Determinants of Treatment Success Among Drug Resistant Tuberculosis Patients in West Sumatra, Indonesia: a Retrospective Cohort Study (2017–2021)

Authors

  • Ratno Widoyo Department of Public Health, Universitas Andalas, West Sumatra Author
  • Defriman Djafri Department of Public Health, Universitas Andalas, West Sumatra Author
  • Vivi Triana Department of Public Health, Universitas Andalas, West Sumatra Author
  • Anisa Salsabila Department of Public Health, Universitas Andalas, West Sumatra Author

DOI:

https://doi.org/10.22437/jkmj.v10i2.55473

Keywords:

District Hospitals, Drug-resistant tuberculosis, Referral Systems, Treatment Success, West Sumatra

Abstract

Treatment success rates remain below the national target in Indonesia. This study aims to identify individual characteristics and health facility-level factors associated with treatment success among Drug-resistant tuberculosis (DR-TB) patients in West Sumatra. A retrospective cohort study encompassing DR-TB patients treated in West Sumatra between 2017 and 2021 was undertaken. Univariate, bivariate, and multivariate analyses are used to evaluate the association between facility-level factors, individual characteristics, and treatment outcomes. The analysis indicated a heightened propensity for successful treatment among male patients and those within younger age cohorts. Patients treated in district-level hospitals were more likely to achieve successful treatment outcomes than those treated in city-based hospitals. Furthermore, patients referred from other facilities to a different district hospital had significantly higher odds of success than those who received care at a single facility throughout their treatment. Younger Age, male gender, district hospital, and patients referred for DR-TB are likely to achieve treatment success. Besides individual characteristics, decentralized care and structured referral systems need improvement. Consequently, the prioritization of inter-facility coordination reinforcement and the augmentation of district hospital capacities are imperative within provincial tuberculosis control strategies.

References

1. Sutanto YS, Sutanto M, Harti AS. Anti-Tuberculosis Drugs against the Resistance Level of Mycobacterium tuberculosis isolates. J Kesehat Masy. 2021 Jul 24;17(1):14–23. https://doi:10.15294/kemas.v17i1.24158

2. Yapa HM, MacLean E, Menzies NA, Dodd PJ, Dean A, Mirzayev F, et al. Drug-resistant tuberculosis: a priority pathogen for enhanced public health research and practice. Clin Microbiol Rev. 2025 Nov 4;38(4). Located at: 41186421. https://doi:10.1128/cmr.00064-25

3. Harika KCG, Giridhar A. Mechanism Of Antibiotic Resistance In Tuberculosis. Int J Pharm Health Care Res. 2025 Feb 13;13(1):18–26. https://doi:10.61096/ijphr.v13.iss1.2025.18-26

4. Gopalaswamy R, Subbian S. The power of resistance: mechanisms of antimicrobial resistance in Mycobacterium tuberculosis and its impact on tuberculosis management. Clin Microbiol Rev. 2026 Jan 7. Located at: 41498549. https://doi:10.1128/cmr.00194-25

5. Ashfaq H, Humayun A, Naseem MA, Siddiqui SW, Kamal A, Mohsin S, et al. Pattern and predictors of drug resistance and treatment outcome in tuberculosis patients at the centers of programmatic management of drug-resistant tuberculosis in Lahore, Pakistan. BMC Public Health. 2026 Feb 18. Located at: 41709251. https://doi:10.1186/s12889-026-26576-1

6. Amelia A, Azzahra F, Octavia W. Association Between Medication Adherence and Tuberculosis Treatment Success: Cross-Sectional Primary Care Study in Indonesia. Indones J Pharm Educ. 2026 Feb 1;6(1):38–46. https://doi:10.37311/ijpe.v6i1.36604

7. Kėvelaitienė K, Puronaitė R, Davidavičienė VE, Nakčerienė B, Danila E. Risk factors for treatment failure of drug-resistant pulmonary tuberculosis: results from a two-decade data analysis. J Thorac Dis. 2026 Mar 1;18(3):201–201. https://doi:10.21037/jtd-2025-1-2548

8. Hafa MR, Mufida DC, Wisudanti DD, Raharjo AM. The Impact of Comorbidities on Drug-Resistant Tuberculosis Treatment Success at Dr. Soebandi Hospital Jember 2018-2022. J Indones Med Assoc. 2026 Jan 15;75(5):226–34. https://doi:10.47830/jinma-vol.75.5-2025-1956

