Ivan Surya Pradipta

Medicine stockouts (MSOs) remain a significant challenge to delivering quality health services in primary care, primarily due to inefficiencies in Medicine Supply Chain Management (MSCM). This study reviewed existing MSCM models and key factors to develop strategies for strengthening their implementation in primary care settings. A scoping review was conducted, including original studies published in the PubMed, Scopus, and EBSCO databases between January 2010 and January 2025. The included studies assessed pharmaceutical supply chain models or interventions addressing MSO in primary health care. Studies focused on industry supply chains, wholesalers, vaccines, or reviews were excluded. The Antecedent, Decision, and Outcome (ADO) method was used to lead a systematic scoping review. Antecedents were defined as factors associated with MSCM, decisions referred to the MSCM models, and outcomes represented their performance. Data were thematically analysed using the Pharmaceutical Management Framework, and the reported study followed PRISMA-ScR guidelines. Out of 307 identified articles, 28 met the inclusion criteria. Some countries adopted digital solutions, such as stock tracking tools and Geographic Information Systems. At the same time, those with limited infrastructure focused on strengthening governance and supervision, such as through the Supervision, Performance Assessment, and Recognition Strategy. Contributing factors to MSOs include weaknesses in medicine management, inadequate managerial support, policy gaps, and external disruptions to the supply chain. Successful models for MSOs integrate key factors such as digital technology, strengthened human resource capacity, and supportive governance structures. Future strategies should prioritise systems that are adaptable, data-driven, and backed by strong government commitment.

Background: Community pharmacists (CPs) are accessible healthcare providers with the potential to support care for tuberculosis infection (TBI). However, their role remains limited and poorly integrated into national TB programs. Despite global recognition, no study in Indonesia has explored how CPs can be engaged as direct service providers. This study aims to identify the challenges and develop strategies for involving CPs as direct providers of TB services to improve TB preventive treatment outcomes. Methods: A qualitative case study was conducted in West Java, Indonesia. Data collection involved group interviews (GIs) and in-depth interviews (IDIs) with providers from community health centers (CHCs) and community pharmacies, as well as with patients with TBI. Participants responded to a proposed collaborative model scenario during the interviews, where CPs would provide direct support for TBI treatment. Data were deductively analyzed using ATLAS.ti version 9, employing a thematic analysis approach guided by the Tailored Implementation for Chronic Diseases (TICD) framework to identify challenges and strategies across seven domains. The findings are reported in accordance with the 32-item COREQ checklist. Result: A total of 27 participants were enrolled from CHCs and pharmacies, including TB programmers, medical doctors, community pharmacists, and individuals with TBI. We identified several challenges, including the absence of specific guidelines; limited knowledge and skills among CPs; patient preferences; limited professional interaction between CPs and healthcare workers; the lack of an incentive scheme; and insufficient regulatory support from national and local governments. In response to these challenges, various strategies can be implemented, including providing systematic guidelines, improving CPs’ capacity, building a communication system between CPs and related healthcare workers, implementing an incentive scheme, and advocating for regulatory support from national and local governments. Conclusion: To implement collaborative practice effectively, it is essential to address the identified challenges and, alongside coordinated efforts among all TB stakeholders, develop strategies to establish a sustainable, impactful practice model in real-world settings.

Despite its importance in global TB elimination, tuberculosis preventive treatment (TPT) remains underutilized. Psychosocial barriers significantly contribute to this issue. This systematic review aims primarily to synthesize psychosocial interventions to improve the initiation of TPT. We analyzed psychosocial outcomes as secondary objectives when relevant data were available. This review included studies indexed in PubMed, Scopus, and PsycInfo until August 25, 2025. Original studies addressing psychosocial interventions for people with latent tuberculosis infection (LTBI) indicated for TPT were included in this review. The risk of bias was assessed via the Crowe Critical Appraisal Tool (CCAT). A narrative synthesis summarized the characteristics of interventions, including the format of delivery, settings, intervention providers, psychosocial content, duration, and outcomes. Among the 1725 identified studies, nine (14,428 participants) met the inclusion criteria. The CCAT classification was moderate to high quality, with strengths in clearly articulated study rationales but weaknesses in study design. Most studies were from upper-middle-income countries with a high burden of TB; none were from Asia. Health education is a core component, often incorporating culturally adapted survivor testimonials to reduce stigma and increase motivation. Interventions were mostly community-based and led by multidisciplinary healthcare professionals and community workers. TPT initiation improved in all included studies, with risk differences ranging from 10–52%. This review emphasizes the potential of psychosocial interventions in supporting behavior change and increasing TPT initiation. Methodological limitations and a lack of research in high-burden Asian contexts restrict the current evidence. Future studies should focus on developing rigorous, contextually appropriate strategies for scalable psychosocial interventions that are effective and sustainable.

