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1 B- I n t e r n a t i o n a l S t a n d a r s f o r Tu b e r c u l o s i s C a r (ÏS r c ) E d is i k e - 3 ) a =1 / < ' 3

2 I n t e r n a t i o n a l s t a n d a r d s f o r T B C a r e e «l i s i k e 3 ST A N D A R D IA G N O S IS S t a n d a r U n t t J k m e m a s t r k a n d i a g n o s i s d i n i p e m b e r i p e l a y a n a n k e s e h a t a n h a r u s m e n g e t a h u i fa kt o r n s ik o t u b e r k u l o s l s (T B ) u n t u k in d i v id u d a n k e lo m p o k s e rt a m e l a k u k a n e v a l u a s i k lrn i s c e p a t d a n u ji d i a g n o s t ik y a n g t e p a t u n t u k o r a n g d e n g a n g e j a la d a n t e m u a n y a n g m e n d u k u n g T B S t a n d a r 2 S e m u a p a s i e n t e r m a s u k a n a k a n a k d e n g a n b a t u k y a n g t id a k d ik e t a h u i p e n y e b a b n y a y a n g b e r la n g s u n g d u a m in g g u a t a u le b ih a t a u d e n g a n te m u a n la i n p a d a f o t o t o r a k s y a n g t id a k d ik e t a h u i p e n y e b a b n y a y a n g m e n d u k u n g k e a r a h T B h a r u s d ie v a l u a s i u n t u k T B S t a n d a r 3 S e m u a p a s ie n t e r m a s u k a n a k a n a k y a n g d ic u r i g a i m e m ilik i T B p a r u d a n m a m p u m e n g e lu a r k a n d a h a k h a r u s m e m b e r ik a n s e d ik it n y a d u a s p e s im e n d a h a k u n t u k p e m e r ik s a a n m ik r o s k o p is a t a u s a t u s p e s im e n d a h a k u n t u k p e m e r ik s a a n X p e rt M T B / R IF d ila b o r a t o r i u m y a n g s u d a h t e r u ji k u a lit a s n y a P a s ie n d e n g a n r is ik o r e s is t e n s i o b a t d e n g a n H IV a t a u y a n g s a n g a t s a k it h a r u s d i p e r ik s a d e n g a n X p e rt' M T B / R IF s e b a g a i p e m e r ik s a a n d ia g n o s t ik a w a l u j i s e r o lo g i d a r a h d a n i n t e r fe r o n g a m m a r e l e a s e a s s a y s t id a k b o le h d i g u n a k a n u n t u k d ia g n o s is T B a kt if S t a n d a r 4 U n t u k s e m u a p a s ie n t e r m a s u k a n a k a n a k y a n g d id u g a m e m ilik i T B e k s t r a p a r u s p e s im e n y a n g t e p a t d a r i b a g ia n t u b u h y a n g s a k it h a r u s d i a m b il u n t u k p e m e r ik s a a n m ik r o b io lo g i d a n h is t o lo g i M e n g in g a t p e n t in g n y a d i a g n o s is c e p a t p a d a t e r d u g a T B m e n in g it is m a k a p e m e r ik s a a n X p e r t M T B / R IF d ir e k o m e n d a s ik a n s e b a g a i u j i m ik r o b io lo g i a w a l u n t u k p a s ie n y a n g d id u g a T B M e n in g it is

3 1 11 c r n a t i f 1 n u l \ t a n d a r d \ f n r : 1$ ( a r t e d h i l k t. : 3 S t a n d a r 5 P a d a p a s te n y i n g d ld u g a m e m rlik B T B p a r u d e n g a n B T A n e g a t if p e r l u d ila k u k a n p e m e r ik s a a n X p e r l M T B / R IF d a n / a t a u b ia k a n d a h a k P a d a p a s ie n d e n g a n B T A n e g a t if d a n X p e r l M T B / R IF n e g a t if t e t a p i buk b u k l i k lin is m e n d u k u n g k u a t k e a r a h T B m a k a p e n g o b a t a n d e n g a n o b a t a n t i T