Implementation of screening and management of household contacts of tuberculosis cases in Daru, Papua New Guinea

Honjepari, A.; Madiowi, S.; Madjus, S.; Burkot, Camilla; Islam, S.; Chan, Geoff; Majumdar, S. S.; Graham, Stephen M.

doi:10.5588/pha.18.0072

Cited by 11 publications

(12 citation statements)

References 16 publications

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“…A previous study identified that of 73 PNG MDR-TB patients diagnosed in the Torres Strait, 15 were loss to follow up, and a further 25 had an unknown treatment outcome (20). A recent study conducted on Daru Island, reported longer delays to treatment commencement in symptomatic DR-TB household contacts presenting for TB screening when compared to symptomatic drug-susceptible household contacts (39). This suggests that there may be country-specific risk factors which require focused support for DR-TB patients and their close contacts.…”

Section: Discussionmentioning

confidence: 99%

Time to commencement of effective treatment in patients with drug-resistant tuberculosis diagnosed in the Torres Strait / Papua New Guinea cross-border region

Foster

Méndez

Marais³

et al. 2022

Preprint

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Introduction Delays between self-reported symptom onset and commencement of effective treatment contribute to ongoing tuberculosis (TB) transmission; this is a particular concern in patients with drug-resistant (DR)-TB. We assessed improvements in time to commencement of effective treatment in patients diagnosed with DR-TB in the Torres Strait region. Methods All laboratory-confirmed DR-TB cases diagnosed in the Torres Strait between 1 March 2000 and 31 March 2020 were reviewed. We assessed the total time from self-reported onset of symptoms to effective treatment commencement in different programmatic time periods. Pairwise analyses and time to event proportional hazard calculations were used to explore the association between delays in median time to effective treatment, and selected variables. Data were further analysed to examine predictors of excessive treatment delay. Results The median number of days from self-reported onset of symptoms to effective treatment commencement was 124 days. Between 2006 and 2012, most (57%) cases exceeded this grand median while the median time to treat in the most recent time period (2016-2020) was significantly reduced to 29 days (p <0.001). Although there was a reduction in the median time to treat with the introduction of Xpert MTB/RIF (135 days pre-Xpert vs 67 days post-Xpert) this was not statistically significant (p 0.07). Establishment of the Torres and Cape TB Control Unit on Thursday Island (2016-2020) when compared with previous TB programs (2000-2005 p <0.04; 2006-2012 p <0.001) and case type (new vs past treatment; p 0.02) were significantly associated with reduced treatment delay. Conclusion Minimising TB treatment delay in remote settings like the Torres Strait / Papua New Guinea cross-border region requires effective decentralised diagnosis and management structures. Study results suggest that the establishment of the Torres and Cape TB Control Unit on Thursday Island helped to improve time to treatment for TB patients in the region. Possible contributing factors include better symptom recognition, TB education, cross-border communication and patient-centred care.

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Section: Discussionmentioning

confidence: 99%

Time to commencement of effective treatment in patients with drug-resistant tuberculosis diagnosed in the Torres Strait / Papua New Guinea cross-border region

Foster

Méndez

Marais³

et al. 2022

Preprint

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“…The EMRS in Daru was adapted to include modules for contact screening and TPT in 2018. A household mapping tool that documents investigation of all close contacts of an index case is used as previously described (12). The public health team records patient data using paper-based records.…”

Section: Program Monitoring and Data Systemsmentioning

confidence: 99%

“…The screening and management of household contacts of people with TB commenced in 2016. TB preventive treatment (TPT) for well young child (<5 years) contacts of drug-susceptible (DS) TB index cases was introduced in 2017 and extended to those of MDR-TB index cases in 2019 (12).…”

Section: Introductionmentioning

confidence: 99%

Contact screening and management in a high-transmission MDR-TB setting in Papua New Guinea: Progress, challenges and future directions

