PUTUSKAN MATA RANTAI

PENULARAN TUBERKULOSIS DENGAN

ACTIVE CASE FINDING
Diah Handayani
 Pengendalian Pengendalian
Pengendalian sumber infeksi Pejamu
patogen lingkungan
Surveilens, Terapi adekuat
ventilasi vaksinasi
ACF dan presisi
Terapi segera Imun
DST kepadatan
TOSS boosting
Investigasi
isolasi Nutrisi
kontak dan TPT
Masker pada Berhenti
yang sakit merokok

Etika batuk ARV

APD

Pengendalian
komorbid
Insidens pada remaja → profilaksis, vaksin dan nutrisi
Insidens seriing kemiskinan dan malnutrisi (stunting0
FIG. 23
Global progress in the number of people treated for TB between 2018 and 2021, compared with
cumulative targets set for 2018–2022 at the UN high-level meeting on TB

TB TREATMENT TB TREATMENT
(ALL AGES) (CHILDREN)

Target:
26.3million Target:
1.9million
(66%) (54%)
40 million 3.5 million
2018–2022 treated in 2018–2022 treated in
2018–2021 2018–2021

MDR/RR-TB TREATMENT MDR/RR-TB TREATMENT

(ALL AGES) (CHILDREN)

Target:
649 000 Target:
17 700
(43%) (15%)
1.5 million 115 000
2018–2022 treated in 2018–2022 treated in
2018–2021 2018–2021

In 2021, 10 countries collectively accounted for 75%
of the global gap between estimated TB incidence and
the reported number of people newly diagnosed with
TB (Fig. 24). The top five contributors were India, Indo-
nesia, the Philippines, Pakistan and Nigeria (24%, 13%,
10%, 6.6% and 6.3%, respectively). Gaps are due to a
combination of underreporting of people diagnosed
with TB and underdiagnosis (owing to people with TB
being unable to access health care or not being diag-
nosed when they do). From a global perspective, e orts
to increase levels of case detection are of particular
importance in these countries.

FIG. 24
The ten countries with the largest gaps between notifications of new and relapse (incident) TB
cases and the best estimates of TB incidence, a,b 2021

China
Viet Nam

Philippines

Pakistan
Size of gap Nigeria India
India
China
Shouth Africa
SITUASI PROGRAM TBC
Capaian Indikator Program TBC Tahun 2017-2021
2017 2018 2019 2020 2021
Indikator
Target Capaian Target Capaian Target Capaian Target Capaian Target Capaian

Indikator
RPJMN
Insidensi tuberkulosis
(per 100.000 penduduk)
170 319 165 316 159 312 272 301 252 354
-

Indikator
Cakupan penemuan dan
Kinerja
pengobatan TBC (TBC 70% 53% 70% 67% 70% 67% 80% 47% 85% 36%
kegiatan
Treatment Coverage)
(IKK)

Indikator
Persentase angka
Kinerja
keberhasilan pengobatan 90% 86% 90% 85% 90% 83% 90% 83% 90% 78%
Program
TBC (TBC Success Rate)
(IKP)

Keterangan:
Insiden rate tahun 2021 belum tersedia 3
Data 2021 per 26 Nov 2021
 MCU-UU KEDOK
KERJA

SISTEM DATA BERBASIS

INVESTIGASI KELOMPOK RISIKO DIAGNOSIS DENGAN NIK
NIK

MODIFIKASI ALUR SKRINING

ALUR SKRINING-BPJS
DAN DIAGNOSIS
NOTIFIKASI
KASUS PPM BERBASIS
CXR
APLIKASI
JEJARING
DIAGNOSIS
“PAKET LAYANAN”
MIKROBIOLOGI
FRANCHISE LAYANAN TB TERUTAMA FKTP,
JEJARING
TERAPI

BIAYA LAYANAN TIDAK

LEBIH KECIL
 Ppm-tb Ro, Diagnosis
&Terapi
Cakupan Terapi Telekonsultasi Dalam Jejaring
TB RO RS

Jejaring Diagnosis
a. Algorit ma pemeriksaan ILTB dan pemberian TPT unt uk orang
yang berisiko

Gambar 3. Algoritma Pemeriksaan ILTB dan TPT pada Individu Berisiko

Sumber: WHO consolidat ed guidelines on t uberculosis: t uberculosis
(10)
 KONTAK SERUMAH

13
48 35

TB LATEN TB AKTIF TIDAK TB

air. High population density increases the and electricity, and nutritional intake with the 30 of 34 Firman Firdauz Saputra, et al / Jurnal Berkala Epidemiologi, 8 (1) 2020, 26 34

opportunities for interaction or contact between

JURNAL BERKALA EPIDEMIOLOGI
incidence of tuberculosis.
Volume 8 Nomor 1 (2020) 26-34
DOI: 10.20473/jbe.v8i12020. 26-34
p-ISSN: 2301-7171 ; e-ISSN: 2541-092X

people that increase the transmission of disease

Website: http://journal.unair.ac.id/index.php/JBE/
Email: jbe@fkm.unair.ac.id

SPATIAL MODELING OF ENVIRONMENTAL-BASED RISK FACTORS OF

TUBERCULOSIS IN BALI PROVINCE: AN ECOLOGICAL STUDY
Pemodelan Spasial Faktor Risiko berbasis Lingkungan Kejadian Tuberkulosis di Provinsi Bali : Studi

