The Burden of TB in the Population under the Partnership in Health Project

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1 The Burden of TB in the Population under the Partnership in Health Project Suparat Phuanukoonnon PNGIMR, Madang Walter & Eliza Hall Institute AITHM, James Cook University

2 Background Tuberculosis (TB) is a disease spread by coughing and sneezing. Pulmonary TB and Extra Pulmonary TB Long duration of treatment (6-9 months) BCG vaccine Disease of the poor or Disease of the unfortunate Direct Observed Treatment Short-course (DOTS)

3 TB research in PNG Public health emergency in PNG TB research in PNG started in 2006 Research agenda under PiH project Burden of TB, drug resistance Treatment outcome DOTS improvement, health seeking behavior

4 Study locations Kar Kar Hides Kikori Hiri

5 Laboratory capacity The new infectious disease laboratory at Medical school, UPNG

6 Methods Active case detection survey Passive case detection Diagnosis with WHO gold standard DOTS follow up KAP survey

7 Burden of TB Location Total PTB /10 5 All / 10 5 Incidence PTB:EPTB % PCD Kikori (785) 32 : % Kikori

8 Burden of TB Location Total PTB /10 5 All / 10 5 Incidence PTB:EPTB % PCD Kikori (785) 32 : % Kar Kar (276) 67 : 33 76% Kar Kar Kikori

9 Burden of TB Locatio n Total PTB /10 5 All / 10 5 Incidence PTB:EPTB % PCD Kikori (785) 32 : % Kar Kar (276) 67 : 33 76% Hiri (165) 72 : 28 50% Kar Kar Kikori Hiri

10 Burden of TB Locatio n Total PTB /10 5 All / 10 5 Incidence PTB:EPTB % PCD Kikori (785) 32 : % Kar Kar (276) 67 : 33 76% Hiri (165) 72 : 28 50% Hides (84) 44:56 78% Kar Kar Hides Kikori Hiri

11 Burden of TB Locatio n Total PTB /10 5 All / 10 5 Incidence PTB:EPTB % PCD Kikori (785) 32 : % Kar Kar (276) 67 : 33 76% Hiri (165) 72 : 28 50% Hides (84) 44 : 56 78% Kar Kar Hides Kikori Hiri

12 Country Swaziland 1287 South Africa 981 Timor-Leste 498 D. Republic of Congo 327 Papua New Guinea 303 Kikori Karkar Hiri Per 100, 000 population Indonesia 189 India 185 Russian federation 106 China 80 Australia 6.3 From WHO Global Tuberculosis Control 2011 Report:

13 Why TB is Highly transmitted disease (Kikori) 40% are under 15 years old One third with history of TB illness 75% had previous contact with another TB 90% lived in crowd houses (>5 members) ~70% of PTB live in smaller house size Presence of young children increase transmission risk Those with no BCG 2-3 time higher risk to TB

14 Knowledge and local beliefs of TB Delay in seeking health care was common Believed in sorcery High cost of travel Poor health education Most patients after feeling better would discontinue the treatment. Believed TB infection = skin contact and sharing food Most NOT believed BCG preventing TB illness <10% know relationship of TB and HIV

15 In short TB epidemiology varies in PNG Very high burden of TB and Not HIV driven epidemic Poor health education Strong support to DOTS needed from all parties Diagnosis need to be strengthened Need to reduce the burden of TB in children = ITP (Isoniazid Preventive Treatment)

16 Publications

17 Benefits Informed policy to NTB program Mitigation plan for the PNGLNG project Direct benefit to community from the provision of TB diagnosis and DOTS services to communities Local staff training

18 Acknowledgement TB research is under a Partnership in Health (PiH) Program grant funded by ExxonMobil PNG. Gulf Christian Service Salvation Army Lutheran Health Service Evangelical Church of PNG Medical School, UPNG Divine World University OSL Community development Initiative (CDI) Queensland Mycobacterium Reference Lab, Brisbane

19 Thank you