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Research in Bandung – Indonesia

Overview

Since 2008 the Centre for International Health has established a strong collaboration with partners in Indonesia including the Padjadjaran University, community health centres, the Bandung Tertiary Teaching Hospital, and West Java Reference Laboratory.

These collaborations have been consolidated by full time onsite Otago staff, bi-yearly supervisory visits, and postgraduate student fieldwork.

Furthermore, they have facilitated a wide range of community, clinical, and laboratory-based research, and several important publications.

Bandung collaboration
Collaborators in Bandung.

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Concurrent Tuberculosis and Diabetes Mellitus: Unravelling the causal link and improving care (TANDEM)

TANDEM is a four-year Collaborative Project funded by the European Commission under the 7th Framework Programme of the European Union. TANDEM wants to help unravel the causal relationship between tuberculosis (TB) and diabetes (DM), in order to design more effective strategies for control of both diseases.

Diabetes triples the risk of developing tuberculosis. Consequently, the alarming growth of type 2 DM in TB endemic countries and among people originating from TB-endemic countries poses a serious threat to global TB control. However, there is a lack of evidence to support many of the recently advocated guidelines for care and control of TB and diabetes, and a lack of understanding of the mechanisms underlying the effect of diabetes on TB susceptibility and treatment outcome.

TANDEM aims to improve basic knowledge on the link between tuberculosis and diabetes, as well as on prevention, therapeutic management and prognosis of TB-DM co-occurrence. We are combining clinical, epidemiological and cutting edge expertise in laboratory sciences, bringing together a multi-disciplinary consortium linking field sites in Romania, Peru, South Africa and Indonesia, with leading experts in Germany, United Kingdom, the Netherlands and New Zealand.

Philip Hill and fellow collaborators at the 2014 annual TANDEM research meeting
Philip Hill and fellow collaborators at the 2014 annual TANDEM research meeting - Capetown South Africa

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Four months rifampicin vs. nine months isoniazid in the treatment of latent tuberculosis infection: a multi-centre randomised control trial

Merrin Rutherford

Funder: Canadian Institutes of Health Research

Bandung Health Research Unit is part of a seven-country randomised control trial (RCT) running from 2010 until 2016. During this time 750 adult and 210 child contacts of infectious TB patients will be recruited at the Indonesian site and those who present with latent tuberculosis infection will be randomised to complete one of two treatments.

The site has included more than 150 adults and is now starting to recruit children and HIV patients.

The Bandung team is a successful part of the RCT team engaging fully in the main study as well as spear-heading two sub-studies.

Dr Merrin Rutherford and colleagues
Dr Merrin Rutherford and colleagues.

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Child contact management

Merrin Rutherford

Funder: University of Otago; Mercy Hospital, Dunedin

In Indonesia as well as many other high-burden countries, child tuberculosis (TB) is marginalised and mismanaged. The Bandung team is conducting a situational analysis regarding management of children living with an infectious TB case.

A range of epidemiological tools has been employed to establish all possible gaps and reasons for these gaps between current practice and national policy. Using the findings, options for bridging these gaps will be investigated and interventions designed and implemented.

Furthermore, the Bandung team is creating generic web-based situational analysis tools for use in other high-burden settings.

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Comparison of Quantiferon and Mantoux test for latent tuberculosis in Indonesian children

Merrin Rutherford

Funder: University of Otago, Mercy Hospital Dunedin

We have conducted a formal comparison of the Quantiferon and Mantoux tests for latent tuberculosis infection in child contacts of adult sputum smear positive TB cases.

Both tests performed as predicted against an exposure gradient with neither test outperforming the other.

Given the cost of Quantiferon, there is no justification for introducing this test into routine practice in Indonesia.

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Treatment default cohort

Funder: Mercy Hospital Dunedin

Delayed treatment seeking and incomplete treatment completion remain two major barriers to successful TB control. The Bandung team has been conducting a cohort study over the past 18 months, cross-sectionally documenting treatment seeking behaviour and longitudinally following up treatment completion of 300 TB outpatients.

Risk factors for early, temporary and permanent default will be evaluated using information gathered at baseline, and interventions to reduce defaulting and increase prompt treatment seeking will be developed in collaboration with the study clinic.

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Committed to capacity building

Merrin Rutherford

Funder: Otago Alumni

The Centre for International Health is committed to increasing the research capacity among the staff of Padjadjaran University. We have been involved in several teaching workshops in epidemiology and proposal writing.

We have also provided English lessons for promising health professionals and have sponsored a student to complete a two-year master's course in epidemiology with the London School of Hygiene and Tropical Medicine.

It is hoped that the Centre can facilitate more students in achieving an international master's in epidemiology and public health.

Sumatra Mansion

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