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"ABSTRACTTuberkulosis merupakan salah satu dari banyak penyakit dengan biaya kesehatan yang mahal baik untuk pasien maupun keluarga pasien. Tuberkulosis menyebabkan peningkatan biaya kesehatan, kehilangan pendapatan, dan kehilangan produktifitas bagi pasien untuk bekerja. Penelitian ini menggunakan analisis potong lintang untuk mengetahui perbandingan biaya kesehatan katastropik pasien TB tanpa resistensi obat dengan pasien TB dengan resistensi obat di Jakarta Timur. Dari 159 subjek, diperoleh 97 61 subjek TB tanpa resistensi obat dan 62 39 subjek TB dengan resistensi obat. Dari uji Mann-Whitney didapatkan perbedaan yang bermakna.

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ABSTRACTTuberculosis is one of many diseases with a costly health care either for patients or families in general. Tuberculosis causes an increase in health care costs, loss of income, and productivity losses for patients to work. This study used an cross sectional analysis to compare catastrophic health expenditures in TB patients without drug resistance and in TB patients with drug resistance in East Jakarta. From a total of 159 subjects, obtained 97 subjects 61 suspected TB without drug resistance and 62 subjects 39 suspected TB with drug resistance. In Mann Whitney test, there was a significantly different."

"Penyakit tuberkulosis merupakan salah satu penyakit dengan prevalensi tinggi di Indonesia. Selama proses pemeriksaan pre-diagnosis hingga pengobatan tuberkulosis, banyak biaya yang dikeluarkan pasien tuberkulosis, mulai dari biaya langsung dan biaya tidak langsung yang dapat berdampak terhadap kondisi ekonomi penderita tuberkulosis. Selain itu, pada penyakit tuberkulosis dapat timbul permasalah berupa resistensi terhadap obat anti-tuberkulosis multi-drug resistance tuberculosis yang membutuhkan regimen pengobatan yang berbeda dengan tuberkulosis sensitif. Penelitian ini bertujuan untuk membandingkan pasien tuberkulosis sensitif dan pasien tuberkulosis resistensi obat pada aspek biaya tidak langsung maupun biaya langsung non-medis. Penelitian ini dilakukan dengan pendekatan cross-sectional, sebanyak 156 pasien tuberkulosis diwawancarai dengan mengunakan kuesioner tentang pembiayaan selama mengalami tuberkulosis. Pada hasil uji statistik diperoleh nilai p pada variabel biaya suplementasi p=0,031 , transportasi pre-diagnosis.

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Tuberculosis is one of the disease with high prevalence in Indonesia. Through out the inspection process pre diagnostic to the treatment process of tuberculosis, the patients need to spend a lot of money for the costs, consist of the direct costs and indirect costs that may have an impact for the patients rsquo economic conditions. In addition, many problem may arise in the form of resistance to anti tuberculosis drugs multi drug resistance which require another treatment regimens. The aim of this study is to compare between drug sensitive tuberculosis patients and multi drug resistance tuberculosis patients in the aspect of indirect and direct non medical cost. This research was conducted in a cross sectional model and 156 tuberculosis patients were interviewed by using a questionnaire to know their financing during tuberculosis treatment process. In the statistical test, p values was obtained for different variables, consist of cost supplementation p 0.031, transportation during pre diagnostic phase."