B h a r u s d i m u l a i s e t e l a h d i la k u k a n p e n g u m p u la n s p e s i m e n u n t u k p e m e r ik s a a n b ia k a n S t a n d a r 6 U n t u k s e m u a a n a k a n a k y a n g d id u g a m e n d e r it a T B in t r a t o r a k s (m is a ln y a p a r u p le u r a d a n k e le n j a r g e t a h b e n in g m e d ia s t in u m a t a u h ilu s ) K o n f i r m a s i b a k t e r io lo g is p e r l u d ila k u k a n m e la lu i p e m e r ik s a a n s e k r e s i s a l u r a n p e r n a p a s a n (d a h a k e k s p e k t o r a s i d a h a k h a s il in d u k s i b ila s la m b u n g ) u n t u k p e m e r ik s a a n m ik r o s k o p ik X p e r t ' M T B / R IF d a n / a t a u b ia k a n S T A N D A R P E N G O B A TA N S t a n d a r 7 U n t u k m e m e n u h i k e w a j i b a n t e r h a d a p k e s e h a t a n m a s y a r a k a t d a n k e w a j ib a n n y a t e r h a d a p p a s ie n p e m b e r i p e la y a n a n k e s e h a t a n h a r u s m e m b e r i k a n p a d u a n p e n g o b a t a n y a n g t e p a t m e m a n t a u k e p a t u h a n t e r h a d a p p a d u a t o b a t d a n j ik a d i p e r lu k a n m e m b a n t u m e n g a t a s i b e r b a g a i f a kt o r y a n g m e n y e b a b k a n P u t u s n y a a t a u t e r h e n t in y a p e n g o b a t a n U n t u k m e m e n u h i k e w a j ib a n i n i d i p e r l u k a n k o o r d i n a s i d e n g a n D i n a s K e s e h a t a n s e t e m p a t d a n / a t a u o r g a n is a s i la i n n y a

4 I n t e r n a 1l 1Bn a l \ l» n 1l a r 11\ r 11r l I I ( a r 1 ' S t a n d a r 8 S e m u a p a s te n y a n g b e lu m p e r n a h d io b a ti s e be lu m n y a d a n tid a k m e m i l i k r f a k t o r r i s i k o u n t u k r e s i s te n s i o b a t h a r u s m e n d a p a l k a n p e n g o b a l a n li n i p e r t a m a y a n g s u d a h d is e t u j u i o le h W H O d e n g a n m e n g g u n a k a n o b a t y a n g te r ja m in k u a lil a s n y a F a s e i n t e n s if h a r u s m e n c a k u p d u a b u la n p e n g o b a ta n d e n g a n m e n g g u n a k a n l s o n i a z id R ifa m p i s in P ir a z in a m id d a n Eta m b u t o > P a d a fa s e l a n j u t a n h a r u s d ibe r ik a n ls o n ia z id d a n R ifa m p is in s e la m a 4 b u l a n D o s is p e n g o b a t a n h a r u s m e n g ik u t i r e k o m e n d a s i W H O P e n g g u n a a n o b a t k o m b i n a s i d o s i s t e t a p d a p a t m e m p e r m u d a h pe m b e r ia n o b a t ' E t a m b u t o l d a p a t t id a k d i g u n a k a n p a d a a n a k d e n g a n s t a t u s H IV n e g a t if d a n m e m ilik i T B t a n p a k a v it a s S t a n d a r 9 P a d a p e n g o b a t a n s e m u a p a s ie n p e r l u d ib a n g u n p e n d e k a ta n y a n g b e r p u s a t k e p a d a p a s ie n d a ta m r a n g k a m e n d o r o n g k e p a t u h a n m e n in g k a t k a n k u a lit a s h id u p d a n m e r in g a n k a n p e n d e r it a a n P e n d e k a t a n i n i d il a k u k a n b e r d a s a r k a n k e b u t u h a n p a s ie n d a n r a s a s a l i n g m e n g h o r m a t i a n t a r a p a s i e n d a n p e n y e d i a p e l a y a n a n k e s e h a t a n S t a n d