PEMANFAATAN TES CEPAT MOLEKULER (TCM) GENEXPERT SEBAGAI ALAT DIAGNOSTIK TB PARU DI RSUD WANGAYA KOTA DENPASAR

ABSTRACT Tuberculosis remains a major public health problem, with an estimated 9 million TB incidence cases, 300,000 of which are drug resistant TB cases and resulted in 1.5 million deaths worldwide in 2013. However, only 58% of new cases, TB cases were confirmed bacteriologically using WHO recommended test including the Xpert® MTB/RIF Rapid Diagnosis. The use of GeneXpert in Indonesia has existed since 2014 and has never been evaluated in its utilization, including in the city of Denpasar, namely in Wangaya Hospital as one of the recipients of the GeneXpert pulmonary TB diagnostic aid. The results of this study showed that the results of GeneXpert examination were much higher in the percentage of Positive TB Case Findings compared to microscopic examination so that there is an increase in the number of positive TB cases by 14.3%. The GeneXpert examination succeeded in giving positive results compared to the microscopic results showing negative results, which were sensitive Rifampicin (14.6%) and resistant Rifampicin (2.4%). However, the utilization of TB suspect examination with GeneXpert has not been maximized in increasing the number of TB patients suspected of having TB, in fact, the percentage of positive TB case finding compared to TB suspicion is increasing. Keywords:GeneXpert, rapid diagnosis of tuberculosis, pulmonary tuberculosis   ABSTRAK Tuberkulosis (TB) tetap menjadi masalah kesehatan masyarakat yang utama, diperkirakan telah terjadi 9 juta kasus insiden TB, 300.000 di antaranya adalah kasus TB multidrug resistant (TB MDR) dan mengakibatkan 1,5 juta kematian di seluruh dunia pada tahun 2013. Namun, baru 58% dari kasus baru, kasus TB dikonfirmasi secara bakteriologis menggunakan tes yang direkomendasikan oleh WHO termasuk Tes Cepat Molekuler (TCM) GeneXpert® MTB/RIF (Xpert). Pemanfaatan TCM GeneXpert di Indonesia ada sejak 2014 dan belum pernah dilakukan evaluasi dalam pemanfaatannya termasuk di Kota Denpasar yaitu di RSUD Wangaya sebagai salah satu penerima bantuan alat diagnostik TB Paru TCM GeneXpert. Hasil studi menunjukkan bahwa hasil pemeriksaan dengan TCM GeneXpert jauh lebih tinggi persentase penemuan kasus positif TBC dibanding dengan pemeriksaan mikroskopis sehingga terdapat peningkatan jumlah kasus positif TBC sebesar 14,3% di RSUD Wangaya pada tahun 2018.  Pemeriksaan TCM GeneXpert berhasil memberikan hasil yang positif di saat hasil pemeriksaan mikroskopis menunjukkan hasil negatif yaitu Rifampisin sensitif (14,6%) dan Rifampisin resisten (2,4%). Pemanfaatan pemeriksaan terduga TB dengan TCM GeneXpert belum maksimal dalam meningkatkan jumlah pemeriksaan pasien terduga TB Paru, walaupun persentase penemuan kasus positif TB dibanding terduga TB meningkat. Kata kunci: Tes cepat molekuler, geneXpert, tuberkulosis par

Faktor-Faktor yang Mempengaruhi Kejadian Tuberkulosis pada Umur 15 Tahun ke Atas di Indonesia

