The Analysis of Missing Cases on the Treatment of Resistant Rifampicin Tuberculosis Oster Suriani Simarmata, Dina Bisara Lolong, Kristina L Tobing
National Institute of Health Research Development-Ministry of Health Indonesia
Abstract
Background: Tuberculosis (TB) is one of the deadliest infectious diseases in the world, which is the 10th most significant contributor to death. Currently, Indonesia is in the top three countries contributing to the number of TB cases in the world. The lateness in diagnosing TB can increase transmission opportunities in the community. Besides, the occasional use of anti-tuberculosis drugs causes multidrug-resistant TB (MDR-TB) and Extensive drug-resistant TB (XDR-TB) germs.
Objective: To describe the follow-up treatment of Resistant Rifampicin in health care facilities based on the results of the gene-Xpert examination.
Method: Study design is cross-sectional using data from "Evaluation study of detection of TB cases with molecular rapid test in Indonesia in 2018". The data resources are from 42 hospitals and 2 primary health care facilities having conducted the gene-Xpert examination at least 6 months in 42 districts, 26 provinces.
Results: The number of TB diagnoses with gene-Xpert from health facilities was 33,630 cases, 31.6% of those cases were TB positive, namely rifampicin sensitive of 89% (9,456) and rifampicin resistant of 11% (1,171). 29% of resistant rifampicin tuberculosis case were missing cases consisting of the untreated and unknown follow-up treatment of 18% and 11%, respectively. Missing cases were mostly found in male of 66.1%. Based on the age, 76.9% of the missing cases were in productive age, such as 15 to 54 years. Moreover, according to the TB treatment history and origin of case, missing cases were found in new cases 54.4% and the existing health facility 51.2%. The most reason of missing RR-TB case in the follow-up treatment was the refusal of treatment 40.3%.
Conclusion: This study showed that the high of non-compliance to TB treatment was caused by inadequate general knowledge about TB, lack of social support, medication side effects and long treatment period which were posed as barriers to adherence to treatment. The short distance to reach health facility as puskesmas (public health centers) is necessary in order to simplify the community access for the TB RR diagnoses and treatment. For better treatment adherence, it is crucial to organize the counseling of comprehensive health education for patients family members and the vast community at treatment sites.
