DOTS in PNG? A public-private approach

1. DOTS in PNG? A public-private approach Prepared by Peter Massey Program Manager Health Protection Population Health March 2009

2. Stop TB in PNG? • Maybe a partnership approach?

3. Among the 36 countries and areas of the Western Pacific Region, Papua New Guinea ranks 3rd highest in terms of estimated TB incidence, prevalence and death rates.

5. Rapid assessment • The purpose of the rapid assessment was to review health activities and capacity for TB Control in the Oil Search project area. • Southern Highlands and Gulf Provinces • 5 Oil Search Clinics – Gobe, Hides, Kopi, Moro, Ridge • 2 Hospitals – Kikorri, Tari • 1 Health Centre – Pimaga • 10 Health Sub-Centre / Aid Posts – Hiwanda, Idawi, Inu, Juni, Kaiam, Kaipu, Kopi, Malanda, Sisabia, Tiguri

7. The structure of the assessments included the critical TB control domains of • surveillance, • prevention, • diagnosis, • treatment, • and DOTS capacity • The assessment was extended to include potential synergies with HIV and other related public health programs.

8. How much TB is too much? • Using the census information for the Project area, the reported TB disease prevalence in the Gulf Area is more than four times higher than the rest of PNG (Relative risk 4.75, 4.15-5.44 95%CI).

13. There are currently no functional TB control programs in the Oil Search’s operating area of the Southern Highlands and Gulf Provinces. • DOTS programs do no exist

14. Some of the drivers of the TB epidemic include poverty, inequity, illiteracy and poor housing. • The Stop TB Strategy has seen a number of complementary approaches developed to address these major challenges to TB control. • Addressing factors that make individuals and communities more vulnerable to TB can provide important opportunities for an integrated approach to TB control.

15. Key challenges in TB control include: • Access to health services • Safe and nutritious food • Other pressing issues in life

16. TB is a leading cause of death among women of reproductive age in high incidence countries such as PNG. • Women are less likely than men to be tested and treated for TB. • As greater numbers of women become infected with HIV, more are also becoming sick with TB.

18. Working with community volunteers for Directly Observing Treatment of people with TB may facilitate treatment for other diseases. • The TB control strategy of DOTS could also be an excellent model for delivering antiretroviral therapy to HIV infected people.

19. Connecting the TB control program to related programs may bring benefits to each of the programs as the synergies are enhanced eg, • Malaria control program • Village Health Volunteers – for DOTS • Household surveys – dual survey for people with malaria and TB • Village base health provider program - act as treatment support • Access to treatment of malaria and TB • Training, support & supervision of Health Posts & Aid Post staff

20. Stage 1 – Stop TB • Pursuing high-quality DOTS expansion and implementation and this includes: • Political commitment with increased sustained financing • Case detection through quality-assured bacteriology • Effective drug supply and management system • Standardized treatment with supervision and patient support • A robust monitoring and evaluation system.

23. Acknowledgements • With grateful acknowledgements of: • Foe people • Huli people • Oil Search Health • Ross Hutton • David Durrheim Hunter New England Population Health is a unit of the Hunter New England Area Health Service. Supported by funding from NSW Health through the Hunter Medical Research Institute. Developed in partnership with the University of Newcastle.