Management of drug-resistant tuberculosis in Indonesia

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.

Low Identification and Diagnosis: Only about a third of estimated TB cases at risk of DR-TB were identified and reported, with only a tenth of the estimated true DR-TB cases diagnosed.

Inadequate Diagnostic Support: Approximately half of the treatment regimens were supported by phenotypic drug susceptibility testing (pDST).

High Unsuccessful Treatment Outcomes: Nearly half of all patients initiating treatment had an unsuccessful outcome.

Significant Delays in Treatment: Delays between diagnosis and treatment were substantial, particularly for patients living further away, those with employment, and those with a history of private sector engagement.

Impact of Undetected DR-TB: Undetected DR-TB contributes to ongoing transmission, which hampers global efforts to end TB. Increased testing and treatment could overburden health systems, worsening issues in the care cascade.

Potential of Active Case Finding: Active case finding strategies, when sustainably implemented within a national TB program, are cost-effective and aid in detecting DR-TB cases, especially new cases.

Challenges in Urban Settings: In this urban setting in Indonesia, significant losses and delays were found in DR-TB case finding, pDST testing, and treatment outcomes, despite relatively high treatment initiation. Improving access to diagnostics and linking patients to subsequent care steps could improve outcomes and reduce transmission.