Ahmad Fuady

Background: Nutrition-related non-communicable diseases (NCDs) are major global health challenges, including in Indonesia, where the disease burden continues to rise. Excessive consumption of sugar-sweetened beverages (SSBs) is a well-established contributing factor, with intake levels increasing globally. Despite strong evidence supporting SSB taxation as one of the key policy interventions to reduce consumption, Indonesia has not yet implemented the policy, reflecting a complex interplay of political, economic, and sociocultural factors. This study aimed to examine stakeholder perceptions of the problems, political dynamics, and potential policy actions to control SSB consumption in Indonesia. Methods: This study adopted a qualitative design through two semi-structured focus group discussions and five in-depth interviews with 17 stakeholders from government, academics, policy/economics analysts, and civil society organizations, conducted between December 2022 and April 2024. Data were analyzed thematically using a hybrid inductive-deductive approach, in which initial open coding was followed by deductive organization of themes according to the three streams of the Multiple Streams Framework (MSF) — problem, policy, and politics. Results: In the problem stream, stakeholders across sectors converged in recognizing SSB consumption as a pressing health issue, shaped by Indonesia’s deep-rooted “sweet culture,” obesogenic environment, and a structural regulatory coverage gap for informal sector. The policy stream identified technically feasible interventions across government, market, and community levels, including tiered SSB excise taxation, mandatory nutrition labelling reform, and culturally grounded community education. However, the politics stream revealed competing inter-sectoral mandates and interests, despite existing regulatory frameworks that already authorize SSB control measures, indicating that a policy window exists. Conclusions: While introducing SSB taxation is a promising policy option, taxation alone would not be sufficient to control SSB consumption. Effective control of SSB consumption in Indonesia would require the integration of multilevel (government, market, community), multisectoral, and culturally sensitive approaches, supported by stronger cross-sectoral political commitment to align the politics stream with existing problem recognition and available policy options.

This study explored how parents in Makassar, Indonesia, support childhood tuberculosis (TB) treatment adherence amid emotional, social, and sensory challenges. Seventeen caregivers participated in the in-depth interviews. We conducted a conceptual framework-informed deductive thematic analysis, organizing the findings within seven a priori analytic domains: internal challenges, external challenges, internal coping strategies, external coping strategies, religious coping strategies, expectations of health services, and parental expectations for children and the community. Parents described difficulties with medication schedules, fatigue, stigma, and inconsistent guidance from healthcare workers. To cope, they employed practical and relational strategies: alarms, reframing medicines as “superheroes,” offering treats, and prayer. Practices such as mixing medicines with milk revealed counseling gaps and risks for suboptimal adherence. Parents called for clearer communication and family-centered support, alongside hopes for recovery and freedom from stigma. These findings show that childhood TB caregiving is embodied and emotional, requiring culturally responsive and family-centered approaches.

We co-developed and evaluated a community-based, peer-led psychosocial support intervention consisting of individual and peer-led group counselling, online group messaging, and community-based “TB-Talks” to address tuberculosis (TB)-Stigma and reduce depression among adults with TB in Indonesia. A non-randomized, single-arm prospective interventional cohort study was conducted in five primary healthcare centres and two public hospitals in Depok and Padang cities from June 2024 to January 2025. All newly-diagnosed individuals with either drug-sensitive (DS-) or drug-resistant (DR-) TB, aged 15 years and above, were consecutively recruited and offered individual counselling at baseline, then monthly peer-led group counselling and online group messaging and TB Talks during six months of treatment. Participants were assessed at baseline, end of intensive phase (Month-2), and continuation phase (Month-6) for TB-stigma, depression, and quality of life (QoL), using locally-adapted and validated tools including the Van Rie TB-Stigma scale, PHQ-9, and EQ5D5L, respectively. In addition, we collated quantitative acceptability, appropriateness and feasibility feedback from participants and stakeholders. A total of 129 people with TB (Depok = 85, Padang = 44) participated, including 55 (43%) women. Most participants had new DS-TB (62%), 19 (15%) recurrent DS-TB, and 30 (23%) DR-TB. At baseline, most participants had moderate-to-severe TB-Stigma (74%; 95%CI = 65–82%) and depression symptoms (57%; 35–72%). Among 112 participants who completed all assessments, moderate-to-severe TB-Stigma decreased to 43% (34–53%) and 21% (13–28%) and depression symptom prevalence decreased to 32% (20–47%) and 15% (6–23%) at Month-2 and Month-6, respectively. Participants’ QoL increased from median 0.84 (0.63-1.00, at baseline) to 0.92 (0.83-1.00, Month-2) and 1.00 (0.91-1.00, Month-6). Both study participants and stakeholders perceived that activities in this study were feasible, acceptable, and locally-appropriate. Community-based, peer-led psychosocial support, combining individual and monthly group counselling, has potential to mitigate TB-Stigma and depression while improving QoL among adults with TB in Indonesia.