"Indonesia masuk kedalam Negara dengan tiga beban TB tertinggi, salah satunya adalah TB-MDR. Persentase kematian pada pasien TB-MDR selama masa pengobatan di Indonesia melebihi batasan target WHO yaitu 10. Penelitian ini bertujuan untuk mendapatkan faktor-faktor yang berhubungan dengan kematian pada pasien Tuberkulosis Multi Drug Resistance TB-MDR selama masa pengobatan di Indonesia tahun 2010-2014. Desain penelitian yang digunakan adalah studi cross sectional menggunakan data sekunder registrasi kohort e-TB Manager Surveilans TB Resistan Obat 2010-2014. Variabel independen pada penelitian ini meliputi faktor kerentanan individu usia, jenis kelamin, komorbid diabetes mellitus, jumlah resistansi OAT, hasil pemeriksaan sputum di awal pengobatan, faktor kerentanan sistem kesehatan riwayat pengobatan TB sebelumnya dan interval inisiasi pengobatan, dan faktor kerentanan sosial wilayah tempat tinggal. Variabel dependen pada penelitian ini adalah hasil akhir kematian pada pasien TB-MDR. Hasil penelitian didapatkan bahwa terdapat hubungan bermakna antara usia dengan kematian pada pasien TB-MDR selama masa pengobatan.

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Indonesia is one of the countries in three high burden country list, partially MDR TB. The presentation of mortality among MDR TB patients during treatment in Indonesia is above WHO target which is 10. This study aimed to describe the epidemiological and factors associated with mortality among MDR TB patients during treatment in Indonesia from 2010 through 2014. The study was conducted with cross sectional using secondary data cohort registration e TB Manager Surveillance of TB Drugs Resistance 2010 2014.

Independent variables of this study were individual vulnerability age, sex, diabetes mellitus comorbidities, number of drugs resistance, initial sputum test, programmatic or institutional vulnerability previous history of TB treatment and interval of treatment, and social vulnerability living status. Dependent variable of this study was the end of treatment result for mortality among MDR TB patients. The results indicated that age associated with mortality among MDR TB patients during treatment."

"Tuberkulosis masih merupakan masalah kesehatan masyarakat di dunia. Hasil akhir pengobatan TB pada pasien berupa kematian saat melakukan pengobatan merupakan permasalahan terkini yang perlu diselesaikan. Penyebab pasti terjadinya kematian pada pasien yang sedang menjalani pengobatan TB masih belum banyak di ketahui. Tujuan penelitian ini adalah untuk mengetahui perbedaan faktor-faktor yang berhubungan dengan kematian pasien tuberkulosis pada penderita TB MDR dan TB Sensitif Obat di Indonesia tahun 2015-2017. Penelitian dilakukan dengan menggunakan data sekunder dari aplikasi eTB manager dan SITT di Subdit Tuberkulosis, Direktorat Pencegahan dan Pengendalian Penyakit Menular Langsung (P2PML) - Direktorat Jenderal Pencegahan dan Pengendalian Penyakit (P2P), Kementerian Kesehatan RI. Desain penelitian adalah cohort retrospective. Jumlah sampel dalam penelitian ini sebanyak 1.150 pasien TB MDR dan 12.296 pasien TB SO. Insiden rate kematian kasus TB MDR adalah 4,7 per 1000 orang-bulan, sementara itu insiden rate kematian kasus TB SO adalah 8,4 per 1000 orang-bulan. Dari penelitian ini diketahui bahwa pada kasus TB MDR variabel umur pada titik potog waktu <24 bulan diperoleh HR 1,72 (IK95% 1,18 - 2,52), sedangkan variabel umur pada titik potong waktu ≥24 bulan diperoleh HR 1,28 (IK95% 0,18 - 9,17). Pada kasus TB SO, umur diperoleh HR 1,88 (IK95% 1,57 – 2,27). Status HIV pada titik potog waktu <13 bulan diperoleh HR 4,20 (IK95% 3,43 – 5,14), sedangkan titik potog waktu ≥13 bulan diperoleh HR 9,03 (IK95% 2,58 – 31,61). Diperlukan penanganan secara intensif pada pasien TB MDR dan TB SO di Indonesia dengan HIV positif. Kata kunci: Tuberkulosis, resisten ganda, kematian.

