Publication date: Dec 01, 2024

Papua New Guinea (PNG) is a high-burden country for multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB). There are limited data on MDR/RR-TB notifications and treatment from the most populous province. Describe MDR/RR-TB detection and treatment outcomes in Morobe Province, the impact of the COVID-19 pandemic and factors associated with unfavourable treatment outcomes. Retrospective cohort study of MDR/RR-TB notifications between 2012 and 2021 using routine programme registration data. Favourable outcomes were compared to unfavourable outcomes using multivariable regression. Between 2012 and 2021, 160 cases of MDR/RR-TB were bacteriologically confirmed. Few diagnoses were made among children (2. 5%), extrapulmonary cases (0. 6%) or rural residents (38%). Case notifications rose sharply from 2016 after the introduction of GeneXpert to 5. 6 cases per 100,000 population in 2020 before a reduction in 2021 coinciding with COVID-19 disruptions. Loss to follow-up (27. 5%) and death (8. 1%) were common. Unfavourable treatment outcomes were more common among male participants (aOR 3. 00, 95% CI 1. 38-6. 45) and those treated with longer injectable-containing regimens (aOR 3. 39, 95% CI 1. 30-8. 80). MDR/RR-TB detection has increased overall, but enhanced and decentralised diagnostic capacity is needed, including in important sub-populations. Persisting low treatment success rates must be urgently addressed to minimise the further emergence of drug-resistant TB in Morobe Province.

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