Improving Tuberculosis Case Finding in Indonesia

textabstractTuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis. The most frequent clinical manifestation of the disease is pulmonary TB, but it can affect any part of the body (extra-pulmonary TB), including the skin, lymph nodes, spine, joints, genitourinary tract, nervous system, and gastrointestinal tract.[1] TB is an old disease. It existed in ancient Egypt; historical records show that pathological signs of TB were present in a mummy dating back to 2400 BC.[2] An effective treatment for TB only became available in the 1940s, when the fi rst anti -TB drug streptomycin was discovered.[3] The use of anti -TB drugs, together with improved socio-economic conditions and systematic control of TB in many Western countries, led to a fi rm belief in the 1980s that TB had been conquered and that priority status was no longer justified for the disease.[4,5] However, the emerging HIV epidemic in Africa in the latter half of the 1980s caused a second wave TB epidemic that increased at an alarming speed due to TB-HIV co-infection. Multi -drug resistant TB (MDR-TB) concurrently emerged in several countries due to poorly organized TB services.[3] As a result, the World Health Organization (WHO) declared TB a global emergency in 1993,[6,7] which boosted international efforts to curb the TB epidemic. WHO and the International Union against Tuberculosis and Lung Diseases (IUATLD) introduced the direct observed treatment short course therapy (DOTS) strategy.[8] The Stop TB Partnership was established in 2000 as a global movement to accelerate social and political action aimed at stopping TB.[9] Reduction of the TB burden has also been part of the Millennium Development Goals (MDGs) that aim to halt and reverse the incidence of TB by 2015. A substantial amount of international funding has been secured and channeled through the Global Fund initiative since 2002. However, despite all of these efforts, TB remains a major global health threat and a leading cause of death from curable infectious disease worldwide, especially in Africa and Asia.[9] As the country with the fifth highest TB burden, Indonesia had an estimated 430,000 new cases in 2009, with an estimated mortality of 62,000.[10] TB was the second leading cause of death in Indonesia in 2009.[11