Hasan Sadikin Hospital/Padjadjaran University in Bandung, Indonesia

Indonesia is one of the largest countries in Asia with an estimated 235 million inhabitants. Indonesian and Dutch institutes have a long history of collaborating in infectious diseases, which continue to be the most important health problems. Intitiated by Prof. Jos van der Meer and Prof. Wil Dolmans from Nijmegen, research on dengue, typhoid fever, tuberculosis and antibiotic use has resulted in > 10 PhD-theses since 1990. In recent years, much work has been done on TB and HIV in in Hasan Sadikin hospital / Padjadjaran University in Bandung, the fourth largest city of Indonesia.

Tuberculosis

Indonesia has the fourth highest number of TB-patients worldwide. Since 2002, patient-oriented research has addressed different aspects of tuberculosis (TB) in a comprehensive Dutch-Indonesian program “TB in Indonesia; protection and care”. At present, embedded in the PRIOR-network, five PhD candidates (four Indonesian), and five post-docs (one Indonesian) address different aspects including host response, diagnosis, drug susceptibility testing and pharmacokinetics. Besides research, much has been done in terms of capacity building and patient care. Laboratory service, patient monitoring and treatment in Bandung have been improved, and results have been socialized with the national TB program.

A comprehensive Dutch-Indonesian program “TB in Indonesia; protection and care” coordinated from Nijmegen has contributed considerably to care in Bandung. Three examples:

• Diagnosis of lung TB has been increased by simple patient instruction for better quality of sputum samples.
• Diagnosis of TB meningitis is now possible with liquid media and molecular testing.  
• A high throughput, cheap and faster Dry Suscystibility Testing-method has been introduced, and compared with conventional testing. The new method was more reliable, quicker and more efficient, showing significant rates of resistance to first-line drugs.
• We have identified diabetes as an important risk-factor for TB, and as a negative prognostic factor. Screening for diabetes has now been introduced.

HIV

HIV is still low in the general population in Indonesia, but very high in certain risk groups, especially intravenous drug users and prisoners. In 2005, partners from Bandung and Nijmegen took the intitiative to improve prevention and care of HIV/AIDS in the context of intravenous drug use in west-Java. With 5-year funding from the European Commission, the IMPACT-program was has started in December 2006. IMPACT aims to implement a wide range of evidence-based interventions like targeted HIV-testing, methadone maintenance and comprehensive care in hospital, prison and the community, and to establish the capacity to sustain and upscale these activities. From Nijmegen, scientific and operational assistance will be provided in the fields of drug addiction, HIV/AIDS care and health economics. Dr Reinout van Crevel has been in Bandung for 2,5 years.   Through operational and more basic research in TB and HIV, health staff, facilities, patient service and education have been improved in Bandung. 

Education

Students from Bandung join the Nijmegen curriculum, and Nijmegen students do research electives in Bandung. Preparations are made to start Nijmegen internships in Bandung. Several Indonesian doctors do a PhD in Nijmegen, and preparations are underway to develop a master-program in Bandung.