| multidrug-resistant tuberculosis (MDR-TB) has come to refer to cases in which the TB strain is resistant at least to isoniazid (INH) and rifampicin (RFP). Which with a long duration of treatment and high mortality rate, it's difficult and expensive to treat the disease, and the cure rates fall. According to WHO, China's emerging multi-drug resistant TB cases is the most in the world, accounting for the 25% global burden of MDR-TB. The prevention and treatment of MDR-TB has become the major problems in China. Although we has made remarkable successes in TB control and reach the stage of the global TB control targets. However, we has't establish appropriate prevention technology and management model in the country level yet target the MDR-TB control until now. The number of laboratories associated with MDR-TB is insufficient, the experts and technical personnel in the field of diagnosis, treatment and management are very scarce.The diagnosis, treatment and management of MDR-TB in nationwide is still groping in the exploratory stage. To this end, establish the treatment and management of MDR-TB model that suitable for the "national tuberculosis control program" level as soon as possible is imperative.Study ObjectiveThe objective of this research is to analyze the current status of diagnosis, treatment and management of MDR-TB in China, in order to provide basic information for improving the treatment effectiveness and make rational recommendations for the establishment of new treatment and management of MDR-TB model under the cooperation between hospitals with TB dispensary.Study MethodologyThis study selected Tianjin city, Daqing city of Heilongjiang province, Quzhou city of Zhejiang province, Wanzhou district of Chongqing city and Puyang city of Henan province as the project cities based on the MDR-TB baseline survey data, tuberculosis control levels, geographic distribution and socio-economic conditions. We choose the tuberculosis specialist hospitals in every project city as our research site, and investigate the MDR-TB patients and general patients who were treated in the tuberculosis specialist hospital. finally, we investigated 109 MDR-TB patients and 111 general patients in all. Also, we investigated the MDR-TB patients'medical record in the tuberculosis specialist hospital to understand the examination and treatment services provided by the hospital, finally, we investigated a total of 84 copies of hospital medical record. In addition, the study also interviewed the key figure of the Municipal Health Bureau, the TB control departments and the municipal specialist hospitals, finally, we interviewed 30 people in all.Both quantitative and qualitative analysis methods were used in the study, such as: descriptive analysis, chi-square test, rank sum test, multi-factor analysis to analyze the status of the diagnosis and treatment service that provided by the tuberculosis specialist hospitals to MDR-TB patients, the health-seeking behavior of MDR-TB patients and the management service they received, also, we analyze the financial burden and psychological status of MDR-TB patients.Study Results1) The behavior of seeing a doctor of the MDR-TB patientsIt is a common phenomenon that the majority of MDR-TB patients have repeated treatment in a number of medical institutions, The treatment is complicated for the patients, what's worse, there are many patients buying medicine in the drugstore, treating by themselves. To sum up, the process of treatment for MDR-TB patients is much more complex than general patients. According to the data, until the end of the investigation, the median treatment time of MDR-TB patients is 637 days, while the general patients'is 207 days, which is much more shorter than the MDR patients'. In addition, compare with general patients, MDR-TB patients always go to the hospital for much more times and for a longer time.2) The status of diagnosis and treatment for MDR-TB patientsNowadays, tuberculosis drug susceptibility testing(DST) has not been carried out widely. In the 5 project cities only Tianjin and Daqing are able to carry out DST to confirm MDR-TB patients, while the other three cities can not do DST because their laboratory equipment or conditions do not reach the standard. The cities which can do DST adopt slow sputum culture and traditional DST at present, which take a long time to get the result, generally need 2-3 months.At present, the majority of the MDR-TB patients can not get standard treatment. Judging the hospitals'treatment by using the way that whether the patients'medicine adjust the MDR-TB standard treatment, the result indicates that the proportion of MDR-TB patients who receive standard treatment is just 14.3%, and 73%patients even keep on using isoniazid or rifampicin after be diagnosed with MDR-TB3) The management of MDR-TB patientsIn addition to Henan, the other four regions have not carried out any measures about the cooperation between hospital and TB dispensary toward MDR-TB patients.The management for MDR-TB patients is loose now, there are only 29% patients receive directly observed therapy during their whole treatment. The proportion of patients who receive visit throughout the treatment is less than 40%. Nearly half of patients always forget to take medicine or even stop to take it. After being diagnosed with MDR, there are only 17%patients take medicine under doctor's observation. Besides,40%patients have not receive any forms of visit management after being diagnosed with MDR.The majority of the patients are not transferred to the TB dispensary after they leaving the specialty hospital, and they always lack effective management in the following treatment, and the treatment becomes individual behavior.4) The cost of medical care and financial burden of MDR-TB patients.MDR-TB patients bring a heavy financial burden to their family as the treatment of tuberculosis. The total medical cost of the MDR-TB patients is 22500 yuan, which accounts for 116%of the annual non-food expenditure.90%of MDR-TB patients had a catastrophic medical expenses due to treatment of tuberculosis. The total medical costs before diagnosis were 11900 yuan; while the total medical costs after diagnosis were 15600 yuan, and the daily costs were 38 yuan. Medical insurance may be alleviate the patient's financial burden to some extent. The ratio of medical cost to non-food expenditure reduce from 131%before compensation to 74%after compensation, and the ratio of catastrophic expenditures cut down from 93%to 84%, but most patients are still suffering a heavy financial burden.5) The mental health status of Multi-drug resistant tuberculosis patientsBecause the MDR-TB patients treated TB repeatedly, and the expense is high, though the effect is poor, which influence the patients mental health to a certain extent. Their risk of suffering from mental disorders were significantly higher than general patients. There are 39%of MDR-TB patients with high or higher risk of suffering from mental disorders, compared with 15%of general patients. It also prompted that when develop MDR-TB control strategy, we should emphasis on the patient's psychological support.Suggestions1) Strengthen the capacity building of municipal tuberculosis specialist hospital laboratories from the device inputs, technology and personnel training, and develop novel technologies for rapid detection of drug resistance gradually.2) Establish and recommend standardized MDR-TB diagnostic and treatment practices, standardize the MDR-TB treatment in the municipal tuberculosis specialist hospitals.3) Strengthen the cooperation between the tuberculosis specialist hospitals and TB dispensary, especially the management after patients leave the hospital, enable the patients can be incorporated into the formal management system in the outpatient treatment phase.4) Explore various forms of compensation mechanisms in the basis of existing medical insurance, design special compensation measures target MDR-TB patients to alleviate their burden of disease.5) Strengthen patient-center care and psychological counseling for MDR-TB patients to increase their confidence in curing TB.
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