Modelling a Holistic Comprehensive Approach for The Prevention of Tuberculosis

Background: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. Tuberculosis cases in Indonesia are spread across 34 provinces, with a total of 360,770 cases, with 48,323 cases in East Java province. The process of treating TB is not optimal, and there is a new global problem of multidrug resistance. According to H.L. Blum’s theory, the cause of MDR-TB involves four closely related factors. They are psychobiology, behavior, environment, and health services. They influence each other. Objective: This study aims to analyze a comprehensive, holistic approach to the prevention of MDR TB. Methods: This study employed a cross-sectional design with a sample of TB patients who experienced MDR TB in Jember Regency from 2016 to 2019. A questionnaire with 17 questions was used. The results were analyzed using Kendall’s tau-b (τb) analysis and ordinal logistic regression. Results: All determinants, as per HL Blum, showed an effect on the occurrence of MDR-TB. A person with MDR TB will experience 4.8 times higher stress levels. Patients with MDR TB who protect their surrounding environment have a 6.8 times better chance of successful treatment. Support from the social environment, including both family and community, will increase the chances of successful treatment by 11.4 times. The competence of health workers plays a crucial role in the success of MDR TB treatment. Patients at health facilities with competent health workers have 17.3 times the success rate of treatment compared to those at health facilities where health workers are less active and not competent. Conclusion: The determinants of the HL Blum factor have an influence on the success of MDR TB management, namely stress levels, behavior towards the environment, social environment, and human resources for health services.