Systematic Community-Wide Engagement and Elimination Project for Tuberculosis (SWEEP-TB) in Daru, Western Province, Papua New Guinea

Presenter: So joining us this morning [from] the Burnet Institute's SWEEP program is Dr. Aung Aung. He joins us on the line from Daru. With that I say gutpela moning Dr. Aung and welcome to Pacific Beat. 

Dr Aung: Hi good morning. Uh thank you for having me. Absolutely. Uh doctor can you just firstly maybe tell us what has been the impact of TB on PNG? Well, the impact of TB on PNG is quite huge especially in the western province and where I work in Daru which as you said earlier there is a TB outbreak in the past that has led to all these challenges and then now it's end up with our community screening which is called SWEEP-TB in the last 2 years. But before this project though doctor what were you seeing in terms of numbers like how many people were actually affected by TB? The number of patients affected every year is quite significant let's say like 600 to 700 every year in that area but uh it's not only about the number it's about like a magnitude impact of the population here so it is quite big compared to the other national prevalence as well as other countries.

Presenter: Doctor, you talk about the program that you're part of which is SWEEP-TB. What exactly is that and how has this project I suppose been any different from maybe other approaches?

Dr. Aung: Okay, so SWEEP-TB is actually we want to screen, treat and prevent the whole population in Daru Island. So we want to integrate this TB care into the community find the cases as early as they can before they are getting sick to come to the health centre for the further care. So we also want to be a look at community capability workforce diagnosis system referral linkage. So that is the the main aims of the SWEEP-TB and that is actually not quite very different than other settings that is what the WHO recommended for community screening for the high burden setting. So that's what we have implemented in Daru Island.

Presenter: Can you take us through how that testing looks like when you are screening your clients there?

Dr. Aung: Okay. So we try to reach the every single people on the island. So that is why we use like community engagement and we use house to house screening and we also utilise X-rays and also like a rapid diagnosis test. So on a normal day like we started with the community engagement within with our team and also community leaders and the members and then we distribute the message and the team goes house-to-house door-to-door and we do that symptomatic screening in the house giving some education and then they are referred to a sort of central location close to their houses for the further checkup like X-ray examination and also if they are symptomatic or if they are have some they are presumptive we collect sputum and then after that the result come back either they are a TTP or not so this is a process that we normally do in a normal day.

Presenter: Doctor so it's very much a community approach I can see you're going door-to-door. What has been the response then from the community because you know sometimes maybe stigma plays a big factor into people coming forward right is that the case sometimes.

Dr. Aung: Well, I think people have different ideas and then they have their own concept in that things. So we also have experience with community engagement. So we understand what people will think of. So that's why we strategise our community engagement messages that TB is the thing that we are coming to help them. We're coming to help to screen if they have the disease we can treat them and we can prevent them. So that is what we also strategise ourself our community engagement strategy to reach to the people to reduce the stigma to to make them aware to understand the disease.

Presenter: Nice. Now with those who have been diagnosed with TB I understand some actually had no symptoms at all. So I'm wondering how critical is this in terms of stopping transmission?

Dr. Aung: Well, I think this is the biggest thing that we found out. So as you as you we have like more than half of the total active cases that we found are not showing any symptoms. This is quite significant because it is if we rely on the people who are sick and who came to the health facilities for the care that will be too late and that will be like they will be transmitting the disease in a community. So that this is the main point that we have to we found out and then we have helped them discover those hidden cases to get the treatment as early as possible.

Presenter: Doctor for those who are listening in I'm sure they would like to know though what are the symptoms that families should actually look for when and when should they actually seek testing?

Dr. Aung: Oh the usual TB symptoms are like cough, fever, night sweat, weight loss and they are having like haemoptysis sort of like coughing up blood. So this is a usual TB symptoms that we used to rely on and that's why we also utilise it. But at the same time like as I said earlier like half more than half of the people that we have diagnosed do not report any of these symptoms we only discover through the chest X-rays. So it is not only that we have to rely on the symptoms are developing at the stage which is already maybe late. So whenever there is a contact of TB or whenever there is someone in your household with the TB we have to diagnose we have to screen for the whole the household so something like that so of course symptoms are there but we should not wait for the symptoms for the until very late and we have to have like a sort of like community-wide screening to know the prevalence since earlier.

Presenter: And how has the approach been like what are the results that you've been seeing so far? So we know that initially it was quite [inaudible] that we we know that but we understand at the end like it is possible and feasible to do the community screening in such kind of resource limited setting in Daru and we have achieved a high uptake of screening and then we have found like hundreds of TB cases during this screening. So at the end like this is a significant achievement and this is something that we prove that it's possible to do in such kind of community as like in Daru.

Presenter: Nice to hear. Okay. Well Doctor really could this community-wide approach that you're doing with the SWEEP-TB become maybe a model for the rest of the Pacific?

Dr. Aung: We are trying to do these things and in this community because the TB is high and it's a challenge and then we also knew that this is feasible and possible to do it in such kind of community. So that could be a model that we can we can further spread not only in PNG and Daru Western Province that's also about setting which is applicable to at the same time like we can also uh understand the context in the different locations and then modify a bit to expand this activity to other places. We also require like continuous investment for the further screening.

Presenter: Beautiful. Well, some great work that you are doing there doctor and really appreciate uh that you've been able to come on the show and share about the SWEEP-TB. Again, we just want to say thank you uh for coming on the show.

Dr. Aung: Thank you so much for having a chance uh to speak about that and thank you.

Presenter: Appreciate it. That is Burnet Institute Tuberculosis Specialist Dr Aung Aung here on Pacific Beat.