“I pity the TB patient”: a mixed methods study assessing the impact of the COVID-19 pandemic on TB services in two major Indonesian cities and distilling lessons for the future
Penulis/Author
dr. Yusuf Ari Mashuri, M.Sc. (1); dr. Yanri Wijayanti Subronto, Ph.D., Sp.PD-KPTI (5); Marco Liverani (6); dr. Luh Putu Lila Wulandari, MPH, Ph.D (7); dr. Riris Andono Ahmad, MPH, Ph.D (8); Prof. dr. Hasbullah Thabrany, MPH, Dr.PH (9); John Kaldor (11); Prof. dr. Ari Probandari, MPH, Ph.D (12); Virginia Wiseman (13)
Tanggal/Date
2024
Kata Kunci/Keyword
Abstrak/Abstract
ABSTRACT
Introduction In Indonesia, a country with around
280million people and the second-highest tuberculosis
(TB) incidence rate in the world, the impact of the
COVID-19 pandemic on TB care needs careful assessment
so that future response strategies can be strengthened.
We conducted a study comparing TB testing and treatment
rates before and during the first 2 years of the COVID-19
pandemic in Indonesia, and the reasons for any disruptions
to care.
Methods We conducted retrospective secondary data
analysis and qualitative interviews in Yogyakarta and
Bandung, Indonesia. Routine data on TB testing and
treatment were sourced from the national TB information
system operated by the Indonesian Ministry of Health.
TB testing and treatment outcomes were compared
between two time periods: pre-COVID (2018–19); and
during COVID-19 (2020–21). In-depth interviews were
conducted with patients and health workers to explore
their experiences in accessing and providing TB services
during the pandemic.
Results There was a 45% (21 937/39 962) reduction in
the number of patients tested for TB during the pandemic
compared with pre-COVID-19, while the proportion of
TB tests returning a positive result increased from 12%
(4733/39 962) to 50% (10 945/21 937). The proportion
of TB patients completing treatment increased by 2.6%
during the pandemic, yet the proportion cured and the
number of patients successfully treated both decreased
(by 7% and 4.4%, respectively). Our qualitative interviews
highlighted several factors influencing TB service access
and delivery, including fear of being diagnosed with
COVID-19 during TB-related clinic visits, fear of COVID-19
exposure among patients and health workers, healthcare
facilities prioritising COVID-19 over other services, and
mandatory mobility restrictions affecting both patients and
health workers.
Conclusion The COVID-19 pandemic impacted TB testing
and treatment outcomes in Bandung and Yogyakarta.
