The Burden of MDR-TB in Papua New Guinea

Multi-drug resistant tuberculosis (MDR-TB) is an ongoing public health crisis in Papua New Guinea (PNG) [1]. More than 2,000 new cases of drug-resistant TB are recorded each year with figures at Western Province and the National Capital District accounting for most of those recorded [1]. According to an article by the World Health Organization, it is expected that MDR-TB will be the dominant strain in PNG if no actions are taken to control this burden [1].

Tuberculosis, an airborne disease caused by the Mycobacterium tuberculosis bacteria, usually affects the lungs, though it can also involve the brain, kidneys, or spine [2]. When tuberculosis is non-responsive to at least isoniazid and rifampicin, two important drugs used to treat drug-susceptible tuberculosis (DS-TB), this is called multi-drug resistant tuberculosis [3]. Oftentimes, in cases of treatment mismanagement or in areas with a high prevalence of MDR-TB, the chances of developing drug resistance are much higher [4].

Research data on the prevalence of MDR-TB in PNG are not sufficient to give a reliable estimate [5]. Study samples are often small and results are heterogeneous [5]. Figures range as high as 26% of MDR-TB in new cases in patients of South Fly District, Western Province seeking to cross into the Australian border for treatment, and as low as 5.2% of new cases from a sample in Madang province [5]. Although an article published in 2016 studying over 1,000 TB patients in PNG did conclude that MDR-TB rates were slightly lower than regional rates at 4.4%, most of the MDR-TB cases were recorded from a single hospital in Western Province [5]. As stated by WHO PNG Country Office, hotspot areas such as Western Province have much higher rates than national averages [1].

In Papua New Guinea, the first documented case of MDR-TB was reported from clinics in the Australian Torres Strait Islands, bordering South Fly District, Western Province, where an audit of TB cases showed a substantial increase in cases of PNG nationals between 1998 and 2002 [3]. Reports from the Torres Strait Islands have shown disturbingly high rates of infection transmission [3]. By 2011, the Australian Government had invested financial support in the province to improve the management of TB through the provision of clinical staff, a community engagement partner, and by establishing key infrastructure and service agreements [3]. From 2012 to 2014, case notifications at Daru, South Fly District showed an annual increase of MDR-TB at 59, 61, and 84 new cases per year respectively [3]. Recognising the impending outbreak, the National Department of Health called an Emergency Response Team for MDR-TB in Western Province and other hotspots including Gulf Province and the National Capital District from August 2014 till December 2017 [3].

In September 2017, the National Department of Health in partnership with the World Health Organization launched the emergency TB project in order to control the spread of TB and MDR-TB throughout hotspots in the country by strengthening its programmatic management [1]. Key focus points include early active TB patient detection, effective treatment of TB patients, and strengthening health delivery systems [1].

In a review by the Regional Green Light Committee (rGLC), an international group of TB experts to support public health response to drug-resistant TB, it was observed that much progress had been made in the country. Some of those listed include an increased funding by the PNG and Australian governments; improving patient support while on treatment; improving access to essential TB drugs; a higher number of patients completing TB treatment; more early detection of TB and MDR-TB; and improving in-country diagnostic capabilities [6].

The Union, Médicins Sans Frontières, and WHO’s Special Programme for Training and Research in Tropical Diseases also provided additional support by launching the first operational research capacity-building programme for TB in PNG in 2017-2018 [7]. This was conducted using the Structured Operational Research Training IniTiative (SORT IT) model to upskill the health workforce in data collection and evaluation of early detection strategies and management of new cases [7].

Papua New Guinea still ranks as one of the highest TB incidence rates in the world, however much progress has been made since the government and multiple stakeholders decidedly took action in the country’s battle against TB and MDR-TB [1]. As long as there is continued support from these bodies, there should be a positive decline in the burden of multi-drug-resistant tuberculosis in Papua New Guinea sooner than later.

References

[1]

"Partnership to address PNG’s multi-drug resistant TB challenge," World Health Organization, 2 November 2017. [Online]. Available: https://www.who.int/papuanewguinea/news/detail/02-11-2017-partnership-to-address-png-s-multi-drug-resistant-tb-challenge. [Accessed 15 August 2021].

[2]

"Drug-Resistant TB," Centers for Disease Control and Prevention, 17 January 2017. [Online]. Available: https://www.cdc.gov/tb/topic/drtb/default.htm. [Accessed 15 August 2021].

[3]

L. Morris, S. Hiasihri, G. Chan, A. Honjepari, O. Tugo, M. Taune, P. Aia, P. Dakulala and S. S. Majumdar, "The emergency response to multidrug-resistant tuberculosis in Daru, Western Province, Papua New Guinea, 2014–2017," Public Health Action, vol. 9, no. 1, 2019.

[4]

"Multidrug-Resistant Tuberculosis (MDR TB)," Centers for Disease Control and Prevention, 4 May 2016. [Online]. Available: https://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm. [Accessed 15 August 2021].

[5]

P. Aia, M. Kal, E. Lavu, L. N. John, K. Johnson, C. Coulter, J. Ershova, O. Tosas, M. Zignol, S. Ahmadova and T. Islam, "The Burden of Drug-Resistant Tuberculosis in Papua New Guinea: Results of a Large Population-Based Survey," PLOS ONE, vol. 11, no. 3, 2016.

[6]

"Updates on situation of drug-resistant tuberculosis in Papua New Guinea, with," World Health Organization, April 2016. [Online]. Available: https://www.who.int/tb/areas-of-work/drug-resistant-tb/who_position_on_situation_of_dr_tb_in_png_daru_island.pdf?ua=1. [Accessed 15 August 2021].

[7]

"PUBLIC HEALTH ACTION SUPPLEMENT HIGHLIGHTS OPERATIONAL CHALLENGES AND SUCCESSES IN TB PROGRAMMES IN PAPUA NEW GUINEA," The Union, 2 October 2019. [Online]. Available: https://theunion.org/news/public-health-action-supplement-highlights-operational-challenges-and-successes-in-tb-programmes-in-papua-new-guinea. [Accessed 15 August 2021].