Critical Consideration of Tuberculosis Management of Papua New Guinea Nationals and Cross-Border Health Issues in the Remote Torres Strait Islands, Australia

The international border between Australia and Papua New Guinea (PNG) serves as a gateway for the delivery of primary and tertiary healthcare for PNG patients presenting to Australian health facilities with presumptive tuberculosis (TB). An audit of all PNG nationals with presumptive TB who presented to clinics in the Torres Strait between 2016 and 2019 was conducted to evaluate outcomes for PNG patients and to consider the consistency and equity of decision-making regarding aeromedical evacuation. We also reviewed the current aeromedical retrieval policy and the outcomes of patients referred back to Daru General Hospital in PNG. During the study period, 213 PNG nationals presented with presumptive TB to primary health centres (PHC) in the Torres Strait. In total, 44 (21%) patients were medically evacuated to Australian hospitals; 26 met the evacuation criteria of whom 3 died, and 18 did not meet the criteria of whom 1 died. A further 22 patients who met the medical evacuation criteria into Australia were referred to Daru General Hospital of whom 2 died and 10 were lost to follow-up. The cross-border movement of people from PNG into Australia is associated with an emergent duty of care. Ongoing monitoring and evaluation of patient outcomes are necessary for transparency and justice

Predictors of unfavourable treatment outcome in patients diagnosed with drug-resistant tuberculosis in the Torres Strait / Papua New Guinea border region

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

Clinical variables of patients diagnosed with drug-resistant tuberculosis in the Torres Strait between 2000 and 2020, and their association with successful, unfavourable and other TB treatment outcome.

Clinical variables of patients diagnosed with drug-resistant tuberculosis in the Torres Strait between 2000 and 2020, and their association with successful, unfavourable and other TB treatment outcome.</p

Blood test abnormalities in patients diagnosed with drug-resistant tuberculosis in the Torres Strait between 2000 and 2020, and their association with treatment outcome.

Blood test abnormalities in patients diagnosed with drug-resistant tuberculosis in the Torres Strait between 2000 and 2020, and their association with treatment outcome.</p

Demographic characteristics and treatment outcome of all patients diagnosed with drug-resistant tuberculosis in the Torres Strait Islands between 2000 and 2020.

Demographic characteristics and treatment outcome of all patients diagnosed with drug-resistant tuberculosis in the Torres Strait Islands between 2000 and 2020.</p

Variables associated with unfavourable treatment outcome among drug-resistant tuberculosis cases diagnosed in the Torres Strait / Papua New Guinea border region between 2000 and 2020 (N = 133).

Variables associated with unfavourable treatment outcome among drug-resistant tuberculosis cases diagnosed in the Torres Strait / Papua New Guinea border region between 2000 and 2020 (N = 133).</p

Map of the Torres Strait / Papua New Guinea cross-border region [16]¹ CC BY 4.0.

1International travel without passport or visa is permitted for traditional inhabitants of the Torres Strait Protected Zone and Treaty villages of Papua New Guinea, DOI. 10.6084/m9.figshare.16632823.</p