCT Clinic, community of PLWHA. The data was collected by observation, in-depth interview, and document review. Local government strategic planning on HIV / AIDS prevention efforts is still in the form of policy agenda and exit strategy. Although all stakeholders agree and support HIV / AIDS prevention efforts, stakeholder involvement in the formulation of policies and programs is lacking. Coordination of health offices with other stakeholders is also not working well, so the program is not integrated. The health department advocacy to local leaders is still weak. Health workers began to be evaluated for their performance, especially at sub-district level. Proposed alternatives to HIV / AIDS prevention budget from village funds. Unintegrated HIV / AIDS prevention efforts by stakeholders show weak communication and coordinative functioning. This problem is mainly caused by the key personnel dealing with reshuffle including the head of the health office in addition to the new bupati also not fully understand the case of HIV-AIDS that occurred.

Determinan kejadian multi-drug resistant tuberculosis di rumah sakit Dr. Sardjito Yogyakarta

Background: The new problems emerging with regard to TB that is double immunity TB germ against drug of antituberculosis or MDR TB. The occurrence of MDR TB is a phenomenon of “man-made” as a result of the treatment of patient who don’t adekuat as well as the transmission of MDR TB patients. MDR TB treatment costs more expensive and require longer periods of time as well as the success of the treatment is uncertain. Dr. Sardjito Hospital Yogyakarta is one of MDR TB referral hospital that implemented integrated management of drug resistant tuberculosis control. Activity and performance integrated management of drug resistant tuberculosis control in Dr. Sardjito Hospital has not been documented and analyze to know what factors are associated with MDR TB incidence.Method: In this research using observational analytic and design case control study. The subjects are suspect MDR TB patients which are 61 MDR TB patients and 61 non MDR TB patients. The collected data are secondary data from the register TB. 06 MDR, medical records, register TB. 03 MDR, and from the data base of suspect MDR TD patients in Dr. Sardjito Hospital from January 2012 to September 2016. Data analyze using chi square to know significance of associated between dependen and independent variables and using multiple logistic regression to know the most dominant risk factors.Results: MDR TB patients’s characteristics more in males (63,93%), age >45years (52,46%), previously TB treatment (96,72%), never smoking (75,41%), not contacts with MDR TB patients (86,89%), never examined HIV-AIDS (59,02%). The analysis showed thare was no significant associated between age, sex, previously TB treatment, smoking, contact with MDR TB patients, and HIV-AIDS with MDR TB incidence in Dr. Sardjito Hospital Yogyakarta (P value >0,05).Conclusion: The variables of age, sex, previously TB treatment, smoking, contacs with MDR TB patients, and HIV-AIDS are not risk factors for MDR TB incidence in Dr. Sardjito Hospital Yogyakarta.Determinant of multi-drug resistant tuberculosis events at Dr. Sardjito Hospital Yogyakarta PurposeThe purpose of this study was to identify the determinants of multidrug resistant events in patients with tuberculosis in Dr. Sardjito Hospital in Yogyakarta.MethodsA cross-sectional study was conducted involving 122 patients with suspected MDR TB consisting of 61 cases of MDR TB and 61 non MDR TB cases. The data collected were secondary data from MDR TB.06 registers, medical records, MDR TB.03 registers, and MDR TB patients' baseline data forms at Dr. Sardjito Hospital Yogyakarta from January 2012 until September 2016. Data were analyzed to determine the correlation between independent variables and dependent variable using Chi-Square tests, and to know the most dominant risk factors using multiple logistic regression tests.Results MDR TB patients’ characteristics showed there were more males (63.93%), age >45 years (52.46%), previously TB treatment (96.72%), never smoking (75.41%), no contacts with MDR TB patients (86.89%), and never examined for HIV-AIDS (59.02%). The analysis showed there was no significant association between age, sex, previous TB treatment, smoking, contact with MDR TB patients, and HIV-AIDS status with MDR TB incidence in Dr. Sardjito Hospital Yogyakarta (p value >0.05).Conclusion The variables of age, sex, previous TB treatment, smoking, contacts with MDR TB patients, and HIV-AIDS status were not risk factors for MDR TB incidence in Dr. Sardjito Hospital in Yogyakarta

Faktor risiko loss to follow up terapi ARV pada pasien HIV

Latar belakang: Terapi antiretroviral (ARV) diharapkan dapat memperpanjang harapan hidup pasien HIV dan meningkatkan kualitas hidupnya. Namun, tantangan penggunaan ARV yang bersifat seumur hidup adalah loss to follow up yang berdampak pada kegagalan terapi dan berakibat kematian. Penelitian ini bertujuan untuk mengetahui faktor risiko loss to follow up terapi ARV pada pasien HIV di RSUP Dr. Sardjito Provinsi Daerah Istimewa Yogyakarta.Metode: Penelitian ini merupakan penelitian retrospective cohort study. Melibatkan 499 pasien HIV dengan teknik total sampling. Pengumpulan data pada  22 April-21 Juni 2016 di RSUP Dr. Sardjito Provinsi DIY. Observasi dilakukan selama empat  tahun  dengan  menggunakan  data  rekam  medis.  Analisis  data menggunakan Kaplan-Meier dan cox proportional hazards regression.Hasil: Terdapat 190 Pasien yang loss to follow up (38.1%) dengan proporsi terbesar pada umur ≤ 35 tahun (54.3%), laki-laki (72.1%), pendidikan menengah (68.4%), bekerja di bidang swasta (43.7%), jarak rumah dengan layanan ARV ≥10 km (61.8%), pasien umum (65.2%), kelompok risiko tinggi heteroseksual (77.2%), kadar CD4 1 (43.9%) dan menggunakan regimen ARV AZT+3TC+NVP (35.3%). Incidende Rate (IR) sebesar 1.71 per 100 person month. Faktor risiko loss to follow up terapi ARV yang ditemukan adalah mahasiswa (AHR=2.42; 95% CI=1.20-4.89, p=0.01), jarak rumah ≥ 10 km (AHR=1.58; 95% CI=1.09-2.31; p=0.01), menggunakan jaminan kesehatan (AHR=1.67; 95% CI=1.11-2.51; p=0.01) dan homoseksual sebagai faktor protektif loss to follow up terapi ARV (HR=0.49; 95% CI=0.30-0.80; p=0.00).Kesimpulan: Berstatus mahasiswa, jarak rumah ≥10 km dan menggunakan jaminan kesehatan adalah faktor risiko loss to follow up terapi ARV. Perlu peningkatan konseling kepatuhan pada mahasiswa, kerjasama dengan pendamping pasien dan desentralisasi layanan ARV, pelayanan yang efektif dan efisien pada pasien yang menggunakan jaminan kesehatan. Risk factors for loss to follow up of antiretroviral therapy in HIV patientsPurposeThis study aimed to determine risk factors for loss to follow-up of antiretroviral therapy among HIV-infected patients in Dr. Sardjito Yogyakarta, 2011-2014.MethodsA retrospective cohort study was conducted involving 499 HIV patients. Observations were conducted for four years using medical records. Data analysis was performed using Kaplan-Meier and Cox proportional hazards regression tests.ResultsThere were 190 loss to follow-up patients. Risk factors for loss to follow-up of ARV therapy were: a student (AHR = 2.42; 95% CI = 1.20-4.89), the distance ≥ 10 km (AHR = 1.58; 95% CI = 1:09 to 2:31), using health insurance (AHR = 1.67; 95% CI = 1:11 to 2:51) and homosexual as a protective factor of loss to follow-up of antiretroviral therapy (HR = 0:49; 95% CI = 0.30-0.80).ConclusionBeing a college student, the distance between home and ARV service ≥10 km and using health insurance were the risk factors for loss to follow-up of ARV treatment. Adherence counseling for students, cooperation with the drug taking supervisor and decentralization ARV service, as well as effective and efficient services for patients who use health insurance need to be strengthened

Faktor yang memengaruhi partisipasi ibu hamil melakukan skrining HIV di puskesmas Yogyakarta