a r 10 R e s p o n s t e r h a d a p p e n g o b a t a n p a d a p a s ie n d e n g a n T B p a r u (t e r m a s u k p a d a p a s ie n y a n g d i d i a g n o s is d e n g a n p e m e r ik s a a n m o le k u la r c e p a t) h a r u s d im o n it o r d e n g a n p e m e r ik s a a n m ik r o s k o p is la n j u t a n p a d a s a a t s e le s a in y a fa s e in t e n s if (d u a b u la n ) J ik a a p u s a n d a h a k m a s ih po s it if d ia k h ir fa s e in t e n s if p e m e r ik s a a n m ik r o s k o p is d ila k u k a n la g i p a d a a k h ir b u la n k e t i g a d a n j ik a t e t a p p o s it if p e m e r ik s a a n k e p e k a a n o b a t m o le k u l a r c e p a t (lin e p r o be a s s a y s a t a u X p e r e M T B / R IF ) a t a u b ia k a n d e n g a n u ji k e pe ka a n o b a t h a r u s d il a k u k a n P a d a p a s ie n d e n g a n T B e k s t r a p a r u d a n p a d a a n a k a n a k r e s p o n s p e n g o ba ta n d in ila i s e c a r a k lin i s

5 S t a n d a r 11 P e n ila ia n u n t l j k k e m u t rg k rn a n r e s i s t o n s l o b a l be r d a s a r k a n r iw a y a t p e n g o b a t a n s e b e lu m n y t l i r l a u p ; t j a n a n d a r i k a s u s y a n g m u n g k in m e r u p a k i r n s u rt1b e r p e n u la r a n o r g a n i s m e r e s is te n o b a t d a n s u r v e i p r e v a l e n s r e s is t o n s i o b a l d l k o m u n il a s (jik a d ik e ta h u i) p e r lu d ila k u k a n u n l u k s e m u a p a s i e n u ji r e s i s t e n s i o b a t p e r lu d ila k u k a n s a a t p e n g o b a t a n d im u l a i u n t u k s e m u a p a s ie n d e n g a n r is ik o m e m ilik i T B r e s is t e n o b a t P a s ie n d e n g a n B TA t e ta p p o s itif s e t e l a h m e n y e l e s a ik a n t i g a b u la n p e n g o b a t a n p a s ie n d e n g a n pe n g o b a l a n y a n g g a g a l d a n p a s ie n y a n g p u t u s p e n g o b a ta n a t a u k a m b u h s e t e la h m e n y e le s a ik a n s a t u a t a u le b ih p e n g o b a ta n h a r u s d i p e r ik s a u n t u k k e m u n g k in a n r e s i s t e n s i o b a t P a d a p a s i e n y a n g d id u g a m e m ilik i r e s is t e n s i o b a t p e m e r ik s a a n d e n g a n X p e r t " M T B / R I F p e r l u d ila k u k a n s e b a g a i p e m e r ik s a a n d ia g n o s t ik a w a l J ik a d it e m u k a n r e s is t e n s i t e r h a d a p R if a m p is in b ia k a n d a n u j i k e p e k a a n t e r h a d a p l s o n i a z id F lu o r o k u in o lo n d a n o b a t o b a t a n s u n t ik lin i k e d u a h a r u s s e g e r a d ila k u k a n K o n s e lin g d a n e d u k a s i p a s ie n d a n p e n g o b a t a n e m p ir ik d e n g a n p a d u a n li n i k e d u a h a r u s s e g e r a d i m u la i u n t u k m e m in i m a lis a s i p o t e n s i p e n u la r a n P e r l u d ila k s a n a k a n t in d a k a n y a n g s e s u a i k o n d is i u n t u k p e n g e n d a lia n i n f e k s i S t a n d a r 12 P a s ie n d e n g a n a t a u y a n g s a n g a t m u n g k i n m e m i l ik i T B y a n g d is e b a b k a n o le h o r g a n is m e y a n g r e s is t e n d e n g a n o b a t (t e r u t a m a M D R/X D R ) h a r u