TB incidence and characteristics in the remote gulf province of Papua New Guinea: a prospective study

Abstract

BackgroundThe incidence and characteristics of tuberculosis (TB) in remote areas of Papua New Guinea (PNG) are largely unknown. The purpose of our study was to determine the incidence of TB in the Gulf Province of PNG and describe disease characteristics, co-morbidities and drug resistance profiles that could impact on disease outcomes and transmission.MethodsBetween March 2012 and June 2012, we prospectively collected data on 274 patients presenting to Kikori Hospital with a presumptive diagnosis of TB, and on hospital inpatients receiving TB treatment during the study period. Sputum was collected for microscopy, GeneXpert analysis, culture and genotyping of isolates.ResultsWe estimate the incidence of TB in Kikori to be 1290 per 100,000 people (95% CI 1140 to 1460) in 2012. The proportion of TB patients co-infected with HIV was 1.9%. Three of 32 TB cases tested were rifampicin resistant. Typing of nine isolates demonstrated allelic diversity and most were related to Beijing strains.ConclusionsThe incidence of TB in Kikori is one of the highest in the world and it is not driven by HIV co-infection. The high incidence and the presence of rifampicin resistant warrant urgent attention to mitigate substantial morbidity in the region.

Is IPT more effective in high-burden settings? Modelling the effect of tuberculosis incidence on IPT impact

“…However, a similar TB burden might also occur in more moderate HIV burden settings, when considering smaller subnational populations or local communities such as PNG-GP within countries of much lower national incidence 17. Our results suggest that it is only when incidence reaches extremely high levels (>1400 cases/100 000/year) that the effects of IPT begin to attenuate.…”

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