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

Abstract

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.

Predictors of unfavourable treatment outcome in patients diagnosed with drug-resistant tuberculosis in the Torres Strait / Papua New Guinea border region

“…(27). The major differences in care resulting from these changes were reduction in time to treatment commencement and retention in care (28). Between 2000 and 2012, some treatment for DR-TB was available for PNG nationals diagnosed with DR-TB in Australian border clinics, however, access to treatment was improved between 2006 and 2012 with the establishment of frequent outreach TB clinics in the Torres Strait.…”

“…(27). The major differences in care resulting from these changes were reduction in time to treatment commencement and retention in care (28).…”

“…Mycobacterial culture, phenotypic drug susceptibility testing and genotyping were available throughout the study period and were performed on at least one specimen per patient in the Queensland Mycobacterium Reference Laboratory in Brisbane (Fig 1) (24). The major differences in care resulting from these changes were reduction in time to treatment commencement and retention in care (26). Islands, Boigu and Saibai (27).…”

Critical Review of Tuberculosis Diagnosis in Children from Papua New Guinea Presenting to Health Facilities in the Torres Strait Islands, Australia

“…Unfortunately, local policy prevents recalling PNG patients across the international border for any purpose, including tuberculin skin test (TST) reading, repeat CXR, or review following a course of antibiotics or nutritional rehabilitation [16]. Health services rendered to presumptive TB patients who are in a 'non-critical' condition, are provided with the specific purpose of identifying TB and referring patients back to the PNG health system for ongoing care [17]. Australia has made significant investments to support quality TB care on Daru Island, which is on the PNG side of the border [18].…”

Predictors of unfavourable treatment outcome in patients diagnosed with drug-resistant tuberculosis in the Torres Strait / Papua New Guinea border region

“…Mycobacterial culture, phenotypic drug susceptibility testing and genotyping were available throughout the study period and were performed on at least one specimen per patient in the Queensland Mycobacterium Reference Laboratory in Brisbane (Fig 1) [24]. The major differences in care resulting from these changes were reduction in time to treatment commencement and retention in care [26].…”