ISTC

The Indonesian Experience

Erlina Burhan
Indonesian Society of Respirology
ISTC Task Force
Indonesian Medical Association
 Contents
Background
Initiating ISTC
Endorsement
Key events
Roll out of ISTC
Conclusions
 Back ground - Present practices &
need for ISTC
TB care is standardized & implemented in the public
sector mainly through the network of Primary Health
Centers and some hospitals
CXR is the commonly used diagnostic tool in hospitals &
private practice
Sputum smear is very much underutilized in hospitals &
private practice & sputum culture is uncommon
Many doctors are using other tests (serology test, PCR)
instead of sputum testing
Treatment regimens vary considerably in private practice
Hence the need for a tool to bridge the NTP with
Professional societies, Private sector & Hospitals
The Tool - ISTC
 Process of introducing ISTC
March 2005 : Sensitization of key opinion leader during
JEMM
July 2005: Introduction of ISTC draft to key opinion
leaders (WHO/ KNCV)
August 2005: Introduce ISTC to professional
organization
September 2005: Workshop for professional
organization to develop a plan to endorse, socialize,
disseminate and implement ISTC
September 2005: appoint ISTC team led by Indonesian
Society of Respirology
October 2005: Various professional organization
Meetings
November 2005: First National TB Congress with
presentations on ISTC
December 2005: Finalizing Work Plan for socialization
Supported closely by the ATS with several visits from Dr Phil
Hopewell and Ms Fran Du Melle
 Process of Endorsement
January 2006:
First formal Endorsement Letter from Indonesian Society of
Respirology
Introducing ISTC to the President of the Indonesian Medical
Association and other Specialist Organizations (organized by
Indonesian Society of Respirology)
February 2006:
Follow up meeting
and Discussion with
Indonesian Medical Association
Indonesian Medical Association
endorse the standards in
February 2006
 Launch of ISTC
World TB Day 2006 : IDI
(Indonesian Medical Association)
formally endorsed the standards &
launched by Minister of Health
 Endorsement and Key Events

ISTC Task force at IMA was

established
ISTC short version in Bahasa
(incl addendum) Indonesia
was published and
disseminated
ISTC is included in various
scientific meetings of
professional organization
 Roll Out ISTC
With support from NTP, WHO, and KNCV;
Indonesian Society of Respirology has
implemented:
Two days Workshops in 13 provinces in
coordination with local chapters of
professional societies & Provincial/District
health authorities
ISTC Short version were delivered to all
participants
All the topics were delivered as a CD and
handout to participants
Indonesian Medical Association
Develop National Task Force
Socialization and establishment of Provincial
TF in 12 provinces to ensure sustainability &
local ownership
Development guideline for implementation
TB in Private Practitioner
Piloting TB in PP through certification and
accreditation scheme
 TOPICS
Why & What of ISTC
Epidemiology of TB
Standard diagnosis
Standard treatment
Standard Public Health Responsibility
MDR TB
TB-HIV
The Role of Chest X Ray
Group work & discussions
 The Role of Professional
Organizations
Socialization and dissemination
Having ISTC as a topic in their annual meetings,
scientific sessions and seminars
Meetings to socialize and dissemination the
standards ( Hands on )
ISTC articles in Journals
 Conclusions
Involvement of key professional opinion leaders/champions,
right from introduction is important for buy in, acceptance &
endorsement

Professional society members

relate more easily to ISTC than
NTP guidelines since it is
evidence based & more clinical
oriented
ISTC can act as the bridge
between the NTP, Professional
societies & Private sector
NTPs can outsource the
socialization & roll out of
ISTC to Professional
organizations
A Hospital assessment study done on DOTS practices in 2007/8 in
Public & Private hospitals acts as baseline data to evaluate the impact
of ISTC in future.