Setting: The tuberculosis (TB) programmes at the
Nonga General Hospital, Rabaul Urban Clinic and Kerevat
District Hospital in East New Britain Province, Papua New
Background: In East New Britain, TB care was mainly offered by the General Hospital, resulting in limited community-based care and poor treatment outcomes. In
2016, TB services were decentralised from the provincial
to the district level by 1) training health workers, 2) increasing community awareness of TB, and 3) providing a
weekly Clinical Outreach (TACO) service.
Objective: To describe the effect of TACO on the use of
TB diagnostic and treatment services from 1 January
2014 to 31 December 2017.
Design: This was a retrospective study comparing 2014–
2015 (pre-TACO) and 2016–2017 (TACO) cohorts.
Results: There was an increase in pre-TACO to TACO cohorts in screened cases (1581 to 2195), total registered
TB cases (678 to 824) and registered cases at decentralised sites (209 to 615). Unfavourable treatment outcomes were common (pre-TACO, 46.0% vs. TACO,
40.1%). In multivariable analysis, treatment at a decentralised Basic Management Unit (aOR 0.55, 95%CI 0.42–
0.74) was significantly associated with fewer unfavourable outcomes, but treatment outcomes between the
pre-TACO and the TACO group were not significantly
Conclusion: Strengthening decentralisation of TB services at the district level increased TB screening and case
registration, with similar treatment outcomes.
Link to publisher’s web site