Today, Pulmonary Tuberculosis still remains a notable health concern in Indonesia. Pulmonary Tuberculosis (called TB) is a disease of ancientness who determined by numerous factors. These factors are relating to host, including age, sex, race, socioeconomic, lifestyle, marital status, work, heredity, nutrition and immunity. This study aimed to fi nd out on infl uence factors pulmonary tuberculosis occurrence of 15 years old or above in Indonesia, according to the Tuberculosis Prevalence Survey Data Year 2013-2014. A Cross-Sectional study design. The Number of Samples aged 15 years or above was 67,944. We had performed analysis from secondary data of Tuberculosis Prevalence Survey Year 2013-2014 using Univariate, Bivariate, and Multivariate Logistic Regression analysis. Multivariate analysis showed that participants who had been: diagnosed with TB by a health professional [OR = 6.06 (95% CI; 4.69–7.83)], aged 35-54 years [OR = 1.22 (CI95%; 0 , 96 - 1.5)], aged 55 years + [OR = 1.73 (CI95%; 1.32-2.27)], male [OR = 2.07 (CI95%; 1.60-2 , 69)], Urban areas [OR = 1.48 (CI95%; 1.21-1.80)], Eastern Indonesia Region [OR = 1.59 (CI95%; 1.26-2.02)], Sumatera Region [OR = 1.68 (CI95%; 1.32-2.12)], education level < Junior High School [OR = 1.48 (CI95%; 1.19-1.83)], diagnosed with DM by a physician [OR = 1.44 (95% CI; 0.92-2.25)], lived with TB patient [OR = 1.84 (CI95%; 1.27-2.65)], smoking [OR = 1.25 (CI95%; 098-1.60)]. Furthermore, the fi nal model shows that all independent variables are factors infl uencing TB cases that occurred in Indonesia (p <0.05). These variables are a group of age, sex, regional classifi cation, areas, education level, had been diagnosed with DM by a physician, had been diagnosed with TB by a health professional, and had been lived with TB sufferer. The most dominant factor infl uencing TB occurrence of 15 years or above had been diagnosed with TB. Thus, it concluded that the participant had a risk of 6.06 times the occurrence of TB compared to the participant who had never been diagnosed with TB by a health professional.  Abstrak Saat ini tuberkulosis masih menjadi masalah utama kesehatan di Indonesia. Penyakit TB dipengaruhi oleh beberapa faktor pejamu. Adapun faktor yang berkaitan dengan pejamu antara lain usia, jenis kelamin, ras, sosial ekonomi, kebiasaan hidup, status perkawinan, pekerjaan, keturunan, nutrisi, dan imunitas. Studi ini bertujuan untuk mengetahui faktor-faktor yang mempengaruhi kejadian Tuberkulosis pada umur 15 tahun ke atas di Indonesia berdasarkan data SPTB 2013-2014. Disain studi potong lintang. Jumlah sampel yang berumur 15 tahun ke atas adalah 67.944. Analisis data dengan univariat, bivariate, dan multivariat regresi logistik. Analisis Multivariat menunjukkan bahwa partisipan yang pernah di diagnosis TB oleh tenaga kesehatan [OR= 6,06 (CI 95%; 4,69–7,83)], umur 35-54 tahun [OR=1,22 (CI95%;0,96 – 1,5)], umur 55 tahun+ [OR= 1,73 (CI95%; 1,32-2,27)], laki-laki [OR= 2,07 (CI95%; 1,60-2,69)], Perkotaan [OR=1,48 (CI95%; 1,21-1,80)], Kawasan Timur Indonesia [OR= 1,59 (CI95%; 1,26-2,02)], Kawasan Sumatera [OR=1,68 (CI95%; 1,32-2,12)], Pendidikan < SMP [OR=1,48 (CI95%; 1,19-1,83)], pernah di diagnosis DM oleh dokter [OR=1,44 (CI95%; 0,92-2,25)]. Pernah tinggal dengan penderita TB [OR=1,84 (CI95%; 1,27-2,65)], Merokok [OR=1,25 (CI95%; 098-1,60)]. Pada model akhir terlihat bahwa seluruh variabel independen merupakan faktor-faktor yang mempengaruhi kejadian TB di Indonesia (p<0,05) adalah kelompok umur, jenis kelamin, klasifi kasi daerah, kawasan, pendidikan, pernah di diagnosis DM oleh dokter, pernah di diagnosis TB oleh tenaga kesehatan, dan pernah tinggal dengan penderita TB. Faktor yang paling dominan mempengaruhi terjadinya TB pada usia 15 tahun ke atas adalah pernah di diagnosa TB oleh tenaga kesehatan. Partisipan yang pernah di diagnosa TB oleh tenaga kesehatan berisiko 6,06 kali untuk terjadinya TB dibandingkan orang yang belum pernah di diagnosa TB oleh tenaga kesehatan. &nbsp

