Abstract
Papua New Guinea (PNG) has a high burden of tuberculosis (TB), including drug-resistant TB (DR-TB). DR-TB has been identified in patients in Western Province, although there has been limited study outside the provincial capital of Daru. This study focuses on the Balimo region of Western Province, aiming to identify the proportion of DR-TB, and characterise Mycobacterium tuberculosis (MTB) drug resistance-associated gene mutations. Sputum samples were investigated for MTB infection using published molecular methods. DNA from MTB-positive samples was amplified and sequenced, targeting the rpoB and katG genes to identify mutations associated with rifampicin and isoniazid resistance respectively. A total of 240 sputum samples were collected at Balimo District Hospital (BDH). Of these, 86 were classified as positive based on the results of the molecular assays. For samples where rpoB sequencing was successful, 10.0% (5/50, 95% CI 4.4–21.4%) were considered rifampicin-resistant through detection of drug resistance-associated mutations. We have identified high rates of presumptive DR-TB in the Balimo region of Western Province, PNG. These results emphasise the importance of further surveillance, and strengthening of diagnostic and treatment services at BDH and throughout Western Province, to facilitate detection and treatment of DR-TB, and limit transmission in this setting.
Highlights
Papua New Guinea (PNG) is considered to have a high burden of tuberculosis (TB) and drug-resistant TB (DR-TB) [1]
DR-TB was identified in samples collected at Balimo District Hospital (BDH), with RIF resistance-associated mutations identified in 10% (5/50, 95% CI 4–21) of the Mycobacterium tuberculosis (MTB) or M. tuberculosis complex (MTBC)/non-tuberculous mycobacteria (NTM) samples where rpoB sequencing was obtained
This study has described the presence of RR-TB in the Balimo region, based on the identification of resistance-associated mutations in the rpoB gene
Summary
Papua New Guinea (PNG) is considered to have a high burden of tuberculosis (TB) and drug-resistant TB (DR-TB) [1]. Despite the high burden of TB, HIV is not considered to be a main driver of TB in Western Province [3]. Studies undertaken in PNG have identified MDR-TB at sites in Eastern Highlands, Gulf, Madang, Milne Bay, Morobe, and Western provinces, and the National Capital District [4,5,6,7,8]. At Daru Hospital in the provincial capital of Western Province, MDR-TB has been reported in 34.2% of new and previously treated cases, and extensively drug-resistant TB (MDR-TB with additional fluoroquinolone and second-line injectable antibiotic resistance) has been described [3,4,9,10,11,12,13]. No previous research has investigated DR-TB in the Middle Fly District of Western Province, and the geographic origin of DR-TB patient samples referred to Daru Hospital (the referral hospital for DR-TB in the province) has not been reported
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