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Tuberculosis is still a public health problem in the world. The final outcome of TB treatment in patients consisting of death while taking treatment is a consideration that needs to be addressed. The exact cause of death in patients who are undergoing TB treatment is not much approved. The purpose of this study was to study the differences in factors associated with the death of tuberculosis patients in patients with drug sensitive and multidrug resistant tuberculosis in Indonesia in 2015-2017. The study was conducted using secondary data from the application of eTB managers and SITT in the Tuberculosis Subdistrict, Directorate of Direct Transmission Prevention and Control - Directorate General of Disease Prevention and Control, Ministry of Health of the Republic of Indonesia. The study design was a retrospective cohort. The number of samples in this study were 1,150 MDR TB patients and 12,296 drug sensitive patients. The mortality rate from MDR-TB is 4.7 per 1000 person-months, while the mortality rate from MDR-TB is 8.4 per 1,000 person-months. From this study, it was found that in the MDR TB case the age variable at the time point of <24 months was obtained by HR 1.72 (IK95% 1.18 - 2.52), while the age variable at the intersection time waktu24 months was obtained by HR 1.28 ( IK95% 0.18 - 9.17). In drug sensitive TB cases, HR 1.88 (IK95% 1.57 - 2.27) was obtained. HIV status at the time point <13 months was obtained by HR 4.20 (IK95% 3.43 - 5.14), while the point of interest at ≥13 months was HR 9.03 (CI 95% 2.58 - 31.61). MDR and drug sensitive TB in Indonesia are HIV positive. Keywords: Tuberculosis, multiple resistance, death."

"Faktor spiritualitas merupakan faktor yang krusial dalam memengaruhi kualitas hidup pasien Tuberkulosis resisten obat (TB-RO), selain faktor fisik, psikologi, sosial, dan lingkungan. Penelitian ini bertujuan untuk mengetahui hubungan antara tingkat spiritualitas dengan kualitas hidup pasien TB-RO. Penelitian deskriptif komparatif dengan pendekatan potong lintang ini melibatkan 134 pasien poliklinik TB-RO di Rumah Sakit Paru dr. M. Goenawan Partowidigdo Cisarua yang dipilih dengan teknik purposive sampling. Tingkat spiritualitas diukur dengan kuesioner WHO-SRPB dan kualitas hidup diukur dengan WHOQOL BREF. Hasil uji Chi Square menunjukkan ada hubungan antara tingkat spiritualitas dan kualitas hidup pada pasien TB-RO (x2 = 26,435; p<0,001). Hasil penelitian ini juga menunjukkan bahwa responden dengan tingkat spiritualitas rendah berisiko 7,988 kali memiliki kualitas hidup rendah.Faktor lain yang juga berhubungan dengan kualitas hidup pasien TB-RO yaitu dengan usia (x2 = 5,468 ; p = 0,019) ; jenis kelamin (x2 = 38,311; p<0,001), status pernikahan (x2 = 6,269; p = 0,012), penghasilan keluarga (x2 = 23,141; p<0,001), riwayat merokok masa lalu (x2 = 41,909; p<0,001). Penelitian ini merekomendasikan bidang keperawatan untuk menyusun Standar Operasional Prosedur mengenai pemberian asuhan keperawatan spiritual dan perawat diharapkan dapat melibatkan keluarga untuk meningkatkan kualitas hidup pasien TB-RO.

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Spirituality are a crucial factor in influencing the quality of life of Multiple drug-resistant tuberculosis patients (MDR-TB), in addition to physical, psychological, social, and environmental factors.This study aimed to determine the relationship between the spirituality level and the quality of life of MDR-TB patients in the MDR TB clinics at dr. M. Goenawan Partowidigdo Lungs Hospital. This study used a comparative descriptive with a cross sectional design approach with a sample of 134 patient and use the purposive sampling technique. The study employed the WHO-SRPB questionnaire to determine the patient's spirituality level, and WHOQOL BREF to determine the patient's quality of life. The results of the study showed a significant relationship between the spirituality level and quality of life (x2 = 26.435; p = 0.001); respondents with low spirituality levels are at a risk of 7.988 times more likely to have low quality of life. Other factors that are also related to the quality of life of TB-RO patients are age (x2 = 5,468 ; p = 0,019); gender (x2 = 38,311; p = 0,001); mariage status (x2 = 6,269; p = 0,012); family income (x2 = 23,141; p = 0,001), past smoking history (x2 = 41,909; p = 0,001). This study recommends the Manager of nursing to develop Operational Standards Procedures regarding the provision of spiritual nursing care and nurses are expected to involve families to improve the quality of life of TB-RO patients."

