TB – HIV Collaboration in Medan City

R. K. Rochadi

, L. Tarigan

, and M. Fitria

Health Education and Behavioural Sciences Department, Fakultas Kesehatan Masyarakat, Universitas Sumatera Utara,

Medan, 20155, Indonesia

Occupational Health and Safety Department, Fakultas Kesehatan Masyarakat, Universitas Sumatera Utara, Medan,

20155, Indonesia

Population and Biostatistic Department, Fakultas Kesehatan Masyarakat, Universitas Sumatera Utara, Medan, 20155,

Indonesia

Keywords: TB- HIV, Collaboration, Medan City.

Abstract: Based on data showed that only 2% of TB patients who knew about their HIV status and 33% among them

with positive HIV outcomes. This study aims to describe the collaboration of TB – HIV in Medan City. This

study with Qualitative approaching aims to describe TB – HIV collaboration in medan City. The informants

are TB – HIV manager in Puskesmas, doctors, TB – HIV manager, accompanist NGO of HIV patients at

hospital. The data collection is received through deep interview. Collected Qualitative data processing made

with data transcript and conduct the content analysis. The results reveal that not all TB patients were HIV-

tested since not all TB services provide HIV testing and when referred to a referral hospital causes many

patients are missing. Referral mechanism has not run maximally, cooperation with NGOs has been

intertwined but until now the NGOs which handle TB – HIV are not many. It is suggested that all TB

services in Puskesmas equipped with HIV testing, TB – HIV officers training. Hospital services should be

comprehensive and build network inter hospitals can run as one of indicators in TB – HIV collaboration.

1 INTRODUCTION

The epidemy of Human Immunodeficiency Virus

(HIV) shows the influence to TB epidemy

improvement over the world which causes effect of

the increasing of the number of TB cases in public.

A lot of evidences show the TB controlling will not

work effectively without the successful HIV

control. Similarly, TB is one of the most common

opportunistic infections and the main cause in

people with HIV-AIDS (ODHA). Collaboration

between the two programs is essential to overcome

these two diseases effectively and efficiently

(Kemenkes 2015).

Since 2007 TB – HIV activites were begun to

be developed in accordance with national Policy

such as collaboration mechanism establishment,

ODHA’s TB burden decline, and TB patients’ HIV

burden decline. This collaboration is a part of TB

controlling and also an effort to improve th success

of HIV-AIDS countermeasures. At this

collaboration program, the officers’ behavior have

an important role to find TB cases and HIV cases

as a door way into collaboration. However, until

2012 the cohort results of Indonesian Republic

Ministry of Health showed that only 2% TB

patients who knew their HIV status and 33%

among them with positive HIV outcomes.

Medan city is one of the TB collaboration

project pilot (TB – HIV). An expected target from

these TB cases which knew their HIV status in

2016 as many as 45% and 85% in 2017.

Nevertheless the TB patients who knew their HIV

status in 2015 are 15% and increased to be 24% in

2016 and still lower than the set target. A matter

that is quite encouraging that TB patients who

knew their HIV status and received ARV was

increased high enough (7%) in 2015 became (47%)

in 2016, this data indicates that if TB patients know

their HIV status then they are willing to consume

ARV which improve their quality of life at the end.

The low level of TB – HIV collaboration in Medan

caused by not all DOTS services like Puskesmas

providing the HIV-testing or VCT, an access to

HIV-testing is still limited, from 39 Puskesmas

Rochadi, R., Tarigan, L. and Fitria, M.

TB – HIV Collaboration in Medan City.

DOI: 10.5220/0010086915351538

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

1535-1538

ISBN: 978-989-758-449-7

1535

which own HIV’s Kidney Transplantion (KT) there

are only 18 Puskesmas which have it, 3 Puskesmas

which have moderate Treatment Supporting

Training (PDP), there are only 12 hospitals which

have HIV-testing and initiated by Health care and

counseling officers and 18 hospitals which have

PDP.

Research of Ari Natalia Probandari 2011 et al.

about TB patients willingness to conduct HIV-

testing and fear of HIV-testing procedures in

Provider Initiated testing and Counseling (PITC).

The results showed the high level of willingness to

conduct HIV-testing in PICT program, fear of HIV-

testing procedures was not a factor which influenced

HIV-testing willingness. The researchers

recommended to notice the importance of Patient

centered in PICT program. Based on the background

above we know about the description of TB-HIV

collaboration in Medan city.

2 RESEARCH METHOD

This research is designed with qualitative

approaching to describe TB-HIV in Medan city. The

informants of this research are TB-HIV manager in

Puskesmas, Doctors, TB-HIV manager, accompanist

NGO of HIV patients and hospitals. An interviewing

guide list has been developed to achieve questions

about TB-HIV collaboration, qualitative data

processing which are collected and transcript data

manufacturing which is containing the whole data as

it is without making conclusions, and conduct the

content analysis.

