"We are one of the high burden TB countries in the region. Our case notification has reached up to 30,000. We have difficulty in case holding and getting our success rate where we want it to be. According to [1994-2005] DOTS strategy we should be diagnosing 70% of our cases and successfully treating 85% of them but we are not able to get the figures above 60%. A big problem is that 20% or more of our TB patients are lost to follow up or default - In certain provinces this rate is even higher than 20%. This is a recipe for drug-resistant TB and not surprisingly PNG has a challenge of multidrug-resistant TB. PNG also has extensively drug-resistant TB (XDR-TB) especially in provinces that share the border with Australia such as Western provinces and also in National Capital District. The government has initiated an emergency response for next 12 months to respond to these challenges and we are targeting 3 hotspot provinces where we see the highest rates of TB, MDR-TB and XDR-TB. Organizations such as Medicins Sans Frontieres (MSF) and Burnet Institute are trying to help us deal with this challenge too. The focus is to reach out to all those patients whose treatment got interrupted and they were lost to follow up, and get them back on treatment and move towards a favourable outcome. This is enormous work and very expensive too as MDR-TB is not a cheap option."
This is one of the most important aspects of TB therapy: ensuring patients complete effective treatment therapy and get cured!
Get back to basics! Do DOTS well!
A joint review by global experts of the national TB programme in Papua New Guinea was carried out during 17-21 February 2014. The recommendations made by this review team were taken into account in drafting national strategy (2015-2020) and PNG Prime Minister had put in additional PNG Kena 7 million for TB control since then.
"The global review team has given us recommendations and the biggest one is to improve our DOTS strategy especially with the drug-sensitive TB patients. At this time in our country we still do not have any centres of excellence" said Dr Dakulala.
Same recommendation was made by another review done recently in the country. A review of the Green Light Committee (GLC) was carried out during 11-15 May 2015, key point of concern in GLC's recommendations was for PNG to do basic DOTS well. GLC is a mechanism which advises WHO and Stop TB Partnership by reviewing applications submitted by countries to procure quality-assured, secondline anti-TB drugs at reduced prices.
National TB Strategy aims to accelerate TB control in PNG
"We have put in all the recommendations made by the global review team into our 2015-2020 national TB strategy. The Global Fund financing of USD 21 million has also come in to support this work. Over next three years we will be able to implement part of this strategy. One of the components is to reach out to Basic Management Units (BMUs) as almost 30 of our BMUs are where 90% of our problem is! Our funding for next five years is PNG Kina 407 million. We are continuing to advocate with our government to increase funding" said Dr Dakulala. The National Strategic Plan for TB Control (2015-2020) is also aligned with the WHO End TB Strategy.
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