Drug-resistant TB in Morobe Province, Papua New Guinea, 2012–2021

Abstract

SETTING: Papua New Guinea (PNG) is a high-burden country for multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB). There are limited data on MDR/RR-TB notifications and treatment from the most populous province. OBJECTIVE: Describe MDR/RR-TB detection and treatment outcomes in Morobe Province, the impact of the COVID-19 pandemic and factors associated with unfavourable treatment outcomes. DESIGN: Retrospective cohort study of MDR/RR-TB notifications between 2012 and 2021 using routine programme registration data. Favourable outcomes were compared to unfavourable outcomes using multivariable regression. RESULTS: Between 2012 and 2021, 160 cases of MDR/RR-TB were bacteriologically confirmed. Few diagnoses were made among children (2.5%), extrapulmonary cases (0.6%) or rural residents (38%). Case notifications rose sharply from 2016 after the introduction of GeneXpert to 5.6 cases per 100,000 population in 2020 before a reduction in 2021 coinciding with COVID-19 disruptions. Loss to follow-up (27.5%) and death (8.1%) were common. Unfavourable treatment outcomes were more common among male participants (aOR 3.00, 95% CI 1.38–6.45) and those treated with longer injectable-containing regimens (aOR 3.39, 95% CI 1.30–8.80). CONCLUSION: MDR/RR-TB detection has increased overall, but enhanced and decentralised diagnostic capacity is needed, including in important sub-populations. Persisting low treatment success rates must be urgently addressed to minimise the further emergence of drug-resistant TB in Morobe Province.

Keywords

• loss to follow-up
• rifampicin-resistant tuberculosis
• pulmonary
• xpert