Public Health Action supplement highlights operational challenges and successes in TB programmes in Papua New Guinea

A dedicated supplement drawing attention to the important process of building operational research (OR) capacity in Papua New Guinea (PNG) has been released by the journal Public Health Action (PHA).

PNG is a country where tuberculosis (TB), including drug-resistant TB (DR-TB), is highly prevalent. According to the World Health Organization (WHO), PNG has an estimated annual TB incidence rate of 432 per 100,000 people. In addition, the treatment success rate for new diagnoses registered in 2016 was 62 percent.

In 2017-18, the first OR capacity-building programme for TB was conducted in PNG using the Structured Operational Research Training IniTiative (SORT IT) model. The SORT IT programme offers an intensive course in OR that consists of three six-day modules offered over nine to 12 months, and is a collaboration between The Union, Médicins Sans Frontières and WHO’s Special Programme for Training and Research in Tropical Diseases.

The twelve papers presented in the supplement represent the findings from the research projects undertaken by participants of the SORT-IT course, raising important operational issues for PNG’s TB programme and providing opportunities to inform policy and practice.

The implementation of PNG’s national programmatic response to TB only started in 2008. The supplement’s studies confirm the challenges which is exist in in the country, including: the large number of people with TB who remain undetected, low treatment success rate, high numbers of multidrug-resistant TB (MDR-TB) in concentrated locations, large numbers of children with TB, and high numbers of treatment outcomes reported as ‘lost to follow-up’.

OR is fundamental in providing much-needed baseline data, identifying gaps in provision, and evaluating innovations such as new tools and strategies to increase detection of new cases, improve treatment outcomes and aid prevention.

The 12 studies offer important insight into operational challenges and successes, with the aim of increasing the capacity of the workforce to conduct OR, and ultimately improving health care service provision and patient outcomes for people living in PNG and the wider Pacific region. These include:

  • Drug-resistant tuberculosis diagnosis since Xpert® MTB/RIF introduction in Papua New Guinea, 2012–2017: Xpert® MTB/RIF was introduced in PNG in 2012 for the diagnosis of TB and of rifampicin-resistant TB (RR-TB). The study found that the use of Xpert has increased the detection of RR-TB and MDR-TB in PNG. However, the high frequency of MDR-TB emphasises the need to accelerate the in-country availability of drug susceptibility testing. Ongoing surveillance of DR-TB patterns was also identified as being essential to improve treatment guidelines.
  • Impact of GxAlert on the management of rifampicin-resistant tuberculosis patients, Port Moresby, Papua New Guinea: GxAlert is an automatic electronic notification service that provides immediate Xpert® MTB/RIF testing results. It was implemented for the notification of patients with RR-TB at Port Moresby General Hospital. The study found that considerable improvements have been made in timely RR-TB patient management in Port Moresby, although it was unclear to what extent GxAlert was directly associated with these improved patient outcomes.
  • Implementation of screening and management of household contacts of tuberculosis cases in Daru, Papua New Guinea: Community-based household contact screening and management was successfully implemented, under programme conditions, on Daru Island, which can be described as a low-resource setting with a high burden of TB and DR-TB. Of interest, the study also demonstrated a high level of acceptability of screening among household contacts, and a high level of household crowding on the island, increasing the risk of transmission of TB.
  • Outcomes in children treated for tuberculosis with the new dispersible fixed-dose combinations in Port Moresby: New child-friendly fixed dose combinations were introduced at Port Moresby General Hospital for the first-line treatment of children with TB. Despite the use of child-friendly medicines, a recorded high proportion of loss to follow-up highlighted the need for: promotion of bacteriological confirmation of TB amongst children, better retention in care, increased access to HIV testing, and better links with community TB programmes and nutrition services.
  • Challenges in TB diagnosis and treatment: the Kavieng Provincial Hospital experience, Papua New Guinea: Gaps were identified in diagnosis and treatment in the TB treatment cascade at the Kavieng Basic Management Unit. The study concluded that the TB programme requires strengthening to address: the high proportion of patients with a clinical diagnosis of TB, patients not being tested for HIV, and high levels of loss to follow-up. The challenges are complex and will likely require multiple interventions to improve.

The full supplement can be viewed online.

Public Health Action is The Union's quarterly open-access on-line journal, showcasing OR that addresses issues in health systems and services, providing opportunities to improve access, equity, quality and efficiency. The journal has a particular focus on health systems and services for vulnerable groups, with priorities in TB, lung health, non-communicable diseases and related public health issues.

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