TABLE 1.
Summary of the original plans for a TB ACF program in Yogyakarta, Indonesia
| Programme details |
| Donor: TB REACH (Wave 7) |
| Implementing agencies: Universitas Gadjah Mada (Yogyakarta, Indonesia), Burnet Institute (Melbourne, VIC, Australia) |
| Timeframe: January–December 2020 |
| Geographic scope: Two subdistricts in Yogyakarta Province, Indonesia – one rural and one urban |
| Programme setting |
| Yogyakarta Province has a population of 3.6 million and notified 3,210 TB cases in 2017. Case detection for the province is a key issue and is estimated at 50%. Indonesia’s guidelines recommend household contact investigation but not population screening. Hence TB services in Yogyakarta Province largely rely on passive case-finding. Due to resource limitations, household contact investigation is not routinely undertaken for all notified cases. Current guidelines recommend TPT using isoniazid for contacts of <5 years and for people living with HIV, but coverage among these groups has been very low in Indonesia. In early 2020, Indonesia launched a presidential initiative to eliminate TB in Indonesia by 2030 which will require scale up of TB ACF and prevention |
| Our programme represents an initial attempt to implement and increase coverage of TB ACF in the project subdistricts; and to increase the TPT coverage while introducing short (3-month) regimens |
| TB ACF activities |
| Activity 1 |
| Target population: residents of urban and rural slum areas, boarding school residents, healthcare workers and health facility staff |
| Case-finding strategy: community-based population screening using symptom screening and mobile CXR and Xpert with a target of 200 people screened per day. Referral to health facilities for treatment initiation for patients diagnosed with active TB. TPT offered to eligible boarding school residents and health facility staff |
| Activity 2 |
| Target population: household contacts of persons with TB registered at health facilities |
| Case-finding strategy: home-based symptom screening with referral for CXR and Xpert. Referral to health facilities for treatment initiation for patients diagnosed with active TB; 3-month TPT regimens offered to contacts with evidence of infection and no active disease |
| Activity 3 |
| Target population: women and children attending community health post |
| Case-finding strategy: symptom screening of all attendees of community health post activities with referral to health facilities for investigation and active TB treatment |
ACF = active case-finding; TPT = TB preventive therapy; CXR = chest X-ray.