Table 1
Ekologi

Firman Firdauz Saputra1, Chatarina Umbul Wahjuni2, Muhammad Atoillah Isfandiari3

1
E Ma P a Fac P b cH a ,Universitas Airlangga, FirmanFirdauz@gmail.com
Source : BPS Bali Province, (2018); Dinkesprov Bali (2018)

Figure 4. Healthy House and Incidence of Tuberculosis in the District/City of Bali Province in 2017

Spatial error test results of a risk factor model for the incidence of tuberculosis in Bali Province
2
3
Departement of Epidemiology, Faculty of Public Health,Universitas Airlangga,chatarina.uw@fkm.unair.ac.id
Departement of Epidemiology, Faculty of Public Health, Universitas Airlangga, muhammad-a-
i@fkm.unair.ac.id
Corresponding Author: Chatarina Umbul Wahjuni, chatarina.uw@fkm.unair.ac.id, Departement of

Variable SE Z
Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, East Java, 60115, Indonesia

ARTICLE INFO ABSTRACT

Article History: Background: Indonesia is one of countries with a quite high

Constant
Received July, 8th, 2019
Revised form July, 17th, 2019
Accepted January, 21st, 2020
Published online January,28th , 2020
1612.57 184.03 8.76
incidence of tuberculosis. One of the regions which has issue of
0,00
tuberculosis incidence is Bali Province with a case notification rate
that tends to increase in the last three years so that it has an impact on
increasing the risk of disease transmission. Purpose: This research

Kadar PM10
Keywords:
tuberculosis;
spatial;
0.96 0.09 9.90
aims to identify the risk factor based on the environment/spatial
incidence of the tuberculosis in Bali Province. Methods: This
research used ecological study design through secondary data
0,00* Source : BPS Bali Province, (2018); Dinkesprov Bali (2018)

Figure 5. Particulate Matter 10 and Incidence of Tuberculosis in the District/City of Bali Province in 2017
obtained from the Health Office of Bali Province, Indonesian

Kemiskinan
bali;
risk factors;
spatial error model -2.56 1.44 -1.77
Statistics of Bali Province, and Environmental Office of Bali
Province. The dependent variable was tuberculosis incidence, while 0,07*
the independent variable was the level of PM 10, population density,
There were two assumptions that must be
fulfilled before conducting the spatial regression
test, which were spatial autocorrelation (Moran I
tuberculosis in Bali Province (Table 1). The model
formed was as follows:

Kata Kunci: poverty percentage, healthy house percentage, percentage of Clean test) in the regions and spatial heterogeneity ŷi = 1612,57+ 0,96 * PM 10 Level + 0,04 *

Perilaku Hidup Bersih dan Sehat Keluarga

tuberkulosis;
spasial;
bali;
-3.09 0.51 -6.00 0,00*
and Healthy Lifestyle (PHBS), ratio of healthcare facilities with the
community. Results: The statistical model was obtained in the form
of Spatial Error Model (SEM) with model i=1612,57+ 0,96 * level
(Breusch-Pagan ). T M a
test carried out was 0.02 (p<a), between adjacent
locations that tended to have similar values and
I Population Density - 2,56 * Poverty - 0,58 *
Healthy House - 3,09 * Clean and Healthy
Lifestyle (PHBS) - 0,006 * Health Center, where
faktor risiko lingkungan; groups. The Breusch-Pagan test result showed μi = 0,90 .

Rumah Sehat
model spasial error
-0.58 0.21 -2.77
house - 3,099 * PHBS - 0,006 * health care facility, where i = 0,90
0,00*
of PM10 + 0,04 * population density - 2,56 * poverty - 0,58 * Healthy

. Conclusion: The risk factor spatially affected the

tuberculosis incidence in Bali Province, which were the factors of
p=0.099 > a=0.10, so it could be concluded that
there was a spatial diversity. The determination of
the best spatial model needed to be done using the
The spatial model above can be explained that
if the PM10 level factor rises by 10 digits and other
Lagrange Multiplier (LM) test. The result

Fasilitas Kesehatan -0.00 0.00 -6.66 0,00*

level of PM10, population density, poverty percentage, healthy house
percentage, percentage of PHBS, and ratio of healthcare facilities
with the community.
indicated the Lagrange multiplier (lag) was not
significant (0.78 > 0.1), while the Lagrange
multiplier (error) test was carried out significantly
(0.00 > 0.1). The LM test result showed that the
factors are constant, the number of tuberculosis
cases increase by 9.60. If the population density
factor increases by 100 points and other factors are
constant, the number of tuberculosis cases increase
by 4. If the poverty factor decreases by 10 points

