Need the national representative MDR-TB survey in Indonesia:

lesson learned from sentinel-based surveillance in 2012

Dyah Erti Mustikawati1, Muhammad N. Farid2, Pandu Riono3,
(1) NTP Indonesia, (2) Tuberculosis Operation Research Group (TORG)/BPS
Statistics Indonesia, (3) TORG/Faculty of Public Health, University of Indonesia

Background
Anti-tuberculosis (TB) drug resistance is
an emerging serious public health
problem that threatens progress made in
TB control in Indonesia. Multi-Drug
Resistant (MDR-TB) cases were notified
increasingly in some referral hospitals in
the past 5-year, especially among new
registered TB patients. NTP has been
conducted sentinel-based surveillance in
few locations to monitor the trend of TBMDR occurrence.

Methods

Among new registered patients, prevalence of

any Isoniazid, Rifampicin, Ethambutol, and
Streptomycin resistance were 9.6% (CI=6.013.2%), 2.5% (CI=1.0-4.0%), 2.1% (CI=0.53.6%), and 5.7% (CI=4.0-7.4%), respectively.
The prevalence of MDR-TB among new
registered and retreated patients were 1.6%
(CI=0.4-2.8%) and 20.8% (CI=2.5-39.0%).
Comparing sex, prevalence of MDR-TB
among males was higher than females in both
new registered and retreated patients. Among
new patients, prevalence among males and
females were 2.3% (CI=0.1-4.5%) and 0.6%
(CI=0.1-1.9%), respectively, while among
retreated patients, prevalence among males
and females were 28.0% (CI=1.6-54.4%) and
14.8% (CI=0.1-31.3%), respectively. MDR-TB
cases among new registered patients were
more likely young adults while among
retreated cases were more likely old people.
Comparing to 2009 data in the same location
(i.e., East Java province), there was no
different of MDR-TB prevalence among new
registered patients (2009, 2.0% (CI=1.03.0%); 2012, 2.3% (CI=0.5-4.0%)). However,
among retreated patients, the prevalence was
increased from 9.7% (CI=5.6-13.8%) in 2009
to 30.4% (CI=4.9-56.0%).

The proposed districts of

the national representative survey

The selected districts of

the 2012 DR Surveillance

Sentinel-based of 22 health facilities in 4

provinces had been selected. In those
selected sites, 527 eligible TB cases had
participated. Among them, 491 (93.2%)
has information on Drug Sensitivity
Testing (DST) results. Out of 491 cases,
437 (89%) were new registered patients,
53 (10.8%) were retreated patients, and 1
(0.2%) was unknown treatment history.
Patient and health facility data were
analyzed and adjusted for clustering
effect.

Results

Conclusions
Based on sporadic sites, there is strong
evidence that MDR-TB has emerged in
Indonesia. We need more accurate
information that reflected a real problem in
national level. Urgent need to conduct a
national representative MDR-TB survey in
Indonesia in the near future with more
districts selected.

References
(1) WHO (2009). Guidelines for surveillance of drug resistance in
tuberculosis 4th ed. WHO/HTM/TB/2009.422
(2) WHO (2010). Multidrug and extensively drug-resistant TB
(M/XDR-TB): 2010 global report on surveillance and response.
WHO/HTM/TB/2010.3
(3) Levy, P. S. and Lemeshow, S. (1999). Sampling of Populations:
Methods and Applications 3rd ed. John Wiley & Sons, Ltd.
(4) Lehtonen, R. and Pahkinen, E. (2004). Practical Methods for
Design and Analysis of Complex Surveys 2nd ed. John Wiley &
Sons, Ltd.
(5) Farid, M. N. and Frerichs, R. R. (2007). CSurvey 2.0: Software
and Manual. Dept. of Epidemiology, SPH, UCLA Los Angeles