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All Journal Sriwijaya Journal of Forensic and Medicolegal Sriwijaya Journal of Obstetrics and Gynecology Sriwijaya Journal of Otorhinolaryngology
Lisye Tiur Simanjuntak
Department of Pathology Anatomy, Tanjung Balai Medical Center, Tanjung Balai, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Nursing Public Health

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Efficacy and Cost-Effectiveness of HPV-DNA Self-Sampling with Telemedicine-Supported Triage for Cervical Cancer Screening in Underserved Indonesian Populations: A Pragmatic Randomized Controlled Trial Rachmat Hidayat; Lisye Tiur Simanjuntak; Sarah Fernandez
Sriwijaya Journal of Obstetrics and Gynecology Vol. 3 No. 2 (2025): Sriwijaya Journal of Obstetrics & Gynecology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjog.v3i2.281

Abstract

Introduction: Cervical cancer screening coverage in Indonesia remains far below the WHO elimination target, because distance, lost wages, scarce female providers, and fragmented referral cause low participation and high triage attrition. We evaluated whether HPV-DNA self-sampling integrated with physician-led telemedicine triage improves screening completion and follow-up adherence and is cost-effective versus standard clinic-based screening. Methods: In a pragmatic, open-label, two-arm randomized controlled trial across two contrasting Indonesian regions—a dense metropolitan periphery (Region A) and a riverine/remote periphery (Region B)—1,032 under-screened women aged 30–50 years were randomized 1:1 to community-delivered HPV-DNA self-sampling with telemedicine triage of high-risk HPV (hrHPV)-positive results, or to standard referral for visual inspection with acetic acid or cytology. Primary outcomes were screening uptake within three months and the incremental cost-effectiveness ratio (ICER) per additional hrHPV case successfully triaged. Analysis followed intention-to-treat with multivariable logistic regression. Results: Screening uptake was 82.0% versus 48.1% (risk ratio 1.71, 95% CI 1.55–1.88; absolute difference 33.9%, number-needed-to-invite 3; adjusted odds ratio 4.94, 95% CI 3.72–6.56, p<0.001), consistent across regions (interaction p=0.42). Among hrHPV-positive women, follow-up adherence was 92.7% (38/41) versus 57.1% (12/21) (odds ratio 9.50, 95% CI 2.28–39.6, p=0.003), and CIN2+ was detected and treated in 11 versus 3 women. Cost per successful follow-up was US$315 versus US$516; the intervention was dominant in 96% of probabilistic simulations. Conclusion: Integrating HPV self-sampling with physician-led telemedicine triage substantially increased both screening and triage completion across diverse geographies while remaining cost-effective. National programs should embed telemedicine-supported triage to close the cervical-screening cascade.
Sociocultural Determinants of Clinical Autopsy Refusal and Their Medicolegal Impact on Diagnostic Accuracy in Indonesian Tertiary Hospitals Yuniarti Maretha Pasaribu; Riri Arisanty Syafril Lubis; Franklin Shane; Lisye Tiur Simanjuntak
Sriwijaya Journal of Forensic and Medicolegal Vol. 3 No. 2 (2025): Sriwijaya Journal of Forensic and Medicolegal
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjfm.v3i2.252

Abstract

Introduction: Clinical autopsy refusal remains a critical barrier to diagnostic quality assurance and medicolegal accountability in Indonesian hospital medicine. This retrospective cohort study enrolled 324 consecutive inpatient deaths across three tertiary referral hospitals in Palembang, South Sumatra (January 2019 – December 2023), to characterize sociocultural determinants of autopsy refusal and their impact on diagnostic accuracy and time-to-correct-diagnosis. Methods: The primary outcome was next-of-kin refusal of clinical autopsy consent; secondary outcomes included diagnostic discrepancy classified by the Goldman system, and time-to-correct-diagnosis analyzed by Kaplan-Meier survival analysis with log-rank testing. Multivariate logistic regression with bootstrap-derived confidence intervals identified independent predictors of refusal. Results: The overall autopsy refusal rate was 84.0% (272/324). Independent predictors were Javanese ethnicity (OR 3.64, 95% CI 1.77–7.48; p<0.001), Islamic religious affiliation (OR 2.49, 95% CI 1.42–4.37; p=0.001), primary or no formal education (OR 2.36, 95% CI 1.19–4.68; p=0.014), age per 10-year increment (OR 1.18, 95% CI 1.05–1.33; p=0.006), and low household income below 2 million IDR (OR 1.76, 95% CI 1.00–3.10; p=0.049). The model demonstrated good discrimination (C-statistic 0.81) and calibration (Hosmer-Lemeshow p=0.43). Major diagnostic discrepancy (Goldman Class I–II) occurred in 26.1% of the refused cohort versus 13.5% in the consented cohort (p=0.047). Median time-to-correct-diagnosis was 19 days (95% CI 15–24) in the refused group versus 5 days (95% CI 3–8) in the consented group (log-rank p<0.001). Conclusion: These findings provide robust evidence for the medicolegal urgency of addressing sociocultural barriers to autopsy consent through culturally sensitive policy reform in Indonesia.
Incidence, Mortality, Sex Differences, and Demographic Projections for Six Selected Head and Neck Cancer Site Groups in Indonesia: A Secondary Analysis of GLOBOCAN 2024 Modeled Estimates Lisye Tiur Simanjuntak; Ayesh Mahmood
Sriwijaya Journal of Otorhinolaryngology Vol. 4 No. 1 (2026): Sriwijaya Journal of Otorhinolaryngology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjorl.v4i1.317

Abstract

Background: Nationally representative data on the heterogeneous malignancies managed in head and neck oncology remain limited in Indonesia. Objective: To estimate incidence, mortality, sex differences, and demographic change for six selected head and neck cancer site groups in Indonesia. Methods: We performed a descriptive secondary analysis of GLOBOCAN 2024 aggregate modeled estimates (version 08 July 2026). The definition included lip and oral cavity (C00–C06), salivary glands (C07–C08), oropharynx (C09–C10), nasopharynx (C11), hypopharynx (C12–C13), and larynx (C32). Counts and age-standardized rates were aggregated across mutually exclusive sites. Indonesia was compared descriptively with four reference populations. Constant-rate Cancer Tomorrow projections and two definitional sensitivity analyses were evaluated. Source uncertainty distributions were unavailable; therefore, confidence intervals were not constructed. Results: An estimated 28,226 cases and 16,025 deaths occurred in 2024; summed ASIR and ASMR were 8.91 and 5.06 per 100,000. Nasopharyngeal cancer contributed 16,064 cases (56.9%) and 8,718 deaths (54.4%). Male rates exceeded female rates: ASIR 13.19 versus 5.18 and ASMR 7.73 versus 2.77. With 2024 rates held constant, annual cases increased to 46,895 (+66.1%) and deaths to 27,900 (+74.1%) by 2050. All 21 validation checks passed. Conclusion: Indonesia's selected head and neck cancer burden is dominated by nasopharyngeal cancer and higher male rates. These modeled estimates support prevention, registry strengthening, and planning hypotheses but do not measure stage, utilization, treatment need, survival, cost, or causal effects.
Co-Authors Ayesh Mahmood Franklin Shane RACHMAT HIDAYAT Riri Arisanty Syafril Lubis Sarah Fernandez Yuniarti Maretha Pasaribu