Kepadatan Penduduk
How to Cite (APA): Saputra, F. F.,
ABSTRAK
0.04 0.00 12.09 0,00*
©2020 Jurnal Berkala Epidemiologi. Published by Universitas Airlangga.
This is an open access article under CC-BY-SA license
(https://creativecommons.org/licenses/by-sa/4.0/)
best spatial model that could be done is Spatial
Error Model (SEM).
Based on the result of the Spatial Error Model
(SEM) analysis, it was known that all variables
and other factors are constant, the number of
tuberculosis cases would reduce by 3. If the
healthy house factor decreases by 10 points and
Wahjuni, C.U., & Isfandiari, M. A. other factors are constant, the number of

Lamda
(2020). Spatial modeling of
environmental-based risk factors of
tuberculosis in Bali Province: an
ecological study. Jurnal Berkala
0.90 0.06 13.52
Latar Belakang: Indonesia merupakan salah satu negara dengan
angka insidens penyakit tuberkulosis yang cukup tinggi. Salah satu
wilayah yang memiliki masalah terkait angka kejadian kasus
0,00 were spatially related to the incidence of tuberculosis cases increase by 6. If the PHBS
factor decreases by 1 number and the other factors

Epidemiologi, 8(1), 26-34. tuberkulosis adalah Provinsi Bali dengan case notification rate yang

*significance p<a (0.01), = 0.959379

https:/dx.doi.org/10.20473/
jbe.v8i12020.26-34
cenderung meningkat dalam 3 tahun terakhir sehingga berdampak
pada meningkatnya risiko penularan penyakit. Tujuan: Penelitian ini
 HIV-negative household contacts (kontak serumah HIV-negatif)
§ Anak < 5 tahun tanpa HIV kontak serumah dengan pasien terkonfirmasi
TB dan tidak ada tanda TB aktif sebaikny amendapatkan terapi pencegahan
TB Laten. (Strong recommendation, high-quality evidence. Updated
recommendation)
§ Pada negara dengan insiden TB rendah, evaluasi sistematik penyakit TB
dan TB Laten pada kontak serumah perlu dilakukan dan diberikan terapi
ITBL. (Strong recommendation, high–moderate-quality evidence. Existing
recommendation)
§ Pada negara dengan beban TB tinggi , anak dan dewasa kontak serumah
dengan pasien TB terkofirmasi bakteriologi perlu dievaluasi TB aktif, bila
tidak perlu diberikan terapi pencegahan (Conditional recommendation,
low-quality evidence. New recommendation)
§Pasien mendapat terapai anti-TNF,
§hemodialysis,
§Pasien calon penerima donor organ
§Pasien dengan silikosis, dengan terlebih dahulu disingkarkan kemungkinan TB
aktif, dengan membedakan ITBL dan bukan dengan TB aktif (Strong
recommendation, low–very low-quality evidence. Updated recommendation)
§ Pada negara dengan insidens TB rendah, perlu evaluasi systematis unntuk
menetukan ITBL dan segera memberikan terapi ITBL pada warga binaan di
penjaara, tenaga kesehatan (nakes), imigran dari negara dnegan insiden TB,tuna
wisma, dan penggunan napza (Conditional recommendation, low–very low-
quality evidence. Existing recommendation)
§Orang dengan gagal ginjal , diabetes tidak menjadi prioritas TPT
▪ Data kontak belum dilakukan di faskes
▪ Stigma di masyarakat
▪ Penolakan dari pasien dan keluarga
▪ Alur penemuan ITBL rumit dan berbiaya
▪ Fasilitas penegakan ITBL TIDAK ADA DI FASKES PRIMER
▪ Fasilitas terapi iTBL tidak merata
▪ Informasi ITBL , IK pada kader belum merata
▪ Biaya pemeriksaan tanggung jawab siapa
▪ Informasi dan stigma masyarakat
▪ Informasi komunitas /tomas/toga
▪ Informasi nakes belum merata
▪ Sarana prasarana
▪ Biaya pemeriksaan → CXR?, igra? Tst?
 Grebek Rumah

Profilaksis Masif TPT (VIT D, INH)

PENGENDALIAN KOMORBID

Terapi
Pencegahan Masif Perbaikan Lingkungan

Peningkatan Gizi Masyarakat

Support Ekonomi

Edukasi Masyarakat/Menghapus Stigma

▪ Skrining online --> self skrining
▪ Jejaring online → SITB
▪ Konsultasi online → cohor TB antar faskes
▪ Artificial intelligent
 RISET
BEBAN TB
AKADEMISI

DINAS
KESEHATAN
/SUBDIT

PROBLEM AKADEMISI
LEMBAGA RISET
RISET
TB AKADEMISI

SPONSOR
 Penemuan kasus
Pencegahan dengan
secepat mungkin
TPT pada TB laten
merupakan langkah
juga prevensi
penting dalam
sekunder
pemberantasan TB

Perlu penguatan
Penggabungan
sistem, Teknik,
keduanya dapat
pengetauan ,
dilakukan dengan
kesadaran dalam
ACF
ACF