Tough challenges such as increasing drug-resistant patients, face the country in the fight against tuberculosis, despite Indonesia’s ambitious target to eliminate the disease by 2050.
“We are on the right track. We have a detection rate of more than 70 percent and a success rate of 85 percent,” Iwan Mulyono, the Health Ministry director of directly transmissible diseases controlling division, said Friday in Jakarta.
However, the ministry, along with other stakeholders in the fight, such as private healthcare providers and the community, may face more difficult challenges, including vulnerability due to HIV/AIDS and drug-resistant patients, in the future.
Currently, as many as 300 people die from tuberculosis each day in the country.
The 2008 World Health Organization (WHO) report revealed that the prevalence rate of tuberculosis cases in Indonesia was 253 out of 100,000 citizens. In 1990, the rate reached 438 out of 100,000 citizens.
“HIV/AIDS is a burdening [factor]. HIV is a problem because tuberculosis is an opportunistic infection,” Iwan said.
People carrying the HIV virus have a 60 percent chance of catching tuberculosis, much higher compared to the 10 percent chance of those not infected.
The mortality rate due to tuberculosis for people with HIV/AIDS is 20 percent, while the percentage for those without is 5.
According to last year’s data from the National AIDS Commission (KPA), around 298,000 people in Indonesia live with HIV.
Another challenge in the fight is the prevalence of multi-drugs resistant tuberculosis or MDR-TB, a type of tuberculosis that cannot be treated using commonly used drugs.
MDR-TB and extensively drug-resistant tuberculosis, or XDR-TB, do not respond to the first six-month’s of treatment using first line anti-tuberculosis drugs.
A news release from the WHO mentioned that in 2008, an estimated 440,000 people globally had MDR tuberculosis and a third of them died.
A new record of 28 percent of people diagnosed with tuberculosis in a region of north western Russia in 2008 had MDR tuberculosis.
There are currently 27 countries highly burdened with MDR tuberculosis. These are countries estimated to have had at least 4,000 MDR tuberculosis cases arising annually and/or at least 10 percent of newly registered tuberculosis cases with MDR tuberculosis. “Indonesia is eigth among 27 of the highly burdened countries,” Iwan said.
Erlina Burhan, Indonesian Lung Doctor Association (PDPI) chairwoman, said that the increasing cases of MDR tuberculosis might also be medical specialists fault.
“There are several possibilities: The drug combination may not be according to standards, the dosage may not be according to standards, or third, the patient may have stopped taking the drugs prematurely,” she said.
According to Erlina, doctors should inform patients about the consequences of stopping the drugs prematurely. The usual treatment period spans for six months.
“After two months of taking the drugs, patients stop experiencing tuberculosis symptoms such as weight loss and coughing,” she said.
Retnowati Widiatuti, the Association of Patients and People Concerned with Tuberculosis chairwoman, said patients should responsibly consume the drugs and avoid contact with others. (dis)
