Analysis of Health-Related Quality of Life and Incurred Costs Among Human Immunodeficiency Virus, Tuberculosis, and Tuberculosis/HIV Coinfected Outpatients in Indonesia.

OBJECTIVES: A growing interest in healthcare costs and patients' health-related quality of life (HRQoL) exists in the context of the increasing importance of health technology assessment in countries with high numbers of the HIV and tuberculosis (TB) patient populations, such as Indonesia. This study aimed to analyze the HRQoL and out-of-pocket (OOP) costs of HIV, TB, and TB/HIV coinfected participants in a city in Indonesia with a high prevalence of HIV and TB. METHODS: A cross-sectional survey was conducted in the voluntary counseling and testing and lung clinics of Bekasi City Public Hospital (Indonesia) from January to March 2018. Patients' HRQoL was measured using the EQ-5D-5L questionnaire, whereas OOP costs were extracted from a semistructured questionnaire. RESULTS: Of the 460 eligible participants, 82% resided in the city, 48% of them were married, and their median age was 34 years. Less than half were insured, and more than half had no source of income. The median values of health utilities for participants with HIV, TB, and TB/HIV were perceived as potentially high (1.0, 0.9, and 0.8, respectively). The TB/HIV coinfected outpatients had the highest OOP costs (US$94.5), with the largest contribution coming from direct medical OOP expenditures. Taking loans from family members was adopted as a financial strategy to overcome inadequate household incomes and high treatment costs. CONCLUSION: This study suggests that TB/HIV coinfection potentially lowers HRQoL and increases healthcare costs and the need for economic analysis to underpin cost-effective treatment in such patients.

The effect of pillbox use in increasing patients’ adherence to type 2 diabetes mellitus therapy in Lubuk Kilangan health center

Adherence is the extent to which the patient takes the medication as determined by the health care provider. The success of a patient's therapy is strongly influenced by adherence to the use of the drug. Low adherence to therapy is a particular problem in patients with diabetes mellitus. Diabetes mellitus is a chronic metabolic disease characterized by elevated blood glucose levels, which cause damage to the heart over time, vasculature, eyes, kidneys, and nerves. The pill count method was used by calculating the rest of the drug from the patient to assess the patient's level of adherence. Objective: Adherence assessments are carried out through the Home Medication Review program. This study aimed to determine the differences in therapy adherence of patients with type 2 diabetes mellitus using the pill count method. Method: This type of research is experimental with pretest-posttest control group design research. This method is selected because the calculation of the rest of the drug is carried out before and after the intervention is given. Sampling in this study uses the total sampling method. The data was taken from Chronic Disease Management Program patients with type 2 diabetes mellitus treated at the Lubuk Kilangan Padang Health Center for January-March 2022. There are two groups of patients: patients with and without pillboxes. The data analysis used in this study is the Mann-Whitney Test. Result: The results showed a difference in the level of therapeutic adherence between the pillbox group and those who did not use the pillbox, with a value of p = 0.000 (p<0.05). Conclusion:It can be concluded that the level of adherence is higher in patients who use pillboxes than in those who do not (AU)

The usability testing of the integrated electronic healthcare services for diabetes mellitus patients during the pandemic in Indonesia.

Introduction: Diabetes mellitus is a degenerative disease that obliges patients to take continuous healthcare services. During a pandemic situation, all access to healthcare facilities becomes limited. A web-based integrated electronic-healthcare system (IeHS) study was used to overcome this problem. This study aimed to describe patients' ability to access and understand this web-based application. Method: An observational study using a web-based IeHS took place in Muara Tebo, Indonesia, in 2021. A total of 82 outpatients with diabetes mellitus participated in this study. These patients belonged to local community-based diabetes mellitus. Only adult patients accustomed to using smartphones were invited to participate in this study. All participants were taught to access the web-based application through video recordings. They were asked to fill out the form regarding their understanding of the web-based integrated e-healthcare application. This form was sent online. Results: From the calculation of the usability scale, the results show that patients have not been able to take advantage of this application in life (the system usability scale (SUS) score 63.38). There is no significant difference between patients' characteristics and the SUS score. Conclusion: Participants' condition in this study reflects the general state of outpatients. The ability of these participants to access an internet-based application was related to their education level. This condition becomes a challenge for policymakers to improve local human resources to increase their health literacy.

