Factors associated with loss to follow-up among TB patients in rural Papua New Guinea

BACKGROUND: Papua New Guinea (PNG) is a lower middle-income country that has struggled to contain TB. The loss of patients to follow-up is a major contributing factor towards the high disease burden.OBJECTIVE: To describe persons with drug-susceptible TB (DS-TB) registered for treatment at the Gaubin Rural Hospital (GRH) on Karkar Island, Madang Province, PNG, and to investigate factors associated with patient loss to follow-up (LTFU).DESIGN: A retrospective cohort study was conducted using data from GRH DS-TB registers. Factors associated with LTFU were investigated using univariable and multivariable logistic regression.RESULTS: A total of 722 patients were registered for DS-TB treatment and eligible for inclusion between 1 January 2014 and 30 June 2018, of whom 97 (13.4%) were lost to follow-up. Male sex was associated with an increased odds of LTFU (adjusted OR [aOR] 1.9, 95% CI 1.2–3.0; P = 0.005), as was travel time to GRH >3 h (aOR 3.7, 95%, CI 2.2–6.3; P < 0.001).CONCLUSION: A high LTFU rate has been identified in patients with TB in PNG. This study found male sex and increased travel time from treatment location to be associated with unsuccessful treatment adherence, highlighting the need for further interventions to improve adherence.

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Loss to follow up of pregnant women with HIV and infant HIV outcomes in the prevention of maternal to child transmission of HIV programme in two high-burden provinces in Papua New Guinea: a retrospective clinical audit

BMJ Open ◽

10.1136/bmjopen-2020-038311 ◽

2020 ◽

Vol 10 (12) ◽

pp. e038311

Author(s):

Angela Kelly-Hanku ◽

Claire Elizabeth Nightingale ◽

Minh Duc Pham ◽

Agnes Mek ◽

Primrose Homiehombo ◽

...

Keyword(s):

Pregnant Women ◽

Papua New Guinea ◽

Hiv Positive ◽

Newly Diagnosed ◽

Mother To Child Transmission ◽

Child Transmission ◽

Loss To Follow Up ◽

Factors Associated ◽

Mother To Child

IntroductionDespite early adoption of the WHO guidelines to deliver lifelong antiretroviral (ARV) regimen to pregnant women on HIV diagnosis, the HIV prevention of mother to child transmission programme in Papua New Guinea remains suboptimal. An unacceptable number of babies are infected with HIV and mothers not retained in treatment. This study aimed to describe the characteristics of this programme and to investigate the factors associated with programme performance outcomes.MethodsWe conducted a retrospective analysis of clinical records of HIV-positive pregnant women at two hospitals providing prevention of mother to child transmission services. All women enrolled in the prevention of mother to child transmission programme during the study period (June 2012–June 2015) were eligible for inclusion. Using logistic regression, we examined the factors associated with maternal loss to follow-up (LTFU) before birth and before infant registration in a paediatric ARV programme.Results763 of women had records eligible for inclusion. Demographic and clinical differences existed between women at the two sites. Almost half (45.1%) of the women knew their HIV-positive status prior to the current pregnancy. Multivariate analysis showed that women more likely to be LTFU by the time of birth were younger (adjusted OR (AOR)=2.92, 95% CI 1.16 to 7.63), were newly diagnosed with HIV in the current/most recent pregnancy (AOR=3.50, 95% CI 1.62 to 7.59) and were in an HIV serodiscordant relationship (AOR=2.94, 95% CI 1.11 to 7.84). Factors associated with maternal LTFU before infant registration included being primipara at the time of enrolment (AOR=3.13, 95% CI 1.44 to 6.80) and being newly diagnosed in that current/most recent pregnancy (AOR=2.49, 95% CI 1.31 to 4.73). 6.6% (50 of 763) of exposed infants had a positive HIV DNA test.ConclusionsOur study highlighted predictors of LTFU among women. Understanding these correlates at different stages of the programme offers important insights for targets and timing of greater support for retention in care.

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Individual and contextual factors associated with barriers to accessing healthcare among women in Papua New Guinea: insights from a nationwide demographic and health survey

International Health ◽

10.1093/inthealth/ihaa097 ◽

2020 ◽

Author(s):

Abdul-Aziz Seidu ◽

Ebenezer Agbaglo ◽

Louis Kobina Dadzie ◽

Bright Opoku Ahinkorah ◽

Edward Kwabena Ameyaw ◽

...

