TUBERCULOSIS IN PAPUA NEW GUINEA – FACTSHEET March 2015

TB – Fatal but curable

One-third of the world’s pop-ulation is currently infected with the tuberculosis (TB) ba-cillus. Every year, nine mil-lion people develop active TB and 1.5 million die from it. TB is spread through the air when infected people cough or sneeze. Not everyone in-fected with TB becomes ill, but 10 per cent will develop active TB at some point in their lives.

The disease most often af-fects the lungs but may also infect other parts of the body like the brain, bones, skin. Symptoms include a persis-tent cough, fever, weight loss, chest pain and breath-lessness in the lead-up to death. TB incidence is much higher, and is a leading cause of death, among people with HIV/AIDS.

Interruption of TB treatment can trigger the de-velopment of mycobacteria that are resistant to treatment. Drug-resistant TB (DR-TB) is more complex to detect and treat.

Tuberculosis (TB) is the world’s second-leading cause of death from an infectious disease, with 9 million new cases and 1.5 million deaths every year. Papua New Guinea has one of the highest TB rates in the Western Pacific region, second only to Cambodia. Other than HIV, TB is the top infectious disease in the country in terms of hospital admissions. Médecins Sans Frontières (MSF), which has over 40 years of experience in tackling TB, is working on this disease in Papua New Guinea, in collaboration with the NDOH/NTP.

Laboratory di-agnosis of TB depends on taking a sam-ple from an af-fected part of the body, usu-ally sputum, which can be difficult to ob-tain. There is a new test that can give results after just two hours, and de-tect a certain level of drug resistance, but it depends on a reliable pow-er supply, and still requires a sample.

A course of treatment for uncomplicated TB takes a minimum of six months. DR-TB is not impossible to treat, but the drug regime is ardu-ous, takes up to two years, and causes many side effects.

WHAT IS TUBERCULOSIS?

An infectious disease caused by a germ that can damage your lungs or other parts of your body, causing serious illness and death.

TB is spread from person to person by coughing, sneezing and/or spitting. Touching a person or sharing cups and plates with others is harmless.

ARE YOU HAVING THESE SYMPTOMS?

• Coughlastingmorethantwoweeks• Feverthatoccursonandoffformorethanafewweeks• Chestpainswhencoughing• Sweatingalotatnight• Constanttiredness• Lossofappetite• Weightloss

If so, you could have TB. Get tested and treated!

MSF TB programs

Médecins Sans Frontières (MSF) has fought against tuberculosis since its first day of operations more than 40 years ago.

MSF often works alongside national health authorities to treat patients in a wide variety of settings, including chronic conflict zones, urban slums, prisons, refugee camps and ru-ral areas.

MSF’s first programs to treat DR-TB opened in 1999, and the organisation is now one of the largest NGO treatment provid-ers for DR-TB.

In 2013, MSF treated 32,000 patients with TB in 24 countries, including 1,950 patients with DR-TB.

TB in Papua New Guinea

In Papua New Guinea, TB is one of the top three diseases in terms of hospital admission, with an incidence (number of new cases in one year in a population) of 347/100,000 (25,000 cases) with pockets 2 to 3 times higher. Death rate is 33/100,000. DR-TB accounts for 4.5 per cent of new cases and 24 per cent among retreatment cases (Source: WHO 2013).

With 85 per cent of the population living in ru-ral areas, lack of access to treatment and limited resources contribute to the high burden of TB and an emerging threat of DR-TB in Papua New Guinea.

The government of Papua New Guinea, in re-sponse to the large increase of drug-resistant TB cases, established an emergency task force in

August 2014. Three of the 22 provinces in the country are under the microscope: Western Province, Gulf Province and National Capital district.

CHALLENGES IN TACKLING TB IN PNG• Limiteddiagnoticcapacities• Accesstomedicalcare(85%ofthepopulationlivesinremoteareas)• Highrateof‘losttofollow-up’• EmergingthreatofDR-TB• LackofawarenessofTB

An MSF doctor examines a young patient to determine if she has TB. © Sean Brokenshire/MSF.

Kerema

MSF started its TB project in Kerema, the capital of Gulf province, in May 2014, in close collaboration with the health authorities of Papua New Guinea. Kerema town has an estimated TB incidence of 1075–1450/100,000.

Gulf Province has a high level of ‘lost to follow-up’ and limited laboratory capacities for diagnosis of TB.

MSF works closely in collaboration with NDOH/NTP

MSF works closely with the National Depart-

ment of Health (NDOH) and the National TB

program (NTP) in Papua New Guinea, in line with the national strategy. We have started projects in two regions of the country, Gulf Province and National Capital district. Our objective for the next five years is improving the TB program to ensure that it is replicable and sustainable.

