The Effect And Evaluation For Interventions To Vulnerable People Of TB Control Project In China

Objective: this study aims to review the policies, documents, intervention or activities adopted in the past and on-going TB control programs which aim to improve the obtaining and utilization of TB service for poor and vulnerable people, and to assess the impacts and influences of these projects to provide evidences and suggestions for the future work of TB prevention and treatment.Methods: Referring to the methods of systematic evaluation in basic evidence medicine, taking systematic review and assessment of the literature with combination of qualitative study. Literature review and assessment includes collecting both published and unpublished TB control programs and equity-related study materials of China. Make comprehensive and systematic literature research and systematic review for the published literature while get the unpublished materials from relevant units, institutions and websites. Unpublished materials include relevant policies, documents, implementation schemes, mid-term reports, process reports, end-up reports and so on. Extract relevant information with data extraction lists. Qualitative study includes key-informant interviews to national TB prevention and treatment officials, experts in the field and administrators in TB prevention and control institutions at both province/city and county levels and in-depth interviews for health workers and health services users. Make framework analysis of the qualitative materials. Comprehensively and systematically analyze the impact and influence of the intervention initiatives/activities.Results: This research included 25 published literatures, 45 unpublished data, and 25 qualitative interviews. It shows that the operational research is an important part of implementation of the new Stop TB Strategy, which content is related to Chinese TB control problems that remain to be resolved. The TB prevention and control implementation of the project that the Supply-side supported tend to invest more in western poor areas, the same as National TB control policy of the current environment. In the project, health system interventions mainly reflected in improved health system construction, include improving institution-building to strengthen TB control, improving service system; strengthening the training of personnel to improve TB control capacity; conducting discovery,treatment and management for patients through various ways such as establishing the incentives, referrals, offering free diagnosis and treatment, carrying out tracing and the direction management to the patient, they trying to bring pulmonary tuberculosis into the new rural cooperative medical care chronic disease management in some areas. The project interventions and the overall effect of activities is significant. However, the TB interventions focused on poor and vulnerable groups is inadequate.Conclusion: The interventions and the overall effect of activities of this project are significant, but it is still inadequate in intervention design for the poor and vulnerable people. From the published,unpublished data and qualitative research, the data registration, verification and monitoring hasn't been fully carried out, information data is not complete and enough reliable. These studies less considered in comparable control, lack of detailed investigation before and after intervention and qualitative and quantitative survey methods. Various projects and measures of TB control are overlapping implemented; and there are too many social, economic, and cultural factors influenced TB control. These brought difficulties for the effect evaluation. It is shown in the interview of national TB control experts and local tuberculosis administrator that it is difficult in evaluating a single intervention or a single outcome. As disease control usually adopted integrated control strategy, to better carry out TB control interventions focused on poor and vulnerable people and evaluate its effect, we need to design scientifically, strengthen quality control and supervision in intervention implementation, collect information well and establish an indicator evaluation system, and develop a good evaluation methodology. Therefore, we can carry out comprehensive evaluation and scientifically summarize and share the intervention effect in time.