3 RESULT AND DISCUSSION

3.1 The Harmonization of TB and HIV

Collaboration Program

TB-HIV needs to get handled from many parties

such as hospitals, Health Office, Puskesmas, NGOs

and Patients themselves who want to get services to

improve their health. Results of interview shows that

not all actors who take an important roll do their

duties in harmony like one of this informant’s

opinion :

Not all of TB patients were checked their HIV

case at Puskesmas, so not all of TB patients knew

their HIV status (informant 1 program manager).

This data happened because not all Puskesmas

provide HIV-testing, and absolutely affects the

collaboration program totally. A few previous

researches showed the TB-collaboration program

has a significant relation with health services

facilities.

An one-way door health services means at one

hospital cannot accept a test more than 1 poly and

influence the low level of collaboration indicator

target, which means somebody who was TB-

indicated cannot check his HIV status on the same

date and place which affects TB-detected patients

are unwilling to conduct HIV-testing, thereby a lot

of cases are missing.

The research is in line with the opinion of TB

program managers suc as the Lung Disease

prevention Agency (BP4) that there are still

obstacles in the collaboration of TB-HIV with

referral hospitals, if they send TB patients to check

their HIV status at Adam Malik Hospital, then the

test result is unknown by the sender and where the

next treatment is, although thethe treated patients

at referral hospital is not a concern for the senders

like this informant’s expression :

“that collaboration should be worked, if so the

negative result of the test is referred, well, then

make a notice on that service contained referral

date. When referred at Adam Malik hospital, it will

be found later. Diagnosed, then what is the result?

Then back to BP4 but this matter is not happened

yet.” (Informant 3 TB Implementor).

When the patient was willing to be checked and

the result is negative, the officer did not record

because the officer just wrote the form of positive

TB-HIV, then it made our target was still low.

Actually, there were many officers had done it but

they were lazy to write, my friends at this service

were just like that, when we suggested the patients

to be tested then it should be written, that is the

weakness from the officers (Informant 1 program

manager).”

Referral mechanism, this low records affects a

lot of cases are missing, then it is necessary to work

harder at this referral problem to make notes. There

are still many officers who do not write the forms

properly in accordance with the provision. This

condition is also related with the low level of

socialization on TB-HIV officer at health services.

This matter is in line with Mahlija’s opinion et al.,

2012 that not all the health care officers who got

involved in TB-HIV collaboration followed the

training (Mahlija, et al., 2012). And also in line with

Novelira’s research in Semarang it said that the

officers had not used HIV risk factors assessment

forms on TB patients. Socialization activity is more

conducted on officers individually. PITC strategy

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

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havs a big role to buid a network with HIV-

suspected patients. Service activities are conducted

by officers in accordance with the work instruction

at each unit. Generally, this collaboration activity

describe a Parallel Service Model.

TB patients who knew their HIV tatus in Medan

city is low because TB cases which are not included

into DOTS system, TB case finding at another poly

like internal disease, children, is not reported to

Lung Poly so many TB cases are not reported like at

Adam Malik Hospital. To detect the patients

presence is of course difficult. Further each Poly is

independent, sucah as Internal Disease Poly,

Children Poly, Heart Poly, also have not

collaborated with TB services.

This research is different with Mahlija’s research

at Health Services Facilities (Fasyankes) in Papua

which showed that collaboration mechanism of TB-

HIV had been done as many as (61.0%) and had a

significant relation with Fasyankes and public (p <

0.05). TB burden decline efforts on ODHA had been

done, as many as 80 people (97.6%) had a

significant relation with Fasyankes and public (p <

0.05). TB burden decline efforts had also been done,

as many as 71 (86.6%) and had a significant relation

with Fasyankes and public. There was relation

between Human Resources availability factor (health

care workers) of HIV, logistic and fund, and also the

public in TB-HIV collaboration management with

TB-HIV collaboration mechanism, suppress the

burden of TB on ODHA and suppress HIV burden

on TB patients.

3.2 Collaboration TB-HIV and NGOs

There are not many NGOs which get involved in

TB-HIV collaboration, during this time Aisiyyah

which handle TB-HIV achieves fund from Global

Fund, however at this time the number of NGOs

which carry on TB-HIV is small amounted as this

informant expressed :

“until May 2018 during this time Aisiyyah which

carry on TB-HIV for 2018 fund was not running

enough, Public Health Insurance (JKN) does not

handle TB anymore, NGO which still carries on TB-

HIV at this time is NGO Medan Plus (Informant 1

TB program office manager).