s d io b a t i d e n g a n p a d u a n k h u s u s y a n g m e n g a n d u n g o b a t a n t i T B lin i k e d u a y a n g t e r ia m in k u a lit a s n y a h a r u s s e s u a i d e n g a n r e k o m e n d a s i W H O D o s i s p e n g o b a t a n P a d u a n y a n g d i p ilih d a pa t d is t a n d a r k a n a t a u b e r d a s a r k a n d u g a a n a t a u h a s il k o n fir m a s i p o ta k e p e k a a n o b a t S e d ik it n y a d ib e r ik a n lim a je n is o b a t P ir a z in a m id d a n e m p a t o b a t l a in n y a y a n g o r g a n is m e n y a d ik e t a h u i a t a u d id u g a m a s ih p e k a t e r m a s u k o b a t s u n t ik h a r u s d i g u n a k a n p a d a 6 8 b u la n f a s e in t e n s if d a n g u n a k a n s e t id a k n y a 3 je n is o b a t y a n g o r g a n is m e n y a d ik e ta h u i a t a u d id u g a m a s ih p e k a p a d a f a s e la n j u t a n Te r a p i h a r u s d ib e r ik a n b u la n s e t e la h t e r ia d in y a k o n v e r s i b ia k a n d a h a k B e r b a g a i t in d a k a n y a n g b e r p u s a t k e p a d a p a s ie n t e r m a s u k o b s e r v a s i p e n g o b a t a n d i p e rl u k a n u n t u k m e m a s t ik a n k e p a t u h a n K o n s u lt a s i d e n g a n d o k t e r s p e s ia lis y a n g b e r p e n g a la m a n d a ta m p e n g o b a t a n M D R /X D R h a r u s d il a k u k a n

6 P e lib a t a n N o n G o v e r n m e n t O r g a n iz a t io n (N G O ) u n t u k p e n a p is a n K o n s e lin g d a n t e s H IV p e r l u d ila k u k a n u n t u k s e m u a p a s ie n d e n g a n St a n d a r 1 3 U n t u k s e m u a pa s ie n pe r lu d ib u a t c a t a ta n y a n g m u d a h d ia k s e s d a n d i s u s u n s e c a r a s i s te m a tis m e n g e n a i : O b a t o ba t a n y a n g d ibe r ika n R e s po n s b a kte r io lo g ik H a s il a k h ir p e n g o ba t a n Efe k s a m p in g l m p le m e n t a s i : D O T S d i f a s y a n k e s p e m e r in t a h d a n s w a s t a K e g ia t a n P u b li c P r iv a t e M ix (P P M ) P r o g r a m m a t ic M a n a g e m e n t o f D r u g R e s is t a n t T B (P M DT ) a t a u P e l a k s a n a a n p e n g o b a t a n u n t u k p a s ie n T B M D R s e r t a p e n g u a t a n j e j a r in g p e n e m u a n k a s u s car e ip e r lg o b a t a n s e b a g a i p e n u n j a n g k e b e r h a s ila n p r o g r a m T B P e m a k a i a n X p e rt ' M T E3/ R IF u n t u k k a s u s c u r i g a T B M D R P e l a k s a n a a n pt nc e9del an d a n p e n g e n d a lia n i n f e k s i T B S t a n d a r 14 a t a u y a n g d id u g a T B k e c u a li s u d a h a d a k o n f i r m a s i h a s il t e s y a n g n e g a t if d a ta m d u a b u l a n t e r a k h ir K a r e n a h u b u n g a n y a n g e r a t a n t a r a T B d a n H IV p e n d e k a t a n y a n g t e r i n t e g r a s i u n t u k p e n c e g a h a n d i a g n o s i s d a n p e n g o b a t a n b a i k i n f e k s i T B m a u p u n H I V d ir e k o m e n d a s ik a n p a d a d a e r a h d e n g a n p r e v a le n s i H IV y a n g t in gg i P e m e r i k s a a n H IV t e r u t a m a p e n t i n g s e b a g a i b a g i a n d a r i p e n a ta la k s a n a a n r u t in d i d a e r a h d e n g a n p r e v a l e n s i H IV y a n g t in g g i p a d a p o p u la s i u m u m p a d a p a s ie n d e n g a n g e j a la d a n l a t a u t a n d a k o n d is i te r k a it H IV d a n p a d a p a s ie n y a n g m e m ilik i r iw a y a t r i s ik o t in g g i t e r p a ja n H IV

