China TB Control Progress Report

The ninth Technical Advisory Group and National TB Programme Managers meeting for TB control

in the Western Pacific Region

Manila, Philippines9 -12 December 2014

TB Epidemiology in China• China ranks second among the 22 high burden countries. It was estimated

980,000 new TB patients, accounting for 13.2% of the 22 high burden countries and 61.3% of the Western Pacific Region in 2013.

• The estimated incidence rate of TB was 70/100000 in China which ranks 21st among the 22 high burden countries in 2013.

• In our national infectious internet report system 904, 434 PTB cases were reported with the reporting rate of 66.8/100,000 in 2013.

• Estimates of MDR-TB burden in 2013 was 54000 (MDR-TB cases among notified pulmonary TB cases) which ranks second and occupied 18% globally respectively in 2013.

Dramatic reductions in TB cases and deaths in China, 1990–2010

Incidence and notifications Prevalence Mortality

1990 1990 19902010 2010 2010

Halved in 20 years Cut almost 80%

Incidence falling 3.4%/year

Realizing the TB target of MDG in advance• Promoting WPR realizing the MDG targets which was the only area

achieved the global control targets

Major challenges• Severe TB epidemic

– High TB burden – High PTB prevalence： rural, western region, elderly– MDR-TB, TB/HIV and floating population

• TB control strategies and measures– Control of infection sources： early diagnosis is difficult and cost much– Patient care: whole-course treatment management and compliance is hard to

retain– Infection control： medical institutions and community both need to be

improved– Free medical insurance policy need to be established– TB related health service system need to be strengthened

• R & D– Diagnostic tools are not sensitive enough– The vaccine protection force are still insufficient– New anti-TB drugs are not available

• Insufficient fund and human resource of TB control • Laboratory capacity need strengthening

• MOH are planning for the assessment of NTP(2011-2015), then will develop NTP(2016-2020), establish our renewed strategy for TB control.

• Future national TB control strategy will target at reducing TB incidence and mortality and will be incorporated into the national health development plan.

• We will take every necessary measures to ensure achieving objectives of WHO End TB strategy.

• Future TB control will be based on ensuring drug sensitive TB patients get good health care service, while strengthening MDR-TB control as well.

National TB Strategy/Policies

国际项目

Funding sources from 2001 to 2013

Central government increased funding from 40 million in 2001 to 0.62 billion in 2013

Funds (RMB) for TB control was increased from 0.13 billion in 2001 to 1.4 billion in 2013

*Because of the GF project suspend payment, so there was a gap from GF funding in 2011.

RM

B (m

illion

)

0

200

400

600

800

1000

1200

1400

1600

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

year

Other

J I CA

GF

WB/ DFI D

Local Gov.

Cental Gov.

• Mechanism of the funding input: Strengthened all level government

commitment and funding input, multi-channel fund raising

Laboratory strengthening• Laboratory developing target by 2015

– All counties have ability of culture– All prefecture and provincial laboratories have ability of DST and

molecular test• Rapid DTS test equipment

– LED FM: 1523– Gene-xpert: 1054– HAIN LPA: 150

• Quality control methods– Blind rechecking, Proficiency test, Field Supervision

• Laboratory information management system– Integrated into National TB information management system

• TA partner– Hongkong SRL ,KIT

• Intensive case finding: National basic public health program did TB symptom screening for elderly people, diabetes patients .

• Enhancing screening of close contacts of SS+ TB patients, especially in schools, etc.

• Mutual screening in TB, HIV/ADIS cases. From 2007 to 2013， 1, 050, 000 TB patients received HIV test , 5530 were HIV positive. 730, 000 HIV/AIDS cases received TB examination, 22 thousands was TB/HIV.

• Enhancing trainings for TB diagnosis in children， making better plans for children’s TB control, establishing cooperation mechanisms with pediatric hospitals.

Reach the unreached

Surveillance• Using self-regulation of TB information system and site visit inspection

for quality control. Currently capture-recapture research were ongoing for sensitivity evaluation of our information system.

• New TB definitions has been discussed in national TB expert group, necessary changes will be done in our new TB control guideline and in TB information system.

• Guidebook for TB surveillance data analyzing and using has been published. NCTB release quarterly and yearly TB report according to data analyzing result. Sub-national institutions do the same thing. Occasional analyzing will be done responding to different need.

Design-stepwise approach • Current situation

– launched in October 2006. Till Sep. 2014, the PMDT in China cover 90 prefectures(27%) in 30 provinces, will cover 50% prefectures by 2015.

– Till November 2014, 14267 MDR-TB cases have been confirmed,9748 MDR-TB cases enrolled in treatment

• Barriers– Coverage need expanding– Screening rate was not high enough– Treatment management was difficult

• Priority actions– Adopting rapid screen methodology– Establishing prefecture level designated hospitals

Bold policies and supportive systems• National medical insurance system has covered TB diagnosis and

treatment partially, requiring NCMS to reach 70% reimbursement for TB outpatients and inpatients(including MDR-TB patients).

• National basic public health program will provide funding to primary health institutions, encouraging TB suspect referral, report and treatment management.

• Second-line anti-TB drugs have been included in the" National Essential Drugs List".

• MOH Issued "MDR-TB clinical path".

Patient centred care: involvement of patients and civil society

• Society mobilization− 3.24 TB publicity day− Millions of volunteer activities− In 2013, 240, 000 volunteers were motivated− Using social media like micro-blog to carry out health promotion

and information dissemination

• Incentive mechanism − Transport fee (in the project areas)− Nutritional supplement fee (in some areas)− Hardship allowance from civil affairs department

Thank you for your attention!