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

IF 1.3 Q4 RESPIRATORY SYSTEM

Public Health Action Pub Date : 2024-09-01 DOI:10.5588/pha.24.0015

W Toua, V Lape, J W Bolnga, M Daimen, T Kelebi, S Vaccher, J Greig

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Abstract

Setting: 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.

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

Design: 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.

Results: 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).

Conclusion: 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.

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在巴布亚新几内亚马当省观察到结核病治疗效果不佳的高发率。

背景马当省位于巴布亚新几内亚（PNG）北部海岸，是人口众多的高原地区与较偏远地区的重要交汇点。马当省面临着结核病诊断和治疗能力有限的挑战：描述肺结核病例数，调查与已知不利治疗结果相关的因素：这是一项回顾性队列研究，使用的是例行收集的肺结核项目数据，涉及的是 2019 年 1 月 1 日至 2021 年 12 月 31 日开始的治疗。通过多变量逻辑回归，评估了与已知不利治疗结果--死亡、治疗失败和失去随访（LTFU）--相关的因素：在登记并接受治疗的 4,668 人中，3,755 人获得了评估结果，33% 的人获得了不利结果，其中最常见的是 LTFU（23%）。不利的治疗结果与 HIV 检测未通过（与 HIV 检测阴性相比，aOR 值为 2.82；95% CI 为 2.39-3.33）、耐药结核病（与药敏结核病相比，aOR 值为 3.26；95% CI 为 1.18-9.00）以及前往医疗机构的旅行时间密切相关：结核病治疗的高延迟率与一些因素有关，这些因素表明在获得医疗服务和完成治疗方面存在障碍。马当省亟需下放权力并加强结核病服务，以改善以人为本的护理和治疗支持。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Public Health Action RESPIRATORY SYSTEM-

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期刊介绍： Launched on 1 May 2011, Public Health Action (PHA) is an official publication of the International Union Against Tuberculosis and Lung Disease (The Union). It is an open access, online journal available world-wide to physicians, health workers, researchers, professors, students and decision-makers, including public health centres, medical, university and pharmaceutical libraries, hospitals, clinics, foundations and institutions. PHA is a peer-reviewed scholarly journal that actively encourages, communicates and reports new knowledge, dialogue and controversy in health systems and services for people in vulnerable and resource-limited communities — all topics that reflect the mission of The Union, Health solutions for the poor.