DOI QR코드

DOI QR Code

Knowledge and Attitudes of Indonesian General Practitioners Towards the Isoniazid Preventive Therapy Program in Indonesia

  • Winardi, Wira (Department of Pulmonology and Respiratory Medicine, School of Medicine, Universitas Syiah Kuala) ;
  • Nalapraya, Widhy Yudistira (Faculty of Medicine, Universitas Islam Bandung) ;
  • Sarifuddin, Sarifuddin (Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Tadulako University) ;
  • Anwar, Samsul (Department of Statistics, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala) ;
  • Yufika, Amanda (Department of Family Medicine, School of Medicine, Universitas Syiah Kuala) ;
  • Wibowo, Adityo (Department of Pulmonology and Respiratory Medicine, School of Medicine, Universitas Lampung) ;
  • Fadhil, Iziddin (Faculty of Medicine, Universitas Abulyatama) ;
  • Wahyuni MS, Hendra (Faculty of Medicine, Universitas Malikussaleh) ;
  • Arliny, Yunita (Department of Pulmonology and Respiratory Medicine, School of Medicine, Universitas Syiah Kuala) ;
  • Yanifitri, Dewi Behtri (Department of Pulmonology and Respiratory Medicine, School of Medicine, Universitas Syiah Kuala) ;
  • Zulfikar, Teuku (Department of Pulmonology and Respiratory Medicine, School of Medicine, Universitas Syiah Kuala) ;
  • Harapan, Harapan (Medical Research Unit, School of Medicine, Universitas Syiah Kuala)
  • 투고 : 2022.05.30
  • 심사 : 2022.07.05
  • 발행 : 2022.09.30

초록

Objectives: The Indonesian Ministry of Health launched isoniazid preventive therapy (IPT) in 2016, with general practitioners (GPs) at the frontline of this program. However, the extent to which GPs have internalized this program remains uncertain. The aim of this study was to identify the knowledge and attitudes of GPs towards the IPT program in Indonesia. Methods: This study used an online, self-administered questionnaire distributed via e-mail and social messaging services. A logistic regression model was employed to identify the explanatory variables influencing the level of knowledge and attitudes toward IPT among GPs in Indonesia. An empirical analysis was conducted separately for each response variable (knowledge and attitudes). Results: Of the 418 respondents, 128 (30.6%) had a good knowledge of IPT. Working at a public hospital was the only variable associated with good knowledge, with an adjusted odds ratio (aOR) of 1.69 (95% confidence interval [CI], 1.02 to 2.81). Furthermore, 279 respondents (66.7%) had favorable attitudes toward IPT. In the adjusted logistic regression analysis, good knowledge (aOR, 0.55; 95% CI, 0.34 to 0.89), 1-5 years of work experience (aOR, 2.09; 95% CI, 1.21 to 3.60), and having experienced IPT training (aOR, 0.48; 95% CI, 0.25 to 0.93), were significantly associated with favorable attitudes. Conclusions: In general, GPs in Indonesia had favorable attitudes toward IPT. However, their knowledge of IPT was limited. GPs are an essential element of the IPT program in the country, and therefore, adequate information dissemination to improve their understanding is critical for the long-term viability and quality of the IPT program in Indonesia.

키워드

과제정보

We thank Diyan Ekawati, MD, for her support in data collection.