9. Ndamase N, Faye LM, Dlatu N, Apalata T, Hosu MC. Hierarchical Risk Profiles in Tuberculosis Treatment Outcomes: The Role of Drug Resistance, Age, and Socio-Economic Factors. Microbiol Res. 2026 Feb 14;17(2):42–42. https://doi:10.3390/microbiolres17020042

10. Nasution HS, Wahyono TYM. Factors Influencing Treatment Discontinuation in MDR/RR TB Cases in DKI Jakarta in 2014-2015. J Kesmas Jambi. 2020 Sep 23;4(2):50–8. https://doi:10.22437/jkmj.v4i2.10570

11. Kumar L, Kumar S, Vohra V, Mohan K, Khayyam KU. Risk factors of treatment interruptions among drug-sensitive and drug-resistant pulmonary tuberculosis patients - A study from South Delhi, New Delhi, India. Indian J Tuberc. 2024;71 Suppl 1:S72–6. https://doi:10.1016/j.ijtb.2024.01.001 PubMed PMID: 39067959.

12. Jagtap JR, Atre S, Dumbare Y, Faqih M, Sawant T, Ambike S, et al. Health System Related Barriers To Multidrug-Resistant Tuberculosis (MDR-TB) Care In An Indian Setting: From Patients’ Perspective. Int J Infect Dis. 2023 May 1;130. https://doi:10.1016/j.ijid.2023.04.024

13. Rai S, Sen A, Shah H, Patel J. Barriers to effective management of drug-resistant tuberculosis in India, insights into patient & health system challenges: An exploratory review. Indian J Med Res. 2025 Dec;162(6):801–8. https://doi:10.25259/IJMR_1424_2025 PubMed PMID: 41648976; PubMed Central PMCID: PMC12883136.

14. Widoyo R, Djafri D, Putri ASE, Yani FF, Kusumawati RL, Wongsirichot T, et al. Missing Cases of Bacteriologically Confirmed TB/DR-TB from the National Treatment Registers in West and North Sumatra Provinces, Indonesia. Trop Med Infect Dis. 2023 Jan 2;8(1):31–31. Located at: 36668938. https://doi:10.3390/tropicalmed8010031

15. Simbolon RL, Simatupang ETM, Yovi I, Fauzi ZA. Update on The Current Management of Drug Resistant Tuberculosis (DR-TB). Indones J Trop Infect Dis. 2025 Aug 31;13(2):98–110. https://doi:10.20473/ijtid.v13i2.59075

16. Soeroto AY, Pratiwi C, Santoso P, Lestari BW. Factors affecting outcome of longer regimen multidrug-resistant tuberculosis treatment in West Java Indonesia: A retrospective cohort study. PLoS ONE. 2021 Feb 8;16(2). Located at: 33556094. https://doi:10.1371/journal.pone.0246284

17. Aviana F, Jati SP, Budiyanti RT. Systematic Review Pelaksanaan Programmatic Management Of Drug-Resistant Tuberculosis Pada Pasien Tuberkulosis Resistan Obat. J Kesehat Masy. 2021 Mar 4;9(2):215–22. https://doi:10.14710/jkm.v9i2.28719

18. Lestari BW, Nijman G, Larasmanah A, Soeroto AY, Santoso P, Alisjahbana B, et al. Management of drug-resistant tuberculosis in Indonesia: a four-year cascade of care analysis. Lancet Reg Health - Southeast Asia. 2023 Nov 2;22:100294. https://doi:10.1016/j.lansea.2023.100294 PubMed PMID: 38482149; PubMed Central PMCID: PMC10934335.

19. Silitonga P, Jiang W, Wyatt S, Burhan E, Kes EFM, Long Q. Factors affecting time to treatment initiation after diagnosis for multidrug-resistant/rifampicin-resistant tuberculosis patients: A mixed-methods study in Jakarta, Indonesia. Trop Med Int Health TM IH. 2023 Jan;28(1):43–52. https://doi:10.1111/tmi.13838 PubMed PMID: 36477995.