Penyebab Kematian di Kabupaten Gianyar Tahun 2010-2012

Abstract Cause of death statistics is one of key indicators to determine the health status of Gianyar community for 3 years (2010-2012) as part of Civil Registration and Vital Statistics (CRVS) study. The instruments used were Verbal Autopsy (AV) questionnaire and Causes of Death Form (FKPK). Data were collected from 13 puskesmas and 4 hospitals and analyzed descriptively according to ICD 10. Based on demoghraphic characteristics, the number of deaths is higher among males and older groups, and mostly occurred at home. The highest cause of death is non- communicable diseases (stroke, COPD, IHD, and malignant neoplasm of cervix uteri) followed by communicable diseases (TB and diarrhoea) and transportation accidents. The top ten causes of death in Gianyar show that a non-communicable and communicable diseases would be a double burden for health services. It is essential to establish integrated posts for elderly and NCD, and measures for prevention of TB transmissions and treaments as well as early detection malignant neoplasm of cervix uteri for women had married or sexually active, and to increase the implementation of safe traffic programs. Keywords : cause of death, vital registration, Gianyar Abstrak Penyebab kematian merupakan salah satu indikator kunci untuk menggambarkan status kesehatan masyarakat di masyarakat Gianyar sebagai bagian dari penelitian registrasi sipil dan statistik vital selama 3 tahun (2010-2012) dengan menggunakan kuesioner Autopsi Verbal (AV) dan Formulir Keterangan Penyebab Kematian (FKPK) dari WHO. Data kematian dikumpulkan dari 13 puskesmas dan 4 rumah sakit, dianalisis dengan metode deskriptif, dengan pengelompokan penyebab kematian berdasarkan ICD 10. Berdasarkan karakteristik demografi jumlah kematian lebih banyak laki-laki, kelompok umur tua, dan di rumah. Penyebab kematian tertinggi disebabkan oleh penyakit tidak menular (stroke, PPOK PJK, dan kanker serviks.) diikuti penyakit menular (TB dan diare) dan kecelakaan lalu lintas. Sepuluh besar penyebab kematian terbanyak memperlihatkan adanya penyakit tidak menular dan menular yang merupakan beban ganda bagi pelayanan kesehatan yang harus dihadapi dalam pembangunan bidang kesehatan. Perlunya prioritas program promotif dan preventif seperti mengaktifkan posbindu (Pos Pembinaan Terpadu) lansia dan PTM, sosialisasi tentang upaya pencegahan penularan TB dan adanya program OAT gratis, deteksi dini kanker serviks pada wanita yang sudah menikah atau berhubungan seksual, dan penegakkan peraturan tata tertib pengguna jalan raya lebih ditingkatkan.Kata kunci : pola penyebab kematian, vital registrasi, Gianya

Utilizing Rapid Molecular Tests (RMT/RIF) in Tuberculosis Drug-Sensitive/Resistant Discovery in Indonesia: A Pilot Study

The underdiagnosis and underreporting of tuberculosis (TB) indicators are unresolved problems. The rapid molecular test (RMT) is one of the breakthroughs for TB case finding by using safer and more sensitive equipment; it is even believed to help find drug-resistant TB. The results of several webinars held regularly by a TB program as well as its evaluation and the use of RMT formed the basis of this study. This initial pilot study aimed to provide an overview of case finding for both drug-sensitive and drug-resistant TB using RMT. A cross-sectional study was conducted on samples in several provinces in Indonesia that have used RMT, both in remote or non-remote island borders areas and fiscal capacity. Regarding the use of RMT for drug-sensitive TB case finding, the largest contributors were males aged above 15 years, while in the drug-resistant TB case finding group, the biggest contributor was the use of RMT in 2017 and 2018. Overall, the findings could only describe the situation in the study area. The use of RMT in drug-sensitive TB case finding would be maximized if the detected cases are males aged above 15 years, while RMT can help find cases of drug-resistant TB

