The Practice of Home-based Direct Observer Treatment of Patients with Positive Pulmonary Tuberculosis (DOT – TB) at Kebumen District of Indonesia

Timbul Pranoto(1*), Mora Claramita(2), I Dewa Putu Pramantara(3)

(1) Puskesmas Kutowinangun (Community and Primary Health Care Center); Kebumen; Indonesia
(2) Department of Family and Community Medicine; Faculty of Medicine, Public Health and Nursing; Universitas Gadjah Mada; Indonesia
(3) Department of Internal Medicine – Geriatric Division; Dr. Sardjito Hospital; Yogyakarta; Indonesia
(*) Corresponding Author


Background: Tuberculosis (TB) is a major global health problem, even though TB can be prevented and treated. The WHO Global Tuberculosis Report 2015 reported 1.5 million deaths from TB, of which 1.1 million were TB with HIV-negative and 0.4 million were HIV-positive tuberculosis. As many as 25% of deaths from TB were in productive ages between 15 to 54 years. Low adherence is a major cause of treatment failure, drop-out and the rising number of cases of MDR (Multi Drugs Resistance). Adherence is also a key to improve the cure rate of treatment of TB patients. Home-based Direct Observer Treatment of patients with positive pulmonary Tuberculosis (DOT–TB) or in Bahasa Indonesia also known as Pengawas Minum Obat (PMO) may improve adherence and increase the TB cure rate and success rate. The DOT-TB has tasks to oversee, remind, motivate and assist TB patients who are undergoing the treatment process. Background of DOT–TB in improving adherence needs to be explored by examining their experiences, which can be expressed by using a phenomenological qualitative study to explore the meaning and significance of their experiences. Objectives: This study aimed to explore the efforts of DOT–TB in performing their duties, the constraints arising from these efforts, benefits, and expectations of the DOT–TB position. Methods: This study applied a qualitative approach with descriptive phenomenological methodology. The number of informants were 21 people divided into groups of DOT–TB whose patients were perfectly recovered (7 people), groups of DOT–TB whose patients were drop-out or failed (7 people) and a group of 7 TB programmers. Each group participated in the Focus Group Discussion (FGD) for 90-120 minutes. Results: The results of the study indicate that the presence of DOT–TB is very important and necessary in the management of TB. The biggest challenge of DOT–TBs in performing their duties are communication barriers due to differences in hierarchy and social status in the society. Their sense of hesitancy was a major challenge of DOT–TB in charge. According to respondents, the ideal DOT–TB is someone close to the patients, has patience, compassion, enough knowledge about TB and good communication skills. Conclusions: In order to perform their duties well, DOT–TBs require training concerning tuberculosis and communication.


Home-based Direct Observer Treatment of Patients with Positive Pulmonary Tuberculosis (DOT – TB); Phenomenology; Tuberculosis

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1. Ritz N, Curtis N. Novel concepts in the epidemiology, diagnosis and prevention of childhood tuberculosis. Swiss Med Wkly. 2014 Sep 10;144(September):w14000.

2. Murray CJ, Ortblad KF, Guinovart C, Lim SS, Wolock TM, Roberts DA, Dansereau EA, Graetz N, Barber RM, Brown JC, Wang H. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2014 Sep 13;384(9947):1005-70.

3. World Health Organization. Tuberculosis (TB) Global tuberculosis report 2015. Geneva, Switzerland. 2015.

4. Atif M, Sulaiman SA, Shafi AA, Muttalif AR, Ali I, Saleem F. Applying patient centered approach in management of pulmonary tuberculosis: a case report from Malaysia. Journal of Basic and Clinical Pharmacy. 2011 Jun;2(3):129-130.

5. Mkopi A, Range N, Lwilla F, Egwaga S, Schulze A, Geubbels E, van Leth F. Adherence to tuberculosis therapy among patients receiving home-based directly observed treatment: evidence from the United Republic of Tanzania. PloS One. 2012 Dec 19;7(12):e51828.

6. Jain A, Dixit P. Multidrug resistant to extensively drug resistant tuberculosis: what is next?. Journal of Biosciences. 2008 Nov 1;33(4):605-16.

