Abstract

Tuberculosis (TB) and multidrug-resistant TB (MDR-TB) are major health problems in Western Province, Papua New Guinea. While comprehensive expansion of TB control programs is desirable, logistical challenges are considerable, and there is substantial uncertainty regarding the true disease burden. We parameterized our previously described mathematical model of Mycobacterium tuberculosis dynamics in Western Province, following an epidemiologic assessment. Five hypothetical scenarios representing alternative programmatic approaches during the period from 2013 to 2023 were developed with local staff. Bayesian uncertainty analyses were undertaken to explicitly acknowledge the uncertainty around key epidemiologic parameters, and an economic evaluation was performed. With continuation of existing programmatic strategies, overall TB incidence remained stable at 555 cases per 100,000 population per year (95% simulation interval (SI): 420, 807), but the proportion of incident cases attributable to MDR-TB increased from 16% to 35%. Comprehensive, provincewide strengthening of existing programs reduced incidence to 353 cases per 100,000 population per year (95% SI: 246, 558), with 46% being cases of MDR-TB, while incorporating programmatic management of MDR-TB into these programs reduced incidence to 233 cases per 100,000 population per year (95% SI: 198, 269) with 14% MDR-TB. Most economic costs were due to hospitalization during the intensive treatment phase. Broad scale-up of TB control activities in Western Province with incorporation of programmatic management of MDR-TB is vital if control is to be achieved. Community-based treatment approaches are important to reduce the associated economic costs.

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This report was commissioned by the National Department of Health, Papua New Guinea, and approval for publication was given by Pascoe Kase, Secretary for Health. The work was funded by the aid program of the Australian Department of Foreign Affairs and Trade (known as the Australian Agency for International Development (AusAID) at the time of the research). J.M.T. has received support from the National Health and Medical Research Council of Australia for doctoral studies in tuberculosis. E.S.M. is the recipient of a National Health and Medical Research Council Career Development Fellowship. We gratefully acknowledge the assistance of the Western Province Provincial Health Department, the Western Province Provincial Government, and the National Department of Health, Papua New Guinea, for assistance with this work.