Improving outcomes for tuberculosis patients in the Torres Strait - Papua New Guinea border region

Aim

To use locally derived research outputs and turn them into evidence-based practice in our program to improve TB patient outcomes.

Outcomes

• implementation of advanced diagnostic technology
• reduction in time patients need to remain in either home or hospital isolation
• increased confidence for clinicians who may have never known that TB exists in Australia, let alone been involved in its management
• reduction in numbers of patients needing to travel to Cairns for diagnostic procedures that can be done by Torres and Cape HHS clinicians with the right training
• improved quality of specimens collected
• reduction in costs associated with 'no-tests' - cost to patients who need to remain in isolation until three quality specimens have been collected, sent to Brisbane and the results received, as well as reduced HHS and Pathology Queensland costs.

Background

The outbreak of COVID-19 resulted in the closure of the international border between Australia and Papua New Guinea (PNG) in 2020. There was great fear of the foothold TB may take on PNG villages during this time and the TB transmission risk this poses to residents of the Torres Strait.

Discussion

Although working from home, the TBCU was cohesive with an unfailing commitment to improve outcomes for patients.

Some results have been peer-reviewed and published in the Journal of Rural and Remote Health and presented to the Queensland TB Expert Advisory Committee and National TB Advisory Committee. Quality, safety and risk personnel in TCHHS were also made aware of some results and associated initiatives.

Lessons learnt

Challenges encountered: 

At the beginning of COVID-19, only public health and TB nurses were authorised contact tracing officers. TB nurses were also registered immunisation providers. This led to TB clinicians being moved from the TB Unit to the public health team to assist with COVID-19 activities. The temporary loss of two nurses form our small team to the COVID-19 team was challenging but necessary.

Undertaking community consultation and utilising Indigenous Health Workers cannot be over-emphasised.

References

"Department of Foreign Affairs. (1985). Australian Treaty Series 1985. Canberra: Australian Government Publishing Service. Retrieved from http://www.austlii.edu.au/au/other/dfat/treaties/1985/4.html.

Department of Foreign Affairs and Trade. (2013). Guidelines for traditional visitors travelling under the Torres Strait Treaty. Canberra: Department of Foreign Affairs and Trade.

Donnan, E. J., Coulter, C., Simpson, G., Clark, J., & Nourse, C. (2017). Paediatric tuberculosis in Queensland, Australia: Overrepresentation of cross-border and Indigenous children. International Journal of Tuberculosis and Lung Disease, 21 (3), 263-269. doi:10.5588/ijtld.16.0313

Gilpin, C. M., Simpson, G., Vincent, S., O'Brien, T. P., Knight, T. A., Globan, M., . . . Konstantinos, A. (2008). Evidence of primary transmission of multidrug-resistant tuberculosis in the Western Province of Papua New Guinea. Medical Journal of Australia, 188 (3), 148-152.

Graham, S.M., Sismanidis, C., Menzies, H.J., Marais, B.J. (2014). Importance of tuberculosis control to address child survival. The Lancet, 383 (9928)

Seddon, J.A., Hesseling, A.C., Willemse, M., Donald, P.R., Schaaf, H.S. (2012). Culture-confirmed MDR-TB in children: clinical features, treatment and outcome. Clinical Infectious Diseases, 54 (2), 157-166

Torres and Cape Hospital and Health Service (2020). Management of PNG Nationals presumed to have or diagnosed with tuberculosis.

Torres and Cape Hospital and Health Service (2020). PNG traditional inhabitants presenting to QH facilities within the Torres Strait Protected Zone

Queensland Health (2019). Primary Clinical Care Manual. 10th ed. Brisbane, Australia

Wejse, C., Gustafson, P., Nielsen, J., Gomes, V.F., Aaby, P. et al. (2009). TBscore: signs and symptoms from tuberculosis patients in a low-resource setting have predictive value and may be used to assess clinical course. Scandinavian Journal of Infectious Diseases, 40 (2).

World Health Organization. (2020). WHO Global Report 2020"