New adult tuberculosis (TB) vaccines are in clinical trials and may be licensed as soon as 2028. However, vaccine rollout requires addressing multiple contextual factors beyond clinical trial findings. This study explored stakeholders’ perspectives on the introduction of a new TB vaccine in Indonesia. We used a mixed-methods approach combining a stakeholder consultation in Jakarta (13/03/2025) among 28 participants with diverse expertise and follow-up interviews with two of those participants. Participants completed a structured questionnaire (via Slido) consisting of closed- and open-ended questions, adapted into Bahasa. Questions explored factors to be considered regarding vaccine introduction, target populations, delivery strategies, regulatory considerations, and lessons from other vaccine programs. Quantitative data were analysed descriptively, and qualitative responses underwent thematic analysis. All participants agreed on the importance of TB vaccine introduction. Key concerns were minimum efficacy of 50% and comparative effectiveness against other interventions, such as TB preventive treatment. Most agreed that vaccine introduction should not depend on local manufacturing capacity, administration route, or dosage. Critical enablers identified were adequate funding, strong political commitment, and demand generation through public acceptance. Priority target populations included people living with HIV/AIDS, individuals with diabetes, household contacts of TB patients, adolescents, and healthcare workers. Major challenges highlighted were vaccine hesitancy, halal issues, misinformation, and limited healthcare worker knowledge. Opinions diverged regarding the feasibility of vaccine rollout without Interferon-Gamma Release Assay (IGRA) testing: nine opposed vaccinating those with IGRA-negative status, six abstained, and three argued that IGRA-testing was unnecessary and cost-inefficient due to its high price. Regulatory and budgeting processes were cited as additional barriers. Introducing new TB vaccines in Indonesia will be complex and concerns extend beyond efficacy. Its success will depend on coordinated strategies to define target populations, design tailored delivery approaches, address vaccine hesitancy, and navigate regulatory and financing challenges.

High-quality health research is essential for evidence-based policymaking and health system strengthening. Indonesia has undergone major reforms in its health research governance. However, the country’s National Health Research System (NHRS) remains insufficiently mapped. This study aimed to assess the current status of Indonesia’s NHRS using the WHO framework, which includes four domains: governance, financing, creating and sustaining resources, and producing and using research. A qualitative approach was employed, combining an expert panel discussion and key informant interviews with 13 participants consisting of national and subnational stakeholders from government agencies, research organisations, and universities from May to December 2024. Data were analysed using the Framework Method guided by the NHRS framework and supplemented by the WHO Questionnaire on Country Resources for Health Research. This study found that, despite progress in Indonesia’s NHRS, weak governance, particularly poor coordination between national and subnational levels, remains the main challenge. Overall, the system is still fragmented, even though formal structures and institutions are in place. Governance is characterised by a highly centralised, top-down approach to agenda setting, with limited engagement of local institutions. Research financing is mainly programmatic and proposal-based, aligned with national priorities, but is constrained by limited sustainable domestic funding and unequal access to funding. In terms of resources, advanced research infrastructure and growing international collaboration indicate national commitment to health research; however, mismatches between infrastructure and human resource capacity persist. Finally, although research production and utilisation focus on measurable outputs and are supported by mechanisms for evidence use, effective pathways for translating research into policy and practice remain limited. Improving Indonesia’s health research system calls for an integrated national research agenda, well-defined institutional roles, and streamlined coordination between national and regional levels.

