The Burden of Drug-Resistant Tuberculosis in Papua New Guinea: Results of a Large Population-Based Survey

Abstract

BackgroundReliable estimates of the burden of multidrug-resistant tuberculosis (MDR-TB) are crucial for effective control and prevention of tuberculosis (TB). Papua New Guinea (PNG) is a high TB burden country with limited information on the magnitude of the MDR-TB problem.MethodsA cross-sectional study was conducted in four PNG provinces: Madang, Morobe, National Capital District and Western Province. Patient sputum samples were tested for rifampicin resistance by the Xpert MTB/RIF assay and those showing the presence of resistance underwent phenotypic susceptibility testing to first- and second-line anti-TB drugs including streptomycin, isoniazid, rifampicin, ethambutol, pyrazinamide, ofloxacin, amikacin, kanamycin and capreomycin.ResultsAmong 1,182 TB patients enrolled in the study, MDR-TB was detected in 20 new (2.7%; 95% confidence intervals [CI] 1.1–4.3%) and 24 previously treated (19.1%; 95%CI: 8.5–29.8%) TB cases. No case of extensively drug-resistant TB (XDR-TB) was detected. Thirty percent (6/20) of new and 33.3% (8/24) of previously treated cases with MDR-TB were detected in a single cluster in Western Province.ConclusionIn PNG the proportion of MDR-TB in new cases is slightly lower than the regional average of 4.4% (95%CI: 2.6–6.3%). A large proportion of MDR-TB cases were identified from a single hospital in Western Province, suggesting that the prevalence of MDR-TB across the country is heterogeneous. Future surveys should further explore this finding. The survey also helped strengthening the use of smear microscopy and Xpert MTB/RIF testing as diagnostic tools for TB in the country.

The epidemiology of tuberculosis in the rural Balimo region of Papua New Guinea

“…Our estimate for the Balimo region is higher than the previous Western Province region incidence estimate of 549 cases per 100 000 people per year . The South Fly District and the provincial capital of Daru have previously been noted for having a high burden of TB, and particularly DR‐TB . A heavy burden of TB cases in the North Fly District has previously been observed, while more recent research described 18 cases of TB from Tabubil, with one of these identified as rifampicin resistant .…”

“…The South Fly District and the provincial capital of Daru have previously been noted for having a high burden of TB, and particularly DR-TB [2][3][4][5][20][21][22]. A heavy burden of TB cases in the North Fly District has previously been observed, while more recent research described 18 cases of TB from Tabubil, with one of these identified as rifampicin resistant [4,5]. The data from the North Fly District, in combination with the Middle Fly District data described in our study, highlight the broad reach of TB across Western Province.…”

“…More recently, a multi‐site study that included two sites in Western Province found MDR‐TB in 34.2% of Daru Hospital TB cases . Cases with rifampicin mono‐resistance were also identified, including 7.3% of those from Daru, and 5.6% of those from Tabubil in the North Fly District (Figure ). However, data about the burden of TB in other areas of the province are scarce, particularly outside the South Fly District.…”

Increasing isoniazid preventive therapy uptake in an HIV program in rural Papua New Guinea

“…21 Given the limited access to drug susceptibility testing in PNG, Xpert offers a critical contribution not only to TB diagnosis but also to rapid detection of drug resistance in this setting. There were operational challenges to executing screening using both smear microscopy and Xpert.…”

A complete high quality nanopore-only assembly of an XDR Mycobacterium tuberculosis Beijing lineage strain identifies novel variation in repetitive PE/PPE gene regions

“…Papua New Guinea (PNG) has a high rate of drug resistant TB in its Western Province (22, 23). We recently characterized a drug resistant tuberculosis outbreak on Daru island, which is driven by a modern Beijing sub-lineage 2.2.1.1 strain (24).…”