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Predictors of unfavourable treatment outcome in patients diagnosed with drug-resistant tuberculosis in the Torres Strait / Papua New Guinea border region. PLoS One 2022; 17:e0266436. [PMID: 36490236 PMCID: PMC9733860 DOI: 10.1371/journal.pone.0266436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
Drug-resistant tuberculosis (DR-TB) is an ongoing challenge in the Torres Strait Islands (TSI) / Papua New Guinea (PNG) border region. Treatment success rates have historically been poor for patients diagnosed with DR-TB, leading to increased transmission. This study aimed to identify variables associated with unfavourable outcome in patients diagnosed with DR-TB to inform programmatic improvements. A retrospective study of all DR-TB cases who presented to Australian health facilities in the Torres Strait between 1 March 2000 and 31 March 2020 was performed. This time period covers four distinct TB programmatic approaches which reflect Australian and Queensland Government decisions on TB management in this remote region. Univariate and multivariate predictors of unfavourable outcome were analysed. Unfavourable outcome was defined as lost to follow up, treatment failure and death. Successful outcome was defined as cure and treatment completion. In total, 133 patients with resistance to at least one TB drug were identified. The vast majority (123/133; 92%) of DR-TB patients had pulmonary involvement; and of these, 41% (50/123) had both pulmonary and extrapulmonary TB. Unfavourable outcomes were observed in 29% (39/133) of patients. Patients living with human immunodeficiency virus, renal disease or diabetes (4/133; 4/133; 3/133) had an increased frequency of unfavourable outcome (p <0.05), but the numbers were small. Among all 133 DR-TB patients, 41% had a low lymphocyte count, which was significantly associated with unfavourable outcome (p <0.05). We noted a 50% increase in successful outcomes achieved in the 2016-2020 programmatic period, compared to earlier periods (OR 5.3, 95% Confidence Interval [1.3, 20.4]). Being a close contact of a known TB case was associated with improved outcome. While DR-TB treatment outcomes have improved over time, enhanced surveillance for DR-TB, better cross border collaboration and consistent diagnosis and management of comorbidities and other risk factors should further improve patient care and outcomes.
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2
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Hapolo E, Ilai J, Francis T, du Cros P, Taune M, Chan G. TB treatment delay associated with drug resistance and admission at Daru General Hospital in Papua New Guinea. Public Health Action 2019; 9:S50-S56. [PMID: 31579650 DOI: 10.5588/pha.18.0075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/11/2018] [Indexed: 11/10/2022] Open
Abstract
SETTING Daru General Hospital, Daru Island, Papua New Guinea, where high rates of tuberculosis (TB) have been reported. Prompt diagnosis and effective treatment are needed for improving TB outcomes and to prevent nosocomial transmission. OBJECTIVE To assess the time to treatment initiation and the risk factors associated with delayed treatment for patients started on TB treatment at Daru General Hospital from January to September 2017. DESIGN This was a retrospective cohort study that entailed reviewing the records from treatment, admission, discharge and presumptive TB registers. RESULTS The study included 360 patients on TB treatment. The median time from presentation to treatment initiation was 7 days [IQR 3-11]. Treatment was started <7 days for 215 patients (60%); however, only 16.2% commenced treatment <2 days. Risk factors for delayed treatment were diagnosis of TB as an inpatient (OR 2.67, 95% CI 1.35-5.28, P = 0.005) and having drug-resistant TB (OR 2.65, 95% CI 1.5-4.68. P = 0.001). CONCLUSION A high proportion of TB patients commenced treatment <7 days. Inpatient status, DR-TB and lack of microbiological confirmation were associated with delays in treatment initiation. We recommend that programmes monitor the time from presentation to treatment initiation, and propose that a period of >3 days from presentation to treatment initiation be considered as delayed treatment initiation.
