TB programme outcomes in South Fly District, Papua New Guinea, were maintained through COVID-19

An established response to an outbreak of drug-resistant TB (DR-TB) on Daru Island, South Fly District (SFD), Western Province, Papua New Guinea (PNG).

To describe and evaluate the trends in TB case notification disaggregated by demographic and clinical characteristics, programmatic interventions for TB and COVID-19 and treatment outcomes in 2017-2022.

A cohort study of routinely collected programmatic data of all patients registered for TB treatment in SFD comparing pre-COVID (2017-2019) to COVID (2020-2022) periods.

Of the 3,751 TB cases registered, 19.6% had DR-TB, and the case notification rate was 1,792/100,000 for Daru and 623/100,000 for SFD. There was a 29.2% reduction in case notifications from 2019 to 2021, with recovery in 2022. During COVID, the healthcare workforce was adversely impacted, and active TB case-finding was stopped. During COVID, compared to pre-COVID, bacteriological confirmation increased (62.3% to 71.9%), whereas rates of child TB notifications (11.6% to 9.1%), pulmonary TB (60.8% to 57.4%) and DR-TB (20.7% to 18.6%) decreased. High rates of treatment success were maintained for both drug-susceptible (86.5%) and DR-TB (83.6%).

Health systems strengthening and community engagement before COVID likely contributed to resilience and mitigated potential impacts on TB in this remote and resource-limited setting. Case notifications remain very high, and additional interventions are needed to interrupt transmission.