Abstract
Objectives To examine changes in the screening, diagnosis, treatment and management of drug-resistant tuberculosis (DRTB) patients, and investigate the impacts of DRTB-related policies on patients of different demographic and socioeconomic characteristics. Design A retrospective cohort study using registry data, plus a survey on DRTB-related policies. Setting All prefecture-level Centres for Disease Control in Zhejiang Province, China. Main outcome measures Alongside the care cascade, we examined: (1) reported number of presumptive DRTB patients; (2) percentage of presumptive patients with drug susceptibility testing (DST) records; (3) percentage of DRTB/rifampicin-resistant (RR) patients registered; (4) percentage of RR/multidrug-resistant TB (MDRTB) patients that received anti-DRTB treatment; and (5) percentage of RR/MDRTB patients cured/completed treatment among those treated. Multivariate logistic regressions were conducted to explore the impacts of DRTB policies after adjusting for other factors. Results The number of reported presumptive DRTB patients and the percentage with DST records largely increased during 2015-2018, and the percentage of registered patients who received anti-DRTB treatment also increased from 59.0% to 86.5%. Patients under the policies of equipping GeneXpert plus expanded criteria for DST had a higher likelihood of being registered compared with no GeneXpert (adjusted OR (aOR)=2.57, 95% CI: 1.20 to 5.51), while for treatment initiation the association was only significant when further expanding the registration criteria (aOR=2.38, 95% CI: 1.19 to 4.79). Patients with registered residence inside Zhejiang were more likely to be registered (aOR=1.96, 95% CI: 1.52 to 2.52), treated (aOR=3.83, 95% CI: 2.78 to 5.28) and complete treatment (aOR=1.92, 95% CI: 1.03 to 3.59) compared with those outside. Conclusion The policy changes on DST and registration have effectively improved DRTB case finding and care. Nevertheless, challenges remain in servicing vulnerable groups such as migrants and improving equity in the access to TB care. Future policies should provide comprehensive support for migrants to complete treatment at their current place of residence.
| Original language | English |
|---|---|
| Article number | e047023 |
| Journal | BMJ Open |
| Volume | 11 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 12 Apr 2021 |
Bibliographical note
Publisher Copyright:© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
Funding
1Global Health Research Center, Duke Kunshan University, Kunshan, China 2Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China 3School of Business and Economics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands 4Duke Global Health Institute, Duke University, Durham, North Carolina, USA 5National Center for Tuberculosis Control and Prevention, Centers for Disease Control and Prevention, Beijing, China 6Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Duivendrecht, The Netherlands Acknowledgements This paper is part of the outputs emanating from the program entitled 'China National Health and Family Planning Commission and the Gates Foundation TB Project (Phase III)'—a collaboration between the Government of China and the Bill and Melinda Gates Foundation, and implemented by the China Center of Disease Control and Prevention (CDC). The authors of the paper also gratefully acknowledge the officers in Zhejiang Provincial CDC and the 11 prefectural CDCs for helping with collecting drug-resistant tuberculosis related policies in Zhejiang. Contributors The study was designed by WJ, ST, CE and FC. FH, YP, XW, BC and WJ coordinated and conducted data collection. WJ conducted the literature review and wrote the manuscript as the first author. ST, CE, BC and FC provided suggestions on data analysis framework and data interpretation, and also revised the manuscript. All authors reviewed the draft manuscript, provided comments on the finalisation of the manuscript and have read and approved the manuscript in its current state. Funding The work was supported by the Bill and Melinda Gates Foundation (grant number: OPP1149395). Competing interests None declared. Patient consent for publication Not required.
| Funders | Funder number |
|---|---|
| Government of China | |
| Centers for Disease Control and Prevention | |
| Bill and Melinda Gates Foundation | OPP1149395 |
| National Health and Family Planning Commission of the People's Republic of China | |
| Duke Kunshan University |
Keywords
- health policy
- health services administration & management
- tuberculosis