Cervical cancer remains a major cause of morbidity and mortality, with most cases in Indonesia diagnosed at a locally advanced stage. Although concurrent chemoradiotherapy is the standard treatment, response varies. Dysregulation of microRNAs (miRNAs), particularly oncogenic miR-92a and tumor suppressor miR-125b, may contribute to treatment resistance. This study aimed to evaluate the association between miR-92a and miR-125b expression and chemoradiotherapy response in locally advanced cervical cancer. This single-center retrospective cohort study included patients with stage IB3–IVA cervical cancer treated with chemoradiotherapy between 2019 and 2025. miRNA expression levels were measured from pretreatment tumor biopsy specimens. Poor response was defined as incomplete response or disease progression after treatment. Appropriate comparative, predictive, and survival analyses were performed. Sixty-eight patients were included. Poor response was significantly associated with underweight body mass index, elevated miR-92a, and reduced miR-125b expression (p < 0.05). High miR-92a and low miR-125b expression were also associated with shorter overall survival (p < 0.001). A combined model incorporating BMI, miR-92a, and miR-125b showed good predictive performance. Elevated miR-92a and reduced miR-125b are associated with poor treatment response and worse survival. These miRNAs may support risk stratification and treatment personalization in locally advanced cervical cancer.

Background: We co-developed and evaluated a community-based, peer-led psychosocial support intervention consisting of individual and peer-led group counselling, online group messaging, and community-based “TB-Talks” to address tuberculosis (TB)-Stigma and reduce depression among adults with TB in Indonesia.Methods: A non-randomized, single-arm prospective interventional cohort study was conducted in five primary healthcare centres and two public hospitals in Depok and Padang cities from June 2024 to January 2025. All newly-diagnosed individuals with TB, aged 15 years and above, were consecutively recruited and offered individual counselling at baseline, monthly peer-led group counselling, and online group messaging. We assessed changes in TB-Stigma, depression, and quality of life (QoL) across baseline, Month-2, and Month-6, and collated quantitative acceptability, appropriateness and feasibility feedback from participants and stakeholders.Findings: A total of 129 people with TB, mostly male (57%; 95%CI=49-67%) and with new DS-TB (62%; 53-70%) were recruited. At baseline, most participants had moderate-to-severe TB-Stigma (74%;65-82%) and depression symptoms (57%;35-72%). Among 112 participants who completed all assessments, moderate-to-severe TB-Stigma decreased to 43% (34-53%) and 21% (13-28%) and depression symptom prevalence decreased to 32% (20-47%) and 15% (6-23%) at Month-2 and Month-6, respectively. Participants’ QoL increased from median 0.84 (0.63-1.00, at baseline) to 0.92 (0.83-1.00, Month-2) and 1.00 (0.91-1.00, Month-6). Both study participants and stakeholders perceived that TB-CAPS activities were feasible, acceptable, and locally-appropriate.Interpretation: Community-based, peer-led psychosocial support, combining individual and monthly group counselling, has potential to mitigate TB-Stigma and depression while improving quality of life among adults with TB in Indonesia.

Background: New adult tuberculosis (TB) vaccines are in clinical trials and may be licensed as soon as 2028. However, vaccine rollout requires addressing multiple contextual factors beyond clinical trial findings. This study explored stakeholders’ perspectives on the introduction a new TB vaccine in Indonesia. Methods: We used a mixed-methods approach combining a stakeholder consultation in Jakarta (13/03/2025) among 28 participants with diverse expertise and follow-up interviews with two of those participants. Participants completed a structured questionnaire (via Slido®) consisting of closed- and open-ended questions, adapted into Bahasa. Questions covered factors influencing vaccine introduction, target populations, delivery strategies, regulatory considerations, and lessons from other vaccine programs. Quantitative data were analysed descriptively, and qualitative responses underwent thematic analysis. Results: All participants agreed on the importance of TB vaccine introduction. Key concerns were minimum efficacy of 50% and comparative effectiveness against other interventions, such as TB preventive treatment. Most agreed that vaccine introduction should not depend on local manufacturing capacity, administration route, or dosage. Critical enablers identified were adequate funding, strong political commitment, and demand generation through public acceptance. Priority target populations included people living with HIV/AIDS, individuals with diabetes, household contacts of TB patients, adolescents, and healthcare workers. Major challenges highlighted were vaccine hesitancy, halal issues, misinformation, and limited healthcare worker knowledge. Opinions diverged on feasibility of rollout without IGRA testing. Regulatory and budgeting processes were cited as additional barriers. Conclusions: Introducing new TB vaccines in Indonesia will be complex and concerns extends beyond efficacy. Its success will depend on coordinated strategies to define target populations, design tailored delivery approaches, address vaccine hesitancy, and navigate regulatory and financing challenges.