title: Missed opportunity for standardized diagnosis and treatment among adult tuberculosis patients in hospitals involved in Public-Private Mix for Directly Observed Treatment Short-Course strategy in Indonesia: a cross-sectional study.
abstract: BACKGROUND
  The engagement of hospitals in Public-Private Mix (PPM) for Directly Observed Treatment Short-Course (DOTS) strategy has increased rapidly internationally - including in Indonesia. In view of the rapid global scaling-up of hospital engagement, we aimed to estimate the proportion of outpatient adult Tuberculosis patients who received standardized diagnosis and treatment at outpatients units of hospitals involved in the PPM-DOTS strategy.
  
  
  METHODS
  A cross-sectional study using morbidity reports for outpatients, laboratory registers and Tuberculosis patient registers from 1 January 2005 to 31 December 2005. By quota sampling, 62 hospitals were selected. Post-stratification analysis was conducted to estimate the proportion of Tuberculosis cases receiving standardized management according to the DOTS strategy.
  
  
  RESULTS
  Nineteen to 53% of Tuberculosis cases and 4-18% of sputum smear positive Tuberculosis cases in hospitals that participated in the PPM-DOTS strategy were not treated with standardized diagnosis and treatment as in DOTS.
  
  
  CONCLUSIONS
  This study found that a substantial proportion of TB patients cared for at PPM-DOTS hospitals are not managed under the DOTS strategy. This represents a missed opportunity for standardized diagnoses and treatment. A combination of strong individual commitment of health professionals, organizational supports, leadership, and relevant policy in hospital and National Tuberculosis Programme may be required to strengthen DOTS implementation in hospitals.
authors.affiliation: Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Indonesia. ariprobandari@yahoo.com
authors.forename: Ari
authors.initials: A
authors.lastname: Probandari
authors.forename: Lars
authors.initials: L
authors.lastname: Lindholm
authors.forename: Hans
authors.initials: H
authors.lastname: Stenlund
authors.forename: Adi
authors.initials: A
authors.lastname: Utarini
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Hurtig
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D023801:Directly Observed Therapy / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D007214:Indonesia; D008297:Male; D016134:Organizational Policy; D010342:Patient Acceptance of Health Care; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000628:therapy*
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