DOI: https://doi.org/10.14710/jkli.81961

Efektivitas Active Case Finding (ACF) Menggunakan Portable X-Ray untuk Deteksi Tuberkulosis Paru di Wilayah Pesisir Jawa Tengah

1Dinas Kesehatan Provinsi Jawa Tengah, Semarang, Indonesia

2Bagian Kesehatan Lingkungan, Fakultas Kesehatan Masyarakat, Universitas Diponegoro, Semarang, Indonesia

3Politeknik Kesehatan Semarang, Kementerian Kesehatan, Semarang, Indonesia

Open Access Copyright 2026 Jurnal Kesehatan Lingkungan Indonesia under http://creativecommons.org/licenses/by-sa/4.0.

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Abstract

Latar Belakang: Tuberkulosis (TB) masih menjadi tantangan kesehatan masyarakat yang serius di Indonesia. Di Provinsi Jawa Tengah, tingkat deteksi kasus TB dan keberhasilan pengobatan masih di bawah target nasional yang menunjukkan proporsi kasus yang tidak terdeteksi yang tinggi. Faktor-faktor yang berkontribusi, meliputi keterbatasan dalam ACF  akses terbatas terhadap diagnostik cepat, penyelidikan kontak yang tidak memadai, dan kesadaran masyarakat yang rendah. Kabupaten pesisir menghadapi risiko TB yang lebih tinggi akibat kepadatan penduduk yang tinggi, pekerjaan yang berpindah-pindah dan informal, lingkungan perkumpulan, serta kondisi perumahan dan lingkungan yang buruk sehingga memudahkan penularan. Penemuan kasus aktif menggunakan portable X-Ray menawarkan pendekatan yang menjanjikan untuk meningkatkan deteksi dini TB. Studi ini bertujuan untuk menganalisis efektivitas pelaksanaan ACF berbasis portable x-ray dalam mendeteksi TBC di wilayah Pesisir Jawa Tengah.

Metode: Desain penelitian campuran berurutan eksplanatori menggunakan data sekunder SITB (Januari–Oktober 2025) dari 116 Puskesmas dan diskusi kelompok terfokus (FGD) dengan 34 pemangku kepentingan. Ukuran kuantitatif meliputi frekuensi ACF, jumlah peserta yang diperiksa, jumlah yang diperiksa dengan portable X-Ray, dan kasus TB yang dikonfirmasi secara klinis. Analisis kuantiatif dengan statistik deskriptif dan regresi linier, sedangkan data kualitatif dianalisis secara tematik.

Hasil: Di antara 116 Puskesmas 70 (60,9%) melakukan ACF tanpa portable X-Ray dan 45 (39,1%) dengan portable X-Ray. Rata-rata kasus TB yang dikonfirmasi secara klinis berbeda berdasarkan metode ACF: 4,52 (tanpa portable X-Ray) versus 1,68 (dengan portable X-Ray); perbedaan rata-rata antar kelompok adalah 2,84 (t = 5,28; p = 0,0001), dengan ukuran efek besar (partial η² = 0,44). Temuan kualitatif menunjukkan bahwa portable X-Ray meningkatkan penerimaan masyarakat, partisipasi dalam skrining, dan kemampuan mendeteksi kelainan radiologis pada individu tanpa gejala.

Simpulan: Skrining ACF berbasis portable X-Ray lebih efektif daripada skrining berbasis gejala dalam meningkatkan deteksi TB paru dan berpotensi mempercepat pencapaian target eliminasi TB.

 

ABSTRACT

Title: Effectiveness of Active Case Finding (ACF) Using Portable X-Ray for Detecting Pulmonary Tuberculosis Cases in the Coastal Regions of Central Java

Background: Tuberculosis (TB) remains a major public health challenge in Indonesia. In Central Java Province, TB case detection and treatment success rates remain below national targets, indicating a high proportion of undetected cases. Contributing factors include limited active case finding (ACF), restricted access to rapid diagnostics, inadequate contact investigation, and low community awareness. Coastal districts face higher TB risk due to high population density, mobile and informal occupations, congregate settings, and poor housing and environmental conditions that facilitate transmission. Portable digital chest x-ray based ACF offers a promising approach to improve early TB detection. This study assesses the effectiveness of portable X-ray–based active case finding (ACF) in detecting tuberculosis in six high-burden coastal districts of Central Java.

Method: A mixed-methods sequential explanatory design used secondary SITB data (Jan–Oct 2025) from 116 primary health centers and FGDs with 34 stakeholders. Quantitative measures included ACF frequency, number of screened participants, number screened with portable x-ray, and clinically confirmed TB cases. Descriptive statistics and linear regression were applied; qualitative data underwent thematic analysis.

Result: Among 116 PHCs, 70 (60.9%) performed ACF without portable x-ray and 45 (39.1%) with portable x-ray. Mean clinically confirmed cases differed by ACF method: 4.52 (non portable x-ray) versus 1.68 (portable x-ray); the between-group mean difference was 2.84 (t = 5.28; p = 0.0001), with a large effect size (partial η² = 0.44). Qualitative findings revealed that portable x-rays increased community acceptance, screening participation, and the ability to detect radiological abnormalities in asymptomatic individuals.

Conclusion: Portable x-ray based ACF is more effective than symptom based screening in improving pulmonary TB detection, and has the potential to accelerate the achievement of TB elimination targets.

 

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Keywords: Tuberkulosis; Portable x-ray; Skrining

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