title: The Burden of Drug-Resistant Tuberculosis in Papua New Guinea: Results of a Large Population-Based Survey.
abstract: BACKGROUND
  Reliable estimates of the burden of multidrug-resistant tuberculosis (MDR-TB) are crucial for effective control and prevention of tuberculosis (TB). Papua New Guinea (PNG) is a high TB burden country with limited information on the magnitude of the MDR-TB problem.
  
  
  METHODS
  A cross-sectional study was conducted in four PNG provinces: Madang, Morobe, National Capital District and Western Province. Patient sputum samples were tested for rifampicin resistance by the Xpert MTB/RIF assay and those showing the presence of resistance underwent phenotypic susceptibility testing to first- and second-line anti-TB drugs including streptomycin, isoniazid, rifampicin, ethambutol, pyrazinamide, ofloxacin, amikacin, kanamycin and capreomycin.
  
  
  RESULTS
  Among 1,182 TB patients enrolled in the study, MDR-TB was detected in 20 new (2.7%; 95% confidence intervals [CI] 1.1-4.3%) and 24 previously treated (19.1%; 95%CI: 8.5-29.8%) TB cases. No case of extensively drug-resistant TB (XDR-TB) was detected. Thirty percent (6/20) of new and 33.3% (8/24) of previously treated cases with MDR-TB were detected in a single cluster in Western Province.
  
  
  CONCLUSIONS
  In PNG the proportion of MDR-TB in new cases is slightly lower than the regional average of 4.4% (95%CI: 2.6-6.3%). A large proportion of MDR-TB cases were identified from a single hospital in Western Province, suggesting that the prevalence of MDR-TB across the country is heterogeneous. Future surveys should further explore this finding. The survey also helped strengthening the use of smear microscopy and Xpert MTB/RIF testing as diagnostic tools for TB in the country.
authors.affiliation: National Department of Health, Port Moresby, Papua New Guinea.
authors.forename: Paul
authors.initials: P
authors.lastname: Aia
authors.affiliation: National Department of Health, Port Moresby, Papua New Guinea.
authors.forename: Margaret
authors.initials: M
authors.lastname: Kal
authors.affiliation: National Department of Health, Port Moresby, Papua New Guinea.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Lavu
authors.affiliation: National Department of Health, Port Moresby, Papua New Guinea.
authors.forename: Lucy N
authors.initials: LN
authors.lastname: John
authors.affiliation: Health & HIV Implementation Services Provider, Abt JTA, Port Moresby, Papua New Guinea.
authors.forename: Karen
authors.initials: K
authors.lastname: Johnson
authors.affiliation: Queensland Mycobacterium Reference Laboratory, Pathology Queensland, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Coulter
authors.affiliation: Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America.
authors.forename: Julia
authors.initials: J
authors.lastname: Ershova
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Olga
authors.initials: O
authors.lastname: Tosas
authors.affiliation: Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland.
authors.forename: Matteo
authors.initials: M
authors.lastname: Zignol
authors.affiliation: Stop TB and Leprosy Elimination, World Health Organization, Western Pacific Regional Office, Manila, Philippines.
authors.forename: Shalala
authors.initials: S
authors.lastname: Ahmadova
authors.affiliation: World Health Organization, Port Moresby, Papua New Guinea.
authors.forename: Tauhid
authors.initials: T
authors.lastname: Islam
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D018432:Drug Resistance, Multiple; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D010219:Papua New Guinea / Q000453:epidemiology; D015995:Prevalence; D011795:Surveys and Questionnaires; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents