Jakarta (ANTARA) - The bacteria that cause tuberculosis can survive for months in damp, poorly ventilated spaces that receive little to no sunlight.

Environmental health research indicates that the bacteria responsible for TB are rapidly inactivated when exposed to direct ultraviolet light within 15 to 30 minutes.

However, the opposite occurs in many cramped homes lacking windows and proper airflow as poorly ventilated, dark rooms become ideal support bacterial persistence and transmission risk to persist, significantly increasing the risk of transmission.

For years, TB management in Indonesia has focused more on the patients' treatment, while their homes are rarely the focus of strategies.

Yet, many patients who are declared cured eventually return to the very same environment where they were first infected: cramped, overcrowded rooms with little to no sunlight.

In this regard, the Indonesian government has begun adopting a different approach.

Data from the Indonesian Government Communications Agency (Bakom) shows that over 241,000 TB cases were identified as of early May 2026.

This figure follows an expansion of active screening through the nationwide Free Health Screening (CKG) program, close-contact tracing, and integrated reporting via the Tuberculosis Information System (SITB).

According to the 2025 Global Tuberculosis Report, Indonesia remains the country with the second-highest number of TB cases in the world, right after India.

Behind the high case numbers, the country has shifted its focus to two key policies: improving the living conditions of patients and overhauling the treatment for drug-resistant TB (DR-TB), which is notoriously longer and more difficult to manage.

Under a collaboration between the Ministry of Health and the Ministry of Housing and Settlements, the government aims to renovate 2,000 homes for TB patients throughout 2026, with plans to expand the program to 10,000 units in 2027. This initiative targets low-income communities categorized within Deciles 1 to 4 of the National Socio-Economic Single Data (DTSEN).

The targeted homes are generally located in densely populated areas characterized by poor ventilation and inadequate natural lighting. In many instances, multiple families share one house with small rooms and inadequate windows, causing higher risk of infections.

Deputy Minister of Health Benjamin Paulus Octavianus assessed that the fight against TB will never truly end if patients return to the homes that remain sources of infection after their treatment. Therefore, housing renovations are initiated as a key pillar of disease control rather than just a social housing assistance.

The environmental health standards set are actually quite straightforward: ideal ventilation should cover at least 10 percent of the floor area, natural lighting should reach a minimum of 60 lux, and occupancy should not exceed two people per room of at least eight square meters.

However, these standards are rarely met in many densely populated urban areas—such as North Jakarta, Bekasi, and Tangerang—which have long struggled with a high TB case burden.

This approach marks a shift in the national TB management policies. A disease that was long considered primarily a healthcare issue is now being treated as a matter of environmental health and housing quality.

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Treatment method

The second shift is seen in DR-TB treatment. For years, patients had to endure a grueling 18- to 24-month treatment regimen involving a high volume of medication and severe side effects.

Throughout the course of therapy, patients frequently reported symptoms such as nausea, fatigue, and numbness, along with significant psychological distress.

In the national program evaluation, this condition also explains why many patients chose not to complete the regimen, with research data showing that around 26 percent of patients fail to complete their full course of therapy.

The government has begun expanding the use of the BPaLM regimen—a combination of Bedaquiline, Pretomanid, Linezolid, and Moxifloxacin—for DR-TB patients. This regimen shortens the duration of treatment to six months and is administered entirely in oral form.

Based on ZeNix and TB-PRACTECAL clinical trials, the regimen's success rate ranges between 86 to 89 percent, far higher than that of the old DR-TB treatment which stood at around 52 percent.

The change in treatment duration has become a vital factor in controlling drug resistance.

In many cases, patients discontinue their medication after the initial phase because they feel their condition has improved.

However, when therapy is interrupted, the surviving bacteria can adapt, leading to increased resistance against primary drugs.

Therefore, the BPaLM regimen is viewed not only as a clinical innovation but also a strategy to improve patients' adherence to treatment. A shorter, less taxing regimen significantly increases the likelihood that patients will complete their treatment.

These two interventions are aimed at tackling two issues that have long been hindering TB control in Indonesia: living environments that continue to foster transmission, thereby putting patients at risk of reinfection, and excessively long treatment duration that cause many to give up halfway through.

As the national detection system becomes more aggressive in detecting cases, 2026 SITB data shows that the national treatment initiation rate remains at 84 percent, falling short of the 95 percent target.

Similarly, the treatment success rate stands at around 80 percent, lower than the national target which is set at 90 percent.

These figures reflect that the challenges Indonesia currently faces are not merely about detection, but also ensuring the patients start their treatment on time and complete it until the end and return to a living environment that is free from the chain of TB transmission.

While Indonesia still has a long way to go to reach its 2030 TB elimination target—with high mortality rates and persistent gaps in DR-TB detection—the shift toward integrating healthcare, housing quality, and treatment effectiveness marks a move toward a more measurable approach in national TB control efforts.



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