The effects of decentralisation of tuberculosis services in the East New Britain Province, Papua New Guinea.

ABSTRACT

SETTING: The tuberculosis (TB) programmes at the Nonga General Hospital, Rabaul Urban Clinic and Kerevat District Hospital in East New Britain Province, Papua New Guinea. BACKGROUND: In East New Britain, TB care was mainly offered by the General Hospital, resulting in limited community-based care and poor treatment outcomes. In 2016, TB services were decentralised from the provincial to the district level by 1) training health workers, 2) increasing community awareness of TB, and 3) providing a weekly Clinical Outreach (TACO) service. OBJECTIVE: To describe the effect of TACO on the use of TB diagnostic and treatment services from 1 January 2014 to 31 December 2017. DESIGN: This was a retrospective study comparing 2014-2015 (pre-TACO) and 2016-2017 (TACO) cohorts. RESULTS: There was an increase in pre-TACO to TACO cohorts in screened cases (1581 to 2195), total registered TB cases (678 to 824) and registered cases at decentralised sites (209 to 615). Unfavourable treatment outcomes were common (pre-TACO, 46.0% vs. TACO, 40.1%). In multivariable analysis, treatment at a decentralised Basic Management Unit (aOR 0.55, 95%CI 0.42-0.74) was significantly associated with fewer unfavourable outcomes, but treatment outcomes between the pre-TACO and the TACO group were not significantly different. CONCLUSION: Strengthening decentralisation of TB services at the district level increased TB screening and case registration, with similar treatment outcomes.