Foster, J'Belle, Mendez, Diana, Marais, Ben, Peniyamina, Dunstan, and McBryde, Emma (2023) Time to commencement of effective treatment in patients with drug-resistant tuberculosis diagnosed in the Torres Strait–Papua New Guinea cross-border region. Rural and Remote Health, 23. 7165.

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Abstract

Introduction: Delays between self-reported symptom onset and commencement of effective treatment contribute to ongoing tuberculosis (TB) transmission, which is a particular concern in patients with drug-resistant (DR)-TB. The study authors assessed improvements in time to commencement of effective treatment in patients diagnosed with DR-TB in the Torres Strait–Papua New Guinea cross-border region.

Methods: All laboratory-confirmed DR-TB cases diagnosed in the Torres Strait between 1 March 2000 and 31 March 2020 were reviewed. Total time from self-reported onset of symptoms to effective treatment commencement in different programmatic time periods was assessed. Pairwise analyses and time to event proportional hazard calculations were used to explore the association between delays in median time to effective treatment, and selected variables. Data were further analysed to examine predictors of excessive treatment delay.

Results: The median number of days from self-reported onset of symptoms to effective treatment commencement was 124 days (interquartile range 51–214) over two decades. Between 2006 and 2012, most (57%) cases exceeded this ‘grand median’ while the median ‘time to treat’ in the most recent time period (2016–2020) was significantly reduced to 29 days (p<0.001). Although there was a reduction in the median ‘time to treat’ with the introduction of Xpert MTB/RIF (135 days pre-Xpert v 67 days post-Xpert) this was not statistically significant (p=0.07). Establishment of the Torres and Cape TB Control Unit on Thursday Island (2016–2020) was significantly associated with reduced treatment delay, compared to the previous TB program period (2000–2005, p<0.04; 2006–2012, p<0.001).

Conclusion: Minimising TB treatment delay in remote settings like the Torres Strait–Papua New Guinea cross-border region requires effective decentralised diagnosis and management structures. The results of this study suggest that the establishment of the Torres and Cape TB Control Unit on Thursday Island significantly improved time to commencement of effective TB treatment. Possible contributing factors include better TB education, cross-border communication and patient-centred care.

Item ID:	78190
Item Type:	Article (Non-Refereed Research)
ISSN:	1445-6354
Keywords:	cross-border, drug-resistant tuberculosis, time to treat, Torres Strait
Copyright Information:	© James Cook University. This work is licensed under a Creative Commons Attribution 4.0 International Licence.
Date Deposited:	06 Jun 2023 00:57
FoR Codes:	49 MATHEMATICAL SCIENCES > 4901 Applied mathematics > 490102 Biological mathematics @ 30% 42 HEALTH SCIENCES > 4202 Epidemiology > 420205 Epidemiological modelling @ 70%
SEO Codes:	20 HEALTH > 2004 Public health (excl. specific population health) > 200404 Disease distribution and transmission (incl. surveillance and response) @ 80% 20 HEALTH > 2002 Evaluation of health and support services > 200205 Health policy evaluation @ 20%
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