Latar Belakang: Peningkatan angka infeksi HIV pada anak usia 1-14 tahun kemungkinan besar berasal dari ibu sejak kandungan. Penularan HIV dari ibu ke anak dapat di tekan dengan mengetahui status HIV ibu, sehingga dapat dilakukan penanganan sedini mungkin.Yogyakarta merupakan daerah terkonsentrasi HIV sehingga setiap ibu hamil harus dilakukan pemeriksaan HIV.Cakupan ibu hamil yang melakukan tes HIV pada tahun 2014 dipuskesmas yang menyediakan fasilitas pemeriksaan HIV hanya sebesar 50%.Persepsi, dukungan tenaga kesehatan, informasi tentang HIV dan faktor lainnya berpengaruh pada pemeriksaan tes HIV pada ibu hamil. Penelitian ini bertujuan untuk melihat faktor yang mempengaruhi perilaku ibu hamil untuk melakukan tes HIV di puskesmas kota YogyakartaMetode: Menggunakan pendekatan kuantitatif dan kualitatif. Kuantitatif bersifat deskriptif analitik dengan desain observasional berupa rancangan cross sectional untuk melihat hubungan antara variabel bebas dan variabel terikat.Kualitatif berupa wawancara mendalam untuk mendukung hasil penelitian kuantitatif.Hasil:Jumlah subjek penelitian sebesar 85 orang dengan usia rata-rata 25-34 tahun, dan responden yang melakukan tes HIV sebesar 92.94%Analisis bivariabel menunjukkan tidak adanya hubungan yang bermakna secara statistik namun secara praktis berhubungan antara pengetahuan HIV, persepsi kerentanan, persepsi keparahan, persepsi manfaat, persepsi hambatan, paparan informasi, dukungan tenaga kesehatan dan usia kehamilan dengan perilaku ibu hamil melakukan tes HIV di Puskesmas Kota YogyakartaKesimpulan: Hampir seluruh ibu hamil melakukan tes HIV di puskesmas walaupun tidak seluruh ibu memiliki pengetahuan, persepsi kerentanan, persepsi keparahan, persepsi manfaat, paparan informasi, dukungan tenaga kesehatan yang tinggi, dan persepsi hambatan yang rendah, hal ini karna tes HIV merupakan tes atas inisiatif tenaga kesehatan dan merupakan program dari pemerintah.Factors affecting pregnant women’s participation in HIV screening test in public health care centers of YogyakartaPurposeThis study aimed to explore the behavioral factors that influence pregnant women’s participation in HIV testing in public health centers of Yogyakarta. MethodsThis research used quantitative and qualitative methods with a quantitative analytical descriptive design and cross-sectional observational approach to determine any association between independent variables and the dependent variable. Qualitative in-depth interviews were conducted to support the results of the quantitative research. ResultsResults showed 92.94% of respondents had been HIV tested with an average age of 25-34 years. Almost all pregnant women had an HIV test in a clinic although not all mothers have the knowledge, perceived susceptibility, perceived severity, and perceived benefits. While the exposure information, and support of health workers were high, and there was a perception of low resistance, since the HIV test is a test done by health workers and an initiative of the government program. ConclusionThis study recommends that counseling and information on HIV and HIV testing from health workers and support from related agencies are needed. Subsequent research could examine factors that affect healthcare workers' performance in providing education to health-care users

"I pity the TB patient": a mixed methods study assessing the impact of the COVID-19 pandemic on TB services in two major Indonesian cities and distilling lessons for the future.

INTRODUCTION: In Indonesia, a country with around 280 million people and the second-highest tuberculosis (TB) incidence rate in the world, the impact of the COVID-19 pandemic on TB care needs careful assessment so that future response strategies can be strengthened. We conducted a study comparing TB testing and treatment rates before and during the first 2 years of the COVID-19 pandemic in Indonesia, and the reasons for any disruptions to care. METHODS: We conducted retrospective secondary data analysis and qualitative interviews in Yogyakarta and Bandung, Indonesia. Routine data on TB testing and treatment were sourced from the national TB information system operated by the Indonesian Ministry of Health. TB testing and treatment outcomes were compared between two time periods: pre-COVID (2018-19); and during COVID-19 (2020-21). In-depth interviews were conducted with patients and health workers to explore their experiences in accessing and providing TB services during the pandemic. RESULTS: There was a 45% (21 937/39 962) reduction in the number of patients tested for TB during the pandemic compared with pre-COVID-19, while the proportion of TB tests returning a positive result increased from 12% (4733/39 962) to 50% (10 945/21 937). The proportion of TB patients completing treatment increased by 2.6% during the pandemic, yet the proportion cured and the number of patients successfully treated both decreased (by 7% and 4.4%, respectively). Our qualitative interviews highlighted several factors influencing TB service access and delivery, including fear of being diagnosed with COVID-19 during TB-related clinic visits, fear of COVID-19 exposure among patients and health workers, healthcare facilities prioritising COVID-19 over other services, and mandatory mobility restrictions affecting both patients and health workers. CONCLUSION: The COVID-19 pandemic impacted TB testing and treatment outcomes in Bandung and Yogyakarta. Policymakers should consider these findings in designing strategies to ensure TB services are maintained and supported during future health crises

