International collaboration to eradicate TB in Indonesia

"The world has made defeating AIDS a top priority. This is a blessing. But TB [tuberculosis] remains ignored. Today we are calling on the world to recognize that we can't fight AIDS unless we do much more to fight TB as well," the late South African president Nelson Mandela once warned the world.

Dr. Lucica Ditiu from the Stop TB Partnership confirmed Mandela's statement, saying that TB was the second most deadly disease after HIV/AIDS. Many HIV/AIDS positive people have also been diagnosed with TB.

"Forty-six percent of people with TB were tested for HIV in 2010 alone," said Ditiu in a recent international media workshop here in Geneva.

The meeting was organized by the Global Fund to Fight AIDS, Tuberculosis and Malaria, which represents 82 percent of all international donors funding for TB.

According to Ditiu, around one in three people with TB cannot be reached by the current healthcare system. Poverty and stigma are strongly related to the disease. They have little knowledge about TB and its dangers, and health facilities are often out of reach.

"Weak recording and reporting systems are also big problems in many countries," said the medical doctor.

There are also problems of multi-drug resistance (MDR)-TB, meaning many patients cannot be cured just by the standard medication. They need special drugs and two-year consecutive treatment.

"The drug resistance-TB treatment will [hopefully be able to] be cut from two years to only six months," said Ditiu.

Indonesia is home to the world's fourth-largest TB cases. An international cooperation and assistance are much-needed. Last week, delegations from the Bill and Melinda Gates Foundations, the Global Fund visited Persahabatan Hospital and two community health centers (Puskesmas) in Jakarta.

They were hosted by the Tahir Foundation, chaired by business tycoon Dato' Sri Tahir, who contributed US$65 million to the Global Fund last year. It was a part of an agreement signed with the Gates Foundation last year. Gates and Tahir set up the Indonesian Health Fund.

Doctors at the hospital explained their problems in treating TB patients. "Many patients refuse or are reluctant to seek treatment due to concerns over leaving their jobs, as TB treatment requires strict daily procedures. Some also refuse treatment due to the fear of being stigmatized by the public," said Erlina Burhan, the head of MDR-TB at Persahabatan Hospital in East Jakarta.

According to Erlina, a patient must adhere to a strict nonstop regiment lasting up to 24 months involving pills and various testing, and the reason the disease remains as prevalent as it is, is because of external factors.

Persahabatan Hospital is the largest respiratory center in the country. Over the years, the hospital has seen people from outside Java, such as Pontianak, Medan, and Papua come for treatment, further noting that out-of-town patients make up the majority of patients at the hospital.

One of the hospital's current patients is SA, a 28-year-old from Jambi. He has been receiving treatment for his MDR-TB of the lungs at Persahabatan since May 2013 and is reportedly one-month away from being cured. The father of three's daily regiment includes taking 18 to 25 pills per intake and has to spend his time outdoors in a special area designated by the hospital, as sunlight allegedly kills the TB bacteria.

"I am also a diabetic, so I have an even higher daily pill intake, as I also receive insulin injections," SA told The Jakarta Post. His tuberculosis was classified as MDR by the doctors at the hospital.

Most TB patients that have sought treatment at Persahabatan since 2009 are mostly between 25 and 34 years of age, which Erlina calls "the productive age" group, and says that the disease affects those of all economic backgrounds.

"It most likely will get worse if the same obstacles, such as stigma, affect those who are supposed to seek treatment," she said.

About 47.28 percent of MDR-TB patients at Persahabatan have been cured as of 2011 after going through their two-year regiments, while more than a quarter have defaulted on their treatment.

"We are working to support the Indonesia Health Fund in developing a drug that will help shorten the regiment for TB treatment, therefore making the treatment process more efficient," Gates Foundation senior program officer Jennifer Alcorn told the Post .

Meanwhile, Tahir believed that community health centers could help raise awareness on the importance of seeking treatment and on how to spot someone with TB, so that preventive measures to avoid infection were taken.

"This is the first time that we have ever directly worked with institutions [such as health centers]. Why is that? Because their tidy and planned-out organizational system shows discipline and commitment," Tahir said.

source: http://www.thejakartapost.com