Management of drug-resistant tuberculosis in Indonesia

A study identifies key factors associated with successful treatment outcomes in multidrug-resistant tuberculosis (MDR-TB) patients in Indonesia through a retrospective analysis of 492 cases. The findings show that age ≤ 45 years, male sex, normal BMI, no prior TB treatment, and culture conversion within ≤ 2 months significantly increase treatment success. Among these, early culture conversion is the strongest predictor (RR = 2.79, p < 0.001), emphasizing the importance of a rapid response to therapy in achieving positive outcomes. Conversely, factors linked to lower treatment success include HIV infection (RR = 0.14, p = 0.017), chronic kidney disease (CKD), and cavitary lung lesions, with HIV being the most detrimental, reducing success rates by 86.1%. Other variables, such as anemia and diabetes mellitus, showed no significant impact. These findings highlight the need for early detection and close monitoring of modifiable factors to improve MDR-TB treatment outcomes in high-burden settings.[1]

In an urban setting in Indonesia, the identification and diagnosis of drug-resistant tuberculosis (DR-TB) remain critically low, with only a third of estimated at-risk cases identified and merely a tenth of true DR-TB cases diagnosed. Limited diagnostic support further compounds the issue, as only half of treatment regimens were backed by phenotypic drug susceptibility testing (pDST). Among those who began treatment, nearly half faced unsuccessful outcomes, exacerbated by significant delays between diagnosis and treatment—particularly for patients living far from healthcare centers, those employed, or those with a history of private sector engagement. These delays and undetected DR-TB cases contribute to ongoing transmission, undermining global TB eradication efforts. While scaling up testing and treatment is necessary, it risks overwhelming already burdened healthcare systems, worsening the care cascade. However, active case-finding strategies, if integrated sustainably into national TB programs, present a cost-effective solution to improving detection, particularly for new cases. Addressing the unique challenges of urban settings, such as patient losses during case-finding and delayed pDST testing, is crucial. Enhancing access to diagnostics and ensuring seamless linkage to care can ultimately improve treatment outcomes and curb the spread of DR-TB.[2]

References:

1. Soeroto, A.Y., Pratiwi, C., Santoso, P. and Lestari, B.W., 2021. Factors affecting outcome of longer regimen multidrug-resistant tuberculosis treatment in West Java Indonesia: A retrospective cohort study. PloS one, 16(2), p.e0246284.

2. Lestari, B.W., Nijman, G., Larasmanah, A., Soeroto, A.Y., Santoso, P., Alisjahbana, B., Chaidir, L., Andriyoko, B., Van Crevel, R. and Hill, P.C., 2024. Management of drug-resistant tuberculosis in Indonesia: a four-year cascade of care analysis. The Lancet Regional Health-Southeast Asia, 22:100294.