Identifying Gaps in the Multidrug-Resistant Tuberculosis (MDR-TB) Cascade of Care: Barriers and Improvement Opportunities in North Maluku, Indonesia

Authors

Eko Sudarmo Dahad Prihanto, : Doctorate Program, Faculty of Medicine, Padjadjaran University, Bandung, IndonesiaFollow
Prayudi Santoso, Division Pulmonology, Internal Medicine Department, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
Elsa Pudji Setiawati, Public Health Department, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia Jl Rose no K6 Kompleke Mitra Dago Parahiangan Antapani
Rovina Ruslami, Division of Pharmacology, Department of Biomedical Science, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia

Abstract

Background: The Multidrug-Resistant-Tuberculosis (MDR-TB) Cascade of Care includes MDR-TB treatments from suspicion to completion. Implementation gaps can lower treatment success. This study aimed to identify gap causes and opportunities to improve MDR-TB treatment in North Maluku, Indonesia

Methods: To identify gaps, we conducted in-depth interviews and focus group discussions with health workers at Puskesmas (Indonesian government's primary healthcare centers) and hospitals, MDR-TB patients, and patients’ families. Thematic analysis was conducted using the Consolidated Framework for Implementation Research (CFIR) for health workersand the health belief model (HBM) approach for patients and their families.

Results: Significant gaps were found in all MDR-TB services in North Maluku, especially in health facility services. The gaps occurred due to the absence of Standard Operating Procedures (SOPs) and technical guidelines, discrepancy between these guidelines with MDR-TB services at Puskesmas, limited operational funds, and management teams. Other barriers included a lack of TB knowledge among health workers, errors in filling out the TB information system, stigma towards MDR-TB patients, limited health workers for home services, and assignment of officers without training. Patients and their families faced barriers, including lack of knowledge about MDR-TB, use of traditional medicine, belief in magic, delay in seeking health services, and complaints about hospital service times.

Conclusions: Improvements should focus on increasing MDR-TB knowledge among health workers and community members, improving management of MDR-TB services, and stregnthening communication and coordination between Puskesmas and hospitals to manage MDR-TB effectively.

Keywords: Cascade of Care, MDR-TB, Health barrier, Healthcare gaps, Patients perception

Recommended Citation

Prihanto E, Santoso P, Setiawati E, Ruslami R. Identifying Gaps in the Multidrug-Resistant Tuberculosis (MDR-TB) Cascade of Care: Barriers and Improvement Opportunities in North Maluku, Indonesia. J Health Res. 2025; 39(4):-. DOI: https://doi.org/10.56808/2586-940X.1148

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