Challenges in TB diagnosis and treatment: the Kavieng Provincial Hospital experience, Papua New Guinea.

Abstract

The Tuberculosis (TB) Basic Management Unit at Kavieng Provincial Hospital, New Ireland Province, Papua New Guinea. To assess the linkage between laboratory diagnosis and treatment initiation and describe the characteristics and treatment outcomes of TB patients. This was a retrospective cohort study of 1) sputum smear-positive TB patients recorded in the laboratory register, and 2) TB patients recorded in the treatment register in 2015 and 2016. Of the 221 patients registered for TB treatment, 173 (78%) were clinically diagnosed; extrapulmonary TB was common (36% of all patients). Unfavourable treatment outcomes were seen in more than 40% of patients, including death (10%) and loss to follow-up (26%), and were significantly more common in smear-negative vs. smear-positive pulmonary TB patients (RR 1.69 [95%CI 1.02-2.80]). Only 4 (<2%) TB patients had undergone testing for HIV. Twelve (21%) of 58 sputum smear-positive TB patients were not registered as undergoing treatment for TB. This study identifies diagnostic and treatment gaps in the TB treatment cascade at the Kavieng Basic Management Unit. The TB programme requires strengthening to address the high proportions of clinically diagnosed TB, of patients not tested for HIV and of loss to follow-up.