MAIN OBJECTIVES OF MSF’S SUPPORT: • Improvingcasedetectionandmanagement;• Ensuringearlytreatmentinitiationand follow-upofpatientsandcompletionof treatment;• ProvidingbetteraccesstoTBdiagnosisand treatment by reinforcing decentralised patientfollow-up(withafocusonDR-TBin NCD).

The first phase of the program was to set up TB outpatient and in-patient services, improving the TB laboratory and general water and sanitation conditions within the Kerema General Hospital.

The second phase is to implement decentral-ised activities in order to provide access to diag-nostic and treatment to the population living in remote areas of the province. An MSF team has started outreach activities for remote areas on regular basis to follow-up patients during their treatment at the community level.

300 patients were diagnosed and on treatment in 2014.

To address the issue of difficulty in access to medical care in the remote communities outside Kerema town, MSF team started considering in-novative solutions. MSF and US Company Mat-ternet trialled the use of small quadcopter Un-manned Aerial Vehicles (UAVs) to transport sputum samples of patients with suspected TB from remote health centres to Kerema General Hospital for testing as well as possibly transport results and treatments back to the facilities.

National Capital District

There is a high burden of TB in the National Cap-ital District (NCD) with 6,000 cases reported an-nually (one of the highest recorded incidences worldwide), 25 per cent of the total TB burden in the country. Even with this high numbers the de-tection capacities are not sufficient and usually long delays occur before a result.

Most of the health facilities need capacity build-ing to provide sufficient TB care. The manage-ment of DR-TB patients is centralised at the Port

Moresby General Hospital which can be difficult to access for many patients, and has long wait times for admission. In this context MSF, in collaboration with the provincial health authorities, will imple-ment a decentralised TB program by focusing on peripheral health facilities in order to improve de-tection, treatment and follow-up of TB patients.

An MSF TB nurse consults a patient at Kerema General Hospital © Aris Messinis/Matternet.

TB clinic in Gerehu HospitalIn March 2015, MSF and NDOH have started sup-porting a TB clinic at Gerehu Hospital in NCD.

The program includes:• Supporting the TB clinic to ensure proper in-

fection control and patient flows• Improving of the TB laboratory capacity • Decentralising activities to improve access to

diagnostic and treatment closer to the popu-lation.

• Introducing the nine-month drug regimen for DR-TB.

An Unmanned Aerial Vehicle hovers over Kerema General Hospital © Sean Brokenshire/MSF.

“TB is curable. We provide treatment for free and it takes six months. If you have failed to treat TB once, do not hesitate to come to a health centre because you might have devel-oped DR-TB.”

Benjamin Gaudin, Head of Mission MSF’s TB program in Papua New Guinea

MSF LONG PAPUA NIUGINI LONG 1993

THE MÉDECINS SANS FRONTIÈRES CHARTERMédecins Sans Frontières provides assistance to populations in distress, to victims of natural or man-made disasters and to victims of armed conflict. They do so irrespective of race, reli-gion, creed or political convictions.

Médecins Sans Frontières observes neutrality and impartiality in the name of universal medical eth-ics and the right to humanitarian assistance and claims full and unhindered freedom in the exercise of its functions.

Members undertake to respect their professional code of ethics and maintain complete independ-ence from all political, economic or religious powers.

As volunteers, members understand the risks and dangers of the missions they carry out and make no claim for themselves or their assigns for any form of compensation other than that which the as-sociation might be able to afford them.

OUR PRINCIPLESMembers of MSF are committed to MSF’s Charter and its key principles as follows:

MEDICAL ETHICS: MSF staff are bound to adhere to and uphold universal medical ethics, and are committed to the delivery of quality care.

INDEPENDENCE: MSF is independent of any other interest, manages its own programmes and car-ries out its own evaluations.

IMPARTIALITY: MSF will treat anyone who needs medical care, irrespective of race, religion, gender or political affiliation.

NEUTRALITY: MSF does not take sides.

Médecins Sans Frontières (MSF) is an internation-al, independent, medical humanitarian organisa-tion that delivers emergency aid to people affect-ed by armed conflict, epidemics, natural disasters and exclusion from healthcare. MSF was founded in Paris, France in 1971. Its principles are described in the organisation’s founding charter.

Today, MSF is a worldwide movement of 24 associ-ations, bound together as MSF International, based in Switzerland. Thousands of health professionals,

logistical and administrative staff – most of whom are hired locally – work on programs in some 70 countries worldwide.

MSF first worked in Papua New Guinea in 1993, and has since been providing medical assistance in a variety of fields, including primary and ma-ternal child healthcare, family and sexual violence, emergency surgical services and basic healthcare, including TB management. As of the end of 2013, there were 214 staff working in the country.

Médecins Sans Frontières Port Moresby OfficeGB house, Unit 9 and 10, Kunai Street, HoholaP.O Box 1280, Boroko, Papua New Guinea

www.msf.org

© S

ean

Brok

ensh

ire/M

SF

© A

ris M

essi

nis/

MSF

© A

ris M

essi

nis/

MSF