Depok, August 1st 2023. Treatment of Drug Sensitive Tuberculosis (DS-TB) cases using a combination of standard anti-tuberculosis drugs (OAT) for six months has proven to be an effective strategy in managing this disease. However, it is difficult to ensure that patients adhere to the treatment for six months when this influences the success of treatment and prevents the occurrence of drug resistance.
One of the researchers from the Faculty of Medicine (FK) Universitas Indonesia (UI), Dr. dr. Erlina Burhan, M.Sc, Sp.P(K), saw the need to find an alternative combination of OAT with a shorter duration while still maintaining its effectiveness. According to her, this is a priority considering the high increase in cases of Drug-Resistant Tuberculosis (DR TB) which threatens global and national progress in eliminating TB by 2030.
DR TB or Drug-Resistant TB is a condition where a person is infected with the same type of TB germs/bacteria, but is resistant to first-line TB drugs. DR TB cannot be treated with ordinary TB drugs, but must be treated with a combination of drugs or second-line OAT. DR TB cases occur because patients do not regularly take OAT according to health workers’ guidelines; the patient stops treatment unilaterally before the time determined by the doctor; or the patient experiences impaired drug absorption.
In Indonesia, in 2021 the estimated DR TB cases were 28,000 with details of 2.2% coming from new cases and 25% from re-treatment cases. The estimated incidence of these cases is 24,000 or 8.8/100,000 population. Meanwhile, in 2022, around 12,531 Rifampicin-Resistant TB patients were found and reported nationally, with 8,089 (65%) patients starting second-line TB treatment. The low rate of initiation of DR TB treatment is one of the main obstacles in controlling DR TB.
Through a research collaboration led by Nicholas Paton, MD, FRCP from the National University of Singapore, Dr. Erlina and her team conducted clinical trial research called Two-Month Regimens Using Novel Combinations to Augment Treatment Effectiveness for Drug-Sensitive Tuberculosis (TRUNCATE-TB). The results of the research were presented at the UI and the TRUNCATE-TB Team Clinical Trial Study Appreciation event, on Monday (31/7), in the IMERI Hall of FKUI Salemba, Jakarta, and was also attended by the Dean of FKUI, Prof. Dr. dr. Ari Fahrial Syam, SpPD-KGEH, MMB.
In her presentation, Dr. Erlina said that the TRUNCATE-TB treatment strategy using a reinforced OAT combination for two months showed non-inferiority compared to the standard treatment combination. This means that giving medication to patients, which was originally given for six months, can be shortened to two months. These findings open new avenues for DS-TB treatment, especially with the application of operational research which provides the opportunity to link clinical trial results and programmatic implementation in the real world.
“This evaluation can provide valuable insight into the effectiveness, acceptability, and safety of this treatment strategy as a step in establishing a nationally accepted government program. In addition, this research can help identify challenges and potential solutions to increase treatment adherence and improve outcomes for DS-TB patients,” said Dr. Erlina.
Meanwhile, regarding the control and management of DR TB in Indonesia, one of the policies that must be implemented is DR TB management with a patient-centered approach. Based on data collected by the national TB program, one of the reasons why patients do not start DR TB treatment is because the health service facilities for DR TB treatment are far from where the patient lives. Therefore, DR TB treatment services must be more accessible and as close to the patient as possible.
To ensure the continuity of DR TB treatment, collaboration is needed between hospitals and health centers implementing DR TB services and the community health centers/health facilities closest to the patient’s residence. The national TB program plans to strengthen community health centers which are currently DR TB satellite health facilities to have the capacity to initiate DR TB treatment.
Submission of research results by Dr. Erlina was accompanied by a presentation of material from a representative of the Ministry of Health of the Republic of Indonesia, namely dr. Imran Pambudi, MPHM as Director of Infectious Disease Prevention and Control; and Dr. Dra. Lucia Rizka Andalucia, Apt., M.Pharm, MARS as Director General of Farmalkes. The two discussed the situation of TB cases in Indonesia and the government’s current strategy; as well as Indonesia’s readiness to implement various drug innovations and tools for the successful elimination of TB.
