title: TB incidence and characteristics in the remote gulf province of Papua New Guinea: a prospective study.
abstract: BACKGROUND
  The incidence and characteristics of tuberculosis (TB) in remote areas of Papua New Guinea (PNG) are largely unknown. The purpose of our study was to determine the incidence of TB in the Gulf Province of PNG and describe disease characteristics, co-morbidities and drug resistance profiles that could impact on disease outcomes and transmission.
  
  
  METHODS
  Between March 2012 and June 2012, we prospectively collected data on 274 patients presenting to Kikori Hospital with a presumptive diagnosis of TB, and on hospital inpatients receiving TB treatment during the study period. Sputum was collected for microscopy, GeneXpert analysis, culture and genotyping of isolates.
  
  
  RESULTS
  We estimate the incidence of TB in Kikori to be 1290 per 100,000 people (95% CI 1140 to 1460) in 2012. The proportion of TB patients co-infected with HIV was 1.9%. Three of 32 TB cases tested were rifampicin resistant. Typing of nine isolates demonstrated allelic diversity and most were related to Beijing strains.
  
  
  CONCLUSIONS
  The incidence of TB in Kikori is one of the highest in the world and it is not driven by HIV co-infection. The high incidence and the presence of rifampicin resistant warrant urgent attention to mitigate substantial morbidity in the region.
authors.forename: Gail B
authors.initials: GB
authors.lastname: Cross
authors.forename: Katie
authors.initials: K
authors.lastname: Coles
authors.forename: Mandana
authors.initials: M
authors.lastname: Nikpour
authors.forename: Owen A
authors.initials: OA
authors.lastname: Moore
authors.forename: Justin
authors.initials: J
authors.lastname: Denholm
authors.forename: Emma S
authors.initials: ES
authors.lastname: McBryde
authors.forename: Damon P
authors.initials: DP
authors.lastname: Eisen
authors.forename: Beverlyn
authors.initials: B
authors.lastname: Warigi
authors.forename: Robyn
authors.initials: R
authors.lastname: Carter
authors.forename: Sushil
authors.initials: S
authors.lastname: Pandey
authors.forename: Paul
authors.initials: P
authors.lastname: Harino
authors.forename: Peter
authors.initials: P
authors.lastname: Siba
authors.forename: Christopher
authors.initials: C
authors.lastname: Coulter
authors.forename: Ivo
authors.initials: I
authors.lastname: Mueller
authors.affiliation: Infection and Immunity Division, Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC 3052, Australia. phuanukoonnon@wehi.edu.au.
authors.forename: Suparat
authors.initials: S
authors.lastname: Phuanukoonnon
authors.forename: Marc
authors.initials: M
authors.lastname: Pellegrini
mesh_terms: D000293:Adolescent; D000328:Adult; D000483:Alleles; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D060085:Coinfection; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000150:complications; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010219:Papua New Guinea / Q000453:epidemiology; D011446:Prospective Studies; D012293:Rifampin / Q000627:therapeutic use; D012307:Risk Factors; D013183:Sputum; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology*; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D012293:Rifampin