{"database":"biostudies-literature","file_versions":[],"scores":null,"additional":{"omics_type":["Unknown"],"volume":["22"],"submitter":["Lestari BW"],"funding":["University of Otago","Radboudumc"],"pubmed_abstract":["<h4>Background</h4>In Indonesia, drug resistance testing for TB largely relies on Xpert MTB/RIF, and it is unknown what proportion of drug-resistant (DR) TB is adequately diagnosed and treated.<h4>Methods</h4>We conducted a cascade of care analysis on a cohort of presumptive rifampicin-resistant (RR) TB patients registered in 2015-2018 in a tertiary hospital in Indonesia. Estimated incidences of (presumptive) DR-TB cases were assumption-based using global reports. Data on diagnosis and consecutive cascades steps, including their timing were collected from national electronic registers, and medical records. We described a secondary cascade for patients receiving treatment not supported by phenotypic drug susceptibility testing (pDST). Factors associated with delay and loss between diagnosis and treatment were identified using logistic regression.<h4>Findings</h4>Less than a third of estimated incident TB cases at risk of DR-TB were identified as presumptive DR-TB case and tested, and 9.8% (982/10,065) of estimated true DR-TB cases was diagnosed. Of those diagnosed, only 45.1% (443/982) had treatment regimens supported by pDST results, but this did not significantly influence treatment outcomes. Only 25.5% (250/982) of diagnosed patients completed all steps of the cascade including successful treatment. Delays between diagnosis and treatment were substantial, and more common among those referred from a primary healthcare facility, and among those who were employed, living outside of Bandung, and reporting engagement with the private sector.<h4>Interpretation</h4>The DR-TB care cascade in this urban setting in Indonesia is characterized by substantial attrition and delays. Strategies to increase access to DR-TB diagnosis accompanied by optimisation of clinical care could substantially improve outcomes and reduce onward transmission.<h4>Funding</h4>Radboud university medical center and University of Otago."],"journal":["The Lancet regional health. Southeast Asia"],"pagination":["100294"],"full_dataset_link":["https://www.ebi.ac.uk/biostudies/studies/S-EPMC10934335"],"repository":["biostudies-literature"],"pubmed_title":["Management of drug-resistant tuberculosis in Indonesia: a four-year cascade of care analysis."],"pmcid":["PMC10934335"],"pubmed_authors":["Andriyoko B","Lestari BW","Chaidir L","Hill PC","Larasmanah A","Santoso P","van Crevel R","Alisjahbana B","Nijman G","Soeroto AY"],"additional_accession":[]},"is_claimable":false,"name":"Management of drug-resistant tuberculosis in Indonesia: a four-year cascade of care analysis.","description":"<h4>Background</h4>In Indonesia, drug resistance testing for TB largely relies on Xpert MTB/RIF, and it is unknown what proportion of drug-resistant (DR) TB is adequately diagnosed and treated.<h4>Methods</h4>We conducted a cascade of care analysis on a cohort of presumptive rifampicin-resistant (RR) TB patients registered in 2015-2018 in a tertiary hospital in Indonesia. Estimated incidences of (presumptive) DR-TB cases were assumption-based using global reports. Data on diagnosis and consecutive cascades steps, including their timing were collected from national electronic registers, and medical records. We described a secondary cascade for patients receiving treatment not supported by phenotypic drug susceptibility testing (pDST). Factors associated with delay and loss between diagnosis and treatment were identified using logistic regression.<h4>Findings</h4>Less than a third of estimated incident TB cases at risk of DR-TB were identified as presumptive DR-TB case and tested, and 9.8% (982/10,065) of estimated true DR-TB cases was diagnosed. Of those diagnosed, only 45.1% (443/982) had treatment regimens supported by pDST results, but this did not significantly influence treatment outcomes. Only 25.5% (250/982) of diagnosed patients completed all steps of the cascade including successful treatment. Delays between diagnosis and treatment were substantial, and more common among those referred from a primary healthcare facility, and among those who were employed, living outside of Bandung, and reporting engagement with the private sector.<h4>Interpretation</h4>The DR-TB care cascade in this urban setting in Indonesia is characterized by substantial attrition and delays. Strategies to increase access to DR-TB diagnosis accompanied by optimisation of clinical care could substantially improve outcomes and reduce onward transmission.<h4>Funding</h4>Radboud university medical center and University of Otago.","dates":{"release":"2024-01-01T00:00:00Z","publication":"2024 Mar","modification":"2026-06-25T03:14:43.287Z","creation":"2026-06-25T03:07:44.364Z"},"accession":"S-EPMC10934335","cross_references":{"pubmed":["38482149"],"doi":["10.1016/j.lansea.2023.100294"]}}