"Berdasarkan data SITB per 2 Februari 2022, terdapat 8306 kasus TB-RR/MDR terkonfirmasi melalui pemeriksaan laboratorium. Keberhasilan pengobatan TB MDR di Indonesia tahun 2021 belum mencapai target dan termasuk rendah dibandingkan dengan global yaitu sebesar 45%. Penelitian bertujuan mengidentifikasi faktor-faktor yang berhubungan dengan keberhasilan pengobatan pasien TB MDR di RSUP Persahabatan tahun 2019. Penelitian ini menggunakan desain studi kohort retrospektif. Penelitian menggunakan data sekunder dari rekam medis pasien TB MDR yang berobat di RSUP Persahabatan tahun 2019 yang dilihat sejak awal pengobatan hingga didapatkan hasil akhir pengobatan. Terdapat 273 sampel yang sesuai kriteria inklusi dan eksklusi. Data dianalisis menggunakan IBM SPSS Statistics 25 dengan uji chi-square, dengan RR untuk mengetahui derajat hubungan antar variabel dan dan p < 0,05 sebagai batas kemaknaan. Pada hasil analisis diketahui umur (p=0,000; RR=1,603 95CI% 1,251–2,055), jenis kelamin (p=0,749; RR=1,045 95CI% 0,798–1,369), pendidikan (p=0,165; RR=1,228 95CI% 0,929–1.634), pekerjaan (p=0,298; RR=0,893 95CI% 0,8723–1,103), status pernikahan (p=0,000; RR=1,932 95%CI 1,318–2,833), wilayah tempat tinggal (p=0,092, RR=1,288 95%CI 0,933–1,779), hasil pemeriksaan sputum awal (p=0,272; RR=1,126 95%CI 0,911–1,191), interval inisiasi pengobatan (p=0,021; RR=0,698 95%CI 0,494–0,986). Faktor yang memiliki hubungan signifikan secara statistik dengan keberhasilan pengobatan adalah umur, status pernikahan, dan interval inisiasi pengobatan.Based on SITB data as of February 2, 2022, there were 8306 confirmed cases of RR/MDR TB through laboratory tests. The success of MDR TB treatment in Indonesia in 2021 has not reached the target and is low compared to global, which is 45%. This study aims to identify factors associated with successful treatment of MDR TB patients at Persahabatan Hospital in 2019. This study used a retrospective cohort study design. The study used secondary data from the medical records of MDR TB patients who were treated at the Friendship Hospital in 2019 which were seen from the beginning of treatment until the final results of treatment were obtained. There were 273 samples that met the inclusion and exclusion criteria. Data were analyzed using IBM SPSS Statistics 25 with chi-square test, with RR to determine the degree of relationship between variables and p < 0.05 as the limit of significance. The results of the analysis showed that age (p=0.000; RR=1.603 95CI% 1.251–2.055), gender (p=0.749; RR=1.045 95CI% 0.798–1.369), education (p=0.165; RR=1.228 95CI% 0.929– 1.634), occupation (p=0.298; RR=0.893 95CI% 0.8723–1.103), marital status (p=0.000; RR=1.932 95%CI 1.318–2.833), area of ​​residence (p=0.092, RR=1.288 95%CI 0.933–1.779), results of initial sputum examination (p=0.272; RR=1.126 95%CI 0.911–1.191), treatment initiation interval (p=0.021; RR=0.698 95%CI 0.494–0.986). Factors that had a statistically significant relationship with treatment success were age, marital status, and treatment initiation interval."