20. Lyakurwa DM, Lekule I, Mziray SR, Balama RF, Sililo GA, Kisonga R, et al. Success rates of DR-TB patients and associated factors in Tanzania: a six-year cohort study. BMC Infect Dis. 2026 Jan 20. Located at: 41559620. https://doi:10.1186/s12879-026-12599-x

21. Kasozi ND, Charles L, JohnBosco A, Henry L. Predictors of treatment delay among drug resistant tuberculosis patients in Uganda. BMC Infect Dis. 2024 Dec 20;24(1):1452–1452. Located at: 39707234. https://doi:10.1186/s12879-024-10339-7

22. Sutherland C, Hare D, Johnson PJ, Linden DW, Montgomery RA, Droge E. Practical advice on variable selection and reporting using Akaike information criterion. Proc R Soc B Biol Sci. 290(2007):20231261. https://doi:10.1098/rspb.2023.1261 PubMed PMID: 37752836; PubMed Central PMCID: PMC10523071.

23. Sujan MJ, Rahman A, Taleb A, Khan AH, Sultana SR, Moni MA, et al. Tuberculosis notification trends and treatment outcomes in Bangladesh: findings from a National TB Program data, 2019–2021. BMC Infect Dis. 2026 Jan 31;26(1):464. https://doi:10.1186/s12879-026-12664-5

24. Massud A, Khan AH, Sulaiman SAS, Ahmad N, Shafqat MN, Ming LC. Unsuccessful treatment outcome and associated risk factors. A prospective study of DR-TB patients from a high burden country, Pakistan. PLoS ONE. 2023 Aug 10;18(8). Located at: 37561810. https://doi:10.1371/journal.pone.0287966

25. Dlatu N, Faye LM. Explanatory Modelling of Tuberculosis Treatment Outcomes: The Role of Community Engagement and Clinical Governance [Internet]. Public Health and Healthcare; 2026 [cited 2026 May 14]. Available from: https://www.preprints.org/manuscript/202603.0761/v1doi:10.20944/preprints202603.0761.v1

26. Ararame GG, Senbeta BS, Liche TN, Sileshi EZ. Impact of comorbid diseases and associated factors on tuberculosis treatment outcomes among tuberculosis patients in South West Oromia, Ethiopia: a retrospective cohort study. Sci Rep. 2026 Mar 21;16(1):14351. https://doi:10.1038/s41598-026-44604-3

27. Hackman HK, Mensah AC, Annison L, Arhin RE, Aidoo EK, Osei-Adjei G, et al. Treatment outcomes among tuberculosis patients with co-morbidities at Ghana’s premier national referral centre: a retrospective cross-sectional study. BMC Infect Dis. 2026 Feb 14;26(1):608. https://doi:10.1186/s12879-026-12884-9

28. Pradipta IS, Boveneind-Vrubleuskaya N van’t, Akkerman OW, Alffenaar JC, Hak E. Treatment outcomes of drug-resistant tuberculosis in the Netherlands, 2005–2015. Antimicrob Resist Infect Control. 2019 Jul 12;8(1). Located at: 31338162. https://doi:10.1186/s13756-019-0561-z

29. JO I, Pather M. Determinants and Outcomes of the Decentralised Management of Patients With Drug-resistant Tuberculosis in the O.r Tambo District Municipality, Eastern Cape, South Africa, a Cohort Study. Res Sq Res Sq. 2024 Feb 29. https://doi:10.21203/rs.3.rs-3965395/v1

30. Horter S, Stringer B, Greig J, Amangeldiev A, Tillashaikhov MN, Parpieva N, et al. Where there is hope: a qualitative study examining patients’ adherence to multi-drug resistant tuberculosis treatment in Karakalpakstan, Uzbekistan. BMC Infect Dis. 2016 Jul 27;16(1). Located at: 27465783. https://doi:10.1186/s12879-016-1723-8

31. Makabayi-Mugabe R, Musaazi J, Zawedde‐Muyanja S, Kizito E, Fatta K, Namwanje-Kaweesi H, et al. Community-based directly observed therapy is effective and results in better treatment outcomes for patients with multi-drug resistant tuberculosis in Uganda. BMC Health Serv Res. 2023 Nov 13;23(1). Located at: 37957610. https://doi:10.1186/s12913-023-10120-7

32. Bharti A, Tomar A, Tiwari R. Treatment outcome of drug-resistant tuberculosis (DR-TB) following uptake of universal drug susceptibility testing: A record review from a nodal DR-TB center. Asian J Med Sci. 2023 Mar 1;14(3):130–5. https://doi:10.3126/ajms.v14i3.49860

33. Alemu T, Amogne G, Berhe TT. Multi-Drug Resistant Tuberculosis Treatment Outcome and Associated Factors in Addis Ababa, Ethiopia: A Retrospective Cross-Sectional Study. Res Sq Res Sq. 2020 Sep 29. https://doi:10.21203/rs.3.rs-83241/v1

