| Objective:The objective of this study is to analyze and explore associated factors with treatment management and effectiveness of migrant tuberculosis (TB) cases in shanghai, in order to provide recommendations to further improve TB prevention and control work among migrants.Methods:Both quantitative and qualitative methods were used in the study.1. Analysis of policy documentsAnalysis of policy documents to understand the implementation process of TB prevention and control work among migrant in shanghai.2. Quantitative researchThe quantitative data were derived from TB Management Information System, which included information about all TB cases from2006to2010in shanghai. To describe the status of incidence, treatment management and treatment effectiveness of TB cases among migrants and local residents, and to analyze the epidemic characteristics and control effectiveness of migrant TB cases and explore the associated factors, and to evaluate the effectiveness of the integrated TB control measures among migrants in shanghai.3. Qualitative interviewsQualitative interviews on policies implementation and response both from providers and administrators were carried.Results:1. Epidemic characteristics of migrant TB cases in shanghaiFrom2006to2010, the epidemic situation of TB among local residents has been basically stable, while both the registration rate of active TB cases and that of smear-positive TB cases among migrants decreased significantly, which were still higher than that among local residents. The migrant TB cases occupied about45%of the total TB cases in2010with a tendency to continuously go up. The epidemic characteristics of migrant TB cases were as follows:There were more males than females among migrant TB cases, and the proportion of females among migrant TB cases were higher than that among local residents. The majority of TB cases were the youth among migrants, while that were in middle-aged and aged among local residents. Distribution of occupation was different among migrant and local resident TB cases. Among the migrant TB cases, the most cases were workers (about45%), house helper and home maker/the unemployed followed (about20%).The smear-positive rate was about40%among migrant TB cases and45%among local resident TB cases. Among smear-positive TB cases, the proportion of migrants showed tendency to ascend, which reached44.1%in2010. Initially treated proportion was about90%among migrant TB cases, which was a bit higher than that among local resident TB cases.2. Integrated control measures of TB among migrants in shanghaiTB management network in Shanghai was based on municipal, district and community level organizations, and the current management model of TB control in Shanghai consisted of CDC, designated TB hospital and community health services center. The management model laid stress on looking the TB cases as the center, and fulfilled the advantage of cooperation between institutions at all levels to improve the efficiency of TB control work, while fully strengthened the role of general hospitals in case detection. On the basis of current management model network of TB control, TB management network operation manly included case detection, registration and report, diagnosis and treatment, supervision of chemotherapy, health education, and so on.The services and reduction policies migrant TB cases received in Shanghai were the same as that received by the local resident TB cases. Deductible expenses for TB diagnosis and treatment in Shanghai have been increasing, and the object of reduction policy extended from smear-positive TB cases, smear-negative TB cases to TB suspected cases, while the scope of reduction expanded from first-line anti-tuberculosis drugs, sputum examination, chest X-ray examination and liver function test to second-line anti-tuberculosis drugs and Liver-protecting drugs. Besides, a project was launched in some districts in Shanghai that all TB migrant cases in the project districts received transportation subsidy and living allowance.3. Treatment management and effectiveness of migrant TB cases in shanghaiFrom2006to2010, both the accumulative sputum examination rate at the end of the2nd and3rd month of smear-positive TB cases among migrants and local residents showed an upward tendency, ascent scope of which were20%and10%respectively. Treatment success rate of migrant TB cases showed a tendency to continuously go up, which rose from70.1%in2006to87.9%in2010, while treatment success rate of local resident TB cases appeared to have a decline trend after an initial ascent. From2006to2009, treatment success rate among migrant TB cases has been lower than that among local resident TB cases, and the difference of them showed a shrinking trend, which reduced from16.3%in2006to1.3%in2009, while treatment success rate among migrant TB cases is a bit higher than that among local resident TB cases. Among migrant PTB cases, treatment success rate among smear-positive TB cases has been lower than that among smear-negative TB cases from2006to2010, which were69.2%and70.7%in2006respectively, while that were85.2%and89.7%in2010respectively. From2008to2010, systematic management rate among migrant TB cases has been a bit lower than that among local resident TB cases, which suggested that there still existed some difficulties in the management of migrant TB cases.4. Analysis of the factors associated with treatment management and effectiveness of migrant TB cases in shanghaiMultivariate unconditional logistic regression was run on different dependent variables (accumulative sputum examination rate at the end of the2nd and3rd month or not; systematic management or not; treatment success or not) respectively, and independent variables included in logistic model were:sex; age; occupation; therapy classification; diagnosis classification; district group; time; interaction between district group and time. All statistical tests use a=0.05as level of inspection. Results of logistic regression analysis showed that:(1) Age, sex, therapy classification and time had significant relationship with accumulative sputum examination rate at the end of the2nd and3rd month of smear-positive migrant TB cases:the older TB cases got, the lower accumulative sputum examination rate at the end of the2nd and3rd month was (OR=0.992); accumulative sputum examination rate at the end of the2nd and3rd month among males was lower than that among females (OR=0.737); accumulative sputum examination rate at the end of the2nd and3rd month among re-treated TB cases was higher than that among initially treated TB cases (OR=1.528); accumulative sputum examination rate at the end of the2nd and3rd month in2010was higher than that in2006(OR=3.240).(2) Occupation, therapy classification and diagnosis classification had significant relationship with systematic management rate of migrant TB cases:compared with workers, systematic management rate among house helper and home maker/the unemployed was higher (OR=2.136); systematic management rate among re-treated TB cases was lower than that among initially treated TB cases (OR=0.529); systematic management rate among smear-positive TB cases was lower than that among smear-negative TB cases (OR=0.526).(3) Age, sex, occupation, diagnosis classification and time had significant relationship with treatment success rate among migrant TB cases:the older TB cases got, the lower treatment success rate was (OR=0.991); treatment success rate among males was lower than that among females (OR=0.762); compared with workers, treatment success rate among the retired was lower (OR=0.628), and that among cadre staff was higher (OR=2.251); treatment success rate among smear-positive TB cases was lower than that among smear-negative TB cases (OR=0.848); treatment success rate in2010was higher than that in2006(OR=3.178).Qualitative interviews with TB control staff revealed that the problem of the migrants living in shanghai is the uncertainty of continuing their treatment in shanghai as some of them lose their jobs as soon as they contract TB, on the other hand, they lack necessary care and attention from their family during their treatment process which makes it more difficult for them to continue staying in shanghai, and so on. The transportation subsidy and living allowance provide for the migrant TB cases could have some help on the home visits, since TB cases tended to trust in medical staff after they received the subsidy.Conclusions:1. TB control in migrants is still the focus of urban TB control;2. The integrated TB control measures among migrants in shanghai brings about a striking effectiveness;3. Demographic characteristics are associated with treatment management and effectiveness of migrant TB cases. Patients with poor treatment compliance and low treatment success rate tend to be in man and the elderly, which also vary in different occupation;4. The classification of diagnosis is associated with treatment management and effectiveness of migrant TB cases;5. The classification of therapy is associated with treatment management of migrant TB cases. Recommendations:1. Continue to take the integrated measures for TB control among migrants, which should be administrated by the government;2. Continue to invest transportation subsidy and living allowance for migrant TB cases, and optimize of the subsidy implementation plan;3. Strengthen the supervision and management of migrant TB cases, and enhance their treatment compliance;4. Strengthen the policy advocacy and the health education for different characteristics of migrants. |
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