Variation of tuberculosis prevalence across diagnostic approaches and geographical areas of Indonesia

Abstract

Background: Tuberculosis (TB) has contributed a significant disease burden and economic loss worldwide. Given no gold standard for diagnosis, early identification of TB infection has been challenging. This study aimed to comparatively investigate the prevalence of TB across diagnostic approaches (sputum AFB, sputum culture, sputum genetic test, and chest x-ray) and geographical areas in Indonesia. Methods: Participant demographic variables and TB screening test results were obtained from the Tuberculosis Unit, Health Research and Development Agency, Ministry of Health (HRDA-MoH). Variations across geographical areas and diagnostic approaches are expressed as prevalence rate and 95%CI. Results: A total of 67,944 records were reviewed. Based on bacteriological evidence, the prevalence of TB in Indonesia was 759 (95%CI 589.7- 960.8) with variations across areas: 913 (95%CI 696.7-1,176.7; Sumatra), 593 (95%CI 447.2-770.6; Java-Bali), and 842 (95%CI 634.7- 1,091.8; others). Also, the prevalence of TB varied across diagnostic approaches, from 262 (sputum AFB) to 895 (sputum genetic test). Based on sputum AFB, the TB prevalence varied from 216.6 (95%CI 146.5-286.8; Java-Bali) to 307.4 (95%CI 208.3-406.5; Sumatra). Based on sputum culture, the TB prevalence ranged from 487.9 (95%CI 433.6-548.6; Java-Bali) to 2,129.8 (95%CI 1,664-2,735.6; others). Based on chest x-ray, the TB prevalence varied from 152.1 (95%CI 147.9-156.3; Java-Bali) to 864 (95%CI 809-921.4; others). Based on sputum genetic test, the TB prevalence ranged from 838.7 (95%CI 748.4-900.8; Java-Bali) to 941.2 (95%CI 663.6-992.3; others). Conclusions: The variation of TB prevalence across geographical regions could be confounded by the diagnostic approaches.