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Affiliation(s)
- E Hapolo
- Daru General Hospital, Daru, Western Province, Papua New Guinea
| | - J Ilai
- Daru General Hospital, Daru, Western Province, Papua New Guinea
| | - T Francis
- Daru General Hospital, Daru, Western Province, Papua New Guinea
| | - P du Cros
- Burnet Institute, Melbourne, Victoria, Australia
| | - M Taune
- Daru General Hospital, Daru, Western Province, Papua New Guinea
| | - G Chan
- Burnet Institute, Melbourne, Victoria, Australia
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3
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Morris L, Hiasihri S, Chan G, Honjepari A, Tugo O, Taune M, Aia P, Dakulala P, Majumdar SS. The emergency response to multidrug-resistant tuberculosis in Daru, Western Province, Papua New Guinea, 2014-2017. Public Health Action 2019; 9:S4-S11. [PMID: 31580333 PMCID: PMC6735456 DOI: 10.5588/pha.18.0074] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/05/2019] [Indexed: 11/10/2022] Open
Abstract
SETTING A response to an outbreak of multidrug-resistant tuberculosis (MDR-TB) on Daru Island, South Fly District (SFD), Western Province, Papua New Guinea (PNG) was implemented by a national emergency response taskforce. OBJECTIVE To describe programmatic interventions for TB in SFD and evaluate characteristics of TB case notifications, drug resistance and treatment outcomes. DESIGN This was a retrospective cohort study based on routine programmatic data for all patients enrolled on TB treatment at Daru General Hospital from 2014 to 2017. RESULTS The response involved high-level political commitment, joint planning, resource mobilisation, community engagement and strengthening TB case detection and treatment. Of 1548 people enrolled on TB treatment, 1208 (78%) had drug-susceptible TB (DS-TB) and 333 (21.5%) had MDR-TB. There was an increase in MDR-TB as a proportion of all TB. Treatment success rates increased over the study period from 55% to 86% for DS-TB, and from 70% to 81% for MDR-TB from 2014 to 2015. The 2014 case notification rate for TB in SFD was 1031/100 000, decreasing to 736/100 000 in 2017. CONCLUSION The outbreak was stabilised through the response from the national and provincial governments and international partners. Additional interventions are needed to decrease the TB burden in Daru.
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Affiliation(s)
- L Morris
- Western Province Health Department, Daru, Western Province, Papua New Guinea (PNG)
| | - S Hiasihri
- Burnet Institute, Melbourne, Victoria, Australia
| | - G Chan
- Burnet Institute, Melbourne, Victoria, Australia
| | - A Honjepari
- Western Province Health Department, Daru, Western Province, Papua New Guinea (PNG)
| | - O Tugo
- Daru General Hospital, Daru, Western Province, PNG
| | - M Taune
- Daru General Hospital, Daru, Western Province, PNG
| | - P Aia
- National Department of Health, Port Morseby, PNG
| | - P Dakulala
- National Department of Health, Port Morseby, PNG
| | - S S Majumdar
- Burnet Institute, Melbourne, Victoria, Australia
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4
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Bainomugisa A, Pandey S, Donnan E, Simpson G, Foster J, Lavu E, Hiasihri S, McBryde ES, Moke R, Vincent S, Sintchenko V, Marais BJ, Coin LJM, Coulter C. Cross-Border Movement of Highly Drug-Resistant Mycobacterium tuberculosis from Papua New Guinea to Australia through Torres Strait Protected Zone, 2010-2015. Emerg Infect Dis 2019; 25:406-415. [PMID: 30789135 DOI: 10.3201/eid2503.181003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
In this retrospective study, we used whole-genome sequencing (WGS) to delineate transmission dynamics, characterize drug-resistance markers, and identify risk factors of transmission among Papua New Guinea residents of the Torres Strait Protected Zone (TSPZ) who had tuberculosis diagnoses during 2010-2015. Of 117 isolates collected, we could acquire WGS data for 100; 79 were Beijing sublineage 2.2.1.1, which was associated with active transmission (odds ratio 6.190, 95% CI 2.221-18.077). Strains were distributed widely throughout the TSPZ. Clustering occurred more often within than between villages (p = 0.0013). Including 4 multidrug-resistant tuberculosis isolates from Australia citizens epidemiologically linked to the TSPZ into the transmission network analysis revealed 2 probable cross-border transmission events. All multidrug-resistant isolates (33/104) belonged to Beijing sublineage 2.2.1.1 and had high-level isoniazid and ethionamide co-resistance; 2 isolates were extensively drug resistant. Including WGS in regional surveillance could improve tuberculosis transmission tracking and control strategies within the TSPZ.
