Image: Participants in one of the TB Elimination courses at Burnet Institute

An android app, a comic book, a set of health promotional videos, and a motivational puzzle are some of the innovative and potentially life-saving projects developed by Indonesian health professionals to address the heavy burden of tuberculosis (TB) in their country in a series of courses hosted by Burnet Institute and Menzies School of Health Research during 2018.

Three separate specialised training and professional development courses were hosted by a collaboration between Burnet, Menzies, and Gadjah Mada University (UGM), and funded by the Australian Department of Foreign Affairs and Trade, through the Australian Awards Indonesia mechanism.

One of the primary tasks for the 76 participants, who included clinicians, pharmacists, nurses, community health workers, Ministry of Health staff and University researchers drawn from across Indonesia, was to develop innovative and evidence-based projects to be implemented across the Indonesian TB program.

Finding local solutions to a serious problem

Burnet Infectious Diseases Specialist and course leader, Dr Philipp du Cros said the course was an opportunity for professionals who understand the key TB challenges to try something different and creative to find local solutions to a serious problem.

“The activities had to be entirely run by them, down to the fact that if funding was needed, they had to find the money to start and implement, so it was high-level in that respect and a great chance to see how learning gets put into action,” Dr du Cros said.

“And what they came up with was so varied, simple and useful, like an android app with TB guidelines for clinicians for easy access to diagnostic information, and a comic book for adolescents to learn about TB, reducing stigma and raising awareness.”

“Then there was a motivational puzzle that one group created that depicted a set of lungs, and every day that a patient attended the clinic they would add another piece, and when their treatment was complete, the puzzle would be complete and they would have something tangible to celebrate their achievement.

“This project also won an award for the best poster at the Indonesian TB Research conference this year.”

Image: Course participants on a tour of the Burnet laboratories

Dr Du Cros said further opportunities for networking and collaboration will be one of the by-products of the courses, which focused on TB elimination.

“Most TB programs are focused around diagnosis and treating people for drug-sensitive and drug-resistant TB, and while that’s important to reduce deaths it doesn’t lead to elimination of TB,” Dr du Cros, said.

“What we need to do is to also include prevention, including treatment to stop those exposed to TB from getting active disease, and that’s what these courses focused on.

“Indonesia has a very high burden of TB, of TB-HIV co-infection and drug-resistant TB, so it’s got this triple scourge to tackle, and all the participants returned home ready to take on that challenge.”

Collaboration a key strength

Support and involvement of key Indonesian National TB Program experts ensured the relevance of the course, grounding it in key Indonesian TB challenges and policies.

Menzies/UGM TB researcher and course facilitator Dr Trisasi Lestari said the collaborative aspect of the courses was one of its strengths.

“It’s very important because Australia doesn’t have a lot of TB cases, but you have a lot of TB experts here with different perspectives and skills, and the opportunity to bring them together, to meet and learn from them and network is excellent for the participants,“ Dr Lestari said.

“Training courses like these illustrate that Australia has a key role and capacity to respond to the regional and global TB epidemic.”

Image: Course participants embraced the opportunity to network with expat Indonesian health professionals living in Melbourne

Course participant, Dea Adespin, a lecturer in the Faculty of Medicine at the University of Diponegoro, said the course had changed her perspective about TB.

“I have learned a lot of new things, like the concept of the cascade of care to evaluate a program or the disease,” she said.

“We look at numbers but never think there are gaps and connections and that the problem can be viewed as a cascade.

“This course will have an impact in Indonesia because it caters to so many aspects and gives us opportunities to collaborate in ways that’s not currently being done in Indonesia.”

TB cases in the Asia-Pacific region represent 62 percent of all TB cases globally, and the region has the lowest rates (75 percent) of treatment success.

In 2017, Indonesia had eight percent of the global burden of TB disease, the third highest behind India and China, according to the World Health Organization.

These courses, focused on capacity building, are a step in the right direction for TB elimination in Indonesia and the region.