1. National TB Program Indonesia 1 TB Epidemic DOTS HIV Epidemic

2. National TB Program Indonesia 2 Average age male/female patients 2003 data (Lowest mean age in provinces with high HIV prevalence)

3. National TB Program Indonesia 3

4. 4

5. 5 Urban TB clinic (PPTI) 2004:  TB patient  44 IDU  VCT  22 (50%) HIV+  11 (50%) SS- 1 Sep 2004 – 31 Aug 2005:  641 TB patient  VCT  147 (23%) HIV(+)  90% SS(-)

6. National TB Program Indonesia 6

7. 7 < 50% 50 – 80% 81 – 100% 100% Medical Doctors Paramedics Lab Technician Trained Health Center Staff per Province mid 2005 LEGEND : % Trained to Standard

8. National TB Program Indonesia 8 Hospital distribution (absolute numbers)

9. National TB Program Indonesia 9 Summary of hospital distribution & involvement TOTAL 213,722,300125929724

10. National TB Program Indonesia 10

11. National TB Program Indonesia 11 Involving all health facilities and all provider  increasing Case Notification Warning!!  Treatment Success

12. National TB Program Indonesia 12 “DOTS” SAT Cured47 (19.75%)97 (7.28%) Complete82 (34.45%)470 (35.26%) Failed4 (1.68%)4 (0.3%) Drop out88 (36.9%)670 (50.26%) Move17 (7.14%)67 (5.03%) Died 0 0 Others 0 25 (1.88%) Total no of cases2381333 Persahabatan Hospital Retrospective Study July 1999 – June 2001 3

13. National TB Program Indonesia 13 Lung hospital and clinics low success rate Percent of TB-patients who were cured or completed treatment, by province, 2002 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Aceh N Sumatra W Sumatra Riau Jambi S Sumatra Babel BengkuluLampung Banten Jakarta W Java C Java Yogyakarta E Java W Kalimantan C KalimantanS Kalimantan E Kalimantan N Sulawesi Gorontalo C Sulawesi S Sulawesi SE Sulawesi Bali NTB NTT Maluku N Maluku Papua BP4-RS proportion of cohort Completed Cured

14. National TB Program Indonesia 14 Lung hospital and clinics low success rate

15. National TB Program Indonesia 15 Proportion of Case Notified by Health Clinics & Lung Clinics/Hospital

16. National TB Program Indonesia 16

17. National TB Program Indonesia 17 Treatment-seeking practices of patients with history of TB (Prevalence survey 2004)

18. National TB Program Indonesia 18 Towards 70% case-detection Indonesians when sick go to Puskesmas (60%-urban and 70% rural) TB services are available and 'gratis' BUT BUT: Perception population= “puskemas are for poor” Treatment seeking to services  regional differences Weak ACS capacity at province/ district level   We need to build capacity of DOTS teams to promote TB services Health-seeking behaviors: The percentage of people with TB symptoms who have the intention to seek treatment…

19. National TB Program Indonesia 19 Knowledge about TB Source of TB information Urban-Rural differences

20. National TB Program Indonesia 20 = GFATM= DUTCH GOVT.= KNCV + + USAID + GF-ATM (Q9) = CIDA + USAID+ GF-ATM (Q9) = TBCTA/ USAID Donor Support to Provinces – phased expansion Q5 2004 (GF 19 provs) Q4 2004 (GF 16 provs) Q9 2005 (GF 21 provs) Q1 - Q3 2003 (GF 8 provs)

21. National TB Program Indonesia 21 WHO-Recommended Global Strategy to Stop TB and Reach the 2015 MDGs 1.Pursuing quality DOTS expansion and enhancement  Political commitment  Case detection through bacteriology  Standardised treatment, with supervision and patient support  Effective drug supply system  Monitoring system and impact evaluation Stop TB Department Additional components: 2Addressing TB/HIV and MDR-TB 3. Contributing to health-system strengthening 4. Engaging all care providers 5. Empowering patients and communities 6. Enabling and promoting research

22. National TB Program Indonesia 22 Budgeting Indonesia’s TB-Control Program propose to the GF-Rnd5

23. National TB Program Indonesia 23 Jawa-BaliSumatraKTI Population130.995.50046.984.30041.162.000 Incidence107/100.000160/100.000210/100.000 Expected Number of SS(+) 140.16575.17586.440 Notified Number of SS(+) 58.05025.95628.711 Sisa82.11549.21857.729 Potential cases by region