Determinan pengendalian tuberkulosis melalui implementasi pemberian terapi pencegahan tuberkulosis pada kontak serumah di Kabupaten Kebumen tahun 2025
Yunianti, dr. Nur Rahmi Ananda, SpPD, Subs.P.M.K.(K)
2026 | Tesis | S2 Ilmu Kesehatan Masyarakat
Latar Belakang: Indonesia
adalah salah satu dari 30 negara dengan beban tuberkulosis tertinggi dan secara
kolektif menyumbang 87?ri kasus global. Sebagai upaya mencapai eliminasi
tahun 2030, pemerintah menetapkan beberapa indikator program. Salah satu
indikator tersebut adalah pemberian terapi pencegahan tuberkulosis pada kontak
serumah. Namun, dalam beberapa tahun terakhir, indikator tersebut belum
mencapai target.
Tujuan: Penelitian ini
bertujuan untuk mengevaluasi implementasi pemberian terapi pencegahan
tuberkulosis serta mengidentifikasi faktor-faktor yang memengaruhi penerimaan
terapi pencegahan tuberkulosis pada kontak serumah
Methods: Penelitian terdiri
atas 3 sub-studi, yaitu evaluasi program, evaluasi sistem surveilans, dan studi
analitik. Evaluasi program dan evaluasi sistem surveilans menggunakan metode deskriptif
observasional, sedangkan studi analitik menggunakan metode mixed-methods
explanatory sequential study. Data primer dikumpulkan melalui wawancara
menggunakan kuesioner dan penelusuran dokumen. Total sampel untuk evaluasi
program dan evaluasi surveilans adalah 48 responden. Sedangkan total sampel
pada studi analitik adalah 389 dengan teknik proportional stratified random
sampling.
Hasil: Capaian pemberian
terapi pencegahan tuberkulosis di Kabupaten Kebumen meningkat setiap tahun,
tetapi belum mencapai target. Kendala program meliputi keterbatasan logistik,
pembiayaan yang belum memadai, pelatihan pengelola program yang belum merata,
serta pelaksanaan investigasi kontak dan rujukan yang belum optimal. Seluruh
unit pelapor telah menggunakan SITB dalam permintaan logistik, namun kualitas
pencatatan belum sepenuhnya menggambarkan seluruh alur layanan TPT. Faktor yang
secara signifikan berhubungan dengan penerimaan terapi pencegahan tuberkulosis
adalah menerima informasi terkait terapi pencegahan tuberkulosis dari kader
(aPR=1,12; 95% CI 1,01–1,25), responden
yang menerima informasi dari tenaga kesehatan
(aPR=1,09; 95% CI 1,00–1,19),
etikal (aPR=1,64; 95% CI 1,12–2,39), koherensi
intervensi (aPR=0,87; 95% CI 0,79–0,97),
efikasi diri (aPR=2,16; 95% CI 1,38–3,37)
Kesimpulan: Capaian pemberian
terapi pencegahan tuberkulosis mengalami peningkatan, tetapi masih memerlukan
peningkatan terutama pada ketersediaan
logistik, kapasitas pengelola
program, investigasi kontak dan edukasi
masyarakat.
Kata kunci: Terapi pencegahan tuberkulosis, Kontak
serumah, Tuberkulosis, Pengendalian
tuberkulosis
Background: Indonesia is one of the 30 countries with the highest
tuberculosis burden, collectively accounting for 87% of global cases. In an
effort to achieve elimination by 2030, the government has established several
program indicators. One of these indicators is the provision of tuberculosis
preventive therapy to household contacts. However, in recent years, this
indicator has not met its target.
Objective: This study aims to evaluate the implementation of
tuberculosis preventive therapy and identify factors influencing the acceptance
of tuberculosis preventive therapy among household contacts.
Methods: The study consists of three sub-studies: a
program evaluation, a surveillance system evaluation, and an analytical study.
The program evaluation and surveillance system evaluation employed descriptive
observational methods, whereas the analytical study utilized a mixed-methods
explanatory sequential study design. Primary data were collected through
interviews, questionnaires, and document reviews. The total sample size for the
program evaluation and surveillance evaluation was 48 respondents. Meanwhile,
the total sample size for the analytical study was 389, which was determined
using proportional stratified random sampling.
Results: The uptake of tuberculosis preventive therapy
in Kebumen Regency has increased annually, but has not yet reached the target.
Program constraints include logistical limitations, inadequate funding, uneven
training of program managers, and suboptimal implementation of contact tracing
and referrals. All reporting units have used the SITB system for logistics
requests; however, the quality of record-keeping does not yet fully reflect the
entire TPT service pathway. Factors significantly associated with the
acceptance of tuberculosis preventive therapy include receiving information
about tuberculosis preventive therapy from community health workers (aPR=1.12;
95% CI 1.01–1.25), respondents who received information from health workers
(aPR = 1.09; 95% CI 1.00–1.19), and ethical considerations (aPR = 1.64;
95% CI 1.12–2.39), intervention coherence (aPR = 0.87; 95% CI 0.79–0.97), and
self-efficacy (aPR = 2.16; 95% CI 1.38–3.37)
Conclusion: The implementation of tuberculosis preventive therapy has
improved, but further improvements are still needed, particularly in
logistical availability, program management capacity, contact
tracing, and community education.
Keywords: Tuberculosis preventive therapy, Household
contacts, Tuberculosis, Tuberculosis control
Kata Kunci : Keywords: Tuberculosis preventive therapy, Household contacts, Tuberculosis, Tuberculosis control
