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Supporting TB Health Systems

Two recent publications co-authored by TB-CRE investigators have highlighted the benefits and complexities in strengthening health systems to respond to TB in high-caseload environments.

In Indonesia, which has the third highest TB caseload in the world, a group of Indonesian and Australian TB specialists delivered extensive training on both technical knowledge about TB, as well as expertise in project development, to 76 Indonesian healthcare workers, program staff, researchers, and policymakers. An innovative element of the training was participant-designed TB workplace projects focusing on context-specific priorities. Evaluation was undertaken using participant surveys and appraisal of the projects. Participants rated the course highly, although success in project implementation varied. The authors reflected on the importance of involving Indonesian experts in the delivery of training, the need to understand participant learning requirements and to adapt the training content accordingly, and the challenge of measuring tangible training outputs.

In the second publication, the focus was on the multi-drug resistant (MDR) TB epidemic in the South Fly District of Western Province, Papua New Guinea, centred on Daru Island. In recent years, an evolving science and evidence base for MDR-TB has led to changes in international guidelines, promoting the use of newer TB drugs and regimens for MDR-TB. However, there remains a significant implementation gap. Due to the complexity of treating MDR-TB, management of cases is often supported by an expert multidisciplinary team or clinical expert group. This service is often centralised and may be delivered through a telemedicine platform. The authors implemented an internet-based “store-and-forward” telemedicine service to optimise MDR-TB patient care in Daru. From April 2016 to February 2019, 237 cases were discussed using the service. The authors conclude that the service has supported high quality clinical care and fostered collaboration between clinicians and technical experts in a shared learning environment.

This research was conducted as part of several initiatives led by a Menzies-Burnet regional consortium in partnership with institutions in Indonesia and PNG. Funding support was received from the Australian Government through the Reducing the Impact of Drug-resistant TB project and the Stronger Systems for Drug-resistant Tuberculosis and Malaria research grant (Huang et al.), and from the Australian Awards in Indonesia Program (Main et al.). The views expressed in these publications are the authors’ alone and are not necessarily the views of the Australian Government.

Main S, Lestari T, Triasih R, Chan G, Davidson L, Majumdar S, Santoso D, Phung S, Laukkala J, Graham S, du Cros P, Ralph A. Training for Tuberculosis Elimination in Indonesia: Achievements, Reflections, and Potential for Impact. Trop Med Infect Dis 2019; 4(3). pii: E107. doi: 10.3390/tropicalmed4030107.

Huang GKL, Pawape G, Taune M, Hiasihri S, Ustero P, O'Brien DP, du Cros P, Graham S, Wootton R, Majumdar SS. Telemedicine in Resource-Limited Settings to Optimize Care for Multidrug-Resistant Tuberculosis. Front Pub Health 2019.

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