Contribution of operational research in China

National Center for TB Control and Prevention, China CDC

Jiang Shiwen2009.12.3 Cancun

Background

• China is one of high TB(MDR) burden countries in the world

TB Situation• Second largest number of TB patients in the world• 44.5% of the population infected TB • Internet-based Communicable Disease Reporting

System in 2008– 1.17 million TB patients reported, Ranks the

second largest diseases• Prevalence: 4.5 million PTB patients / 1.5 million

SS+ TB patients in 2000• 130,000 TB death in 1999• 120,000 MDR-TB cases occurred in 2008

Achievements of NTP main targets

Challenges for MDG

Millennium Development Goals

DOTS quality need to be improved

Insufficient supporting mechanism

Migrant, MDR-TB and TB/HIV

challenges

Weak infection control

Inadequatesocial mobilization

AddressingAddressingChallengesChallenges

What do we need to reach the MDG?

• DOTS quality need to be improved• Migrant, MDR-TB and TB/HIV challenges to

be solved• ……• Operational research is one very important

issues of our need?

Activities taken for operational research

• Established a operational mechanismSubmit the proposalsReview the proposalsSupervision of researchAudit the research reports

• Implemented operational researches

What do we done for operational research in China

• Epidemical survey• Socio – economic study on TB patients• Survey of the status of knowledge, attitude and

practice of TB among common people• M&E indicators• FDC treatment and drug management• MDR-TB• TB/HIV• Incentives• ……

Example of contribution of operational researches for NTP in China

• National random survey for the epidemiology of TB in 2000

• Socio – economic study on TB patients• Collaboration between hospitals and TB

dispensaries• M&E indicators

National random survey for the epidemiology of TB in 2000

• In order to realize the dynamic epidemiological situation of tuberculosis as well as to identify, access and evaluate the effect of the implementation of the national tuberculosis control program

• The first , the second and the third nationwide random sampling survey for the epidemiology of tuberculosis was conducted respectively in 1979,1990 and 2000

National random survey for the epidemiology of TB in 2000

Main results• In this survey, the prevalence of active,

smear positive and bacteriological positive pulmonary tuberculosis were 367/100,000, 122/100,000 and 160/100,000 respectively.

• The estimated numbers of patients for above-mentioned categories of pulmonary tuberculosis were 4.51 millions, 1.5 millions and 1.96 millions respectively.

• The annual reduction rate of the prevalence of SS+ pulmonary tuberculosis between 1979 and 2000 was 3.8% and it was 3.2% between 1990 and 2000. In general, the declining in the Country in the past twenty years was sluggish.

Utilization and contribution• To provide the information

to central government• State council issued the

NATIONAL TUBERCULOSIS CONTROL PROGRAME (2001 – 2010)

• Central government Increasing the funding from 5 million USD in 2001 to 76 million USD in 2009

Government financial input

• Harmonizing all available financial resources for NTP

• 2001-2008– Central government: 2.16 billion RMB Yuan– Local government: 2.0 billion RMB Yuan

National random survey for the epidemiology of TB in 2000

Results The prevalence of tuberculosis was higher in middle and western than the eastern areas. Utilization

Following activities are supporting for the middle and western areas.

Central government project

WB/DFID project GF project (R1,R4

and R8) JACA project DFB project

Socio – economic study on TB patients

Results • Among 1278 patients, the average annual income per

person of the families with tuberculosis patients who were engaged in countryside field occupation was 941 Yuan and 80% of them were lower than the average annual income per person at same locality in 2000

• Among 1278 patients, 91.9% had no any kind of medical insurance and have to pay medical expense by themselves.

• The various causes for escaping from clinical consultation, 55.2% of escaping was due to not mind by patients themselves and financial problem was the next cause (37.3%).

• The causes of irregular and/or interrupted treatment ,the main causes were economic difficulty (44.5%) and patients did not mind themselves (42.6%).

Utilization• Government

provide funding to free the diagnosis(X films and sputum smear examination) and TB drugs

All active PTB 1278 （ 100%）

With symptoms 1096 （ 85.8%)

Visited doctor 469 （ 49.1%）

Diagnosed TB 378 （ 29.6%）

Registered 93（ 7.3%）

Onion of case finding in China data from TB survey in 2000

Aim of case finding The thin-skinned onion

70%+

All active PTB 1278 （ 100%）

With symptoms 1096 （ 85.8%)

Visited doctor 469 （ 49.1%）

Diagnosed TB 378 （ 29.6%）

Registered 93（ 7.3%）

Based on the results to take the policies and strategies

Incentive basic medical staff to refer the TB symptom suspects

Training the medical staff to identify the TB symptom suspects

Implementing the refer and tracing strategy in medical institutes and TB dispensaries

NTP M&E indicators system in China

Results • Method Firstly ,drafted and listed the indicators

used the Brainstorming and expert experiences

Second, use the delphi method to product the indicators and indicator standard by experts in different level

• Results: the number of key indicators is 35 , : the number of assistant indicators is 38

Utilization• Put the

indicators to NTP indicators handbook