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Multicenter Study
. 2021 Jan 19;10(1):8.
doi: 10.1186/s40249-021-00793-9.

Impact of multiple policy interventions on the screening and diagnosis of drug-resistant tuberculosis patients: a cascade analysis on six prefectures in China

Xiao-Yan Ding #  1 , Wen-Hui Mao #  2 , Wei Lu  1 , Hao Yu  1 , Qiao Liu  1 , Peng Lu  1 , Hui Jiang  3 , Xing Zhang  4 , Feng Lu  5 , Jie Xu  6 , Chong-Qiao Zhong  7 , Jin-Liu Hu  8 , Wei-Xi Jiang  9 , Lei Guo  2 , Sheng-Lan Tang  10 , Li-Mei Zhu  1
Affiliations
Multicenter Study

Impact of multiple policy interventions on the screening and diagnosis of drug-resistant tuberculosis patients: a cascade analysis on six prefectures in China

Xiao-Yan Ding et al. Infect Dis Poverty. .

Abstract

Background: The detection of drug-resistant tuberculosis (DR-TB) is a major health concern in China. We aim to summarize interventions related to the screening and detection of DR-TB in Jiangsu Province, analyse their impact, and highlight policy implications for improving the prevention and control of DR-TB.

Methods: We selected six prefectures from south, central and north Jiangsu Province. We reviewed policy documents between 2008 and 2019, and extracted routine TB patient registration data from the TB Information Management System (TBIMS) between 2013 and 2019. We used the High-quality Health System Framework to structure the analysis. We performed statistical analysis and logistic regression to assess the impact of different policy interventions on DR-TB detection.

Results: Three prefectures in Jiangsu introduced DR-TB related interventions between 2008 and 2010 in partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) and the Bill & Melinda Gates Foundation (Gates Foundation). By 2017, all prefectures in Jiangsu had implemented provincial level DR-TB policies, such as use of rapid molecular tests (RMT), and expanded drug susceptibility testing (DST) for populations at risk of DR-TB. The percentage of pulmonary TB cases confirmed by bacteriology increased from 30.0% in 2013 to over 50.0% in all prefectures by 2019, indicating that the implementation of new diagnostics has provided more sensitive testing results than the traditional smear microscopy. At the same time, the proportion of bacteriologically confirmed cases tested for drug resistance has increased substantially, indicating that the intervention of expanding the coverage of DST has reached more of the population at risk of DR-TB. Prefectures that implemented interventions with support from the Global Fund and the Gates Foundation had better detection performance of DR-TB patiens compared to those did not receive external support. However, the disparities in DR-TB detection across prefectures significantly narrowed after the implementation of provincial DR-TB polices.

Conclusions: The introduction of new diagnostics, including RMT, have improved the detection of DR-TB. Prefectures that received support from the Global Fund and the Gates Foundation had better detection of DR-TB. Additionally, the implementation of provincial DR-TB polices led to improvements in the detection of DR-TB across all prefectures.

Keywords: China; Diagnosis; Drug-resistant tuberculosis; Policy impact; Screen.

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Conflict of interest statement

Sheng-Lan Tang is the deputy Editor-in-Chief of the journal Infectious Diseases of Poverty. He was not involved in the peer-review or handling of the manuscript. The authors have no other competing interests to disclose.

Figures

Fig. 1
Fig. 1
Timeline of major policies and interventions on the screening and diagnosis of DR-TB in Jiangsu, 2008–2019. Notes: DST: drug susceptibility testing; DR-TB: drug-resistant tuberculosis; RMT: rapid molecular tests; Global Fund project: Global Fund to Fight AIDS, Tuberculosis and Malaria
Fig. 2
Fig. 2
Average testing time for the diagnosis of DR-TB (days) in six prefectures of Jiangsu, 2013–2019
See this image and copyright information in PMC

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