Drug-resistant tuberculosis (DR-TB) continues to be a major global health threat, and while advancements in drug therapies have been made, the role of pharmacists in improving patient outcomes has not been fully optimized. This review aims to describe the types, resistance mechanisms, and management strategies of DR-TB, with a focus on discussing the critical role of pharmacists in optimizing treatment outcomes for DR-TB patients. A narrative review approach was adopted to provide an updated and evidence-based perspective. Additionally, manual review of reference lists from the retrieved articles was performed to identify additional relevant studies. The review identifies types of DR-TB, including mono-, poly-, rifampicin-, multi-, pre-extensively, and extensively-drug resistance. Resistance mechanisms are outlined, highlighting mutations in key genes, such as those involved in rifampicin and isoniazid (INH) resistance, which compromise treatment efficacy. The treatment regimens for DR-TB include the INH-R regimen, Bedaquiline, Pretomanid, and Linezolid (with or without Moxifloxacin) (BPaL(M) regimen, shorter oral regimen, and longer oral regimen, each tailored to the specific resistance pattern and patient condition. The challenges in managing DR-TB include complex treatment regimens and side effects, social barriers such as stigma and adherence issues, and system-related obstacles like limited resources and healthcare infrastructure. The review underscores pharmacists’ vital yet underutilized role in addressing challenges. Pharmacists’ contributions include patient counseling to improve adherence, and optimizing regimens for vulnerable populations and therapeutic drug monitoring. Addressing DR-TB requires a multifaceted approach, with pharmacists playing a critical role in its management. Their contributions are key to improving patient outcomes and overcoming the challenges associated with DR-TB management.

Introduction: A significant number of possible tuberculosis (TB) missing cases are still reported globally. Pharmacies are reported as a significant first point of contact for people with TB. Unfortunately, the practice of TB detection in pharmacies is still lacking. Therefore, this study aims to implement and evaluate a community pharmacy program for TB case finding in a systematic and structural approach. Methods: An implementation study will be piloted in Bandung City, Indonesia, from February to November 2025. The program will engage pharmacy personnel in screening, educating, and referring people with presumed TB to community health centers (CHCs) for further diagnostic work-up. This study will involve selecting 20 pharmacies and 4 CHCs. Sequential research activities will be performed, incorporating quantitative and qualitative approaches, i.e., (1) building a coalition, (2) developing a conceptual program, (3) program socialization and educational intervention, and (4) program implementation and evaluation. The program outcomes will be reached according to the sequential research activities: (1) a joint agreement among the key actors and implementers, (2) a conceptual program for implementation, (3) improved capacity of implementers and availability of practice aids and system for the implementation, (4) the effectiveness of the program implementation. The Consolidated Framework for Implementation Research will be used as a framework in this study. Descriptive and multivariable analyses will be used for quantitative data, while thematic analysis will be used for qualitative data. Finally, an implementation outcome will be comprehensively analyzed, considering the quantitative and qualitative data analyses for the key factors of the successful program.

