Indonesia is one of the countries with the highest burden of tuberculosis (TB) in the world. Approximately 800,000 new cases of TB are estimated to occur each year, with a death toll of 93,000 per year. Indonesia has implemented recommended methods in running its TB control program. However, the achievements are still far from expectations, with a national case detection rate of only 67% in 2018.
Rapid reduction in incidence can be achieved by implementing all control strategies simultaneously and on a large scale. Case finding, diagnosis, treatment, and prevention need to be carried out intensively and on a large scale. These efforts should cover all age groups, employ effective methods, and involve all stakeholders, including those outside the health sector.
ZeroTB Yogyakarta is a TB control initiative based on three elements: active case finding, effective treatment, and prevention of TB among household contacts. This initiative aims to reduce TB cases in Yogyakarta by developing and implementing comprehensive activities involving multiple sectors. The target is to decrease TB cases by 50% within five years.
The program is implemented in the Special Region of Yogyakarta (DIY). This province, with a population of 3,618,084 people (as of the first trimester of 2018), experiences a continuously increasing number of TB cases each year, as indicated by data from the DIY Health Office from 2014 to 2017. In 2017, the actual number of TB cases detected and treated in DIY was only 3,225, which is lower than the Ministry of Health’s target of 3,513 cases. The success rate of TB treatment was 83.3%, still below the target of 85%.
Initially, the ZeroTB Yogyakarta program was implemented in two areas: Gondomanan Sub-district in Yogyakarta City and Samigaluh Sub-district in Kulon Progo Regency. With an effective model evaluation and financial support, the program can be expanded to other areas.
In general, the ZeroTB Yogyakarta program is implemented by forming cross-sectoral networks to combat TB in Yogyakarta. Additionally, ZeroTB Yogyakarta increases case finding through mass active case finding and the use of more accurate diagnostic tools, including a mobile chest X-ray unit equipped with other diagnostic examinations (such as genXpert machines and mantoux tests) that visits communities. TB screening is prioritized among populations at high risk, such as densely populated settlements, slum areas, healthcare workers in healthcare facilities, and hospital residents.
The overall activities adopting the “find, treat, and prevent” approach will be evaluated for their effectiveness in terms of implementation and funding. The results will be handed over to the National TB Program for implementation in other regions. This contribution from ZeroTB Yogyakarta is part of the efforts to achieve an end to TB in Indonesia.