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5
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Diefenbach-Elstob T, Guernier V, Burgess G, Pelowa D, Dowi R, Gula B, Puri M, Pomat W, McBryde E, Plummer D, Rush C, Warner J. Molecular Evidence of Drug-Resistant Tuberculosis in the Balimo Region of Papua New Guinea. Trop Med Infect Dis 2019; 4:tropicalmed4010033. [PMID: 30744192 PMCID: PMC6473227 DOI: 10.3390/tropicalmed4010033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 12/02/2022] Open
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.
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Affiliation(s)
- Tanya Diefenbach-Elstob
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia.
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville 4811, Australia.
| | - Vanina Guernier
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville 4811, Australia.
| | - Graham Burgess
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia.
| | - Daniel Pelowa
- Balimo District Hospital, Balimo, Western Province, Papua New Guinea.
| | - Robert Dowi
- Balimo District Hospital, Balimo, Western Province, Papua New Guinea.
| | - Bisato Gula
- Balimo District Hospital, Balimo, Western Province, Papua New Guinea.
| | - Munish Puri
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia.
| | - William Pomat
- Papua New Guinea Institute of Medical Research, Goroka 441, Papua New Guinea.
| | - Emma McBryde
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville 4811, Australia.
| | - David Plummer
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia.
| | - Catherine Rush
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia.
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville 4811, Australia.
| | - Jeffrey Warner
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia.
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville 4811, Australia.
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6
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Horwood PF, McBryde ES, Peniyamina D, Ritchie SA. The Indo-Papuan conduit: a biosecurity challenge for Northern Australia. Aust N Z J Public Health 2018; 42:434-436. [PMID: 30088687 DOI: 10.1111/1753-6405.12808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Paul F Horwood
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland
| | - Emma S McBryde
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland
| | - Dunstan Peniyamina
- Tropical Public Health Services, Cairns and Hinterland Hospital and Health Service, Queensland Health
| | - Scott A Ritchie
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland
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7
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Diefenbach-Elstob T, Graves P, Dowi R, Gula B, Plummer D, McBryde E, Pelowa D, Siba P, Pomat W, Warner J. The epidemiology of tuberculosis in the rural Balimo region of Papua New Guinea. Trop Med Int Health 2018; 23:1022-1032. [DOI: 10.1111/tmi.13118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tanya Diefenbach-Elstob
- College of Public Health; Medical and Veterinary Sciences; James Cook University; Townsville Australia
- Australian Institute of Tropical Health and Medicine; James Cook University; Townsville Australia
| | - Patricia Graves
- College of Public Health; Medical and Veterinary Sciences; James Cook University; Townsville Australia
| | - Robert Dowi
- Balimo District Hospital; Balimo Western Province Papua New Guinea
| | - Bisato Gula
- Balimo District Hospital; Balimo Western Province Papua New Guinea
| | - David Plummer
- College of Public Health; Medical and Veterinary Sciences; James Cook University; Townsville Australia
| | - Emma McBryde
- Australian Institute of Tropical Health and Medicine; James Cook University; Townsville Australia
| | - Daniel Pelowa
- Balimo District Hospital; Balimo Western Province Papua New Guinea
| | - Peter Siba
- Papua New Guinea Institute of Medical Research; Goroka Eastern Highlands Province Papua New Guinea
| | - William Pomat
- Papua New Guinea Institute of Medical Research; Goroka Eastern Highlands Province Papua New Guinea
| | - Jeffrey Warner
- College of Public Health; Medical and Veterinary Sciences; James Cook University; Townsville Australia
- Australian Institute of Tropical Health and Medicine; James Cook University; Townsville Australia
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8
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Elmahdawy M, Elsisi GH, Carapinha J, Lamorde M, Habib A, Agyie-Baffour P, Soualmi R, Ragab S, Udezi AW, Usifoh C, Usifoh S. Ebola Virus Epidemic in West Africa: Global Health Economic Challenges, Lessons Learned, and Policy Recommendations. Value Health Reg Issues 2017; 13:67-70. [PMID: 29073992 DOI: 10.1016/j.vhri.2017.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 07/25/2017] [Accepted: 08/13/2017] [Indexed: 11/19/2022]
Abstract
The Ebola virus has spread across several Western Africa countries, adding a significant financial burden to their health systems and economies. In this article the experience with Ebola is reviewed, and economic challenges and policy recommendations are discussed to help curb the impact of other diseases in the future. The West African Ebola virus disease epidemic started in resource-constrained settings and caused thousands of fatalities during the last epidemic. Nevertheless, given population mobility, international travel, and an increasingly globalized economy, it has the potential to re-occur and evolve into a global pandemic. Struggling health systems in West African countries hinder the ability to reduce the causes and effects of the Ebola epidemic. The lessons learned include the need for strengthening health systems, mainly primary care systems, expedited access to treatments and vaccines to treat the Ebola virus disease, guidance on safety, efficacy, and regulatory standards for such treatments, and ensuring that research and development efforts are directed toward existing needs. Other lessons include adopting policies that allow for better flow of relief, averting the adverse impact of strong quarantine policy that includes exaggerating the aversion behavior by alarming trade and business partners providing financial support to strengthen growth in the affected fragile economies by the Ebola outbreak. Curbing the impact of future Ebola epidemics, or comparable diseases, requires increased long-term investments in health system strengthening, better collaboration between different international organizations, more funding for research and development efforts aimed at developing vaccines and treatments, and tools to detect, treat, and prevent future epidemics.
