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PNG breaks new ground in tuberculosis research

  • 12 Sep 2019

 

Image: One of the new authors, Deputy Chief Physician (New Guinea Islands), NDoH, Dr Al Maha

The publication of the first compendium of studies on tuberculosis (TB) in Papua New Guinea (PNG) marks a watershed for scientific research in the field and the development of future leaders for the national response to this pressing public health crisis.

In summary:

  • The studies focus on a broad range of issues relating to TB across seven provinces, and collectively represent an important resource for health planning and policy in PNG
  • The authors all work in TB as clinicians, scientists and administrators, but had never previously published research
  • The authors are all PNG nationals, who are invested in their communities and committed to the elimination of TB
  • Tuberculosis is a leading cause of morbidity and mortality in Papua New Guinea (PNG). Major challenges include under-detection of cases, poor treatment outcomes and high numbers of multidrug-resistant tuberculosis in several locations.

PNG’s National Department of Health and National Tuberculosis Program recognise that operational research is fundamental to the enormous challenge of ending TB in PNG.

In 2017-18, the first operational research capacity building program for tuberculosis was implemented in PNG, supported by by the Australian Government through the Tropical Disease Research Regional Collaboration.

Published as a dedicated supplement in the journal Public Health Action, the studies were conducted as part of a special training course to build much-needed operational research capacity in PNG and inform the public response to tuberculosis.

The papers focus on a range of epidemiological, clinical and programmatic implementation aspects of TB in Papua New Guinea and represent findings from the research projects undertaken by participants in the operational research training course implemented by Burnet Institute, University of PNG and PNG Institute of Medical Research under the stewardship of the National Department of Health.

The authors work in TB in roles ranging from frontline clinicians, laboratory scientists and public health managers from PNG government services, representing the diverse geographical and health service settings from seven provinces in PNG.

This included the three provinces where the National Department of Health is convening an emergency response to multidrug-resistant TB – National Capital District, Gulf Province and Western Province.

“The manuscripts produced from this course highlight important operational issues for the TB program in Papua New Guinea, and collectively represent an extremely valuable resource,” Dr Suman Majumdar, Burnet Deputy Program Director (Health Security), said.

“And the significance of building the operational research capacity of health workers from PNG, who work in the field, who are committed to, live in, and understand their communities and the special problems that TB presents, can’t be overstated.”

TB is the leading infectious disease killer globally with 1.6 million deaths in 2017, and the second leading cause of death in PNG. Research is a critical component of the World Health Organization’s END TB Strategy, and the output of these projects highlights important issues in PNG, including:

  • The low proportion of TB cases with bacteriological confirmation
  • The high proportion of cases registered as extrapulmonary TB
  • Large numbers of TB in children
  • High numbers of treatment outcomes reported as lost to follow-up or not evaluated
  • As per Pillar 3 of the END TB Strategy, the studies also report original findings from the evaluation of the recent introduction of innovations in PNG in laboratory diagnostics, treatment options and community-based contact screening and management.

“This initiative has created a new environment and means for research, and we need to ensure that this is sustained to inform policy and practice, to identify research champions, and to embed research as part of Papua New Guinea’s response to critical health issues like TB,” said Prof Steve Graham, Senior Principal Research Fellow, Burnet Institute,

One of the new authors, Deputy Chief Physician (New Guinea Islands), National Department of Health, Dr Al Maha said: “Building research capacity gives us tools to analyse our own performance especially at the implementation levels, and critically assess the effectiveness of local interventions and share ideas that need to be more widely trialled.”

“TB remains a leading health and development issue in PNG and we need to own the problem and also own the development of solutions rather than wait to adopt or adapt solutions from other regions.”

The participants and facilitators deserve enormous credit for such a high completion rate from project inception through to peer-reviewed publication, and this body of work was recently highlighted at the recent Annual PNG Medical Symposium in Port Moresby where the publication was launched by Dr Paison Dakulala, Deputy Secretary of Health, NDoH and Dr Paul Aia, Manager National TB Program, PNG.

Ongoing initiatives are planned to continue to sustain the enabling environment this initiative has created to conduct operational research relevant to policy and practice, and to identify national operational research champions.

The training programme was delivered as part of the Tropical Disease Research Regional Collaboration Initiative, and supported by the Australian Government and implemented by Menzies School of Health Research and Burnet Institute.

The training programme was developed and implemented by the Burnet Institute in collaboration with the PNG Institute of Medical Research (PNGIMR) and University of PNG (UPNG) under the stewardship of the PNG National Department of Health, National TB Program and Western Provincial Health Office.

The model is based on the Structured Operational Research and Training Initiative (SORT IT), a global partnership led by the Special Programme for Research and Training in Tropical Diseases at the World Health Organization (WHO/TDR).

The full list of course participants and their publications: