Tuberculosis in Papua New Guinea

A study exploring the implementation of Tuberculosis Infection Prevention and Control (TB-IPC) guidelines in rural Papua New Guinea (PNG) used a socio-ecological model (SEM) to examine barriers and strategies at multiple levels, including individual, institutional, and policy factors. Conducted across four rural hospitals, the research employed a qualitative multiple case study design, gathering insights from 32 healthcare workers (HCWs) and 10 patients through interviews and document reviews. The findings revealed that governance gaps, funding delays, and cultural beliefs—such as associations between TB and sorcery—significantly impact TB-IPC implementation.[1] See also: https://tbreadingnotes.blogspot.com/2024/10/patient-health-system-population.html

Key challenges included limited prioritization of TB-IPC in national health plans, leadership and accountability issues, and HCW burnout due to staff shortages. Many HCWs highlighted the lack of timely funding approvals at the Provincial Health Authority level, which directly affects infection control efforts. Additionally, stigma and misinformation hinder community acceptance of TB-IPC measures, requiring targeted engagement strategies. Participants also emphasized the importance of intersectoral collaboration, particularly with NGOs and development agencies, to sustain TB-IPC initiatives in resource-limited settings.[1] See also: https://tbreadingnotes.blogspot.com/2024/09/tb-in-patients-with-hiv-and-diabetes.html

The study concludes that a multi-level, coordinated approach is essential for effective TB control in PNG. Strengthening healthcare infrastructure, enhancing HCW training, fostering community engagement, and ensuring policy commitment at all levels are critical for success. While the research offers valuable qualitative insights, future studies could incorporate quantitative impact assessments and longitudinal data to track progress. Addressing both structural and cultural barriers through policy reform and cross-sector partnerships is vital for improving TB-IPC implementation in PNG’s rural hospitals.[1] See also: https://tbreadingnotes.blogspot.com/2024/10/tb-treatment-and-resulting-abnormal.html

Papua New Guinea (PNG) is among the 30 high-burden countries for tuberculosis (TB) and multidrug-resistant TB (MDR/RR-TB), as identified by the World Health Organization (WHO). In 2022, PNG recorded a TB incidence rate of 432 per 100,000 people, with MDR/RR-TB cases at 22 per 100,000. As a middle-income country with 22 provinces and a population of approximately 12 million, PNG faces significant challenges in controlling TB, particularly in its rural and remote areas, where 80% of the population resides. The country's young demographic, with 75% under the age of 35, is especially vulnerable, contributing to high rates of transmission. However, the treatment success rate remains low at 50%, far below the national target of 90%, and is compounded by a 22% loss to follow-up (LTFU) rate, particularly among individuals aged 15–34 years.[2]

LTFU is driven by socioeconomic and geographic barriers, including difficult treatment regimens that involve long durations, toxic drugs, high pill burdens, and painful injections. Many rural patients struggle to access healthcare facilities for daily TB treatment, increasing the risk of untreated cases leading to complications and further community transmission. Addressing these challenges requires decentralizing TB services and expanding rapid molecular diagnostics at the primary care level to enhance accessibility and coverage while ensuring effective treatment outcomes.[2]

References:

1. Marme, G., Kuzma, J., Zimmerman, P.A., Harris, N. and Rutherford, S., 2024. Investigating socio-ecological factors influencing implementation of tuberculosis infection prevention and control in rural Papua New Guinea. Journal of Public Health, 46(2), pp.267-276.

2. Charles, F., Lin, Y.D., Greig, J., Gurra, S., Morikawa, R., Graham, S.M. and Maha, A., 2024. Loss to follow-up among adults with drug-resistant TB in Papua New Guinea. Public Health Action, 14(3), pp.85-90.