Abstract
BackgroundThe China National Health Commission-Gates TB Project Phase III implemented a comprehensive TB control model including multiple interventions to address the burden of drug-resistant TB (DRTB). This study aims to evaluate the quality of DRTB clinical services and assess the financial burden of DRTB patients during the intervention period.MethodsA mixed-methods approach was used to evaluate the effectiveness of interventions in the three project provinces: Zhejiang, Jilin and Ningxia Hui Autonomous Region. The quantitative data included de-identified DRTB registry data during 2015–2018 in project provinces from China CDC, medical records of DRTB patients registered in 2018 (n = 106) from designated hospitals, and a structured DRTB patient survey in six sample prefectures in 2019. The quality of clinical services was evaluated using seven indicators across patient screening, diagnosis and treatment. Logistic regression was conducted to explore factors associated with the extremely high financial burden. Semi-structured in-depth interviews with policymakers and focus group discussions with physicians and DRTB patients were conducted to understand the interventions implemented and their impacts.ResultsThe percentage of bacterially confirmed patients taking a drug susceptibility test (DST) increased significantly between 2015 and 2018: from 57.4 to 93.6% in Zhejiang, 12.5 to 86.5% in Jilin, and 29.7 to 91.4% in Ningxia. The treatment enrollment rate among diagnosed DRTB patients also increased significantly and varied from 73 to 82% in the three provinces in 2018. Over 90% of patients in Zhejiang and Jilin and 75% in Ningxia remained in treatment by the end of the first six months’ treatment. Among all survey respondents 77.5% incurred extremely high financial burden of treatment. Qualitative results showed that interventions on promoting rapid DST technologies and patient referral were successfully implemented, but the new financing policies for reducing patients’ financial burden were not implemented as planned.ConclusionsThe quality of DRTB related clinical services has been significantly improved following the comprehensive interventions, while the financial burden of DRTB patients remains high due to the delay in implementing financing policies. Stronger political commitment and leadership are required for multi-channel financing to provide additional financial support to DRTB patients.
Highlights
The China National Health Commission-Gates TB Project Phase III implemented a comprehensive TB control model including multiple interventions to address the burden of drug-resistant TB (DRTB)
Stronger political commitment and leadership are required for multi-channel financing to provide additional financial support to DRTB patients
Study sites The study was conducted in the three project provinces where the Gates TB Project Phase III was implemented: Zhejiang, Jilin, and the Ningxia Hui Autonomous Region (( referred to as Zhejiang Province (ZJ), Jilin Province (JL) and NX), and these sites were selected according to their range in socioeconomic development in order to examine the effects of interventions in different resource settings
Summary
According to the World Health Organization (WHO), 3.3% of new TB patients and 18% of previously treated patients developed rifampicin-resistant TB (RRTB) in 2019, including multidrug resistant TB (MDR-TB). China together with India accounted for 41% of global gaps between the number of RR/MDR-TB patients enrolled in treatment and the estimated number of new cases as reported by the WHO [2]. The standard treatment for RR/ MDR-TB patients is expensive and time-consuming, and the accessibility of quality treatment has been challenging in developing countries [7, 8]. According to the WHO, the treatment success rate for RR/MDR-TB patients in China who started on second-line treatment was 54% in 2017 [17]
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