# Influences of radiographic silicosis and drug supervisor on the development of multi drug resistant-tuberculosis in West Java, Indonesia

## TL;DR

This study in Indonesia finds that having a supportive drug supervisor helps prevent multi-drug-resistant tuberculosis, while silicosis does not significantly increase the risk.

## Contribution

The study identifies the role of a supportive drug supervisor as a novel preventive factor against MDR-TB in Indonesia.

## Key findings

- Supportive drug supervisors reduce the risk of developing MDR-TB.
- Silicosis showed no significant association with MDR-TB development.
- 17 cases (5.4%) had silico-tuberculosis, mostly with severe radiographic features.

## Abstract

Indonesia is among countries with a high incidence of multi drug-resistant tuberculosis (MDR-TB) globally. In this study, we aim to determine the prevalence of silico-tuberculosis among TB patients and to investigate the association of radiographic silicosis and the role of drug supervisor as well as other socio-clinical factors, in the development of MDR-TB in Indonesia.

A hospital-based study in West Java among 148 MDR-TB patients (case) and 164 drug-sensitive/DS-TB patients (control) was conducted. Chest x-rays were evaluated by two radiologists and one NIOSH B reader according to the ILO Classification. Face-to-face interviews were conducted using structured questionnaires to collect patients’ information, including the task of drug supervisor.

Findings indicate that supportive drug supervisor reduces the risk of developing MDR-TB, but silicosis showed no significant association. Nevertheless, in this study we found that 17 cases (5.4%) had silico-tuberculosis mostly exhibited as ILO profusion 3; predominated by q shape, 52.9% with large opacities and dominated by size A. Other factors significantly associated with the risk of developing MDR-TB were marital status, low income, longer traveling time to hospital, unsuccessful previous treatment and suffering drug side effects.

This study reveals that one of preventive healthcare strategy to protect TB patients from developing MDR-TB is supportive drug supervisor. While, the development of MDR-TB was not significantly influenced by silicosis; however, there is a notable prevalence of silicosis as determined by chest radiography, highlighting the critical need for dust control, occupational hygiene, and health screening for high-risk populations.

The online version contains supplementary material available at https://doi.org/10.1265/ehpm.24-00169.