참고문헌

  1. MacNeil A, Glaziou P, Sismanidis C, Date A, Maloney S, Floyd K. Global epidemiology of tuberculosis and progress toward meeting global targets - worldwide, 2018. MMWR Morb Mortal Wkly Rep 2020;69(11):281-285.
  2. Chakaya J, Khan M, Ntoumi F, Aklillu E, Fatima R, Mwaba P, et al. Global tuberculosis report 2020 - reflections on the global tb burden, treatment and prevention efforts. Int J Infect Dis 2021;113(Suppl 1):S7-S12. https://doi.org/10.1016/j.ijid.2021.02.107
  3. Zumla A, Nahid P, Cole ST. Advances in the development of new tuberculosis drugs and treatment regimens. Nat Rev Drug Discov 2013;12(5):388-404. https://doi.org/10.1038/nrd4001
  4. Burke RM, Nliwasa M, Feasey HR, Chaisson LH, Golub JE, Naufal F, et al. Community-based active case-finding interventions for tuberculosis: a systematic review. Lancet Public Health 2021;6(5):e283-e299. https://doi.org/10.1016/S2468-2667(21)00033-5
  5. GBD Tuberculosis Collaborators. The global burden of tuberculosis: results from the Global Burden of Disease Study 2015. Lancet Infect Dis 2018;18(3):261-284. https://doi.org/10.1016/S1473-3099(17)30703-X
  6. Chaudhary R, Bhatta S, Singh A, Pradhan M, Shrivastava B, Singh YI, et al. Diagnostic performance of GeneXpert MTB/RIF assay compared to conventional Mycobacterium tuberculosis culture for diagnosis of pulmonary and extrapulmonary tuberculosis, Nepal. Narra J 2021;1(2):e33.
  7. Jeremiah C, Petersen E, Nantanda R, Mungai BN, Migliori GB, Amanullah F, et al. The WHO global tuberculosis 2021 report - not so good news and turning the tide back to End TB. Int J Infect Dis 2022:S1201-9712(22)00149-7.
  8. Uplekar M, Raviglione M. WHO's End TB Strategy: from stopping to ending the global TB epidemic. Indian J Tuberc 2015;62(4):196-199. https://doi.org/10.1016/j.ijtb.2015.11.001
  9. Houben RM, Dodd PJ. The global burden of latent tuberculosis infection: a re-estimation using mathematical modelling. PLoS Med 2016;13(10):e1002152. https://doi.org/10.1371/journal.pmed.1002152
  10. Ayele HT, Mourik MS, Debray TP, Bonten MJ. Isoniazid prophylactic therapy for the prevention of tuberculosis in HIV infected adults: a systematic review and meta-analysis of randomized trials. PLoS One 2015;10(11):e0142290. https://doi.org/10.1371/journal.pone.0142290
  11. Mandal S, Bhatia V, Sharma M, Mandal PP, Arinaminpathy N. The potential impact of preventive therapy against tuberculosis in the WHO South-East Asian Region: a modelling approach. BMC Med 2020;18(1):163. https://doi.org/10.1186/s12916-020-01651-5
  12. Ross JM, Badje A, Rangaka MX, Walker AS, Shapiro AE, Thomas KK, et al. Isoniazid preventive therapy plus antiretroviral therapy for the prevention of tuberculosis: a systematic review and meta-analysis of individual participant data. Lancet HIV 2021;8(1):e8-e15. https://doi.org/10.1016/S2352-3018(20)30299-X
  13. Huang CC, Becerra MC, Calderon R, Contreras C, Galea J, Grandjean L, et al. Isoniazid preventive therapy in contacts of multidrug-resistant tuberculosis. Am J Respir Crit Care Med 2020; 202(8):1159-1168. https://doi.org/10.1164/rccm.201908-1576OC
  14. Ayele HT, van Mourik MS, Bonten MJ. Predictors of adherence to isoniazid preventive therapy in people living with HIV in Ethiopia. Int J Tuberc Lung Dis 2016;20(10):1342-1347. https://doi.org/10.5588/ijtld.15.0805
  15. Smieja MJ, Marchetti CA, Cook DJ, Smaill FM. Isoniazid for preventing tuberculosis in non-HIV infected persons. Cochrane Database Syst Rev 2000;1999(2):CD001363.
  16. Collins D, Hafidz F, Mustikawati D. The economic burden of tuberculosis in Indonesia. Int J Tuberc Lung Dis 2017;21(9):1041-1048. https://doi.org/10.5588/ijtld.16.0898
  17. Ministry of Health, Republic of Indonesia. Technical instructions for handling latent tuberculosis infection (ILTB); 2020 [cited 2022 May 1]. Available from: https://tbindonesia.or.id/wp-content/uploads/2021/01/Isi-Juknis-ILTB-FINAL-ok_published.pdf (Indonesian).
  18. Ministry of Health, Republic of Indonesia. Regulation of the Minister of Health number 67 year 2016 on tuberculosis control [cited 2022 May 1]. Available from: http://hukor.kemkes.go.id/uploads/produk_hukum/PMK_No._67_ttg_Penanggulangan_Tuberkolosis_.pdf (Indonesian).
  19. Reviono R, Setianingsih W, Damayanti KE, Ekasari R. The dynamic of tuberculosis case finding in the era of the public-private mix strategy for tuberculosis control in Central Java, Indonesia. Glob Health Action 2017;10(1):1353777. https://doi.org/10.1080/16549716.2017.1353777
  20. Mahendradhata Y, Lestari T, Probandari A, Indriarini LE, Burhan E, Mustikawati D, et al. How do private general practitioners manage tuberculosis cases? A survey in eight cities in Indonesia. BMC Res Notes 2015;8:564. https://doi.org/10.1186/s13104-015-1560-7
  21. Durovni B, Cavalcante SC, Saraceni V, Vellozo V, Israel G, King BS, et al. The implementation of isoniazid preventive therapy in HIV clinics: the experience from the TB/HIV in Rio (THRio) study. AIDS 2010;24(Suppl 5):S49-S56.
  22. Abdulrazaak AT, Govender I, Nzaumvila D. Knowledge, attitudes and practices of doctors regarding isoniazid preventive therapy in HIV/AIDS patients at Odi District Hospital, Gauteng province, South Africa. S Afr J Infect Dis 2018;33(5):1-11.
  23. Martinson NA, Barnes GL, Moulton LH, Msandiwa R, Hausler H, Ram M, et al. New regimens to prevent tuberculosis in adults with HIV infection. N Engl J Med 2011;365(1):11-20. https://doi.org/10.1056/NEJMoa1005136
  24. Surya A, Setyaningsih B, Suryani Nasution H, Gita Parwati C, Yuzwar YE, Osberg M, et al. Quality tuberculosis care in Indonesia: using patient pathway analysis to optimize public-private collaboration. J Infect Dis 2017;216(Suppl_7):S724-S732. https://doi.org/10.1093/infdis/jix379
  25. Suryanto, Plummer V, Boyle M. Healthcare system in Indonesia. Hosp Top 2017;95(4):82-89. https://doi.org/10.1080/00185868.2017.1333806
  26. Bateman C. Doctor IPT ignorance contributing to TB epidemic--study. S Afr Med J 2011;101(2):88, 90.
  27. Teklay G, Teklu T, Legesse B, Tedla K, Klinkenberg E. Barriers in the implementation of isoniazid preventive therapy for people living with HIV in Northern Ethiopia: a mixed quantitative and qualitative study. BMC Public Health 2016;16(1):840. https://doi.org/10.1186/s12889-016-3525-8
  28. van Halsema CL, Fielding KL, Chihota VN, Russell EC, Lewis JJ, Churchyard GJ, et al. Tuberculosis outcomes and drug susceptibility in individuals exposed to isoniazid preventive therapy in a high HIV prevalence setting. AIDS 2010;24(7):1051-1055. https://doi.org/10.1097/QAD.0b013e32833849df