Pengendalian dan

pencegahan Tuberkulosis
Diah handayani
“Scarcely four years have elapsed since the important discovery of the
tubercle-bacillus by Koch was announced. Many then thought that the
key to the various problems of pulmonary consumption was close at
hand, if not in our actual possession” (W N, 1886).1

and we are still searching for ‘the key’ as envisioned in the 1880s….
1.1 Pendahuluan

• Global TB report 2017 : TB kasus baru 10,4 Juta,

• 10% (1,02 juta) di Indonesia
• 600.000 kasus TB RR dan 490 000 kasus TB MDR
• 20% terdiagnosis dan mendapatkan pengobatan.
• Angka kesembuhan TB MDR hanya 54%,

Global TB Report: 2017. Country : Indonesia : World Health Organization

The TB Elimination Strategy

VISION
A WORLD FREE OF TB

TOWARDS

ZERO ZERO ZERO

TB DEATHS TB CASES TB SUFFERING
TB elimination
Proposed Goal and Targets

GOAL: End the Global TB Epidemic

2035
Target 1 Target 2

95% reduction in <10/100 000

TB deaths (compared TB incidence rate
with 2015)
GLOBAL TB
PROGRAMME
Getting there: Milestones

2020 2025 2030 2035

TARGETS TARGETS TARGETS GOAL

• 35% reduction in • 75% reduction in • 90% reduction in • 95% reduction
TB deaths TB deaths TB deaths in TB deaths
• <85/100 000 TB • <55/100 000 TB • <20/100 000 TB • <10/100 000 TB
incidence rate incidence rate incidence rate incidence rate
• No affected • No affected • No affected • No affected
families with families with families with families with
catastrophic catastrophic catastrophic costs catastrophic
costs due to TB costs due to TB due to TB costs due to TB
Proposed targets Goal: End the global TB epidemic

1. Universal health coverage by 2025 2. New tools available from 2025

TB deaths TB incidence

Rate per 100,000 population

-75% vs. 2015
Millions

4 per 100,000

-95% vs. 2015 10 per 100,000

<0.8 per 100,000

GLOBAL TB
PROGRAMME
Proposed targets Goal: End the global TB epidemic

TB deaths TB incidence

Existing +

Rate per 100,000 population

Existing +
UHC UHC

-75%
Millions

R&D
R&D
-95%

GLOBAL TB
PROGRAMME
 M.tuberculosis
• Mycobacterium tuberculosis Complex
• -M tuberculosis, M. bovis, M.
africanum and M. microtti
• Basil tahan asam (alcohol)
• Tahan dalam iklim dingin, beku dan
kering
• Sensitif terhadap panas, sinar
matahari, dan radiasi UV
• Aerobic (tergantung O2 dan pH)
• Kapasitas membelah diri lambat
Faktor Risiko TB
Patogenesis TB
TB pathogenesis
Risiko penularan
Proses infeksi –sakit TB
Gejala TB
TB elimination strategy
Post-2015 TB Elimination Strategies

High- Bold
quality, policies and Intensified
integrated supportive research
TB care systems and
and innovation
prevention
Pilar dan komponen
Three pillars of the
Post-2015 TB Strategy

Early diagnosis of TB
Treatment of all people with
including universal
drug susceptibility 1 High- 2 TB including drug-resistant
TB, with patient-centered
testing; systematic quality,
integrated support
screening of contacts
TB care
and high-risk groups and
prevention