This result is in line with the result of interview

with Medan Plus and showed that during this time

NGO Medan Plus handle TB-HIV collaboration

along with the other NGOs but in last 3 years the

other NGOs like Aisiyyah and JKM were not

involved anymore in carrying on TB-HIV. At last,

the conducted strategy by Medan Plus to handle TB-

HIV thorugh their cadres just like this expression :

“At the moment when the cadres found the TB

patient at field, then HIV-testing conducted, but the

result was negative, because he was not related

with HIV and then he contacted us, so we could

cooperate. So our TB friends are with their TB, and

we are with their HIV” (Informant 1 LSM).

The strategy that has been done by NGO in

carrying on TB-HIV cases was expressed by

informant below :

“At the moment when we took a counseling

with patients we stayed giving a very high

motivation, because actually, our supporting

friends at this Medan Plus are direct-caused with

HIV which it means they ever have a TB, so we

turn them into a role model at field with a purpose

when they found identified case of TB or HIV, the

could give an example to that patient. Indeed

before you felt like this that I ever had had it

before, through our spirit to live healthy, may God

always give us a good healthy.”

So the relationship with the other NGOs has

been tightly intertwined thereby with government

institution like Health Office just like this

informant’s expression below :

“There is a good strong coordination formally

and non-formally (kinship). An officer said directly

the he would be delightful to be contacted if there

is something happened. So our relation is tightly

intertwined because of this TB and HIV.”

(Informan 1 NGO).

Furthermore, cooperation is also builtwith

Puskesmas and Health Office through :

“We must obey the office’s instruction, to reach

the patients we also cooperate with another agency,

especially Puskesmas in addition to cooperate with

TB cadres, many of us are also oriented with

Puskesmas, except if the disease becomes severed,

then we refer to Adam Malik Hospital.”

Based on the results above, it were revealed that

TB-HIV collaboration needs to involve NGOs and

Government Institution and also feel and think the

importance of cooperation but NGOs that have

been involved in TB-HIV control are fewer during

this time, the numbers and qualities of TB-HIV

should be improved. This research is related with

Muhammad Muqorrobin’s research in Blitar

Regency it was said that mechanism of

collaboration had not run effectively in indicator

movement and collective principles enforcement,

joint motivation to build together had not been

established for collaboration, collaboration

movements was still not good.

TB – HIV Collaboration in Medan City

1537

Based on the description above known that not

all patients of TB to be HIV-tested since not all of

TB services provide HIV-testing and when they are

referred so at the moment a lot of patients are

missing. Referral mechanism have not worked

maximally, cooperation with NGOs has been

intertwined but until now NGOs which handle TB-

HIV have not been many as well. It is suggested

that all of TB services at Puskesmas equipped with

HIV-testing, TB-HIV officers training especially in

changing behavior about the importance of data

and they are willing to write a record in accordance

with the provisions that have been set. Services at

hospital should be more comprehensive and build a

network between poly to poly and inter hospitals in

order to get an effective and efficient work as one

of TB-HIV indicators.

4 CONCLUSIONS

The results reveal that not all TB patients were HIV-

tested since not all TB services provide HIV testing

and when referred to a referral hospital causes many

patients are missing. Referral mechanism has not run

maximally, cooperation with NGOs has been

intertwined but until now the NGOs which handle

TB – HIV are not many. It is suggested that all TB

services in Puskesmas equipped with HIV testing,

TB – HIV officers training.

ACKNOWLEDGEMENT

Thanks to the Directorate of Research and

Community Service, General Directorate of

Research Empowerment and Development, The

Ministry of Research, Technology, and Higher

Education as the source of research fund, DRPM

Kemenristekdikti with research scheme Basic

Research University of Fiscal Year 2018 Number

118/UN5.2.3.1/PPM/KP-DRPM/2018.

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Aulia Novelira. 2013 Perilaku Petugas Dalam Penemuan

Kasus Pasien TB - HIV Di Balai Kesehatan Paru

Masyarakat Semarang Skripsi Fakultas Kesehatan

Masyarakat UnDip.

Ari Natalia Probandari dkk, 2011 Kesediaan Pasien

Tuberkulosis Melakukan Tes HIV dan Rasa Takut

Akan Prosedur Tes HIV Pada Program Provider

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Kedokteran Universitas Sebelas Maret Surakarta.

Kemenkes RI, 2015. Infodatin HIV/AIDS. Kemenkes RI,

Jakarta.

Mahlija Lasta Siregar. 2014 Faktor Yang Berhubungan

Dengan Penatalaksanaan Program Kolaborasi TB -

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Muhammad Muqorrobi, 2016 Proses Collaborative

Governance Dalam Bidang Kesehatan Skripsi Fakultas

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