Tuberculosis Prophylaxis Drug : Challenging Problem In Indonesia
Respirology Division Child Health Department CiptoMangunkusumo Hospital Faculty of Medicine Universitas Indonesia
The WHO estimates that almost 1.7 billion people globally have latent TB infection (LTBI). Recently, Indonesia is the second rank of high burden country for TB cases. In 2017 WHO predicted that there were almost 1 million new TB cases every year in Indonesia. The childhood TB proportion is about 10 % of the adult cases. Thus to overcome this problem, Indonesian government released a strategy to eradicate tuberculosis through ministry of health regulation (No 67, 2016). One of the strategy is to give tuberculosis prophylaxis drug for children < 5 years old or people with HIV. This strategy has been implemented by inserting TB prophylaxis drug into national technical guidance for childhood TB in 2016. The collaboration between national TB program (NTPs) with Indonesian Pediatric Society to disseminate the guideline has already been done since then. However, the coverage of TB prophylaxis drug in Indonesia is still very low (27% in 2017). Barriers to preventive therapy include (1) the perceived inability to rule out active disease (2) poor adherence with long preventive treatment (3) fear of creating drug resistance (4) non-implementation of existing guidelines in the absence of adequate monitoring. To overcome these problem, there is a need for better collaboration between paediatricians, NTPs and Maternal and Child Health initiatives in TB endemic countries to improve detection and management of children with TB, otherwise the End TB strategy will never be achieved.
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