Comparative Study On The Effects Of MDR-TB Prevention And Control Project Around And After Global Fund In Shandong Province

BackgroundChina is one of the top 30 high TB burden countries and also one of the top 30 high MDR-TB burden countries.MDR-TB is difficult to cure and requires about 2-year treatment with a costly second-line regimen.MDR-TB possesses the character of both low cure rate and high mortality.China Global Fund MDR-TB Control Program in Shandong Province(hereinafter referred to as GFP)started from February 2009,and the cities covered by GFP such as city A and city D completed the arrangement of designated hospital and started MDR-TB control work,which greatly enhanced the MDR-TB control work in Shandong.The program came to an end in June 2014.Therefore to do the comparative study on the effects of MDR-TB prevention and control around and after GFP,and propose relative countermeasures and suggestions were quite significant for the MDR-TB policy improvement.ObjectiveGlobal Fund MDR-TB Control Program reports and information from Shandong TB Management Information System were collected to do the comparative study on the effects of MDR-TB prevention and control around and after GFP.So related suggestions and strategies would be proposed.Reference basis would be provided for decision makers and administrators in improving multidrug-resistant TB prevention and control in Shandong province.MethodsThis study selects 5 cities which were chosen as studied cities since 2009.The 5 cities were city A,B,C,D and E.To analyze the work of TB screening,case detection,treatment and patients'management by doing the effects comparison research during the implementation of GFP and after.Data collection includes GFP reports and information from TB Management Information System.Field research for information check and interviewing directors of prefectural TB institutions were also included.Data analysis was done through Excel and SPSS 21.0.Results1.The basic situation of study area.The five cities covered at the beginning of GLF from 2009,possess 44 counties and a population of 31,026,000.The model of TB control on municipal level of the five cities was the combination of the designated hospital and TB control center2.The work of MDR-TB screening,treatment and prognosis around GFPThe MDR-TB screening rate based on sputum culture was 36.3%,and confirmed diagnosis rate was 7.6%.479 accepted the treatment from designated medical institutions,which took 71.7%among the confirmed MDR-TB cases.From 2010.7 to 2012.3,297 MDR-TB patients accepted the treatment,among whom 104 cured and completed the treatment,getting a successful treatment rate of 35%.The TB screening rate of city C was the lowest in the 5 targeted cities.MDR-TB screening work system didn't play its full function in city C,which affected local TB control work.3.The work of MDR-TB screening,treatment and prognosis after GFPTotally 11024 smear positive patients were found during the period.Among them 5548 got sputum culture test and 265 patients were confirmed MDR-TB.265 patients get treatment from the fixed designated medical institutions,which took a percentage of 58.5%.The TB screening rate was 50.3%and TB confirmed diagnosis rate was 4.8%.155 patients accepted regular treatment,getting a rate of treatment of 58.5%.The successful treatment rate of city Dand city E was comparatively lower and the loss ratio and death rate of the two cities were higher than the other targeted area.The loss control on patients chosen was to blame for the unsatisfied patients' treatment.4.Comparison of the TB work of case detection,treatment and results around and after GFPThe TB screening rate during GFP and after had statistical significance(x2=621.9,P<0.05).The related index on MDR-TB control in Tuberculosis Control Program in Shandong played a vital role in enhancing TB screening work.TB screening work in city A and city D went down after GFP,which was affected by the performance of TB control fund.The case detection rate during GFP and after had statistical significance(x2=44.78,P<0.05).It showed that the new smear positive TB patients' takes a bigger part in the screened TB patients after the pilot program.The rate of receiving treatment during GFP and after had statistical significance(?2=15.218,P<0.05),which showed that lack of capital and medicine,and insufficient medical insurance were negative factors in this field.Treatment quality see a great improvement.The rate of treatment completion was beyond 50%after GFP,which possessed statistical significance(?2=10.936,P<0.05)· Performance of GFP provided rich experiences in patients'treatment and management,which promoted the patients treatment work in targeted area.While the MDR-TB treatment work in city B went down.The low efficiency of Basic Public Health service was to blame for this.Conclusions and suggestionsGFP provided precious experience for MDR-TB control work in Shandong and the experience was still helpful in the later years.After GFP,the former five cities continued to carry out the MDR-TB control work.A work system on MDR-TB case detection was developed,which played an essential part in local TB control work scheme.While the MDR-TB work system had no restraining force on the designated hospitals.The rural doctors'service quality was also important factor affecting patients'treatment compliance.Basic public health service contained TB control work,while medical staff of towns and villages played a limited role on TB patients' management.Shandong Tuberculosis Control Program played a leading role in guiding the MDR-TB control work in Shandong.According to the above conclusion,suggestions were made below.Strengthen leadership development and formulate policy on MDR-TB sustainable development.Be realistic when formulating policy at provincial level and avoid merely seeking numbers.Increase special funds for TB control,make feasible funds expenditure scheme.Assure the high quality and persistent second-line medicine support;Rationalize the relationship between TB control institution and designated hospital.Try to make a feasible compensation scheme for designated medical institutions.Providing beneficial policy for designated medical institution for their TB treatment,such as outpatient,ward,lab and so on.Promote the use of molecular biology to find active TB patients from sputum smear negative patients.Seek support for medical insurance on TB treatment.To cooperate with basic public health service on TB control.