Tuberculosis control in China: use of modelling to develop targets and policies.

Hsien-Ho Lin,Christopher Dye,Daniel P Chin,Yunzhou Ruan,Hui Zhang,Lixia Wang

doi:10.2471/blt.15.154492

Abstract

It is unclear if current programmes in China can achieve the post-2015 global targets for tuberculosis – 50% reduction in incidence and a 75% reduction in mortality by 2025. Chinese policy-makers need to maintain the recent decline in the prevalence of tuberculosis, while revising control policies to cope with an epidemic of drug-resistant tuberculosis and the effects of ongoing health reform. Health reforms are expected to shift patients from tuberculosis dispensaries to designated hospitals. We developed a mathematical model of tuberculosis control in China to help set appropriate targets and prioritize interventions that might be implemented in the next 10 years. This model indicates that, even under the most optimistic scenario – improved treatment in tuberculosis dispensaries, introduction of a new effective regimen for the treatment of drug-susceptible tuberculosis and optimal care of cases of multidrug-resistant tuberculosis – the current global targets for tuberculosis are unlikely to be reached. However, reductions in the incidence of multidrug-resistant tuberculosis should be feasible. We conclude that a shift of patients from tuberculosis dispensaries to designated hospitals is likely to hamper efforts at tuberculosis control if cure rates in the designated hospitals cannot be maintained at a high level. Our results can inform the planning of tuberculosis control in China.

Highlights

In China, between 1990 and 2010, the prevalence of smearpositive tuberculosis and tuberculosis-related mortality fell by 63% and 80%, respectively – one of the most rapid declines in tuberculosis morbidity and mortality in the world.[1]. These improvements have primarily been attributed to the nationwide scale-up of a tuberculosis control programme using short-courses of directly observed treatment, implemented by the Chinese Center for Disease Control and Prevention (CCDC).1Between 2000 and 2010, this scale-up was associated with a substantial increase in the proportion of people treated by the Chinese CDC and this increase appears to have played a critical role in reducing tuberculosis prevalence
The Chinese CDC system generally diagnoses and treats patients according to national guidelines on tuberculosis control
As in scenario 3A, all patients in the hospital system were shifted to the Chinese CDC system, the reductions in tuberculosis incidence and mortality would be improved to 15.6% (95% credible intervals (CrI): 12.9 to 19.6%) and 22.3% (95% CrI: 18.4 to 27.9%;), respectively, by 2025 (Table 1)

Summary

Introduction

In China, between 1990 and 2010, the prevalence of smearpositive tuberculosis and tuberculosis-related mortality fell by 63% and 80%, respectively – one of the most rapid declines in tuberculosis morbidity and mortality in the world.[1]. Some of the values we used for the input parameters of the model – e.g. the rate of progression from latent infection to active disease – were based on the results of epidemiological studies of tuberculosis but other values – e.g. the long-term cure rates of drug-susceptible tuberculosis and MDR tuberculosis in the Chinese CDC and hospital systems – were based on the consensus of the national experts (Box 1).

Results

Conclusion