Over the past two decades, China has expanded the use of the tuberculosis (TB) control strategy recommended by the World Health Organization (WHO) across the country. This approach helped China meet its TB-related UN Millennium Development Goal — to reduce TB prevalence and mortality by half between 1990 and 2015 — five years ahead of the target date.
However, challenges remain huge. According to the WHO, China today still has the third-largest tuberculosis epidemic, with around 900,000 newly developed tuberculosis (TB) cases each year. In addition, China has about one-fifth of the world’s cases of multidrug-resistant TB (MDR-TB), which is especially difficult and costly to treat.
In 2009, we collaborated with the Ministry of Health (now the National Health Commission, NHC) to kick off a joint six-year TB control program to develop and demonstrate innovative TB control models that can help China further reduce the number of patients who develop TB, particularly MDR-TB.
The model piloted during the first phase of the program (2009-2012) focused primarily on MDR-TB. It identified nine times more MDR-TB cases than the existing system, shortened the time required for diagnosis and treatment initiation by 90 percent, reduced premature discontinuation of treatment by 90 percent, and reduced patients’ share of costs by 80 percent. These results have been praised by the WHO as a global model for addressing the threat of MDR-TB.
The second phase of the program (2013-2015) expanded this model into a comprehensive approach for all TB cases that includes integration with health systems, creative financing mechanisms, and the use of new tools such as molecular diagnostics and medication monitors. This model was piloted in the three prefecture-level cities of Zhenjiang, Yichang and Hanzhong, benefiting about 14 million people.
We are now in the third phase of the collaborative program (2016-2018). We are scaling up the comprehensive TB control model developed and piloted during the previous phases in the Zhejiang, Jilin and Ningxia provinces with a total population of 90 million. This phase intends to help the three provinces streamline the collaboration among hospitals, centers for disease control and prevention and the primary healthcare units at all levels for TB care, to apply molecular diagnostics for universal TB drug susceptibility testing and electronic medication monitors for case management, and to carry out new financing and payment reform to reduce TB patients’ catastrophic medical expenditures. This phase will also highlight important innovations in information and communications technologies, such as updating the national TB information system to capture TB patients’ information from hospitals and primary healthcare units and establishing an e-learning and certification system for TB related healthcare providers at all levels.