Association of diabetes, smoking, and alcohol use with subclinical-to-symptomatic spectrum of tuberculosis in 16 countries: an individual participant data meta-analysis of national tuberculosis prevalence surveys

Summary Background Non-communicable diseases (NCDs) and NCD risk factors, such as smoking, increase the risk for tuberculosis (TB). Data are scarce on the risk of prevalent TB associated with these factors in the context of population-wide systematic screening and on the association between NCDs and NCD risk factors with different manifestations of TB, where ∼50% being asymptomatic but bacteriologically positive (subclinical). We did an individual participant data (IPD) meta-analysis of national and sub-national TB prevalence surveys to synthesise the evidence on the risk of symptomatic and subclinical TB in people with NCDs or risk factors, which could help countries to plan screening activities. Methods In this systematic review and IPD meta-analysis, we identified eligible prevalence surveys in low-income and middle-income countries that reported at least one NCD (e.g., diabetes) or NCD risk factor (e.g., smoking, alcohol use) through the archive maintained by the World Health Organization and by searching in Medline and Embase from January 1, 2000 to August 10, 2021. The search was updated on March 23, 2023. We performed a one-stage meta-analysis using multivariable multinomial models. We estimated the proportion of and the odds ratio for subclinical and symptomatic TB compared to people without TB for current smoking, alcohol use, and self-reported diabetes, adjusted for age and gender. Subclinical TB was defined as microbiologically confirmed TB without symptoms of current cough, fever, night sweats, or weight loss and symptomatic TB with at least one of these symptoms. We assessed heterogeneity using forest plots and I2 statistic. Missing variables were imputed through multi-level multiple imputation. This study is registered with PROSPERO (CRD42021272679). Findings We obtained IPD from 16 national surveys out of 21 national and five sub-national surveys identified (five in Asia and 11 in Africa, N = 740,815). Across surveys, 15.1%–56.7% of TB were subclinical (median: 38.1%). In the multivariable model, current smoking was associated with both subclinical (OR 1.67, 95% CI 1.27–2.40) and symptomatic TB (OR 1.49, 95% CI 1.34–1.66). Self-reported diabetes was associated with symptomatic TB (OR 1.67, 95% CI 1.17–2.40) but not with subclinical TB (OR 0.92, 95% CI 0.55–1.55). For alcohol drinking ≥ twice per week vs no alcohol drinking, the estimates were imprecise (OR 1.59, 95% CI 0.70–3.62) for subclinical TB and OR 1.43, 95% CI 0.59–3.46 for symptomatic TB). For the association between current smoking and symptomatic TB, I2 was high (76.5% (95% CI 62.0–85.4), while the direction of the point estimates was consistent except for three surveys with wide CIs. Interpretation Our findings suggest that current smokers are more likely to have both symptomatic and subclinical TB. These individuals can, therefore, be prioritised for intensified screening, such as the use of chest X-ray in the context of community-based screening. People with self-reported diabetes are also more likely to have symptomatic TB, but the association is unclear for subclinical TB

Tobacco smoking clusters in households affected by tuberculosis in an individual participant data meta-analysis of national tuberculosis prevalence surveys: Time for household-wide interventions?