Majumdar

Islam²,

Huang³

et al. 2023

Front. Trop. Dis

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Daru, South Fly District, Papua New Guinea is a high transmission setting for multidrug-resistant tuberculosis (MDR-TB). An emergency response by the Government in 2014 established a high-quality model for treatment and care. Household contact screening and management commenced in 2016 with TB preventive treatment (TPT) for well young child (<5 years) contacts of people with drug-susceptible TB and later expanded to young child contacts of MDR-TB. The model of care is community-based and led by non-specialist health workers, under supervision. An electronic medical record system supports care, reporting and operational research. Community engagement and education has been central, with a concerted focus on peer-led counselling and patient-centred services to improve TPT uptake and completion. Challenges include the application of households as the unit of intervention for detection of active TB and TPT provision. Our implementation experience in Daru has highlighted significant population mixing dynamics with most transmission likely occurring outside the household. We propose a community-wide screening approach with the provision of TPT based on testing to include older children, adolescents, and young adults. As there is the possibility of MDR-TB infection irrespective of the drug susceptibility of the household index case, a novel option is a combination TPT regimen of 6 months of daily isoniazid and levofloxacin (6HLfx). A sensitive aged-related algorithm to detect and exclude active TB is being developed. Ongoing community engagement, quality data systems with operational research to evaluate approaches are critical in high transmission MDR-TB settings.

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“…These will include procurement of diagnostic equipment; training for healthcare workers, including on the use of gastric aspirate, fine-needle aspiration, and other procedures; and updating and dissemination of all guidelines, algorithms, and standard operating procedures. Interventions to increase treatment success and prevention for child TB include: expansion of child TB treatment, including child-friendly formulations and all-oral regimens for drug-resistant TB; contact evaluation and TPT through community TB workers with implementation of integrated patient and family education and counseling secessions [66]; expansion of treatment facilities with nutritional support for all child TB patients; and identification and training of a provincial child TB focal person to support training of healthcare workers on child TB management. Additional Global Fund support provides transport and food incentives for children and families of drug-resistant TB patients.…”

Section: Papua New Guinea: Addressing Challenges In a High-burden Chi...mentioning

confidence: 99%

Priority Activities in Child and Adolescent Tuberculosis to Close the Policy-Practice Gap in Low- and Middle-Income Countries

et al. 2022

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Over the past 15 years, and despite many difficulties, significant progress has been made to advance child and adolescent tuberculosis (TB) care. Despite increasing availability of safe and effective treatment and prevention options, TB remains a global health priority as a major cause of child and adolescent morbidity and mortality—over one and a half million children and adolescents develop TB each year. A history of the global public health perspective on child and adolescent TB is followed by 12 narratives detailing challenges and progress in 19 TB endemic low and middle-income countries. Overarching challenges include: under-detection and under-reporting of child and adolescent TB; poor implementation and reporting of contact investigation and TB preventive treatment services; the need for health systems strengthening to deliver effective, decentralized services; and lack of integration between TB programs and child health services. The COVID-19 pandemic has had a significant negative impact on case detection and treatment outcomes. Child and adolescent TB working groups can address country-specific challenges to close the policy–practice gaps by developing and supporting decentral ized models of care, strengthening clinical and laboratory diagnosis, including of multidrug-resistant TB, providing recommended options for treatment of disease and infection, and forging strong collaborations across relevant health sectors.

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Implementation of screening and management of household contacts of tuberculosis cases in Daru, Papua New Guinea

Cited by 11 publications

References 16 publications

Time to commencement of effective treatment in patients with drug-resistant tuberculosis diagnosed in the Torres Strait / Papua New Guinea cross-border region

Time to commencement of effective treatment in patients with drug-resistant tuberculosis diagnosed in the Torres Strait / Papua New Guinea cross-border region

Contact screening and management in a high-transmission MDR-TB setting in Papua New Guinea: Progress, challenges and future directions

Priority Activities in Child and Adolescent Tuberculosis to Close the Policy-Practice Gap in Low- and Middle-Income Countries

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