Tuberculosis (TB) is preventable and curable yet remains the leading infectious cause of death globally. Papua New Guinea (PNG) has among the highest TB incidence rates (417/100,000 population per annum) in the world, with rates considerably higher in some settings including the South Fly District of Western Province and the National Capital District. Despite formal adoption of international standards for clinical and public health management of TB, past strategies have repeatedly proven insufficient to respond to the epidemic in this context of a fragile, over-stretched health system and complex socio-cultural environments.
The project aim is to investigate the sociocultural beliefs and behaviours that sustain and enhance the transmission of TB in the South Fly District of PNG and assess the accessibility and acceptability of current interventions for TB control. The optimal utilisation of novel and current biomedical innovations, such as rapid diagnostic testing and shorter regimens for the treatment and prevention of TB, requires socially-embedded public health approaches.
In our study, we adopted an interpretive qualitative approach which centres emic perspectives and lived experience. We conducted 128 semi-structured in-depth interviews and 12 focus group discussions with a total of 85 people in the following locations in the South Fly District: Daru Island, Abam (mainland), and Katatai (mainland). Participants included people on TB treatment, caregivers and family members of people on TB treatment and people on TB preventive treatment, TB service providers, health care workers, community and church leaders and local policymakers. We also conducted a week-long Photovoice workshop in Daru with people on or currently on treatment for TB.
Photovoice is an arts-based participatory research method where participants capture and discuss photos of their lived experiences.
Optimally contextualised solutions are needed to address TB risk in the South Fly District. Treatment, education and awareness are key, but addressing the structural conditions in which TB thrives also needs to remain at the forefront. TB risk will never be stabilised without also examining the political economy and social production of the disease.
We acknowledge that these factors are beyond the scope of TB programs to address and that a whole-of-government approach is needed to address the multifaceted risk factors identified by the local population. Calls to action more than just public health authorities but housing, sanitation and income generation.
Actualising a person-centred and effective decentralised model of TB care as outlined in health policies is imperative for equitable access to essential health care services in PNG, but this will require human and financial resources, innovation, and highly contextualised solutions to be sustainable.
The study fills an evidence gap as, in contrast to HIV, TB-related qualitative research in PNG has been very limited. Formally collected and reported evidence that has informed the TB response in PNG has been largely clinical, biological or epidemiological in nature and this study integrates a social dimension to this approach, a potentially critical aspect which to date has been largely neglected in PNG and elsewhere.
Additionally, our study included a substantial dataset that included people from mainland South Fly District and Daru Island who were directly impacted by TB. The people we interviewed were eager to tell their stories. Data generated included a high level of detail and description, and we believe the knowledge gained will be crucial when advocating for an equitable and responsive health system within this context.
- Papua New Guinea Institute of Medical Research (PNGIMR)
- Ministry of Health-PNG
- Burnet Institute
- University of Melbourne
This work was supported by the National Health and Medical Research Council [grant number 1142715].