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Affiliation(s)
| | - Gihan H Elsisi
- Pharmacoeconomic Unit, Central Administration for Pharmaceutical Affairs, Cairo, Egypt
| | | | - Mohamed Lamorde
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Abdulrazaq Habib
- Infectious and Tropical Diseases Unit, Bayero University, Kano, Nigeria
| | - Peter Agyie-Baffour
- School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Anthony W Udezi
- Faculty of Pharmacy, University of Benin, Benin City, Nigeria
| | - Cyril Usifoh
- Faculty of Pharmacy, University of Benin, Benin City, Nigeria
| | - Stella Usifoh
- Faculty of Pharmacy, University of Benin, Benin City, Nigeria
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9
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Ragonnet R, Trauer JM, Denholm JT, Marais BJ, McBryde ES. A user-friendly mathematical modelling web interface to assist local decision making in the fight against drug-resistant tuberculosis. BMC Infect Dis 2017; 17:374. [PMID: 28558651 PMCID: PMC5450394 DOI: 10.1186/s12879-017-2478-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/21/2017] [Indexed: 01/26/2023] Open
Abstract
Multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) represent an important challenge for global tuberculosis (TB) control. The high rates of MDR/RR-TB observed among re-treatment cases can arise from diverse pathways: de novo amplification during initial treatment, inappropriate treatment of undiagnosed MDR/RR-TB, relapse despite appropriate treatment, or reinfection with MDR/RR-TB. Mathematical modelling allows quantification of the contribution made by these pathways in different settings. This information provides valuable insights for TB policy-makers, allowing better contextualised solutions. However, mathematical modelling outputs need to consider local data and be easily accessible to decision makers in order to improve their usefulness. We present a user-friendly web-based modelling interface, which can be used by people without technical knowledge. Users can input their own parameter values and produce estimates for their specific setting. This innovative tool provides easy access to mathematical modelling outputs that are highly relevant to national TB control programs. In future, the same approach could be applied to a variety of modelling applications, enhancing local decision making.
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Affiliation(s)
- Romain Ragonnet
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia. .,Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3141, Australia.
| | - James M Trauer
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Victorian Tuberculosis Program, Melbourne Health, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Justin T Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, Australia.,Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute, Melbourne, Australia.,Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Ben J Marais
- Marie Bashir Institute and the Centre for Research Excellence in Tuberculosis, University of Sydney, Sydney, Australia
| | - Emma S McBryde
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3141, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
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10
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McBryde ES, Meehan MT, Doan TN, Ragonnet R, Marais BJ, Guernier V, Trauer JM. The risk of global epidemic replacement with drug-resistant Mycobacterium tuberculosis strains. Int J Infect Dis 2017; 56:14-20. [PMID: 28163165 DOI: 10.1016/j.ijid.2017.01.031] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/24/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Multidrug-resistant tuberculosis (MDR-TB) is a threat to tuberculosis (TB) control. To guide TB control, it is essential to understand the extent to which and the circumstances in which MDR-TB will replace drug-susceptible TB (DS-TB) as the dominant phenotype. The issue was examined by assessing evidence from genomics, pharmacokinetics, and epidemiology studies. This evidence was then synthesized into a mathematical model. METHODS This model considers two TB strains, one with and one without an MDR phenotype. It was considered that intrinsic transmissibility may be different between the two strains, as may the control response including the detection, treatment failure, and default rates. The outcomes were explored in terms of the incidence of MDR-TB and time until MDR-TB surpasses DS-TB as the dominant strain. RESULTS AND CONCLUSIONS The ability of MDR-TB to dominate DS-TB was highly sensitive to the relative transmissibility of the resistant strain; however, MDR-TB could dominate even when its transmissibility was modestly reduced (to between 50% and 100% as transmissible as the DS-TB strain). This model suggests that it may take decades or more for strain replacement to occur. It was also found that while the amplification of resistance is the early cause of MDR-TB, this will rapidly give way to person-to-person transmission.
