Effective TB control

1. Determinants and Consequences of Tuberculosis (TB) and Latent TB Infection (LTBI)

1. Treatment Adherence and Reactivation Risk: A study in northern Taiwan found that completing LTBI treatment substantially reduced TB reactivation risk—from 6.1% in untreated patients to 0.5% in those who completed therapy. Every 10% increase in adherence lowered risk by 23–24%.
2. High-Risk Populations for Poor Adherence: Older adults and individuals with comorbidities like diabetes, chronic kidney disease, cancer, and HIV were less likely to initiate or complete treatment, indicating a need for targeted interventions.
3. Mental Illness and TB Vulnerability: Patients with chronic psychiatric disorders showed a 1.48-fold higher risk of TB compared to matched controls, independent of diabetes or kidney disease. Risk was particularly elevated in those aged 65 and older.
4. Socioeconomic Influences: Lower income was inversely correlated with TB risk, highlighting how social determinants exacerbate vulnerability despite medical interventions.
5. Public Health Implication: Both adherence-focused LTBI management and targeted screening of mental health patients are critical to reducing TB burden in at-risk populations.

---

2. National and Structural Responses to TB Control

1. Taiwan’s Coordinated TB Strategy: Taiwan’s “End TB by 2035 Project” builds on earlier national programs, integrating mandatory reporting, electronic surveillance systems (NIDRS, LARS), and universal health coverage through the National Health Insurance system.
2. Healthcare Workforce and Support Systems: Over 700 case managers and 2,500 public health nurses support patients through Directly Observed Therapy (DOT) and eDOT, maintaining recurrence rates below 1% since 2008.
3. Legal and Financial Mechanisms: The “No Reporting, No Reimbursement” policy ensures mandatory TB reporting. Full reimbursement of TB-related care removes financial barriers, while targeted grants aid low-income patients.
4. Inclusion of Migrant Populations: Legal reforms since 2014 have allowed migrant workers with TB to remain for treatment, raising treatment retention from 10.6% to nearly 89% and improving notification rates above 96%.
5. Demographic Challenges and Policy Adaptation: With Taiwan’s aging population (18% aged 65+), TB control must adapt to demographic shifts that increase chronic comorbidities and reactivation risk, despite declining incidence and mortality rates.

---

3. Diagnostic Systems, Epidemiology, and Surveillance in Indonesia

1. Multi-Modal Diagnostic Framework: Indonesia employs clinical assessment, sputum AFB microscopy, culture, and rapid molecular methods (GeneXpert MTB/RIF). GeneXpert allows simultaneous detection of M. tuberculosis and rifampicin resistance.
2. Performance and Accessibility of Tests: Diagnostic sensitivities range from 70% (microscopy) to >99% (GeneXpert). However, molecular tests are limited to tertiary hospitals, restricting rural diagnostic capacity.
3. National Survey Findings: Secondary analysis across 34 provinces estimated a TB prevalence of 759.1 per 100,000 adults, with higher rates in men, urban residents, and older adults (≥65 years).
4. Regional and Age Variations: The “other islands” region recorded the highest culture-positive TB prevalence (2,129.8 per 100,000). Prevalence rose consistently with age and was highest in older adults and rural communities.
5. Systemic Challenges and Policy Measures: Despite structured diagnostic protocols, underreporting remains an issue. The Ministry of Health has introduced mandatory case notification, GeneXpert integration in prevalence surveys, and enhanced collaboration between private and public health sectors to strengthen detection and reporting.

References:

1.     Chien, Y.C., Chang, C.H., Shu, C.C., Wang, H.C. and Yu, C.J., 2025. Adherence to Tuberculosis Infection Treatment and its Impact on Prevention of Tuberculosis Reactivation: A Retrospective Cohort Study from Taiwan. Journal of Infection and Public Health, p.102917.

2.     Hung, L.C., Kung, P.T., Tsai, T.H., Tsai, W.C. and Huang, K.H., 2025. Risk Assessment of Tuberculosis in Patients With Chronic Mental Illness and Related Factors: A Population‐Based Cohort Study in Taiwan. The Clinical Respiratory Journal, 19(6), p.e70088.

3.     Chan, P.C., Chiang, C.Y., Lee, P.H., Lo, H.Y., Chu, P.W., Chen, J.J., Kato, S. and Raviglione, M.C.B., 2025. Assessing the impact of the TB response in Taiwan–the journey towards ending TB. IJTLD open, 2(5), pp.251-259.

4.     Susilawati, T.N. and Larasati, R., 2019. A recent update of the diagnostic methods for tuberculosis and their applicability in Indonesia: a narrative review. Medical Journal of Indonesia, 28(3), pp.284-91.

5.     Noviyani, A., Nopsopon, T. and Pongpirul, K., 2021. Variation of tuberculosis prevalence across diagnostic approaches and geographical areas of Indonesia. PLoS One, 16(10), p.e0258809.

(Yoseph L. Samodra) See also: https://idebeasiswa.com

TBN 001