title: Diagnostic work-up and loss of tuberculosis suspects in Jogjakarta, Indonesia.
abstract: BACKGROUND
  Early and accurate diagnosis of pulmonary tuberculosis (TB) is critical for successful TB control. To assist in the diagnosis of smear-negative pulmonary TB, the World Health Organisation (WHO) recommends the use of a diagnostic algorithm. Our study evaluated the implementation of the national tuberculosis programme's diagnostic algorithm in routine health care settings in Jogjakarta, Indonesia. The diagnostic algorithm is based on the WHO TB diagnostic algorithm, which had already been implemented in the health facilities.
  
  
  METHODS
  We prospectively documented the diagnostic work-up of all new tuberculosis suspects until a diagnosis was reached. We used clinical audit forms to record each step chronologically. Data on the patient's gender, age, symptoms, examinations (types, dates, and results), and final diagnosis were collected.
  
  
  RESULTS
  Information was recorded for 754 TB suspects; 43.5% of whom were lost during the diagnostic work-up in health centres, 0% in lung clinics. Among the TB suspects who completed diagnostic work-ups, 51.1% and 100.0% were diagnosed without following the national TB diagnostic algorithm in health centres and lung clinics, respectively. However, the work-up in the health centres and lung clinics generally conformed to international standards for tuberculosis care (ISTC). Diagnostic delays were significantly longer in health centres compared to lung clinics.
  
  
  CONCLUSIONS
  The high rate of patients lost in health centres needs to be addressed through the implementation of TB suspect tracing and better programme supervision. The national TB algorithm needs to be revised and differentiated according to the level of care.
authors.affiliation: Centre for Tropical Medicine, Faculty of Medicine, Gadjah Mada University, Jogjakarta, Indonesia. risandono.ahmad@gmail.com
authors.forename: Riris Andono
authors.initials: RA
authors.lastname: Ahmad
authors.forename: Francine
authors.initials: F
authors.lastname: Matthys
authors.forename: Bintari
authors.initials: B
authors.lastname: Dwihardiani
authors.forename: Ning
authors.initials: N
authors.lastname: Rintiswati
authors.forename: Sake J
authors.initials: SJ
authors.lastname: de Vlas
authors.forename: Yodi
authors.initials: Y
authors.lastname: Mahendradhata
authors.forename: Patrick
authors.initials: P
authors.lastname: van der Stuyft
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D000554:Ambulatory Care Facilities / Q000592:standards; D019091:Critical Pathways / Q000458:organization & administration / Q000592:standards; D005260:Female; D019983:Guideline Adherence / Q000331:legislation & jurisprudence / Q000592:standards*; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000592:standards; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D015397:Program Evaluation; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018571:Sentinel Surveillance; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D014374:Tuberculin Test / Q000379:methods; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy