Community-based TB treatment program remains the critical link between patients, communities and TB clinics
“The moment I was diagnosed with tuberculosis (TB), lots of thoughts came into my mind on how I would look after my kids,” shares Rachel, a 31-year-old mother living in the capital of Papua New Guinea (PNG), Port Moresby, who was diagnosed with TB in August 2020.
“I was thinking of going back to work but I have to go to the TB outreach site every morning for treatment. While I was having this doubt, World Vision came with the food voucher and bus fare … I was very thankful, and thought to myself that I am so special to the doctors’ eyes that they are giving me this treatment.”
Rachel is one of over 5000 TB patients in the National Capital District (NCD) that has received community-level TB treatment since April 2020 as part of the PNG Department of Health’s US$15 million Emergency TB Project, funded by the World Bank, and implemented in partnership with the National Capital District Provincial Health Authority, the World Health Organization, UNOPS, World Vision Australia and the Burnett Institute. The project builds on the success of the PNG National Department of Health and the Australian Government’s successful intervention in PNG’s Western Province.
In the past 18 months, the project has supported the establishment of 23 TB outreach sites across the capital, with more than 130 community treatment supporters providing close support and check-ins with patients on a daily or weekly basis. The outreach sites, transport and food – together with daily visits – give TB patients a much better chance of making a full recovery.
TB patients, particularly those with Multi-Drug Resistant TB, must take heavy doses of medication every day; many for two years. The drugs can cause serious side-effects, including nausea, lethargy and joint pain, making successful completion of TB treatment both a physically and mentally challenging time for patients.
“I was born in Hanuabada (a coastal village on the outskirts of Port Moresby) and grew up here, and I was interested in looking after my village because I saw there was a big need and it was classified as a TB hotspot,” explains Helen Dawanicura, a World Vision treatment supporter. “I was trained as a TB warden when I was with my former employer, and now I support about 50 people on my end of the village.”
“Every day I go to their homes and give them their treatments, and three ex-TB patients help me with the daily program. So, we go around to their homes about 6:30am to 8am, and then at 9am I open the clinic for the public.”
More than just medication
Daily medication compliance is integral to treatment of TB, yet it’s the emotional, social and psychological support that makes this model so powerful. First piloted on Daru Island – once one of the world’s major TB hotspots – the program ensured that patient treatment drop-out rates reduced from 30 percent to almost zero. In NCD, the program has maintained a drop-out rate of less than six percent since it first started.
“When my TB patients are discharged; I'm happy,” exclaims Dawanicura. “In the beginning, most of them are coughing, they have shortness of breath. Some can’t even walk. But at the end of the six months, when they are discharged, and they are nice and smiling at me, it lifts my heart. I’ve helped save their life.”
Treatment supporters also provide help to those with HIV, and work to tackle stigmas about both TB and HIV in the community. Many people who are newly diagnosed with either disease are likely to face social isolation from their family and friends, making recovery a lonely experience.
Josephine is a drug-resistant TB patient, and her mum used to think TB was caused by sorcery. During a household visit by treatment supporters, her mum, Nita, was educated about the medical realities of TB.
“All of us were afraid of sharing food with Josephine because we thought we might get sick like her. [The treatment supporter] told me the right thing so now I am happy with my daughter, and we will eat together and live happily together,” says Jim.
COVID-19 brings further challenges to the fight against TB
However, with the arrival of COVID-19 in PNG, there have been immense challenges, particularly as both diseases are highly transmissible between people. Outreach sites had to close during COVID-19 lockdowns, and some of the services have been disrupted due to the pandemic.
“And treatment supporters remain the critical link between the community and the TB clinics, ensuring nearly all TB patients are continuing with their treatment plans. They have deep connections in the communities where they live and work, which is why we reassigned some supporters to community engagement efforts to help prevent the spread of COVID-19.”
The TB work in NCD is part of a wider Government of PNG-led effort that includes partners like the World Bank and World Vision; one that ultimately aims to kick TB out of PNG, explains Dr. Edith Kariko, World Bank Senior Health Specialist in PNG.
“TB is a recognised priority for the Government of PNG, and the World Bank has partnered with the Government for the past decade to try and eradicate the disease from vulnerable communities,” said Dr Kariko.
“The TB project also laid the foundations for the COVID-19 response. With the staff trained in diagnostics through the project, and the existing links with testing labs in Australia, Port Moresby General Hospital was already equipped with diagnostic support when the first case landed on our shores.
“Our team at the World Bank is committed to the fight against COVID-19 – just like TB – alongside the PNG Government.”
The World Bank’s commitment to the Emergency TB Project is part of US$95 million in support to tackle several of PNG’s most pressing health challenges, including the response to the COVID-19 pandemic. The World Bank is one of the largest sources of funding and knowledge for PNG and is currently delivering US$562 million in funding across 10 projects in PNG aimed at improving transport, health, water and sanitation, and agriculture, including the second phases of the PNG Road Rehabilitation Project and the Urban Youth Employment Project.