"Pendahuluan : Kerusakan paru yang luas dan riwayat pemakaian antibakteri jangka panjang merupakan faktor risiko yang meningkatkan angka kejadian kolonisasi jamur. Kedua hal ini terjadi pada pasien TB paru MDR. Meningkatnya kasus TB MDR di Indonesia akan meningkatkan risiko terjadinya kolonisasi jamur di paru. Penelitian ini untuk mengetahui profil kolonisasi jamur pada pasien bekas TB paru MDR.Metode : Penelitian potong lintang terhadap pasien yang telah dinyatakan sembuh dari TB paru MDR dari tahun 2009-2015, yang kontrol ke Poli TB MDR RSUP Persahabatan selama bulan November-Desember 2015. Dengan menggunakan teknik consecutive sampling maka ditentukan sebanyak 61 subjek yang kemudian dilakukan induksi sputum. Hasil sputum induksi kemudian dilakukan pemeriksaan sputum jamur langsung dan biakan jamur dalam media Saboraud Dextrose Agar.Hasil : Subjek berusia antara 19-76 tahun. Dari 61 pasien , kelompok usia terbanyak antara usia 35-50 tahun sebnayak 28 orang (45,9%) diikuti usia kurang dari 35 tahun 23 orang (37,7%) dan usia lebih dari 50 tahun sebanyak 10 orang (16,01%). Sebanyak 28 orang (45,95) IMT normal, 17 orang IMT berlebih dan 16 orang (26%) IMT kurang. Sebanyak 28 subjek (45,9%) mempunyai riwayat merokok. Spektrum kolonisasi jamur pada pasien bekas TB paru MDR adalah 42 orang (68,9%) kolonisasi jamur positif dengan 29 orang (47,5) spesies C. albicans, 6 (9,8%) kombinasi C. albicans dan C. tropicalis, 2 orang (3,3%) masing-masing As flavus dan kombinasi C. albicans dan C. krusei serta masing-masing 1 orang (1,6%) spesies C. tropicalis, C. parapsilosis dan kombinasi C. albicans+C. parapsilosis.Kesimpulan: Kolonisasi jamur pada pasien bekas TB paru MDR tinggi dan harus diawasi dan harus dievaluasi untuk membedakan antara kolonisasi atau penyakit serta diobati untuk meningkatkan kualitas hidup pasca pengobatan TB MDR.

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Introduction : Extensive lung damage and long term history of using antibacterial drugs are a risk factor that increase the incidence of fungal colonization. Both of these occurred in patients with pulmonary MDR TB. The increasing cases of MDR TB in Indonesia will increase the risk of fungal colonization in the lung. This study is to determine the profile of fungal colonization in post MDR TB patients.

Methods: This cross sectional study included patients who had been cured by the doctor in 2009-2015 and came to MDR Clinic from November-Desember 2015 in Persahabatan Hospital to check up. Sixty one patients were decided by consecutive sampling. From each patient, sputum induction for sputum fungal smear and fungal culture using Sabaraud Dextrose Agar.

Results: The age range of patients are between 19 to 76 years old. Out of 61 patients, among those group 45,9% are between the age of 35-50 years , 37,7% below the age 35 years old and 16,4% above age 50 years old. Twenty eight patients have normal body mass index, 17 patients are overweight and 16 patients are underweight. Number of patients who have smoking history are 45,9%. The spectrum of positive fungal colonization in post pulmonary MDR TB patients were 42 subjects (68.9%) consist of 29 subjects (47.5%)were Candida albicans, 6 subjects (9.8%) were combination of C. albicans and C. tropicalis, 2 subjects (3.3%) respectively were Aspergillus flavus and combinations of C. albicans and C. krusei. The others were C. tropicalis, C. parapsilosis and C. albicans + C. parapsilosis combination were 1 subject (1.6%) respectively.