Preventive treatment of
people at high-risk and 4
vaccination for TB Collaborative TB/HIV
3 activities and management
of co-morbidities
GLOBAL TB
PROGRAMME
1. Early diagnosis and
screening
TOSS

imunisasi Investigasi
kontak
KPLDH

Pencegahan Terapi
lingkungan profilkasis/TBlaten
Risk of reactivation from TB
Risk of active TB
among contact
Population at risk of reactivation
Identify population at risk of TB transmission
Risk population groups Strength of recommendation
• People living with HIV Strong: systematic testing and
• Adult and child PTB contacts treatment should be performed (Low
• Patients initiating anti-TNF treatment to very low quality of evidence)
• Patients receiving dialysis
• Patients preparing for transplantation
• Patients with silicosis.
• Prisoners Conditional: Systematic testing and
• Health workers treatment should be considered (Low
• Immigrants from high burden countries to very low quality of evidence)
• Homeless persons
• Illicit drug user

• Patients with diabetes Conditional: systematic testing and

• People with harmful alcohol use treatment is not recommended unless
• Tobacco smokers they belong in the upper two groups
• Under-weight people (Very low quality of evidence)
 Low Transmission Among House-Hold Contacts with Smear
Positive TB Patient Living in a Dormitory, in Indonesia
Rezadi Satya, Diah Handayani , Agus D Susanto*, Dewi Mayanti**

Latent Tuberculosis infection (LTBI)

• 1 index case with the new TB, AFB smear positive

evaluation have not yet been program in
Indonesia, since we focused in active
TB. Investigation LTBI and active TB for
specific high risk population such as
Result

• 57 house-hold contacts, female, 21 years old, normal BMI,

house hold contact is an important
activity in TB elimination program. Many
evidences showed high association of Discusion
no history of TB treatment and 83% had BCG scar.
TB transmission among close or
household contact with smear positive
TB patients.
Number of LTBI and active TB in this
study was low compare to another
countries from 19% in Spanyol and 70%
Methods in Chinacould be because all subjects
These

• 5 (7%) subjects had positive QFT-GIT result , had normal BMI, and nonsmoking. It
also could prove that household contact
associate with transmission.

• 1 active TB with pleural effusion

conclusion
LTBI investigation among house hold
Result contact Is important.

• The dormitory has 2 floors, each consist of 15 room, ACH 8 x

. keyword
house hold contact, investigation, LTBI

per hour. Acknowledgement

UBC Indonesia
Tujuan Pengobatan TB
1. Menyembuhkan pasien

2. Mencegah Kematian karena TB

3. Mencegah Kekambuhan

4. Memutus mata rantai Penularan

5. Mencegah Resistensi Obat

6. Mengurangi dampak Ekonomi dan Sosial

 STANDAR 7 : Pengobatan TB
• paduan pengobatan yang tepat,
• memantau kepatuhan dan membantu mengatasi berbagai faktor
putus obat.
• koordinasi dengan DinKes
• Penetapan PMO
• Penggunaan alat bantu seperti SMS, dll
Prinsip paduan pengobatan
•Kombinasi obat
•Jangka panjang
•Pemberian single dose
Era keemasan Antibiotik (1940-1960)
• 1943  streptomysin
• 1945  resistant to streptomysin
• Myers 1963 total eradication of TB in the world
• 1980  MDR TB outbreaks
• 2006  XDR
• 2007,  TDR , two patients from Italy
• 2009  TDR TB patients in Iran
• 2011  4 TDR TB patients in Mumbai
Migliori GB, et al. Euro Surveill. 2007 May;12(5):E070517.1 2) Velayati AA, et al. Chest. 2009
Aug;136(2):420–5. 3) Udwadia ZF, et al. Clin. Infect. Dis. 2012 Feb 15;54(4):579–81.
 1. Pencegahan TB MDR

• pencegahanTB MDR = penatalaksanaan TB sensitif

yang berkualitas
• Layanan DOTS
• PPM
 2. Perluas diagnosis cepat TB MDR
• Lokasi TCM di Jakarta 56 fassyankes

Penggunaan diagnosis cepat TB MDR 2011−2014

3. Akses universal pengobatan TB MDR

• Pengobatan di rawat jalan

• Desentralisasi
• RS rujukan /sub rujukan  RSUD kali deres, (tipe D)
Infection control?
5. Increase funding
Thank You