JakartaGlobe External Web Site Policy, (11.19.2012)
Tjandra Yoga Aditama, director general of Disease Control and Environmental Health at Indonesia’s Health Ministry explained that patients’ lack of treatment adherence to the lengthy and rigorous TB treatment has led to the disease becoming stronger and more drug-resistant. An estimated 65,000 people in Indonesia have a strain of TB that is resistant to first-line treatment anti-tuberculosis drugs. Aditama, in an address to the 43rd World Conference of the International Union Against Tuberculosis and Lung Disease in Kuala Lumpur, noted that TB requires six to eight months of uninterrupted anti-tuberculosis drug treatment to bring about a cure. This requires the patient to take the drugs every day. He acknowledged that adherence is low for various reasons. The government provided free TB treatment for those who have been positively diagnosed, but for many people, taking the drugs daily for months was difficult and time-consuming. Also, they have to spend money on transportation to collect the drugs from the clinic, and they may have to leave their work to do so. Sometimes the patients feel better after two months and do not think they need to continue taking medication.
Lucica Ditiu, executive secretary of Stop TB Partnership, stated that patients sometimes stop treatment because of adverse side effects. Also, they find taking medication every day to be burdensome. When patients stop treatment, that is when the disease becomes multiple drug resistant (MDR), and when MDR TB is poorly treated, it can become extensively drug-resistant TB (XDR TB). Recovery for persons with MDR TB is projected to be 15 percent.
To date, 84 countries including Indonesia have reported XDR TB cases. A recent WHO report on the global burden of TB shows 450,000 cases of TB in Indonesia, with 65,000 MDR TB cases. Manica Balasegaram, executive director of Médecins sans Frontières Access Campaign, commented that MDR TB takes at least 24 months of treatment. The treatment is expensive and many patients suffer from severe adverse reactions to the drugs. Balasegaram stated that 60 percent of drug-resistant cases are in Southeast Asia and the western Pacific.
Aditama announced that Indonesia was developing a program to treat MDR TB patients in regional hospitals. Doctors and nurses are being trained at satellite hospitals to treat MDR TB patients after they have been diagnosed, but the diagnosis of MDR TB still has to be made at an accredited laboratory in a well-equipped hospital.