Conclusion: Fungal colonization in post pulmonary MDR TB patients is high and should be monitored and must be evaluated to distinguish between colonization and disease and treated to improve quality of life post-treatment of MDR TB."

"[ABSTRAK Multi Drug Resitance Tuberculosis (MDR TB) merupakan masalah terbesar dalampencegahan dan pemberantasan TB dunia. Indonesia berada di peringkat 8 dari 27 negaradengan MDR TB terbanyak di dunia. WHO Global Report 2013, memperkirakan pasienMDR TB di Indonesia berjumlah 6.900 pasien. MDR TB adalah penyakit yangdisebabkan oleh Mycobacterium Tuberculosis yang resisten minimal terhadap rifampisindan isoniazid. Penelitian ini berfokus pada bagaimana pengalaman pasien menjalanipengobatan Multi Drugs Resistance Tuberculosis dan seperti apa pasien memaknaipengalamannya tersebut. Desain penelitian kualitatif fenomenologi dipilih untukmendapatkan informasi yang sifatnya individual secara mendalam sesuai pengalaman dankondisi penyakit yang dialami. Partisipan ditentukan dengan tehnik purposive sampling,berjumlah tujuh orang. Tehnik wawancara mendalam dilakukan menggunakan alatperekam dan panduan wawancara semiterstruktur, serta catatan lapangan. Analisa datamenggunakan qualitative content analysis dengan pendekatan Collaizi. Tema yangditemukan sebagai hasil penelitian yaitu : Pemahaman penyakit MDR TB;ketidaknyamanan saat menjalani pengobatan Multi Drugs Resistance Tuberculosis;hambatan penderita untuk sembuh, menerima dukungan, dan harapan pengobatan.Diperlukan studi lebih lanjut untuk mengkaji secara mendalam tema yang telahteridentifikasi pada jumlah partisipan yang lebih banyak dan bervariasi.ABSTRACT Multi Drug Resistant (MDR - TB ) is the biggest problem of TB prevention and

eradication in the world. Indonesia is ranked 8 of 27 countries with MDR-TB in the

world. WHO global reported 2013, estimated MDR-TB patients in Indonesia amounted to

6.900 patient. MDR-TB is caused by Mycobacterium tuberculosis that resistant to at least

rifampicin and isoniazid. This study will focus on how the experience of undergoing

treatment of Multi Drugs Resistance Tuberculosis and patient?s insight of the experience.

Phenomenological qualitative research design was choosen to obtain information that is

significantly individual according to the experience. Participants were determined by

purposive sampling technique to seven people. In-depth interview conducted using a

recorder and semi-structured approach. Themes found as a result of the research : the

understanding of MDR TB; the experience discomfort while undergoing treatment of

Multi Drugs Resistance Tuberculosis; difficulties experienced during treatment; the

support received during treatment; and client expectations. Further study is needed to

profoundly examine the themes that have been identified on more numerous and varied

participants, Multi Drug Resistant (MDR - TB ) is the biggest problem of TB prevention and

eradication in the world. Indonesia is ranked 8 of 27 countries with MDR-TB in the

world. WHO global reported 2013, estimated MDR-TB patients in Indonesia amounted to

6.900 patient. MDR-TB is caused by Mycobacterium tuberculosis that resistant to at least

rifampicin and isoniazid. This study will focus on how the experience of undergoing

treatment of Multi Drugs Resistance Tuberculosis and patient’s insight of the experience.

Phenomenological qualitative research design was choosen to obtain information that is

significantly individual according to the experience. Participants were determined by

purposive sampling technique to seven people. In-depth interview conducted using a

recorder and semi-structured approach. Themes found as a result of the research : the

understanding of MDR TB; the experience discomfort while undergoing treatment of

Multi Drugs Resistance Tuberculosis; difficulties experienced during treatment; the

support received during treatment; and client expectations. Further study is needed to

profoundly examine the themes that have been identified on more numerous and varied

participants]"