Abstract
BackgroundThe very high burden of rifampicin resistance tuberculosis (RR-TB) and the very low detection of RR-TB cases are a major challenge that China has been facing. This study analyzed the characteristics of RR-TB detection in China after the change of RR-TB detection strategy since 2015, aiming to provide reference and evidence for the development of more precise national drug resistance tuberculosis prevention and control policy.MethodsWe extracted data related to rifampicin resistance screening from the national Tuberculosis Information Management System (TBIMS) from 2015 to 2019, and used descriptive research methods to analyze the screening rate of presumptive RR-TB, the number and duration of RR-TB patients detected and drug resistance testing methods in each year. Chi-square test was used to compare the differences in component ratio or rate between years, and Kruskal Wallis test was used to compare the differences in median days for detection of RR-TB patients in each year.ResultsA total of 68,200 RR-TB cases were detected during 2015–2019, of which 48.1% were new cases. The number and detection rate of RR-TB cases increased year by year, from 10 019 and 14.3% in 2015 to 18 623 and 28.7% in 2019, respectively. Of the bacteriologically confirmed TB cases, 81.9% were tested for RR in 2019, a considerable increase from 29.5% in 2015. In 2019, only 41.0% of RR-TB cases had fluoroquinolones (FQs) susceptibility testing performed, and this proportion has been declining year by year since 2016. The proportion of application of rapid molecular tools increased from 24.0% in 2015 to 67.1% in 2019, and the median days to obtain RR results was significantly shortened. In 2019, 76.0% of RR-TB cases were diagnosed as presumptive RR-TB in county-level hospitals.ConclusionsAfter China modified the RR-TB detection strategy, the screening rate of RR and the number of RR-TB cases increased significantly. The RR testing methods now predominantly utilize rapid molecular tools. However, comprehensive measures should be implemented to close the gap in the detection of RR-TB cases. It is imperative to take FQs susceptibility testing seriously and effectively strengthen the laboratory capacity of county-level hospitals.Graphical
Highlights
The very high burden of rifampicin resistance tuberculosis (RR-TB) and the very low detection of RR-TB cases are a major challenge that China has been facing
In order to better understand the changes of RR-TB detection in China after 2015 and provide evidence for the national drug-resistant TB prevention and control strategy, we present a review of the current status of RR-TB detection in China from 2015 to 2019 based on data of the national Tuberculosis Information Management System (TBIMS) [13]
This review focuses on the RR screening rate, the number of RR-TB cases detected, and the application of rifampicin resistance diagnostic tools as well as the change in the source of presumptive RR-TB cases
Summary
The very high burden of rifampicin resistance tuberculosis (RR-TB) and the very low detection of RR-TB cases are a major challenge that China has been facing. This study analyzed the characteristics of RR-TB detection in China after the change of RR-TB detection strategy since 2015, aiming to provide reference and evidence for the development of more precise national drug resistance tuberculosis prevention and control policy. Drug-resistant tuberculosis (TB) remains an important public health concern worldwide, especially rifampicin resistance TB (RR-TB). 465 000 RR-TB cases worldwide; 56% were undetected. The rifampicin resistance (RR) rates of new and retreated TB cases were 7.1% and 23.0%, respectively, which were higher than the global levels of 3.3% and 17.7% [2]. China initiated the Programmatic Management of Drug-resistant Tuberculosis (PMDT) in 2006 with the support of the Global
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