Tackling tuberculosis in PNG's Western Province

Burnet Institute

28 May, 2013

Drug shortages, drug supply security and access to health services in the Western Province is contributing to one of the worst tuberculosis (TB) epidemics in the world.

Burnet’s Head of Modelling and Biostatistics, Associate Professor Emma McBryde, with the support of AusAID, spent two weeks in PNG’s Western Province last year, assessing the incidence of TB and multi-drug resistant TB (MDRTB) in the region.

Associate Professor McBryde found that there were more than 1000 cases of TB in the province of 200,000 people.

“That puts PNG at the same level as Cambodia which has the highest incidence level in Asia and also the same level as some Sub-Saharan African countries. The number could be higher – this data is based only on the people who are on the TB register in Western Province,” she said.

“Of those cases tested for drug resistance in Daru, about a third were confirmed as having multi-drug resistant TB.”

Daru Hospital treats the majority of drug-resistant TB patients in Western Province and according to Associate Professor McBryde are doing quite well but still not meeting World Health Organization targets.

The hospital experiences about 70 per cent completion success rates (patients cured), 10 per cent defaults (patients who the hospital has lost contact with) and 10 per cent failure rates – this is when patients continue to have active disease despite conventional therapy and have to go on a different treatment – this is a reflection on the drug resistance rates.

In the Middle Fly region and the southern part of North Fly of Western Province, the default rate can be up to 40 per cent and about 10 per cent of those treated for TB in Western Province die.

Associate Professor McBryde said HIV isn’t driving the high TB rates – unlike in in sub-Saharan Africa for example, where HIV contributes to TB prevalence.

“Access to healthcare is a factor but it’s also the amount of crowding. You should educate people about what tuberculosis is, seeking care early and understanding cough etiquette but in the end it’s going to be things like the state of the housing and how people interact that drives tuberculosis,” she explained.

“For example Western Province is sparsely populated, so it’s two people per square kilometre, but they’re all in a very restricted space – it’s not unusual to have more than 10 people in one household, which is essentially one room.”

Image: A community TB treatment supporter supervises a TB patient in Western Province taking her daily medication.

Drug-resistant TB

Multi-drug resistant tuberculosis (MDRTB) is an emerging problem in the Asia and Pacific regions and particularly in PNG – it occurs when diagnosed patients are only partially treated.

Standard TB treatment consists of four medications, if patients are given these pills separately and they don’t adhere to the treatment regime of taking them all together or if they take the drugs then stop after a month but return for further treatment – this often leads to drug resistance.

“As far as is known, MDRTB is just as transmissible as standard TB so even if you aren’t creating drug resistance through the drug taking – it can propagate through transmission,” McBryde said.

“I am worried if MDRTB increases in PNG, because those patients require longer treatment (two years) and it’s 200 times more expensive. Currently, Daru Hospital has around 70 patients on their books with MDRTB.

“Not all of them are in hospital, some are ambulatory but they still have to come in everyday for an injection.”

McBryde is also concerned about the other districts in Western Province because MDRTB is only very occasionally being tested for – so the picture in the region could actually be a lot worse.

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