WHAT IS TBC ?
infection
Bacterial
Difficult diagnosis, especially in children
Multiple drug, no new drugs
Long term therapy - adherence
MDR, XDR, HIV, … etc
TB MANAGEMENT IN INDONESIA
PHC
Government Private
PHCGovernme
nt hospital
GP
dots
strateg
y
Private
hospital
Private
clinic
Specialist,
assisted by GP
GP &
Specialis
t
Guidelines: PDPI, PAPDI,
IDAI: PNTA
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
DOTS
DOTS strategy
WHAT IS DOTS ??
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
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.
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
the
achievem
ents
people treated for TB since 199556 million
Reduction in TB mortalitySince 199045%
Lives savedSince 199522 million
PASIEN TB BANYAK YANG BEROBAT KE PRAKTIK
SWASTA*
*Riskesdas 2010, Balitbangkes (2011)
12/1/2014 15God only knows Wallahu A’lam