Drug-resistant tuberculosis control in China: progress and challenges

Qian Long,Henry Lucas,Yan Qu

doi:10.1186/s40249-016-0103-3

Abstract

BackgroundChina has the second highest caseload of multidrug-resistant tuberculosis (MDR-TB) in the world. In 2009, the Chinese government agreed to draw up a plan for MDR-TB prevention and control in the context of a comprehensive health system reform launched in the same year.DiscussionChina is facing high prevalence rates of drug-resistant TB and MDR-TB. MDR-TB disproportionally affects the poor rural population and the highest rates are in less developed regions largely due to interrupted and/or inappropriate TB treatment. Most households with an affected member suffer a heavy financial burden because of a combination of treatment and other related costs. The influential Global Fund programme for MDR-TB control in China provides technical and financial support for MDR-TB diagnosis and treatment. However, this programme has a fixed timeline and cannot provide a long term solution. In 2009, the Bill and Melinda Gates Foundation, in cooperation with the National Health and Family Planning Commission of China, started to develop innovative approaches to TB/MDR-TB management and case-based payment mechanisms for treatment, alongside increased health insurance benefits for patients, in order to contain medical costs and reduce financial barriers to treatment. Although these efforts appear to be in the right direction, they may not be sufficient unless (a) domestic sources are mobilized to raise funding for TB/MDR-TB prevention and control and (b) appropriate incentives are given to both health facilities and their care providers.SummaryAlong with the on-going Chinese health system reform, sustained government financing and social health protection schemes will be critical to ensure universal access to appropriate TB treatment in order to reduce risk of developing MDR-TB and systematic MDR-TB treatment and management.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0103-3) contains supplementary material, which is available to authorized users.

Highlights

China has the second highest caseload of multidrug-resistant tuberculosis (MDR-TB) in the world
In 2009, World Health Organization (WHO), the Bill and Melinda Gates Foundation and the Chinese Ministry of Health organized a ministerial meeting in Beijing calling for action to tackle TB and drugresistant tuberculosis (DR-TB) in 27 countries with a high burden of MDR-TB and extensively drug-resistant tuberculosis (XDR-TB) [5]
China reported a serious MDR-TB epidemic and agreed to draw up a plan for MDR-TB prevention and control in the context of a comprehensive health system reform launched in the same year

Summary

Discussion

China has the second highest caseload of MDR-TB in the world [1]. According to the National Survey of Drug-Resistant TB in 2007, one third of new TB cases and one half of previously treated cases exhibited antiTB drug resistance. In the context of a new round of Chinese health system reforms, the Bill and Melinda Gates Foundation in cooperation with the government of China started to develop innovative approaches to TB/MDR-TB prevention and control including 1) new MDR-TB diagnosis, treatment and management mechanisms; 2) increased health insurance benefits and a travel subsidy provided by the Civil Affair Bureau to remove financial barriers to access to treatment; 3) a case-based payment method to contain costs These efforts appear to be in the right direction, they may not be sufficient unless: 1) domestic sources are mobilized to raise funding for TB/MDR-TB prevention and control; and 2) appropriate incentives are given to both health facilities and their care providers.

Findings

Background