title: Implementation of tuberculosis infection prevention and control in rural Papua New Guinea: Towards prioritising actions
Creators: name: Marme, Gigil
Publisher: name: Griffith University
Year: 2024
Subjects: subject: tuberculosis
subject: public health
subject: infection prevention and control policy
subject: Papua New Guinea

description: Despite the availability of preventive medications, tuberculosis (TB) remains a significant global public health challenge. Before the coronavirus disease (COVID-19) pandemic, TB caused more deaths than any other infectious disease. More than 90% of current TB infections and deaths occur in low-and middle-income countries (LMICs), highlighting the need for more efforts to reduce the high burden of TB in these countries. The World Health Organization (WHO) recommends implementing TB-IPC guidelines in unsafe and overcrowded environments such as healthcare settings. These recommendations include administrative, environmental, and personal protective measures. According to the WHO, the administrative control measure is the TB-IPC strategy's first and most crucial component. These measures consist of targeted activities to minimise exposure and reduce the spread of Mycobacterium TB (MTB). Environmental control measures aim to reduce the concentration of infected pathogens' droplet nuclei in the air. This is accomplished by increasing airflow rates in the building to dilute the room air. Even though administrative and environmental control measures can prevent exposure to infectious MTB, individuals are still at risk of TB infection. Therefore, personal respiratory control measures are designed to benefit individuals exposed to unsafe settings. Furthermore, respiratory control measures help prevent infectious persons from spreading infection to healthy individuals. For instance, the use of medical face masks prevents patients with TB from spreading infections to health workers while the use of personal respirators by health workers prevents them from inhaling infectious bacteria expelled from the patients. Although these guidelines have been found to reduce TB infections in tertiary healthcare settings, little is known about the context in which these guidelines are implemented in rural health settings, particularly in Papua New Guinea (PNG), which has a high burden of TB, multi-drug-resistant TB (MDR-TB), and extensively drug-resistant TB (XDR-TB). This thesis aims to provide a more comprehensive understanding of the implementation of TB-IPC guidelines in rural health settings in PNG. This thesis incorporates four research studies designed to address the overall research aim and questions. The overall aim is to understand the implementation of TB-IPC guidelines in rural health settings in PNG. Each of the four studies informs subsequent research in the research program to enable a deeper understanding of the environment in which TB-IPC guidelines are being implemented in rural health settings in PNG. The findings have been published (n=3) or submitted (n=1) in peer-reviewed journals. A pragmatic research paradigm incorporating both quantitative and qualitative methods underpinned the research program, as it enabled a rich understanding of the socio-ecological factors influencing the implementation of TB-IPC guidelines, and relevant strategies to improve these guidelines in rural healthcare settings in PNG. A conceptual framework was developed to guide this program of research. [...]