High rates of unfavourable TB treatment outcomes observed in Madang Province, Papua New Guinea

TL;DR

A study in Madang Province, Papua New Guinea, found high rates of poor TB treatment outcomes, with loss to follow-up being the most common issue.

Contribution

The study identifies key factors like HIV status, drug resistance, and travel time that contribute to unfavorable TB treatment outcomes in Madang Province.

Findings

33% of TB patients had unfavourable treatment outcomes, with 23% lost to follow-up.

HIV-untested patients had 2.82 times higher odds of unfavourable outcomes compared to HIV-negative patients.

Travel time to health facilities was significantly associated with unfavourable outcomes.

Abstract

Madang Province is located on the northern coast of Papua New Guinea (PNG), a critical mixing point between the populous highlands and more remote regions. Madang Province faces challenges with limited capacity to diagnose and treat TB.

To describe the TB caseload and investigate factors associated with known unfavourable treatment outcomes.

This is a retrospective cohort study using routinely collected TB programmatic data for treatments commenced 1 January 2019 to 31 December 2021. Using multivariable logistic regression, factors associated with known unfavourable treatment outcomes—death, failure after treatment, and loss to follow-up (LTFU)—were evaluated.

Of the 4,668 registered and treated, 3,755 had an evaluated outcome, and 33% had unfavourable outcomes, most commonly LTFU (23%). Unfavourable treatment outcomes were significantly associated with HIV-untested (aOR 2.82 compared to HIV-negative; 95% CI 2.39–3.33), having drug-resistant TB (aOR 3.26 compared to drug-susceptible TB, 95% CI 1.18–9.00), and travel time to the health facility 1–<3 hours by foot (aOR 3.53 compared to <1 hour by foot; 95% CI 1.04–12.06).

High LTFU from TB treatment was associated with factors that indicate barriers to access to care and treatment completion. Decentralisation and strengthening of TB services for improved person-centred care and treatment support are urgently required in Madang Province.