The emergency response to multidrug-resistant tuberculosis in Daru, Western Province, Papua New Guinea, 2014–2017

Abstract

Setting: A response to an outbreak of multidrug-resistant tuberculosis (MDR-TB) on Daru Island, South Fly District (SFD), Western Province, Papua New Guinea (PNG) was implemented by a national emergency response taskforce. Objective: To describe programmatic interventions for TB in SFD and evaluate characteristics of TB case notifications, drug resistance and treatment outcomes. Design: This was a retrospective cohort study based on routine programmatic data for all patients enrolled on TB treatment at Daru General Hospital from 2014 to 2017. Results: The response involved high-level political commitment, joint planning, resource mobilisation, community engagement and strengthening TB case detection and treatment. Of 1548 people enrolled on TB treatment, 1208 (78%) had drug-susceptible TB (DS-TB) and 333 (21.5%) had MDR-TB. There was an increase in MDR-TB as a proportion of all TB. Treatment success rates increased over the study period from 55% to 86% for DS-TB, and from 70% to 81% for MDR-TB from 2014 to 2015. The 2014 case notification rate for TB in SFD was 1031/100 000, decreasing to 736/100 000 in 2017. Conclusion:The outbreak was stabilised through the response from the national and provincial governments and international partners. Additional interventions are needed to decrease the TB burden in Daru.

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

“…It may also reflect a decrease in TB transmission prior to and during the study period due to the strengthening of case detection and improved treatment outcomes in this community. 19 A key gap identified is that one fourth of contacts who report TB-related symptoms at the time of household screening do not PNG supplement…”

Telemedicine in Resource-Limited Settings to Optimize Care for Multidrug-Resistant Tuberculosis

“…Although there were a number of concurrent interventions across this time period, we believe that this service has contributed, in part, to the very good outcomes now seen for MDR-TB patients in Daru (20, 21). Treatment success rates for the 2015 MDR TB enrolment cohort were 81%, with only 4% of patients being lost to follow up and 4% failing treatment (20).…”

“…This led to the establishment of the emergency response task force for MDR-TB in 2014, led by the National Department of Health in PNG with support from the Australian Government, across three identified “hotspot” provinces, including Daru, Western Province. The programmatic interventions during the response in Daru 2014-17 and clinical care model have been described elsewhere (20, 21).…”

Transforming the health information system using mobile and geographic information technologies, Papua New Guinea

“…We have created a tuberculosis patient information management system within the electronic information system, currently being used in selected priority provinces of the country’s national tuberculosis emergency plan. 7 The electronic system has replaced a poorly performing paper register and report-filing on spreadsheets, 8 with detailed quarterly reports on drug-sensitive tuberculosis patients now being automated. The new system supports clinicians with the capture and ongoing management of geolocated tuberculosis patient information; automatically shifts patients between the intensive and continuation phase of therapy; automates patient progress summary reports and medical notes; provides clinicians with the drug, dose and number of pills to provide until the next appointment; sets dosage limits; and reports adverse events.…”