Update on the situation of drug-resistant tuberculosis in Papua New Guinea, with special emphasis on Daru Island
Tuberculosis (TB) remains a major public health threat in Papua New Guinea. TB kills more people in Papua New Guinea than any other infectious disease. The problem is further compounded by high levels of drug-resistant TB particularly in hotspot areas1, namely Daru of South Fly District in the Western Province2,3, the National Capital District and Gulf province4.
Recognising the serious problem with drug-resistant TB in Papua New Guinea, the Government of Papua New Guinea in coordination with all partners established an emergency response team (ERT) in August 2014. The ERT assists in raising high-level advocacy, resource mobilization, planning and monitoring of implementation of the national response to drug-resistant TB. Subsequently, an accelerated plan was developed and the government and partners have been further increasing their efforts to address the issue.
As part of continued support to national efforts, the Western Pacific Regional Green Light Committee (rGLC) conducted its annual mission to Papua New Guinea in August 2016. The mission commended the progress made in the management of drug-resistant TB in Papua New Guinea and provided further recommendations. The rGLC is a group of international TB experts tasked with supporting the public health response to address drug-resistant TB across the Western Pacific Region.
Below is a summary of the response to the drug-resistant TB situation in PNG and the progress made up to August 2016.
- Increasing funding: The Government of Papua New Guinea has committed funding to implement the accelerated response plan to address drug-resistant TB and released 8 million Kina (equivalent to US$ 2.6 million) in January 2016. The Australian Government and the Global Fund to Fight AIDS, Tuberculosis and Malaria continue to provide significant financial support. The United States Agency for International Development (USAID) has started to provide support to the TB program of Papua New Guinea and World Bank is also considering providing funding.
- Improving patient support while on treatment: To ensure all patients successfully complete their treatment, community-based treatment teams under the Daru Accelerated Response for Tuberculosis (DART), have been established. Robust community-based care with nutritional support has been provided in Daru in Western Province and Kerema in Gulf province. Patients now can receive treatment close to home.
- Organizing care around individual patient needs: Weekly individual care planning meetings have been instituted in Daru General Hospital with a focus on delivering patient-centred care.
- Improving access to essential medicines to treat drug-resistant TB: The government procures all second-line TB medicines and medicines to treat side effects. These are available to patients with drug-resistant TB free of charge.
- Expanding access to an important new medicine: Building on the experience of compassionate use of the new drug bedaquiline since 2013, the National TB programme introduced a procedure for access to bedaquiline for patients requiring the drug. Under the drug donation programme of USAID, an additional 85 courses of bedaquiline arrived in PNG in September 2016. Expanded access to novel TB drugs can be critical for curing patients when drug-resistance is extensive.
- More patients successfully treated: Since January 2016, none of the patients with drug-resistant TB in Daru and Kerema had dropped out of treatment when assessed 6 months after it was started. This indicates improvement in patient education and support as well as better clinical care including management of adverse side effects.
- More patients diagnosed with TB and MDR-TB at an earlier stage of the disease: Diagnosis of patients with drug-resistant TB has significantly improved in Daru and Kerema thanks to an expanded use of rapid diagnostic technology (Xpert MTB/RIF) and international collaboration with offshore laboratories.
- Preventing transmission: Infection prevention and control have been strengthened through administrative, mechanical and personal protective measures. The hospital management in Daru developed an infection control plan, introduced a cough triage centre, assigned an infection control focal person and now regularly monitors the use of protective equipment by health care staff in the drug-resistant TB ward. In Kerema General Hospital, a new TB unit and drug-resistant TB ward was built with proper environmental infection control.
- Updating policies to further strengthen the services: All three hotspot provinces developed and updated their provincial plans with the support of all relevant stakeholders. They also set up provincial core groups for TB to coordinate and oversee the programme activities.
Observations and next steps as recommended by the recent rGLC mission
- Ensuring continued availability of financial resources and adequate human resources are major issues across all locations in order to further strengthen the response.
- Rapid improvement in laboratory capacity including in-country capacity for TB culture and drug susceptibility tests is urgently needed.
- Systematic screening for active TB among residents in Daru Island has been proposed and is under preparation. This activity is expected to identify as many patients as possible, provide them with effective treatment, and reduce transmission in the community.
- Uptake and expansion of new tools and technologies including new drugs, a shorter regimen, and rapid diagnostics should be accelerated.
WHO continues to support the National Department of Health, together with local and international partners, for rapid implementation of these recommendations to further strengthen the national response to this critical public health issue.
1 Aia P, Kal M, Lavu E, et al. The Burden of Drug-Resistant Tuberculosis in Papua New Guinea: Results of a Large Population-Based Survey. PLoS ONE 2016;11(3).
2 Simpson G, Coulter C, Weston J, et al. Resistance patterns of multidrug-resistant TB in Western Province, Papua New Guinea. Int. J. Tuberc. Lung Dis 2011; 15:551–552.
3 Gilpin CM, Simpson G, Vincent S, et al. Evidence of primary transmission of multidrug-resistant TB in the Western Province of Papua New Guinea. Med. J. Aust 2008; 188:148–152.
4 Cross GB, Coles K, Nikpour M, et al.: TB incidence and characteristics in the remote gulf province of Papua New Guinea: a prospective study. BMC Infect Dis 2014; 14:93.