Keyword(s):

Papua New Guinea ◽

Health Survey ◽

Rural Areas ◽

Contextual Factors ◽

Statistical Significance ◽

New Guinea ◽

Wealth Quintile ◽

Demographic And Health Survey ◽

Outcome Variable ◽

Factors Associated

Abstract Background This study sought to assess the individual and contextual factors associated with barriers to accessing healthcare among women in Papua New Guinea. Methods The study was conducted among 14 653 women aged 15–49 y using data from the 2016–2018 Papua New Guinea Demographic and Health Survey. The outcome variable was barriers to accessing healthcare. Descriptive and multilevel logistic regression analyses were conducted. Statistical significance was declared at P < 0.05. Results Women aged 15–19 y were more likely to experience at least one barrier compared with those aged 40–49 y (adjusted OR [AOR]=1.48; 95% CI 1.18 to 1.86). Women with secondary/higher education (AOR=0.68; 95% CI 0.57 to 0.81), women in the richest wealth quintile (AOR=0.36; 95% CI 0.28 to 0.46) and those in the least disadvantaged socioeconomic status (AOR=0.46; 95% CI 0.33 to 0.64) had lower odds of having challenges with at least one barrier to healthcare. However, living in rural areas increased the odds of facing at least one barrier to healthcare (AOR=1.87; 95% CI 1.27 to 2.77). Conclusions This study has demonstrated that both individual and contextual factors are associated with barriers to healthcare accessibility among women in Papua New Guinea. To enhance the achievement of the Sustainable Development Goals 3.1, 3.7 and 3.8, it is critical to deem these factors necessary and reinforce prevailing policies to tackle barriers to accessing healthcare among women in Papua New Guinea.

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Microbiologically Confirmed Tuberculosis: Factors Associated with Pre-Treatment Loss to Follow-Up, and Time to Treatment Initiation

PLoS ONE ◽

10.1371/journal.pone.0168659 ◽

2017 ◽

Vol 12 (1) ◽

pp. e0168659 ◽

Cited By ~ 8

Author(s):

Judith Mwansa-Kambafwile ◽

Boitumelo Maitshotlo ◽

Andrew Black

Keyword(s):

Treatment Initiation ◽

Time To Treatment ◽

Loss To Follow Up ◽

Factors Associated ◽

Pre Treatment ◽

Time To Treatment Initiation

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Factors associated with children’s health facility visits for primaquine treatment in rural Papua New Guinea

Malaria Journal ◽

10.1186/s12936-019-2675-4 ◽

2019 ◽

Vol 18 (1) ◽

Author(s):

Akiko Yoshii ◽

Makoto Sekihara ◽

Takuro Furusawa ◽

Francis Hombhanje ◽

Takahiro Tsukahara

Keyword(s):

Papua New Guinea ◽

Health Facility ◽

New Guinea ◽

Children's Health ◽

Children’S Health ◽

Factors Associated

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Analysis of loss to follow-up in 4099 multidrug-resistant pulmonary tuberculosis patients

European Respiratory Journal ◽

10.1183/13993003.00353-2018 ◽

2019 ◽

Vol 54 (1) ◽

pp. 1800353 ◽

Cited By ~ 1

Author(s):

Ian F. Walker ◽

Oumin Shi ◽

Joseph P. Hicks ◽

Helen Elsey ◽

Xiaolin Wei ◽

...

Keyword(s):

Risk Factors ◽

Adverse Event ◽

Treatment Success ◽

Multidrug Resistant ◽

Cox Proportional Hazards Model ◽

Serious Adverse Event ◽

Loss To Follow Up ◽

Factors Associated ◽

Mdr Tb

Loss to follow-up (LFU) of ≥2 consecutive months contributes to the poor levels of treatment success in multidrug-resistant tuberculosis (MDR-TB) reported by TB programmes. We explored the timing of when LFU occurs by month of MDR-TB treatment and identified patient-level risk factors associated with LFU.We analysed a dataset of individual MDR-TB patient data (4099 patients from 22 countries). We used Kaplan–Meier survival curves to plot time to LFU and a Cox proportional hazards model to explore the association of potential risk factors with LFU.Around one-sixth (n=702) of patients were recorded as LFU. Median (interquartile range) time to LFU was 7 (3–11) months. The majority of LFU occurred in the initial phase of treatment (75% in the first 11 months). Major risk factors associated with LFU were: age 36–50 years (HR 1.3, 95% CI 1.0–1.6; p=0.04) compared with age 0–25 years, being HIV positive (HR 1.8, 95% CI 1.2–2.7; p<0.01) compared with HIV negative, on an individualised treatment regimen (HR 0.7, 95% CI 0.6–1.0; p=0.03) compared with a standardised regimen and a recorded serious adverse event (HR 0.5, 95% CI 0.4–0.6; p<0.01) compared with no serious adverse event.Both patient- and regimen-related factors were associated with LFU, which may guide interventions to improve treatment adherence, particularly in the first 11 months.