Background: Community pharmacists should provide qualified drug information services for the rational use of medicine in community. However, there is no standard professional incentive for the service in Indonesia. This study aimed to assess drug information services with incentives and its associated factors among community pharmacists in Indonesia. Method: A multi-centre cross-sectional study was conducted among community pharmacists in Medan City, Bandung City, Bandung Regency, and Makassar City. A validated online self-administered questionnaire was used to collect data on pharmacists’ demographics, pharmacy characteristics, and drug information provision practices. Multivariate logistic regression was applied to identify factors associated with incentivized drug information services. Results: A total of 639 community pharmacists participated, with representation from Medan (21.9%), Bandung City (20.8%), Bandung Regency (26%), and Makassar (31.3%). Most respondents were female (79%) with a median age of 31 years (IQR: 9). Only 12% of pharmacists reported receiving incentives for providing drug information services. Factors significantly associated with receiving incentives included being male (OR: 2.04, 95% CI: 1.16–3.58), aged 20–30 years (OR: 3.25, 95% CI: 1.10–9.58), working over 40 hours per week (OR: 2.30, 95% CI: 1.16–4.58), working in a chain pharmacy (OR: 2.08, 95% CI: 1.18–3.67), and having an onsite physician practice (OR: 1.72, 95% CI: 1.04–2.85). Conclusion: Limited number of community pharmacists received an incentive for drug information services. The development of a remuneration system for drug information services can be considered to enhance the quality of pharmaceutical care services in the community setting.

Background: Chronic disease has become an increasing burden in Indonesia, increasing the importance of treatment adherence to control the disease prognosis. Therefore, we aim to determine the prevalence and characteristics of nonadherence in Indonesian chronic disease population. Methods: We identified 11,408 adult subjects with chronic diseases from the fifth Indonesian Family Life Survey. We defined treatment nonadherence as the outcome variable and characteristics related to the World Health Organization Multidimensional Adherence Model as exposure variables. We used descriptive and multivariable analyses to analyze factors related to treatment nonadherence. Results: We identified that 57% (95% CI 56.1– 57.9) of chronic disease patients were nonadherent to their treatment. Treatment nonadherence was notable in subjects with liver disease (61.8%), tuberculosis (59.8%), digestive diseases (57.9%), other lung diseases (56.8%), psychiatric diseases (51.6%), asthma (51.2%), and hypertension (50%). Treatment nonadherence was associated with socioeconomic-related factors of being aged 15– 65 years, living in rural areas, having history of formal education, and having a household size of 2– 6 people. Furthermore, in patient- and condition-related factors, positive perceptions of their health condition, missing 0– 7 days of their regular activity in the last month, being ex- and non-smokers, having no depression symptoms, and having only one chronic disease were associated with treatment nonadherence. Conclusion: Treatment nonadherence for chronic diseases in Indonesia was found to be prevalent. Further consideration of characteristics associated with treatment nonadherence should be given to ensure optimal control of chronic diseases.

Background and Objectives: Multimorbid patients require intensive treatment for their diseases. However, little research has been given to their treatment adherence as part of its management. This study aims to determine the prevalence and characteristics of chronic disease multimorbidity in Indonesia, alongside its treatment nonadherence. Materials and Methods: We conducted a cross-sectional study using the fifth Indonesian Family Life Survey database among adult subjects aged ≥ 15 years with multimorbidity. Our descriptive and multivariate analyses include sex, age, formal education, ethnicity, geographic residence, demographic residence, household size, insurance ownership, annual income, current self-perceived health status, missing active days, smoking behavior, and body mass index. Results: We identified 3515 multimorbid patients, constituting 30.8% prevalence across chronic disease patients. Hypertension was found to be a prevalent component of multimorbidity (61.2%), followed by digestive diseases (44.5%) and arthritis (30.3%). We identified that 36.4% of the subjects were nonadherent to their chronic disease treatment. Characteristics associated with nonadherence were found to be a good self-perception of health (aOR 1.79, 95% CI 1.54–2.08), active smoking behavior (aOR 1.51, 95% CI 1.14–1.99), no smoking behavior (aOR 1.44, 95% CI 1.08–1.90), missing seven active/productive days or less in the past month due to poor health (aOR 1.36, 95% CI 1.10–1.68), no insurance ownership (aOR 1.20, 95% CI 1.04–1.39), age of 15–65 years (aOR 1.25, 95% CI 1.01–1.55), income below IDR 40 million (aOR 1.23, 95% CI 1.04–1.46), and household size of 2–6 people (aOR 1.17, 95% CI 1.01–1.36). Conclusions: While the prevalence of multimorbidity in Indonesia is generally similar to that observed in previous studies, we have identified patient characteristics related to nonadherence. We suggest that patient’s nonadherence was primarily dictated by their self-perception of health and treatment complexity. With the longstanding issue of nonadherence, this study indicated the need to consider creating patient-tailored treatment programs in clinical practice to improve adherence by considering individual patients’ characteristics.