Electronic Theses and Dissertation

Tuberkulosis (TB) dengan koinfeksi Human Immunodeficiency Virus (HIV) merupakan salah satu penyebab utama kematian akibat penyakit menular di dunia, terutama di kawasan Asia yang memiliki beban kasus tinggi. Namun, evaluasi kuantitatif mengenai variasi risiko kematian antarnegara masih terbatas. Penelitian ini bertujuan menganalisis risiko relatif kematian koinfeksi TB-HIV di Asia menggunakan Standardized Mortality Ratio (SMR), menghitung excess mortality (EM), serta mengevaluasi perbedaan distribusi kematian selama periode 2019-2024. Penelitian ini menggunakan desain studi ekologi deret waktu dengan data sekunder dari Global Tuberculosis Report WHO. Data mencakup 49 negara di Asia selama periode 2019-2024 dengan total 294 amatan. Variabel yang dianalisis meliputi jumlah kematian koinfeksi TB-HIV dan populasi. Analisis dilakukan menggunakan perangkat lunak R melalui statistika deskriptif, estimasi SMR, perhitungan EM, serta uji Kruskal-Wallis dengan tingkat signifikansi 5%. Hasil menunjukkan adanya variasi risiko kematian koinfeksi TB-HIV antarnegara di Asia. Negara di Asia Timur dan Asia Barat umumnya berada pada kategori risiko sangat rendah hingga rendah, sedangkan beberapa negara di Asia Selatan dan Asia Tenggara menunjukkan risiko sedang hingga sangat tinggi. Analisis EM menunjukkan kematian berlebih di Indonesia, Myanmar, Thailand, dan Vietnam. Uji Kruskal-Wallis menunjukkan perbedaan distribusi kematian yang signifikan antar kawasan di Asia (p-value < 0,05), namun tidak ditemukan perbedaan signifikan antar tahun. Risiko kematian koinfeksi TB-HIV di Asia menunjukkan ketimpangan spasial antar kawasan. Temuan ini menegaskan perlunya penguatan sistem kesehatan, peningkatan deteksi dini, dan integrasi layanan TB-HIV di wilayah berisiko tinggi.

Tuberculosis (TB) with Human Immunodeficiency Virus (HIV) coinfection is one of the leading causes of death from infectious diseases worldwide, especially in Asia, which has a high burden of cases. However, quantitative evaluations of variations in mortality risk between countries are still limited. This study aims to analyze the relative risk of TB-HIV coinfection mortality in Asia using the Standardized Mortality Ratio (SMR), calculate excess mortality (EM), and evaluate differences in mortality distribution during the period 2019-2024. This study uses a time-series ecological study design with secondary data from the WHO Global Tuberculosis Report. The data covered 49 countries in Asia during the 2019-2024 period with a total of 294 observations. The variables analyzed included the number of TB-HIV co-infection deaths and population. The analysis was performed using R software through descriptive statistics, SMR estimation, EM calculation, and the Kruskal-Wallis test with a significance level of 5%. The results show variations in the risk of TB-HIV co-infection mortality between countries in Asia. Countries in East Asia and West Asia are generally in the very low to low risk category, while several countries in South Asia and Southeast Asia show moderate to very high risk. EM analysis shows excess mortality in Indonesia, Myanmar, Thailand, and Vietnam. The Kruskal-Wallis test showed a significant difference in the distribution of mortality between regions in Asia (p < 0.05), but no significant difference was found between years. The risk of TB-HIV coinfection mortality in Asia shows spatial inequality between regions. These findings emphasize the need to strengthen health systems, improve early detection, and integrate TB-HIV services in high-risk areas.