Krjogja.com – The PANDEMIC of Covid-19 in Indonesia which has been going on since March 2020 is now entering the end of its third year. Various active, massive and structured control efforts have been carried out and have succeeded in controlling the pandemic, and it is only a matter of time before pandemic status becomes endemic. One of the impacts of the pandemic that has been felt in the healthcare sector is the decline in the attainment of nationally detected tuberculosis (TB) cases in 2020 and 2021.
As cases of Covid-19 declined during 2022, TB case detections in Indonesia increased again, even surpassing the results of 2019, before the pandemic hit. However, Indonesia was shocked by the release of WHO’s 2022 Global TB Report (GTB) which contained the world TB situation in 2021 and published the changes in TB incidents around the world. So, what about the TB situation in Indonesia and DIY?
Incidence of tuberculosis in Indonesia and DIY
According to GTB 2022, Indonesia is the country with the second highest number of TB cases after India, surpassing China, which previously ranked second. The estimated incidence of tuberculosis in Indonesia has increased to 969,000 cases (354/100,000 population), from the previous estimate of 824,000 (301/100,000 population). Meanwhile, India is still the country with the highest estimated number of TB cases, i.e. 2,950,000 cases (210/100,000 population), and China is the third-largest contributing country in TB cases with an estimated 780,000 cases (55/100,000 inhabitants). However, if we look at the average number of TB cases per 100,000 population, Indonesia (354) is actually higher than India (210) and China (55).
The conditions in DIY are not much different from the conditions nationwide. The estimated incidence of tuberculosis in DIYers was previously 9,064 cases per year, increasing to 10,530 cases per year. The estimates for each district/city are as follows: Yogyakarta City 1,570 cases, Bantul Regency 2,824 cases, Kulonprogo Regency 1,091 cases, Gunungkidul Regency 1,700 cases and Sleman Regency 3,345 cases.
Eliminate tuberculosis 2030
Indonesia’s commitment to fight tuberculosis is outlined in Presidential Regulation No. 67/2021 relating to the control of tuberculosis. In Chapter II, article four, it is stated that the goal of eliminating tuberculosis by 2030 is to reduce the incidence rate of tuberculosis to 65/100,000 population and to reduce the tuberculosis death rate to 6/100,000 population. If on the basis of the GTR 2022 the current estimated incidence of tuberculosis is 354/100,000 inhabitants, within eight years it should be able to reduce the incidence of tuberculosis to 65/100,000 inhabitants.
This increase in the estimated incidence of TB indicates the growing number of new TB cases in the community. The data released by WHO has had an impact on reducing the rate of TB elimination indicators achieved in Indonesia, especially the treatment coverage indicator for TB cases. Data on TB cases recorded in the Tuberculosis Information System (SITB) up to 15 December 2022 totaled 528,269 cases out of an estimated 843,000 cases (62.7%). Using the new estimate (969,000), national coverage of TB treatment is only 54.5%, which means it is still far from the 90% elimination goal.
Meanwhile, data on DIY TB cases for 2019-2022 were 4,026 – 3,075 – 3,082 – 4,547 cases, respectively. In the period 2020-2021 (Covid-19 pandemic) there has been a significant decrease due to the PPKM policy (imposition of restrictions on community activities) whereby the number of visits to health facilities has decreased and the concentration of health workers in Covid control -19 (tracing, swab and vaccination). In 2022, community activities and health services will be relatively normal, so the detection of TB cases (active and passive) will also increase to 4,547 cases (50.2% of the estimated 9,064 cases), also exceeding the number of TB cases in the 2019 (before the pandemic). However, using the new estimate (10,530), coverage of TB treatment in the DIY sector in 2022 will be just 43.2%.
Epidemiologically, the reduction in the incidence of tuberculosis will occur more rapidly if these three conditions are met:
to. More and more cases of tuberculosis are being diagnosed and treated. Presidential Decree 67/2021 aims to cure cases of tuberculosis at least 95% of the estimate.
b) More cases of tuberculosis complete treatment (recovered). Presidential Decree 67/2021 aims for the success rate for the treatment of tuberculosis to be at least 90% of the total treated.
c. More and more people with latent tuberculosis infection (ILTB) are receiving preventive treatment. In Presidential Decree 67/2021, the targeted coverage of tuberculosis prevention therapy (TPT) is equal to 90% of the estimated TPT target.
Compliance with these three conditions will minimize the sources of transmission in the community, thereby minimizing the emergence of new cases of tuberculosis. The successive successes of these three conditions for the period 2022 nationwide are: 62.7% – 82.5% – 0.8%, while the successive successes of DIY are 50.2% – 82.5% – 10.3%.
Tuberculosis elimination strategy
The elimination of TB in 2030 can be achieved with greater efforts by more sectors, not just the health sector, as was the case yesterday with the Covid-19 pandemic. The following six strategies should be implemented and periodically evaluated for progress:
1. Strengthen the commitment and leadership of central and regional (province and district/city) governments in the form of policies, provision of adequate human resources and budgeting
2. Increase access to quality, patient-friendly TB services by all health care settings, both state and private
3. Intensification of health care efforts in the context of TB fight, including promotion efforts, risk factor control, discovery and treatment, provision of immunity, and administration of preventive medications
4. Increase research, development and innovation in the field of tuberculosis control, including diagnostic tools, drugs, vaccines, appropriate services, and changing people’s behavior that supports the elimination of tuberculosis
5. Increase community, stakeholder and other multi-sector engagement through the TB Control Partnership Forum
6. Strengthen program management through strengthening planning, monitoring functions, strengthening human resource capacity, strengthening funding system, strengthening drug management system, and increasing motivation to deal with tuberculosis. (Suharna, SKM, MPH, Yogyakarta Special Region Health Service Infectious Disease Analyst)
