Original Research
Time to commencement of effective treatment in patients with drug-resistant tuberculosis diagnosed in the Torres Strait–Papua New Guinea cross-border region
AUTHORS
J'Belle Foster1 BN, MPH/MIPH (current PhD Scholar - James Cook University), Nursing Director Torres and Cape Tuberculosis Control Unit * 
Diana Mendez2 MPH, PhD, Senior Lecturer and Cohort Doctoral Studies Program Mentor
Ben Marais3 PhD, Co-Director of the Sydney Infectious Diseases Institute (Sydney ID) and WHO Collaborating Centre in Tuberculosis at the University of Sydney. Paediatric Infectious Diseases Specialist at The Children's Hospital Westmead
Dunstan Peniyamina4 MPH, Cross Border Communication Officer
Emma McBryde5 PhD, Professor of Infectious Diseases Modelling (James Cook University); TB Specialist - Torres and Cape Tuberculosis Control Unit
AFFILIATIONS
1, 5 Torres and Cape Tuberculosis Control Unit, Thursday Island, Queensland, Australia; and Australian Institute of Tropical Health and Medicine, Townsville, Queensland, Australia. Present address: College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
2 Australian Institute of Tropical Health and Medicine, Townsville, Queensland, Australia; Research & Academy Divisions and College of Public Health, Veterinary and Medical Science; and James Cook University, Townsville, Queensland, Australia
3 Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, Australia
4 Cairns Tropical Public Health Services, Cairns, Queensland, Australia
ACCEPTED: 27 January 2023
early 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. We 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. We assessed the total time from self-reported onset of symptoms to effective treatment commencement in different programmatic time periods. 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 vs 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 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.