Tuberculosis (TB) and non-communicable diseases (NCD) share predisposing risk factors. TB-associated NCD might cluster within households affected with TB requiring shared prevention and care strategies. We conducted an individual participant data meta-analysis of national TB prevalence surveys to determine whether NCD cluster in members of households with TB. We identified eligible surveys that reported at least one NCD or NCD risk factor through the archive maintained by the World Health Organization and searching in Medline and Embase from 1 January 2000 to 10 August 2021, which was updated on 23 March 2023. We compared the prevalence of NCD and their risk factors between people who do not have TB living in households with at least one person with TB (members of households with TB), and members of households without TB. We included 16 surveys (n = 740,815) from Asia and Africa. In a multivariable model adjusted for age and gender, the odds of smoking was higher among members of households with TB (adjusted odds ratio (aOR) 1.23; 95% CI: 1.11–1.38), compared with members of households without TB. The analysis did not find a significant difference in the prevalence of alcohol drinking, diabetes, hypertension, or BMI between members of households with and without TB. Studies evaluating household-wide interventions for smoking to reduce its dual impact on TB and NCD may be warranted. Systematically screening for NCD using objective diagnostic methods is needed to understand the actual burden of NCD and inform comprehensive interventions

Association of diabetes, smoking, and alcohol use with subclinical-to-symptomatic spectrum of tuberculosis in 16 countries: an individual participant data meta-analysis of national tuberculosis prevalence surveys

Background Non-communicable diseases (NCDs) and NCD risk factors, such as smoking, increase the risk for tuberculosis (TB). Data are scarce on the risk of prevalent TB associated with these factors in the context of population-wide systematic screening and on the association between NCDs and NCD risk factors with different manifestations of TB, where ∼50% being asymptomatic but bacteriologically positive (subclinical). We did an individual participant data (IPD) meta-analysis of national and sub-national TB prevalence surveys to synthesise the evidence on the risk of symptomatic and subclinical TB in people with NCDs or risk factors, which could help countries to plan screening activities. Methods In this systematic review and IPD meta-analysis, we identified eligible prevalence surveys in low-income and middle-income countries that reported at least one NCD (e.g., diabetes) or NCD risk factor (e.g., smoking, alcohol use) through the archive maintained by the World Health Organization and by searching in Medline and Embase from January 1, 2000 to August 10, 2021. The search was updated on March 23, 2023. We performed a one-stage meta-analysis using multivariable multinomial models. We estimated the proportion of and the odds ratio for subclinical and symptomatic TB compared to people without TB for current smoking, alcohol use, and self-reported diabetes, adjusted for age and gender. Subclinical TB was defined as microbiologically confirmed TB without symptoms of current cough, fever, night sweats, or weight loss and symptomatic TB with at least one of these symptoms. We assessed heterogeneity using forest plots and I2 statistic. Missing variables were imputed through multi-level multiple imputation. This study is registered with PROSPERO (CRD42021272679). Findings We obtained IPD from 16 national surveys out of 21 national and five sub-national surveys identified (five in Asia and 11 in Africa, N = 740,815). Across surveys, 15.1%–56.7% of TB were subclinical (median: 38.1%). In the multivariable model, current smoking was associated with both subclinical (OR 1.67, 95% CI 1.27–2.40) and symptomatic TB (OR 1.49, 95% CI 1.34–1.66). Self-reported diabetes was associated with symptomatic TB (OR 1.67, 95% CI 1.17–2.40) but not with subclinical TB (OR 0.92, 95% CI 0.55–1.55). For alcohol drinking ≥ twice per week vs no alcohol drinking, the estimates were imprecise (OR 1.59, 95% CI 0.70–3.62) for subclinical TB and OR 1.43, 95% CI 0.59–3.46 for symptomatic TB). For the association between current smoking and symptomatic TB, I2 was high (76.5% (95% CI 62.0–85.4), while the direction of the point estimates was consistent except for three surveys with wide CIs. Interpretation Our findings suggest that current smokers are more likely to have both symptomatic and subclinical TB. These individuals can, therefore, be prioritised for intensified screening, such as the use of chest X-ray in the context of community-based screening. People with self-reported diabetes are also more likely to have symptomatic TB, but the association is unclear for subclinical TB