Multi-Drug Resistant Tuberculosis

According to the national health authorities of PNG, TB infection in the country is a “national emergency” requiring to be tackled on a war footing. With one of the highest TB infection rates in the world, drug-resistant strains of tuberculosis are causing a disaster in PNG. Approximately 30,000 people in the country are newly infected with TB every year with increasing cases of drug-resistant strains.

These drug resistant strains are difficult to treat even with the most effective TB medication. Thus, patients are left with a more severe strain of infection and less effective treatment options. Understanding the urgency to curtail the spread of multi-drug resistant TB , government, public, private sectors and healthcare workers all should come together to combat the escalation of drug-resistant cases in PNG.

What is Multi-Drug Resistant–TB?

TB bacteria can grow resistance to many TB drugs used to cure the disease; they develop into a unique strain of multi-drug resistant tuberculosis or M-D-R-T-B as it’s known. These strains do not respond to isoniazid and rifampicin, the two most powerful anti-TB drugs, leaving the patient with an even severe strain of TB bacteria that is difficult to cure.

Causes of MDRTB

Not undergoing proper TB treatment, incorrect use of antibacterial drugs, use of ineffective formulations of drugs (e.g. use of single drugs, poor quality medicines or bad storage conditions), and discontinuing treatment can all be the reasons for drug resistance.

Solutions to control drug-resistant TB are:

  • TB screening tests for timely diagnosis
  • Curing the TB patient the first time
  • Ensure adequate infection control measures
  • Ensure the appropriate use of recommended second-line drugs
  • Educate public and raise awareness on prevention and treatment

TB treatment may require a daily regimen of injections, oral medication, and supervised medical care for anywhere between 6 and 24 months. To prevent MDRTB it is necessary for every TB patient to complete his or her treatment.

Prevalence of MDRTB in PNG

Multi-drug resistant cases in PNG have increased almost by 2% since 2013. The epicenters of drug resistant TB are the rural Western and Gulf Provinces. Daru Island is the centre of this epidemic and the rates of drug-resistant TB are among the highest documented globally. As per a study by the national TB control programme 2016, the levels of MDRTB found in PNG are higher than those reported by high MDRTB burden countries such as the Philippines and Vietnam.

The higher prevalence of drug resistance in this area is because of poor treatment, large number of patients not finishing the treatment course, poor quality diagnosis (with smear microscopy) and poor DOTs program execution.

Overcrowded settlements and extreme poverty also play a major role in escalating the spread of MDRTB infection.

MDRTB and HIV

In 2014, at least one-third of people living with HIV worldwide were infected with TB bacteria. People living with HIV are 20 to 30 times more likely to develop active TB disease than people without HIV (WHO 2015). In such immune compromised cases it becomes more difficult to treat drug resistant TB. In PNG with high prevalence of HIV and AIDS the transmission of MDRTB infection can be even more rampant.