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Perpetration of Violence by Female Sex Workers in Papua New Guinea: ‘We will Crush their Bones’

The British Journal of Criminology ◽

10.1093/bjc/azaa058 ◽

2020 ◽

Vol 61 (1) ◽

pp. 104-122

Author(s):

Angela Kelly-Hanku ◽

H Worth ◽

M Redman-MacLaren ◽

S Nosi ◽

R Boli-Neo ◽

...

Keyword(s):

Papua New Guinea ◽

Sex Workers ◽

Female Sex Workers ◽

Physical Violence ◽

New Guinea ◽

Middle Income ◽

Middle Income Countries ◽

Female Sex ◽

Low And Middle Income

Abstract There is a small but important body of literature on female sex workers’ (FSWs) violence towards others, but little of that focused on low- and middle-income countries. Drawn from a larger biobehavioural study of FSWs in three cities in Papua New Guinea, we analyse the interviews from 19 FSWs who reported having perpetrated physical violence towards four major groups: (1) ex-husbands; (2) clients; (3) other sex workers and (4) other people (mainly women). Our study demonstrates that FSWs’ use of violence arises from a complex set of social, material and gendered circumstances and cannot be addressed in isolation from other aspects of their lives.

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Compliance among infants exposed to hepatitis B virus in a post-vaccination serological testing program in four provinces in China

Infectious Diseases of Poverty ◽

10.1186/s40249-019-0568-y ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 1

Author(s):

Hui Zheng ◽

Guo-Min Zhang ◽

Po-Lin Chan ◽

Fu-Zhen Wang ◽

Lance Everett Rodewald ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Venous Blood ◽

Serological Testing ◽

Sample Collection ◽

Post Vaccination ◽

Loss To Follow Up ◽

Factors Associated ◽

B Virus

Abstract Background Mother to child transmission of hepatitis B virus (HBV) remains the most common form of HBV infection in China. Prevention of HBV vertical transmission involves timely administration of the complete hepatitis B vaccine (HepB) series and hepatitis B immunoglobulin. Post-vaccination serological testing (PVST) is utilized to determine an infant’s outcome after HBV exposure and completion of HepB series. We aim to determine the frequency of compliance with a PVST testing cascade for HBV infected mothers and analyze factors associated with infant lost to follow up (LTFU). Methods We conducted a retrospective cohort review of previously collected data in Fujian, Jiangxi, Zhejiang and Chongqing provinces in China from 1 June 2016–31 December 2017. The study population included all HBV-exposed infants and their mothers. SAS software was used for statistical analyses. Bivariate and multivariate regression analyses (presented in odds ratio [OR] with 95% confidence intervals [CI]) were used to compare the proportional differences of factors associated with PVST not being completed. Results Among enrolled 8474 target infants, 40% of them transferred out of the study provinces without further information and 4988 were eligible for PVST. We found 20% (994) of infants were not compliant with the testing cascade: 55% of LTFU occurred because parents refused venous blood sample collection or failure of sample collection in the field, 16% transferred out after 6 months of age, and 10% of families chose to have independent, confidential PVST completed without reporting results. High PVST noncompliance rates were more likely to be from Fujian (aOR = 17.0, 95% CI: 9.7–29.9), Zhejiang (aOR = 5.7, 95% CI: 3.2–10.1) and Jiangxi (aOR = 1.9, 95% CI: 1.0–3.4), and from HBV e antigen positive mother (aOR = 1.2, 95% CI: 1.1–1.4). Conclusions This study found that the LTFU rate reached 20% in PVST program, which was a significant problem. We recommend implementing a national electronic information system for tracking HBV at risk mother-infant pairs; encourage further research in developing a less invasive means of completing PVST, and take effective measures nationally to reduce HBV stigma. Without reducing the loss to follow up rate among infants eligible for PVST, elimination of vertical HBV transmission will be impossible.

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