Aksesibilitas Geografis Layanan Diagnosis dan Pengobatan Tuberkulosis Resistan Obat dan Hubungannya dengan Cakupan Penemuan Kasus dan Loss to Follow-Up di Provinsi Jawa Barat, Indonesia

Abstract

Background: Diagnosis and treatment services for drug-resistant tuberculosis (DR-TB) in West Java expanded in 2024. However, evidence on geographic accessibility and its relationship with program indicators remains limited. This study assessed geographic accessibility of DR-TB services in West Java by examining the proportion of the population within a 5-km radius of service facilities, median travel distance, and their associations with case notification rates and loss to follow-up (LTFU).

Methods: This ecological study used 27 districts/cities in West Java as the units of analysis. Geographic accessibility was assessed through spatial analysis using two indicators, including the median Euclidean distance to the nearest DR-TB facility and the proportion of the population residing within a ≤5 km service radius. Spearman’s rank correlation was used to examine the relationships between these accessibility measures, case notification rates, and LTFU.

Result: DR-TB diagnostic facilities were concentrated in urban areas, with >50% of the population within a ≤5 km radius and median distances <5 km. Treatment services showed a similar pattern, although several districts had lower coverage and longer travel distances (>15 km). Distance to diagnostic facilities was negatively associated with case notification rates (ρ = −0,5606; p = 0,0024), whereas distance to treatment facilities was not associated with LTFU (ρ = −0,0323; p = 0,8728).

Conclusion: DR-TB services in West Java remain concentrated in urban areas. Greater distance to diagnostic services is associated with lower case notification rates. Improving service distribution based on geographic characteristics may strengthen DR-TB control.