7. Department of Health Republic of Indonesia. National Guidelines for Medical Services, Tuberculosis Management. Jakarta. Ministry of Health Republic of Indonesia. 2013: 6-7.

8. Moleong LJ. Qualitative Research Methodology (Revised edition). Bandung: PT Remaja Rosdakarya. 2015.

9. Collins D, Hafidz F, Suraratdecha C. The economic burden of tuberculosisi in Indonesia. TB Care I – Management Science for Health. Cambridge: Management Sciences for Health. 2013: 31.

10. Egwaga S, Mkopi A, Range N, Haag-Arbenz V, Baraka A, Grewal P, Cobelens F, Mshinda H, Lwilla F, van Leth F. Patient-centred tuberculosis treatment delivery under programmatic conditions in Tanzania: a cohort study. BMC Medicine. 2009 Dec;7(1):80.

11. Ai X, Men K, Guo L, Zhang T, Zhao Y, Sun X, Zhang H, He G, van der Werf MJ, Van Den Hof S. Factors associated with low cure rate of tuberculosis in remote poor areas of Shaanxi Province, China: a case control study. BMC Public Health. 2010 Dec;10(1):112.

12. Soomro MH, Qadeer E, Khan MA, Morkve O. Treatment supporters and their impact on treatment outcomes in routine tuberculosis program conditions in Rawalpindi District, Pakistan. National Research Institute of Tuberculosis and Lung Disease, Iran. Tanaffos. 2012;11(3):15-22.

13. Nurhayati J. The relation of treatment adherence supporter to successful TB medication by DOTS at Dr. Kariadi Hospital Semarang. Medica Hospitalia-Journal of Clinical Medicine. 2014 Sep 30;2(1):54-7.

14. Muniroh N, Aisah S, Mifbakhuddin. Factors associated with tuberculosis disease (pulmonary tbc) in work area of Puskesmas Mangkang West Semarang. Journal of Community Nursing. 2013;1(1): 33-42.

15. Mlilo N, Sandy C, Harries AD, Kumar AM, Masuka N, Nyathi B, Edginton M, Isaakidis P, Manzi M, Siziba N. Does the type of treatment supporter influence tuberculosis treatment outcomes in Zimbabwe?. Public Health Action. 2013 Jun 21;3(2):146-8.

16. Claramita M, Nugraheni MD, van Dalen J, van der Vleuten C. Doctor–patient communication in Southeast Asia: a different culture?. Adv Health Sci Educ. 2013 Mar 1;18(1):15-31.

17. Purwanta P. Characteristics of treatment observer desired by pulmonary tuberculosis patients in urban and rural Yogyakarta. Journal of Health Services Management. 2005;8(03):141-7.

18. Ministry of Health Republic of Indonesia. National Guidelines for Medical Services: Tuberculosis Management. Jakarta. Ministry of Health Republic of Indonesia. 2013.

19. Widjanarko B, Prabamurti PN, Widyaningsih N. Analysis of factors affecting medicine supervisory practices (DOT – TB) in the control of pulmonary tuberculosis patients in Semarang city. Journal of Indonesia Health Promotion. 2006;1(1):15-24.

20. Amril Y, Surjanto E, Suriadi, Baktiar A. Directly observed therapy (DOT) in the treatment of new pulmonary tuberculosis cases in BP4 Surakarta. J Respir Indo. 2003;23(2):67-75.

21. Kusbiyantoro. Comparison of the Effectiveness of Health Cadres and Community Struggle as Drug Supervisor of Drugs on Drug Compliance and Sputum Conversion of Pulmonary Tuberculosis in Kebumen District (Thesis). Postgraduate UGM. 2002.

22. Green LW, Kreuter MW, Deeds SG, Partridge KB, Bartlett E. Health Education Planning: A Diagnostic Approach. Tafal, Mamdy, & Krisna (Translation). Jakarta: Development Project FKM UI. 2000.

23. Notoatmodjo S. Education and Health Behavior. Rineka Cipta. Jakarta. 2003


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