Access to quality diagnosis and rational treatment for tuberculosis: real-world evidence from China-Gates Tuberculosis Control Project Phase III.

IF 4.8 1区 医学 Q1 INFECTIOUS DISEASES Infectious Diseases of Poverty Pub Date : 2021-06-29 DOI:10.1186/s40249-021-00875-8
Zhi-Peng Li, Wen-Hui Mao, Fei Huang, Ni Wang, Li-Ping Ma, Li-Qun Zhang, Meng-Qiu Gao, Wei-Bing Wang, Qi Zhao, Sheng-Lan Tang
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引用次数: 2

Abstract

Background: China has successfully reduced tuberculosis (TB) incidence rate over the past three decades, however, challenges remain in improving the quality of TB diagnosis and treatment. In this paper, we assess the effects of the implementation of "China National Health Commission (NHC) and Gates Foundation TB Prevention and Control Project" on the quality of TB care in the three provinces.

Methods: We conducted the baseline study in 2016 and the final evaluations in 2019 in the 12 selected project counties. We obtained TB patients' information from the TB Information Management System and reviewed medical records of TB cases in the TB designated hospitals. We compared TB diagnosis and treatment services with the national practice guideline and used Student's t-test and Pearson χ2 tests or Fisher's exact tests to compare the difference before and after the project implementation.

Results: The percentage of sputum smear-negative (SS-) patients taking culture or rapid molecular test (RMT) doubled between 2015 and 2018 (from 35% to 87%), and the percentage of bacteriologically confirmed pulmonary TB cases increased from 36% to 52%. RMT has been widely used and contributed an additional 20% of bacteriologically confirmed TB cases in 2018. The percentage of TB patients taking drug susceptibility tests (DST) also doubled (from 40% in 2015 to 82% in 2018), and the proportion of TB patients receiving adequate diagnosis services increased from 85% to 96%. Among all SS- TB patients, over 86% received the recommended diagnostic services at the end of the study period, an improvement from 75% prior to the project implementation. However, the proportion of TB patients treated irrationally using second-line anti-TB drugs (SLDs) increased from 12.6% in 2015 to 19.9% in 2018. The regional disparities remained within the project provinces, albeit the gaps between them narrowed down for almost all indicators.

Conclusions: The quality of TB diagnosis services has been improved substantially, which is attributable to the coverage of new diagnosis technology. However, irrational use of SLDs remains a concern after the project implementation.

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获得结核病的优质诊断和合理治疗:来自中国结核控制项目三期的真实证据。
背景:在过去的三十年中,中国成功地降低了结核病的发病率,然而,在提高结核病诊断和治疗质量方面仍然存在挑战。本文评估了实施“中国国家卫生健康委员会与盖茨基金会结核病防治项目”对三省结核病护理质量的影响。方法:2016年在选定的12个项目县开展基线研究,2019年开展终评。我们从结核病信息管理系统获取结核病患者信息,并查阅结核病定点医院的结核病病例病历。我们将结核病诊断和治疗服务与国家实践指南进行比较,并使用学生t检验和Pearson χ2检验或Fisher精确检验来比较项目实施前后的差异。结果:痰涂片阴性(SS-)患者接受培养或快速分子检测(RMT)的比例在2015年至2018年间翻了一番(从35%增加到87%),细菌学确诊肺结核病例的比例从36%增加到52%。RMT得到了广泛应用,并在2018年造成了细菌学确诊结核病病例的20%。接受药敏试验(DST)的结核病患者比例也翻了一番(从2015年的40%增加到2018年的82%),获得适当诊断服务的结核病患者比例从85%增加到96%。在所有SS- TB患者中,86%以上的患者在研究期结束时接受了推荐的诊断服务,比项目实施前的75%有所改善。然而,不合理使用二线抗结核药物治疗的结核病患者比例从2015年的12.6%上升到2018年的19.9%。尽管几乎所有指标之间的差距都缩小了,但在项目省份内部,区域差距仍然存在。结论:结核病诊断服务质量明显提高,这与新诊断技术的普及有关。然而,在项目实施后,SLDs的不合理使用仍然是一个问题。
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来源期刊
Infectious Diseases of Poverty
Infectious Diseases of Poverty Medicine-Public Health, Environmental and Occupational Health
CiteScore
16.70
自引率
1.20%
发文量
368
审稿时长
13 weeks
期刊介绍: Infectious Diseases of Poverty is a peer-reviewed, open access journal that focuses on essential public health questions related to infectious diseases of poverty. It covers a wide range of topics and methods, including the biology of pathogens and vectors, diagnosis and detection, treatment and case management, epidemiology and modeling, zoonotic hosts and animal reservoirs, control strategies and implementation, new technologies, and their application. The journal also explores the impact of transdisciplinary or multisectoral approaches on health systems, ecohealth, environmental management, and innovative technologies. It aims to provide a platform for the exchange of research and ideas that can contribute to the improvement of public health in resource-limited settings. In summary, Infectious Diseases of Poverty aims to address the urgent challenges posed by infectious diseases in impoverished populations. By publishing high-quality research in various areas, the journal seeks to advance our understanding of these diseases and contribute to the development of effective strategies for prevention, diagnosis, and treatment.
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