Currently, diabetes mellitus (DM) is increasing in populations at high risk of contracting tuberculosis (TB). Patients with DM have an increased risk of developing pulmonary TB, especially in high-risk groups. Although active case finding and increased reporting in health facilities are very important, private sector involvement in TB control remains low due to fragmentation and inadequate funding.
In the era of digital transformation, in efforts to control TB in Indonesia, many technology-based applications have been created to simplify the process of reporting TB notifications. One of them, the Indonesian Ministry of Health built a Tuberculosis Information System (SITB) which is the main software in the system for recording and reporting TB cases in Indonesia. Even though it is used by all stakeholders from primary to secondary health facilities, access to SITB is still limited and the system is not well integrated. To overcome this challenge, an e-screening tool is needed to efficiently integrate TB screening into existing diabetes screening so that TB notifications in private First Level Health Facilities (FKTP) can increase.
Based on this background, Malahayati Rusli Bintang conducted research aimed at identifying the determinants of TB disease nationally through analysis of Riskesdas data in 2013 and 2018 with the target population, namely patients with a history of DM which will then be used as a screening guide and as reinforcement in creating an information system and digital transformation in the form of e-screening. This research became a dissertation with the title “Design of an E-Screening Tool for Tuberculosis in Diabetes Mellitus Patients in an Effort to Increase Tuberculosis Notifications in Private First Level Health Facilities (FKTP)” which was defended in the open session for the promotion of the FPH UI Doctor of Public Health Sciences (IKM) on Wednesday, January 3, 2023.
This research uses a mixed exploratory sequential approach, which combines quantitative and qualitative methods in stages. This research consists of 3 stages, namely the first stage uses a quantitative approach and the second and third stages use a qualitative approach. In the first stage, an analysis of the determinants of TB in DM patients was carried out using Riskesdas 2013 and 2018 data. Then in the second stage an analysis/evaluation was carried out regarding the implementation of the TB notification process in private FKTPs and in stage 3 a process of dissemination of the draft policy for TB screening models in DM patients was carried out using policy cycle approach.
The results of phase I research showed that the variables of cancer diagnosis, smoking history, availability of private hospitals, and availability of doctors’ practices/clinics had a statistically significant relationship with the incidence of TB in DM patients. The results of the multivariate test showed that cancer was a predictive factor in the incidence of pulmonary TB in DM sufferers. The results of phase 2 research show that not all private FKTPs have independent SITBs which causes recording and reporting of TB cases to become a finding belonging to the community health center, which has an impact on the low number of TB notifications in private FKTPs. The results of phase 3 research show that improving TB notification in private FKTP can be done by designing a TB e-screening tool with a 6T TB cascade approach. The 6T TB cascade is suspected, notified, diagnosed, treated, controlled, and protected.
By integrating JKN Mobile, E-RM, P-Care and SITB in the form of SATUSEHAT partners, and supported by adequate human resources, infrastructure, and financing, it is hoped that it can increase TB notifications in private FKTPs so that it can reduce the death rate or morbidity rate due to TB in patients DM.
“The 6T cascade, namely suspected, notified, diagnosed, treated, controlled and protected, is the result of findings created by Bintang through his research. This cascade aims to optimize the use of technology in TB control and improve TB notifications at private FKTPs to maximize TB-DM case discovery and treatment. “This is very extraordinary considering that Brother Bintang really started from zero, from not understanding the conditions in Indonesia at all because he studied abroad for a long time, to becoming someone who really understands the problem of TB in Indonesia,” said Promoter, Prof. Dr. Adang Bachtiar, M.P.H., D.Sc., in his speech.
Based on the results of his dissertation, Provendus, born 27 August 1993, who completed his studies in 5 semesters, was successfully declared a Doctor in the field of Public Health Sciences with cum laude predicate. Malahayati Rusli Bintang is the 2nd IKM doctoral graduate in 2024, the 298th IKM doctoral graduate, and the 384th doctoral graduate at FPH UI.
This doctoral promotion open session was chaired by Prof. Dr. Kemal N. Siregar, S.K.M., M.A., Ph.D., as Chair of the Session, with Promoter Prof. Dr. Adang Bachtiar, M.P.H., D.Sc., and Co-Promoter Prof. Dr. Dr. Fachmi Idris, M. Kes. Meanwhile, the examining team consists of Prof. Dr. Dr. Rizanda Mahmud, M.Kes., SpKKLP.; Prof. Dr. Drg. Mardiati Nadjib, M.S.; Prof. Dr. Ali Ghufron Mukti, M.Sc., Ph.D., AAK.; Dr. Dr. Achmad Farich, M.M.; and Dr. Pujiyanto, S.K.M., M.Kes. (wrk)