The impact of directly-observed treatment on the epidemiology of tuberculosis in Beijing

Abstract

Setting: Fully supervised chemotherapy, or directly observed treatment (DOT), for newly detected smear-positive cases in Beijing, has been successfully implemented for two decades.

Objective: To evaluate the progress made in tuberculosis control, and in particular to evaluate the impact of DOT on tuberculosis epidemiology in Beijing.

Design: Epidemiological parameters on tuberculosis, consisting of mortality, prevalence, notification rate, tuberculous meningitis in children and initial drug resistance rate, were collected and analysed. Their trends were evaluated and compared with DOT implemented for new smear-positive cases in Beijing from 1978 to 1996.

Results: The coverage of DOT for new smear-positive pulmonary tuberculosis cases has increased from 10% in 1978 to more than 90% since 1990. Since DOT was introduced in 1978, mortality from tuberculosis has declined by an average of more than 7% per year. The reduction rate of 17.2%, and the rates of chronic cases and tuberculous meningitis in children decreased dramatically. The rate of newly registered smear-positive cases decreased from 18.9/100000 in 1986 to 7.3/100000 in 1996, giving an average annual reduction rate of 9.1 during this period. Initial resistance to isoniazid and streptomycin decreased from respectively 13.9% and 12.3% in 1978-1979 to 4.2% and 5.8% by 1996. The level of multidrug resistance was low and stable, at 0.8% in 1996.

Conclusion: The experience of the Beijing tuberculosis control programme convincingly demonstrates that it is possible to improve the epidemiological situation rapidly in a low-income country, at very low cost and in a manner that is self-sufficient and sustainable.