34. Ndjeka N, Perumal R, Romanowski K, Mathema H, Amusa LB, Campbell JR, et al. Treatment Outcomes and Drug-Related Adverse Events Across Four Short-Course RR-TB Regimens in South Africa: A Retrospective Analysis. Int J Infect Dis. 2026 Feb 1;108473–108473. https://doi:10.1016/j.ijid.2026.108473

35. Cebisa M, Dlatu N, Hosu MC, Apalata T, Faye LM. Multidrug-Resistant Tuberculosis in Rural Eastern Cape, South Africa: Clinical, Bacteriological, and Programmatic Predictors of Poor Treatment Outcomes. Microorganisms. 2026 Mar 18;14(3):690–690. Located at: 41900449. https://doi:10.3390/microorganisms14030690

36. Wolde AA, Bogale B, Gebremedhin M. Health system delay and its associated factors among tuberculosis patients in Gamo Zone public health facilities, Southern Ethiopia: An institution-based cross-sectional study. J Clin Tuberc Mycobact Dis. 2022 Jun 29;28:100325–100325. Located at: 35813285. https://doi:10.1016/j.jctube.2022.100325

37. Koh SWC, Huang JYX, Lam J, Low SH, Goh JC, Ji G, et al. Factors and determinants of primary care to tertiary care referrals in Singapore: A multi-centre analysis using artificial intelligence-powered large language models. Hossain Parash MT, editor. PLOS One. 2026 Feb 5;21(2):e0338085. https://doi:10.1371/journal.pone.0338085

38. Iruedo J, Pather M. Lived experiences of patients and families with decentralised drug-resistant tuberculosis care in the Eastern Cape, South Africa. Afr J Prim Health Care Fam Med. 2023 Dec 22;15(1). Located at: 38197684. https://doi:10.4102/phcfm.v15i1.4255

39. Reviono R, Ramadhiana Y, Probandari A, Setianingsih W, Java PHO of C. Factors Associated with Success Rate for Tuberculosis Treatment in Hospital: A Directly Observed Treatment Short Tuberculosis Prevention Strategy in Central Java. J Epidemiol Public Health. 2019 Jan 1;4(4):283–95. https://doi:10.26911/jepublichealth.2019.04.04.03

40. Lunn AD, Lynch H, Adam BU, Blythe J, Clark E, Engamba SA, et al. Addressing Inequalities in the Primary and Secondary Outpatient Interface: A Policy-Focused Evidence Brief. Public Health Pract. 2026 Mar 1;100783–100783. https://doi:10.1016/j.puhip.2026.100783

41. Zhang J, Shen X, Yang C, Chen Y, Guo J, Wang D, et al. Spatial analysis of tuberculosis treatment outcomes in Shanghai: implications for tuberculosis control. Epidemiol Health. 2022 May 1;44. Located at: 35538695. https://doi:10.4178/epih.e2022045

42. Torokaa PR, Joachim A, Komba A, Bolen T, Allan JN, Onduru OG, et al. Predictors of mortality and treatment failure in tuberculosis patients enrolled in the tuberculosis and leprosy program in mainland Tanzania: a retrospective cohort study. Bull Natl Res CentreBulletin Natl Res Cent. 2025 Oct 27;49(1). https://doi:10.1186/s42269-025-01373-9

43. Njiro BJ, Kisonga R, Joachim C, Sililo GA, Nkiligi E, Ibisomi L, et al. Epidemiology and treatment outcomes of recurrent tuberculosis in Tanzania from 2018 to 2021 using the National TB dataset. PLoS Negl Trop Dis. 2024 Feb 15;18(2). Located at: 38359088. https://doi:10.1371/journal.pntd.0011968

44. Azam M, Hanan L, Azinar M, Khasanah AF, Fibriana AI, Yunus M, et al. Barriers to treatment completion among drug-sensitive tuberculosis patients: evidence from Indonesia’s tuberculosis surveillance system. PubMed. 2026 Mar 19. Located at: 41851606. https://doi:10.24171/j.phrp.2025.0325

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Published

2026-07-18

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Vol. 10 No. 2 (2026): VOLUME 10 - NUMBER 2 - July 2026

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Copyright (c) 2026 Ratno Widoyo, Defriman DJafri, vivi triana, Anisa Salsabila

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