Contact screening and management in a high-transmission MDR-TB setting in Papua New Guinea: Progress, challenges and future directions
Daru, South Fly District, Papua New Guinea is a high transmission setting for multidrug-resistant tuberculosis (MDR-TB). An emergency response by the Government in 2014 established a high-quality model for treatment and care. Household contact screening and management commenced in 2016 with TB preve...
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| Veröffentlicht in: | Frontiers in tropical diseases 2023-01, Vol.3 |
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| container_title | Frontiers in tropical diseases |
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| creator | Majumdar, Suman S. Islam, Shahidul Huang, G. Khai Lin Morris, Lucy Bauri, Mathias Chan, Geoff Kama, Gabriel Keam, Tess Peacock-Smith, Abby Finch, Stacia Marukutira, Tafireyi Bhatt, Shivani Drewett, George Wratten, Melanie Murray, Alexa Pank, Naomi Masah, Christopher Bala, Ruth Umali, Scott Kalon, Stobdan Greig, Jane Chani, Kudakwashe Kal, Margaret Graham, Stephen Michael |
| description | Daru, South Fly District, Papua New Guinea is a high transmission setting for multidrug-resistant tuberculosis (MDR-TB). An emergency response by the Government in 2014 established a high-quality model for treatment and care. Household contact screening and management commenced in 2016 with TB preventive treatment (TPT) for well young child ( |
| doi_str_mv | 10.3389/fitd.2022.1085401 |
| format | Article |
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Khai Lin ; Morris, Lucy ; Bauri, Mathias ; Chan, Geoff ; Kama, Gabriel ; Keam, Tess ; Peacock-Smith, Abby ; Finch, Stacia ; Marukutira, Tafireyi ; Bhatt, Shivani ; Drewett, George ; Wratten, Melanie ; Murray, Alexa ; Pank, Naomi ; Masah, Christopher ; Bala, Ruth ; Umali, Scott ; Kalon, Stobdan ; Greig, Jane ; Chani, Kudakwashe ; Kal, Margaret ; Graham, Stephen Michael</creator><creatorcontrib>Majumdar, Suman S. ; Islam, Shahidul ; Huang, G. Khai Lin ; Morris, Lucy ; Bauri, Mathias ; Chan, Geoff ; Kama, Gabriel ; Keam, Tess ; Peacock-Smith, Abby ; Finch, Stacia ; Marukutira, Tafireyi ; Bhatt, Shivani ; Drewett, George ; Wratten, Melanie ; Murray, Alexa ; Pank, Naomi ; Masah, Christopher ; Bala, Ruth ; Umali, Scott ; Kalon, Stobdan ; Greig, Jane ; Chani, Kudakwashe ; Kal, Margaret ; Graham, Stephen Michael</creatorcontrib><description>Daru, South Fly District, Papua New Guinea is a high transmission setting for multidrug-resistant tuberculosis (MDR-TB). An emergency response by the Government in 2014 established a high-quality model for treatment and care. Household contact screening and management commenced in 2016 with TB preventive treatment (TPT) for well young child (<5 years) contacts of people with drug-susceptible TB and later expanded to young child contacts of MDR-TB. The model of care is community-based and led by non-specialist health workers, under supervision. An electronic medical record system supports care, reporting and operational research. Community engagement and education has been central, with a concerted focus on peer-led counselling and patient-centred services to improve TPT uptake and completion. Challenges include the application of households as the unit of intervention for detection of active TB and TPT provision. Our implementation experience in Daru has highlighted significant population mixing dynamics with most transmission likely occurring outside the household. We propose a community-wide screening approach with the provision of TPT based on testing to include older children, adolescents, and young adults. As there is the possibility of MDR-TB infection irrespective of the drug susceptibility of the household index case, a novel option is a combination TPT regimen of 6 months of daily isoniazid and levofloxacin (6HLfx). A sensitive aged-related algorithm to detect and exclude active TB is being developed. Ongoing community engagement, quality data systems with operational research to evaluate approaches are critical in high transmission MDR-TB settings.</description><identifier>ISSN: 2673-7515</identifier><identifier>EISSN: 2673-7515</identifier><identifier>DOI: 10.3389/fitd.2022.1085401</identifier><language>eng</language><ispartof>Frontiers in tropical diseases, 2023-01, Vol.3</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c1551-32a9824776274659a1d64bb8b70e9b395bc546e4cb43274766588e31aedbd5533</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,860,27901,27902</link.rule.ids></links><search><creatorcontrib>Majumdar, Suman S.</creatorcontrib><creatorcontrib>Islam, Shahidul</creatorcontrib><creatorcontrib>Huang, G. 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An emergency response by the Government in 2014 established a high-quality model for treatment and care. Household contact screening and management commenced in 2016 with TB preventive treatment (TPT) for well young child (<5 years) contacts of people with drug-susceptible TB and later expanded to young child contacts of MDR-TB. The model of care is community-based and led by non-specialist health workers, under supervision. An electronic medical record system supports care, reporting and operational research. Community engagement and education has been central, with a concerted focus on peer-led counselling and patient-centred services to improve TPT uptake and completion. Challenges include the application of households as the unit of intervention for detection of active TB and TPT provision. Our implementation experience in Daru has highlighted significant population mixing dynamics with most transmission likely occurring outside the household. We propose a community-wide screening approach with the provision of TPT based on testing to include older children, adolescents, and young adults. As there is the possibility of MDR-TB infection irrespective of the drug susceptibility of the household index case, a novel option is a combination TPT regimen of 6 months of daily isoniazid and levofloxacin (6HLfx). A sensitive aged-related algorithm to detect and exclude active TB is being developed. 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| title | Contact screening and management in a high-transmission MDR-TB setting in Papua New Guinea: Progress, challenges and future directions |
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