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Affiliation(s)
- Emma S McBryde
- Australian Institute of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Townsville, QLD 4811, Australia.
| | - Michael T Meehan
- Australian Institute of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Townsville, QLD 4811, Australia
| | - Tan N Doan
- Australian Institute of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Townsville, QLD 4811, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Romain Ragonnet
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia; Centre for Population Health, the Burnet Institute, Melbourne, Victoria, Australia
| | - Ben J Marais
- The Children's Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), University of Sydney, Sydney, New South Wales, Australia
| | - Vanina Guernier
- Australian Institute of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Townsville, QLD 4811, Australia
| | - James M Trauer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Victorian Tuberculosis Program at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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11
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Negin J, Dhillon RS. Outsourcing: how to reform WHO for the 21st century. BMJ Glob Health 2016; 1:e000047. [PMID: 28588937 PMCID: PMC5321326 DOI: 10.1136/bmjgh-2016-000047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 07/05/2016] [Accepted: 07/26/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- Joel Negin
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ranu S Dhillon
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Cambridge, Massachusetts, USA
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12
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Kase P, Dakulala P, Bieb S. Outbreak of multidrug-resistant tuberculosis on Daru Island: an update. THE LANCET RESPIRATORY MEDICINE 2016; 4:e40. [PMID: 27342263 DOI: 10.1016/s2213-2600(16)30094-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/21/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Pascoe Kase
- National Department of Health, Port Moresby, Papua New Guinea
| | - Paison Dakulala
- National Department of Health, Port Moresby, Papua New Guinea.
| | - Sibauk Bieb
- National Department of Health, Port Moresby, Papua New Guinea
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13
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Trauer JM, Denholm JT, Waseem S, Ragonnet R, McBryde ES. Scenario Analysis for Programmatic Tuberculosis Control in Western Province, Papua New Guinea. Am J Epidemiol 2016; 183:1138-48. [PMID: 27199387 DOI: 10.1093/aje/kwv323] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 11/16/2015] [Indexed: 01/12/2023] Open
Abstract
Tuberculosis (TB) and multidrug-resistant TB (MDR-TB) are major health problems in Western Province, Papua New Guinea. While comprehensive expansion of TB control programs is desirable, logistical challenges are considerable, and there is substantial uncertainty regarding the true disease burden. We parameterized our previously described mathematical model of Mycobacterium tuberculosis dynamics in Western Province, following an epidemiologic assessment. Five hypothetical scenarios representing alternative programmatic approaches during the period from 2013 to 2023 were developed with local staff. Bayesian uncertainty analyses were undertaken to explicitly acknowledge the uncertainty around key epidemiologic parameters, and an economic evaluation was performed. With continuation of existing programmatic strategies, overall TB incidence remained stable at 555 cases per 100,000 population per year (95% simulation interval (SI): 420, 807), but the proportion of incident cases attributable to MDR-TB increased from 16% to 35%. Comprehensive, provincewide strengthening of existing programs reduced incidence to 353 cases per 100,000 population per year (95% SI: 246, 558), with 46% being cases of MDR-TB, while incorporating programmatic management of MDR-TB into these programs reduced incidence to 233 cases per 100,000 population per year (95% SI: 198, 269) with 14% MDR-TB. Most economic costs were due to hospitalization during the intensive treatment phase. Broad scale-up of TB control activities in Western Province with incorporation of programmatic management of MDR-TB is vital if control is to be achieved. Community-based treatment approaches are important to reduce the associated economic costs.
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