Influence of Diabetes Mellitus on the Development of Multi Drug Resistant-Tuberculosis in Yogyakarta

Background: the correlation between diabetes mellitus (DM) and Multi-Drug-Resistant Tuberculosis (MDR-TB) has never been studied among patients with tuberculosis (TB) in Indonesia, while DM has been identified to alter immune response and pharmacokinetics of TB medications that may lead to a failure of TB treatment and develop MDR-TB. Our study aimed to analyze the influence of diabetes mellitus on the development of MDR-TB. Methods: a retrospective cohort study was carried out on 356 TB patients at the Provincial Lung Clinics and Sardjito Hospital, Yogyakarta, Indonesia between 2010 and 2014. Diagnosis of MDR-TB was established based on GeneXpert or drug sensitivity testing, while DM was determined based on the criteria in the National Guidelines. Demographic, epidemiological and outcome variables were collected. Odds ratios and 95% confidence intervals (95% CI) were analyzed using simple logistic regression. Results: among 356 TB patients, 23 patients were with binomial TB-DM, while 333 patients did not suffered from DM. Patients with TB-DM presented a 6.8-fold (95% CI:2.0-23.7, p=0.003) higher risk of developing MDR-TB. Individuals with TB-DM had a 4.4-fold (95% CI:1.5-12.9, p=0.008) greater chance to have positive sputum smear by the second month of treatment indicating a delay in the resolution of the tuberculosis infection. Conclusion: there was a significant correlation between diabetes mellitus and MDR-TB development. Therefore, it is suggested that clinicians at all levels of health care service should conduct any kind of screening test for MDR-TB in such group of patients. Further prospective cohort study is needed to confirm the findings of this preliminary study

SISTEM KEMITRAAN ANTARA STAKEHOLDERS DALAM PROGRAM PERAWATAN DUKUNGAN DAN PENGOBATAN HIV DAN AIDS DI RSUD KABUPATEN MERAUKE

Background. UNAIDS reports that in 2009 although the number of new HIV infections has been steadily declining since the late 1990's, but the decline is followed by a decline in deaths from AIDS because they do not increase significantly with antiretroviral therapy for several years. Merauke District Hospital is one of the referral hospital for people with HIV and AIDS and has formed a working groups of HIV and AIDS as a a referral center CST HIV and AIDS program. CST HIV and AIDS Program was developed to formed networking among stakeholders in overcoming the resource constraints. Methods. This case study research implemented in Merauke district Hospital with a unit analyst HIV and AIDS working groups Merauke District Hospital in September-November 2011. Independent variables in this study is Networking among stakeholders is the District health department, District Aids Control Commission, District Hospital, HIV and AIDS working groups Merauke District Hospital, NGOs, community organizations, and people living with HIV while the dependent variable is the Care, Support and Treatment of HIV and AIDS. Subjects in this case study research 15 respondents. Results. From the the research found that the system of formal networkings between stakeholders was developed in the group with regular meetings, informal meetings and internships. The provision of human resources that are not placed in a long time sector in which training institutions have followed suit. Institutions provide some services in the care, support and treatment of HIV and AIDS with the help of a growing networking system. Managers Working Group of the CST program to maintain the sustainability of HIV and AIDS in HIV and AIDS Working Group Merauke District Hospital, implementing networkings with more proactive in providing the needs of their institution. Conclusion. networking system has grown along with the capacity and built on the activities of groups working with the network continues to expand. Forum activities still need to socialize a shared understanding of different ways and procedures derived from donor agencies