Tuberculosis Information Management System Research Articles

Gap to End-TB targets in eastern China: A joinpoint analysis from population-based notification data in Zhejiang Province, China, 2005–2018

BackgroundZhejiang is a southeastern province of China with middle level notification rates of tuberculosis in China, but more than 27,000 pulmonary tuberculosis (PTB) cases are still reported annually in this province. We aimed to analyze the time trends of PTB cases and bacteriologically confirmed cases notification rates at the province and city levels of Zhejiang during 2005–2018. MethodsData from the web-based TB Information Management System of Zhejiang Province were used to calculate annual notification rates per 100,000 population of PTB cases and bacteriologically confirmed cases for Zhejiang Province and its 11 cities. The joinpoint regression method was used to analyze the time trends and calculate the annual percentage change of notification rates. ResultsThere were 480,668 notified PTB cases in Zhejiang Province during 2005–2018, 38.78% of which were bacteriologically confirmed cases. Both the PTB cases and bacteriologically confirmed cases notification rates of Zhejiang Province have declined since 2007. Most of the cities’ time trends were the same as Zhejiang Province. The PTB cases and bacteriologically confirmed cases notification rates of males and elderly people are the highest in both sexes and among the four age groups, but the decline speeds of the two groups were slowest. ConclusionsWith the effective implementation of TB control measures and projects, the PTB cases notification rates of Zhejiang Province have declined. In order to reach the target in 2035 of the End TB Strategy, additional efforts should be made in the diagnosis and treatment of TB patients, particularly with regard to males and older adult people.

Management of tuberculosis outbreaks in middle schools of Bijie City

Objective To understand the management of tuberculosis outbreaks in middle schools in Bijie City, and to put forward suggestions to improve the quality of tuberculosis epidemic situation in schools. Methods A unified questionnaire was used to investigate the management of tuberculosis outbreaks in middle schools reported by tuberculosis information management system from August 27, 2018 to January 6, 2019 in Bijie City. Results The screening rate of close contacts was 69.72%(99/142), which significantly varied by counties ( P <0.01). The time from the date of diagnosis of patients to screening of close contacts by local CDC was 3 (1-10.5) days. Rate of standardized management process for close contacts aged 15 years or older (0) was lower than that for close contacts aged younger than 15 years old (23.08%) ( P <0.01). 3 462 close contacts were screened for TB symptom, and chest X-ray among those suspected individuals (process 1), and 2 439 close contacts were screened with TB symptom, PPD test, and chest X-ray among those suspected individuals or those with strong positive in PPD test (process 2). The detection rate of pulmonary tuberculosis in close contacts of Grade I was lower in Process 1 (28.89/100 000) than in Process 2 (328.00/100 000) ( χ 2 = 6.56, P = 0.01). The latent infection rate of the first-class close contacts (6.39%) was higher than that of the second-class close contacts (1.93%) ( χ 2 =54.86, P <0.01). Conclusion Management of tuberculosis outbreaks in middle schools in Bijie City in 2018 is effective and timely, but the standardization needs to be improved. 【摘要】 目的 了解毕节市中学结核病疫情处置措施实施情况,为提升学校结核病疫情处置质量提出建议。 方法 采用 统一调查问卷,对毕节市2018年8月27日一2019年1月6日结核病信息管理系统上报的中学肺结核疫情处置情况进行 调查。 结果 密切接触者筛查开展率为69.72%(99/142),不同县（区）间开展率差异有统计学意义（ P <0.01)。患者确诊 之日至属地疾病预防控制机构开展密切接触者筛查工作的时间为3(1〜10.5)d。年龄≥15岁密切接触者的流程规范率 (0)小于<15岁密切接触者(23.08%) ( P <0.01)。3 462名密切接触者开展了症状筛查,发现可疑症状者进行胸片筛查（流 程1);2 439名密切接触者同时进行症状筛查与结核菌素（PPD)试验,对可疑症状者以及PPD强阳性者进行胸片筛查（流 程2)。I级密切接触者筛查肺结核检出率流程1(28.89/10万）小于流程2(328.00/10万）（ χ 2 = 6.56, P =0.01), I 级密切 接触者潜伏感染率(6.39%)大于II级密切接触者（1.93%) ( χ 2 = 54.86, P <0.01)。 结论 毕节市2018年中学结核病疫情处 置开展度较高、较及时,但规范性有待提高。

