2. WHAT IS TBC ?
infection
Bacterial
Difficult diagnosis, especially in children
Multiple drug, no new drugs
Long term therapy - adherence
MDR, XDR, HIV, … etc
3. TB MANAGEMENT IN INDONESIA
PHC
Government Private
PHC
Governme
nt hospital
GP
dots
strateg
y
Private
hospital
Private
clinic
Specialist,
assisted by GP
GP &
Specialis
t
Guidelines: PDPI, PAPDI,
IDAI: PNTA
4. SUB-STANDARD TB CARE IMPACT
mis-diagnosis (over / under) and mis-treatment
(over / under),
many severe pediatric TB cases
poor patient outcomes,
continued infectiousness with transmission
of M. tuberculosis to family & other
community members,
generation & propagation of drug resistance
(MDR, XDR)
4
8. DOTS STRATEGY
• early 1990, WHO & IUATLD developed a strategy to
combat world TB problem DOTS! (Directly
Observe Treatment Short-course)
• proven as a cost effective strategy
• based on: many studies, clinical trial, best practices, &
program implementation for more than 2 decade
9. THE DEVELOPMENT OF DOTS
Long-course drug treatment
Short-course drug treatment
The Styblo-IUATLD model of TB control
In Tanzania in the 1970s, Dr Karel Styblo of IUATLD
pioneered the development of a model of TB control
based on a managerial approach to case finding &
treatment.
WHO & the DOTS Strategy
In 1993, WHO's Global Tuberculosis Programme (GTB)
began promoting Styblo's strategy in a technical &
management package known by the brand-name
DOTS.
10. DOTS STRATEGY COMPONENTS
1. Government commitment to sustained TB control
activities.
2. Case detection by sputum smear microscopy
among symptomatic patients
3. Standardized treatment regimen of 6-8 mo for at
least all confirmed sputum smear positive cases,
with DOT for at least the initial 2 month
4. A standardized recording & reporting system
5. A regular, uninterrupted supply of all essential
anti-TB drugs
11.
12. the
achievem
ents
people
treated for TB since 1995 56 million
Lives saved
Since 1995 22 million
Reduction in TB mortality
45% Since 1990
13.
14. PASIEN TB BANYAK YANG BEROBAT KE PRAKTIK
SWASTA*
*Riskesdas 2010, Balitbangkes (2011)
The story of AIDS, TB and malaria during the ten years’ existence of the Global Fund has been one of success.
For someone like me, who has fought against TB all through my professional life, I understand very well the pleasure of finally receiving some good news. In TB as well, the past decade has brought considerable progress.
In those ten years alone, 9.7 million people in high burden TB countries have been treated and both treatment success and case detection rates have increased by over 20%. Clearly, the Global Fund is driving progress in the fight against TB.
