Abstract for Case Report

Reaching unreported case: Effectiveness of Active Surveillance,

Overview of hospital visit of supported CTB provinces.
NS Aminah1*, PD Sahanggamu1, T Salman1, Soelistyo2, HS Nasution2
1
Challenge TB Project, KNCV Tuberculosis Foundation, Jakarta, Indonesia
2
National Tuberculosis Program, Ministry of Health, Indonesia
*Corresponding Author: nenden.aminah@kncvtbc.org, ph.; 081388672059

Background: In 2018, the NTP has set the target to find 675,173 TB patients while as of
July 2018, only 157,074 patients are reported in the SITT along two quarter of 2018.
Inventory study conducted by NTP in 2017 mentioned that overall under-reporting TB
cases in Indonesia was 41%, while based on health facilities, under-reporting TB cases in
Puskesmas was 15%, hospitals 62%, and the laboratory, GP’s and clinic was 96%.
Based on data of Hospital Information System (HIS), directorate general of health services
2017, there are 450,000 TB cases reported by hospitals throughout Indonesia and around
300,000 came from 6 provinces supported by CTB. From data TB monitoring of Challenge
TB Project (CTB), hospitals was contributed 53% of TB case finding in 2016. This requires
urgent action to actively find under reported TB patients at the hospitals (public and
private) and primary care level.

Case: CTB supporting activities in finding the missing patients at the hospital lead by NTP
called active surveillans. Hospital selected by number of case reported by HIS and routine
report. Active surveillance conducted in 6 province which are: North Sumatera, DKI
Jakarta, West Java, Central Java, East Java and Papua. The activities lasts from Aug-Sep
2018, covered 380 Hospitals at 121 districts. Additional cases achieved from the activities
was 70,676 cases. Gap of the case finding showed at the graph below:

Gap of Target and Case Finding TB 2018 (Routine and Active Surveillance) 6 CTB
Supported Province
80%
60%
40%
20%
0%
DKI West Java Central Java East Java Papua North
Sumatera
CTB supported Districts Non CTB supported Districts
Discussion: Active surveillance succeed to found the missing patients at the hospitals,
contributed to almost 40% of all notification in CTB supported provinces. However, clear
guideline and training of data officers/enumerators should be part of the activities, to avoid
miss data collection. Main challenge is to ensure the TB case collected is not suspect or
other cases related to miss categorized of ICD X. From data validation which done at 36
hospitals in East Java province, there are 25% of cases categorized as TB known to be non-
TB.
Summary: Active surveillance in hospital could be use as one of ways to solve under
reporting TB cases problem. However, it must be followed up with clear guideline and
treatment outcome monitoring mechanism. NTP needs to coordinate further with
directorate general of health services as the PIC of the Hospital Information System, to
establish a mechanism for recording TB treatment outcome through the HIS.

Keyword: Active Surveillance TB, Hospital Information System, NTP, KNCV,