Effect of fermented milk Pediococcus acidilactici BK01 on cholesterol and microbiota in Wistar mice intestine.

Objective: This study examines the effect of fermented milk containing the probiotic Pediococcus acidilactici BK01 on cholesterol and intestinal microbiota. Materials and Methods: 24 male rats weighing an average of 200 gm each spent 1 week in a cage adapting to their new environment. They were fed standard feed daily and were allowed to drink ad libitum. For 3 weeks, rats were divided into four groups (doses of fermented milk): M+ (control), M1 (0.35 ml), M2 (0.70 ml), and M3 (1.05 ml). The analysis includes bodyweight determination, serum biochemical analysis, and intestine microbiota analysis. Results: The results indicated that while P. acidilactici BK01 fermented milk did not affect body weight or high-density lipoprotein, it did have a beneficial effect on total serum cholesterol and triglyceride levels. Additionally, treatment of fermented milk with P. acidilactici BK01 has been shown to increase the total lactic acid bacteria (LAB) in the intestine, as indicated by changes in the intestinal villi. Conclusion: Administering fermented milk (P. acidilactici BK01, 1.05 ml) can reduce total serum cholesterol and increase the number of LAB in intestinal villi in experimental animals, so it has the potential to be a probiotic.

Cost-effectiveness of controlling gestational diabetes mellitus: a systematic review.

OBJECTIVE: Timely screening for hyperglycaemia in pregnancy using a simple glucose test enhances early detection and control of gestational diabetes mellitus (GDM). The aim of this study was to provide an overview of the evidence on the cost-effectiveness of identification and/or treatment of GDM. METHODS: We conducted a systematic review using three electronic databases (PubMed, EMBASE, and Cochrane) of cost-effectiveness studies of GDM screening and treatment published during 2000-2017. RESULTS: The initial search discovered 287 references (PubMed 86, EMBASE 195, Cochrane library 6) of which six full articles were included in the review. Two articles were model-based analysis and the remaining four were trial based. Two studies demonstrated favorable cost-effectiveness of intensified management of mild GDM. In the other included studies, neither screening nor treatment of GDM was shown to be cost effective, although results varied with the particular outcome measures used and the assumptions that where applied. CONCLUSION: Neither screening nor treating GDM seems to be convincingly cost-effective from the studies reviewed. However, all studies were done in high-income countries with obviously different health systems than low-/middle-income countries (LMIC) have. Since detection of GDM may be relatively poor in LMIC, screening might be more worthwhile in these countries. Comprehensive research is necessary in LMIC, including the potential outcomes of assessing its cost-effectiveness. Favorable cost-effectiveness could help in bridging the need for and access to increased diabetes screening in early pregnancy in these countries.

Antituberculosis Drug-induced Liver Injury in Children: Incidence and Risk Factors During the Two-month Intensive Phase of Therapy.

BACKGROUND: As one of the most frequent and serious adverse reactions during tuberculosis (TB) treatment, antituberculosis drug-induced liver injury (ATLI) in children has been studied insufficiently compared with adults. We aimed to determine the incidence and risk factors of ATLI in children during the first 2 months of TB therapy. METHODS: A total of 41 children with TB and treated with first-line anti-TB drugs were prospectively followed-up for the development of ATLI. Liver function tests were performed at baseline and after 2 weeks of therapy. Subsequent tests were conducted at 4, 6 and 8 weeks if the initial 2-week measurement was abnormal or if symptoms of hepatotoxicity were reported. RESULTS: ATLI was detected in 11 (27%) patients within 14 to 42 days from the start of therapy, with most of them (54%) occurred after 2 weeks. TB treatment was stopped immediately in 6 of 11 patients who developed ATLI, and no recurrent hepatotoxicity after drug reintroductions in these patients. Univariate analysis showed that ATLI was significantly associated with TB meningitis (P < 0.01), hypoalbuminemia (P < 0.05) and hepatotoxic comedications (P < 0.01). Age, sex, nutritional status, HIV status and baseline liver function abnormalities were not associated with ATLI. Multivariate analysis identified hypoalbuminemia and hepatotoxic comedications (both P < 0.1) tend to be independently associated with ATLI. CONCLUSIONS: Children with hypoalbuminemia and use of hepatotoxic comedications are suggested to be monitored closely for the development of ATLI.