[Indonesia] Fighting TB means eradicating poverty

from The Jakarta Post

The fear of an avian influenza pandemic has tended to overshadow the fight against other diseases, such as HIV/AIDS and tuberculosis (TB). Indonesia has the third highest prevalence of TB in the world after India and China, with around 600,000 patients currently being treated and nearly 300 people dying daily from the disease. In line with World TB Day which falls on March 24, the World Health Organization's chief officer on tuberculosis in Indonesia Firdosi R. Mehta gave an interview to The Jakarta Post's Hera Diani.

Question: How alarming is the TB situation in Indonesia?

Answer: The prevalence rate has been reduced by about 40 percent since 1990, and the case detection rates or the number of smear-positive (infectious) cases detected every year has increased from 20 percent to 66 percent.

However, the number of cases is still alarming. An estimated almost quarter million, or 240,000 cases of all forms of TB occur every year.

Based on the 2004 household survey in 22,000 households in 30 provinces, there were big differences between eastern part of Indonesia, Java/Bali region and Sumatra. The national prevalence was 119, prevalence in Sumatra was 182, Java/Bali was 67 and Eastern Part was 250. Basically, there is a lot of TB in the eastern part, while the population is low over there.

In Sub-Saharan Africa, TB is being driven by HIV, and has become the common secondary infection with AIDS. Is that the case here?

It is not the case in Indonesia, but a glimpse of it is starting and we have to act now. HIV as you know is not a generalized problem in this country, it is a concentrated epidemic or mainly occurs in groups with high risk behavior, that is injecting drug users and commercial sex workers.

But in Papua, HIV is heading toward a generalized epidemic. In (provinces with a high HIV prevalence) Papua, Riau, Bali, West Java, East Java, and Jakarta, it appears that HIV is slowly having an impact on TB.

Has the government done enough to fight the disease?

I categorically say yes. The DOTS (Directly Observed Treatment Short Course), which sees health care workers closely monitoring patients to ensure they complete a short course of powerful drugs, is working well here. From 1997 through 2005, more than a million patients have been treated. Indonesia has contributed 5 percent of the number of cases treated in the world. This speaks well of the program as the number of patients treated drastically increases every year. There is no problem of drug availability either.

But many challenges remain. First of all, is the expansion of the hospital sector, because up to now, whatever has been achieved is mainly through implementing the TB program through the network of community health centers.

There are 1,200 hospitals, but only 29 percent have adopted the DOTS program. We need to empower the hospitals through training, equipment, monitoring, and supervision.

The second problem is addressing the problem of TB connected with HIV and multi drug resistance.

The last constraint is sustainable funding. We need to mobilize the local administrations to invest more to increase the government contribution. So far, the total cost for the TB program is $57 million per year. It is well funded basically, but it definitely needs more commitment and ownership at the local level.

TB is a disease of poverty. Fighting TB means fighting poverty.

Are there any success stories from other countries that we can learn from?

Peru has managed to come out of the list of 22 high burden countries, but only because the population there is low, unlike Indonesia.

However, Indonesia, and all members of the medical profession here, need to understand that anything that India, China and Indonesia do, contributes to accelerate the success of global efforts to control TB. Hopefully, we can meet the target of cutting global infections in half by 2015, and eliminate TB by 2050.