7 S t a n d a r = a P a d a p a s ie n d e n g a n in fe k s i H IV d a n T B y a n g m e n d e r it a im u n o s u p r e s i b e r a t (h it u n g C D k u r a n g d a r i 5 0 s e l/ m m ' ) A RT h a r u s d im u la i d a ta m w a kt u 2 m in g g u s e te la h d im u la i n y a p e n g o b a t a n T B k e c u a li j ik a a d a m e n in g it i s t u b e r k u lo s is U n t u k s e m u a pa s ie n d e n g a n H IV d a n T B t e r le p a s d a r i h a s il h it u n g C D 4 t e r a p i a n t i r e t r o v ir a l h a r u s d im u la i d a ta m w a kt u 8 m in g g u s e m e n ja k a w a l p e n g o b a t a n T B P a s ie n d e n g a n in f e k s i T B d a n H IV h a r u s d ib e r ika n k o t r im o k s a z o l u n t u k p e n c e g a h a n in f e k s i la in S t a n d a r 16 P a s i e n d e n g a n in f e k s i H IV y a n g s e t e la h d ie v a lu a s i s e c a r a s e k s a m a t id a k m e m ilik i T B a kt if h a r u s d io b a t i s e b a g a i in fe k s i T B la t e n d e n g a n Is o n ia z id s e la m a s e t id a k n y a 6 b u la n S t a n d a r 1 7 S e m u a p e m b e r i p e [a v a r $Ai! I k e s e h a t a n h a r u s m e la k u k a n p e n ila ia n y a n g m e n y e l u r u h u n Èu k Wì t3 n r ar i k r ] íì d s i k o m o r b id d a n b e r b a g a i fa k t o r l a i n n y a y a n g d i p ä n eq f W ) : enqi r L1hi r e s p o n s a t a u h a s i l a k h i r p e n g o b a t a n T B d ; /! I t w?ng/i j esti fë#{asi p e la y a n a n t a m b a h a n y a n g d a p a t m e n d u k u n g h a s te. 6d +t r p: $Tbat an y a n g o p t im a l b a g i m a s i n g m a s in g p a s ie n B e r b a g a i pel ayi nai 1 i r r i in a r u s d i g a b u n g k a n m e n j a d i r e n c a n a p e la y a n a n in d iv id u a l y a n g m e n c a k u p p e n il a i a n d a n r u j u k a n u n t u k p e n g o b a t a n p e n y a k it la i n n y a P e r lu d ib e r ik a n p e r h a t ia n k h u s u s p a d a p e n y a k it a t a u k o n d is i y a n g d ik e t a h u i d a p a t m e m p e n g a r u h i h a s il a k h i r p e n g o b a t a n s e p e rt i d ia b e t e s m e llit u s p e n y a la h g u n a a n o b a t o b a t a n d a n a lk o h o l n u t r is i y a n g b u r u k d a n p e n g g u n a r o k o k R u j u k a n u n t u k d u k u n g a n p s ik o s o s ia l la in n y a a t a u p e la y a n a n s e p e r t i p e la y a n a n a n t e n a t a l a t a u p e r a w a t a n b a y i j u g a p e r l u d i s e d ia k a n l m p l e m e n t a s i : P e n e r a p a n K o la b o b a r s i T B H IV P e n a n g a n a a n T B y a n g k o m p r e h e n s if m a s ih t e r p u s a t d i R S / s o n i a z i d P r e v e n t i v e T h e r a p y (I P T ) s u d a h d ila k s a n a k a n d ib e b e r a p a R S v e r t ik a l B a d a n P e n g e lo l a J a m in a n S o s ia l (B P J S )

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