Study on spatial clustering characteristics of tuberculosis in China, 2013-2018

Objective: To explore the tuberculosis (TB) clustering areas and changing tendency in China from 2013 to 2018, so as to provide evidence for improving the control and prevention programs on TB. Methods: Spatial distribution of TB in China from 2013 to 2018 was studied using data from TB information management system of Chinese disease prevention and control information system. The SaTScan 9.6 software was used to detect and analyze the TB clusters and relative risks. Likelihood ratio and P value under the scan windows were used as the main index to define the clusters. Results: The TB registration rate declined in China from 2013 to 2018. High-risk clusters were mainly located in western regions of Xinjiang, Tibet, Shaanxi, Sichuan, Chongqing, Yunnan, Guizhou, Guangxi provinces and central and eastern regions of Inner Mongolia, Hubei, Hunan, Jiangxi, Guangdong and Hainan provinces. The number of counties with TB clusters declined slowly, from 1 112 in 2013 to 806 in 2018. In comparison with areas other than the clusters, the RR of TB in the clusters remained at high levels in southern Xinjiang and western Tibet from 2013 to 2018 (RR>3.0). Conclusions: The number of the counties with TB clustering declined slowly from 2013 to 2018, and most of them were located in western and central China. Early detection and health education should be focused on TB patients to prevent the spread of TB. Management programs set for TB patients should be strengthened, especially in the western parts of the country where TB clusters and high relative risks existed.

Analysis and predication of tuberculosis registration rates in Henan Province, China: an exponential smoothing model study

BackgroundThe World Health Organization End TB Strategy meant that compared with 2015 baseline, the reduction in pulmonary tuberculosis (PTB) incidence should be 20 and 50% in 2020 and 2025, respectively. The case number of PTB in China accounted for 9% of the global total in 2018, which ranked the second high in the world. From 2007 to 2019, 854 672 active PTB cases were registered and treated in Henan Province, China. This study was to assess whether the WHO milestones could be achieved in Henan Province.MethodsThe active PTB numbers in Henan Province from 2007 to 2019, registered in Chinese Tuberculosis Information Management System were analyzed to predict the active PTB registration rates in 2020 and 2025, which is conductive to early response measures to ensure the achievement of the WHO milestones. The time series model was created by monthly active PTB registration rates from 2007 to 2016, and the optimal model was verified by data from 2017 to 2019. The Ljung-Box Q statistic was used to evaluate the model. The statistically significant level is α = 0.05. Monthly active PTB registration rates and 95% confidence interval (CI) from 2020 to 2025 were predicted.ResultsHigh active PTB registration rates in March, April, May and June showed the seasonal variations. The exponential smoothing winter’s multiplication model was selected as the best-fitting model. The predicted values were approximately consistent with the observed ones from 2017 to 2019. The annual active PTB registration rates were predicted as 49.1 (95% CI: 36.2–62.0) per 100 000 population and 34.4 (95% CI: 18.6–50.2) per 100 000 population in 2020 and 2025, respectively. Compared with the active PTB registration rate in 2015, the reduction will reach 23.7% (95% CI, 3.2–44.1%) and 46.8% (95% CI, 21.4–72.1%) in 2020 and 2025, respectively.ConclusionsThe high active PTB registration rates in spring and early summer indicate that high risk of tuberculosis infection in late autumn and winter in Henan Province. Without regard to the CI, the first milestone of WHO End TB Strategy in 2020 will be achieved. However, the second milestone in 2025 will not be easily achieved unless there are early response measures in Henan Province, China.

Comparison of different bacteriological testing strategies and factors for bacteriological confirmation among pulmonary TB patients: a retrospective study in Tianjin, China, 2017\u20132018

BackgroundBacteriological confirmation (BC) proportion among notified pulmonary TB patients in China is among the lowest in the world. This study was to understand the yield of BC using different testing strategies and patient-level factors associated with BC among pulmonary TB patients in Tianjin, China during 2017–2018.MethodsA retrospective study was conducted, enrolling pulmonary TB patients reported to National TB Information Management System (TBIMS) in Tianjin during 2017–2018. BC was defined as a positive result by any of the followings: smear microscopy, culture, or nucleic acid amplification test. Individual characteristics were compared between patients with positive and negative bacteriological results using contingency tables and χ2 test. Multivariable logistic regression was applied to analyze factors associated with BC, calculating adjusted odds ratios (aOR) and 95% confidence intervals (CI) (α = 0.05).ResultsOf 6364 reported patients, 4181 (65.7%) were bacteriologically confirmed. Positivity proportion was 43.1% (2746/6364) for smear microscopy, 57.7% (3380/5853) for culture, 61.7% (1608/2605) for Xpert® MTB/RIF assay (Xpert) and 73.4% (1824/2484) for combination of the three. The unemployed (aOR = 1.5, 95% CI: 1.0–2.2) and farmers (aOR = 1.7, 95% CI: 1.1–2.8) compared with students; diagnosis by inpatient hospitals compared with TB clinics (aOR = 3.4, 95% CI: 2.6–4.4); having symptoms for ≥2 weeks (aOR = 1.4, 95% CI: 1.1–1.8); cough (aOR = 2.2, 95% CI: 1.8–2.8); blood sputum (aOR = 1.5, 95% CI: 1.0–2.2); cavitation on chest X-ray (aOR = 3.3, 95% CI: 2.5–4.3); bilateral lung lobes affected (aOR = 1.7, 95% CI: 1.4–2.2) were factors associated with BC.ConclusionsCombination test was an effective way to improve BC among pulmonary TB patients. Being unemployed, farmers, having prolonged symptoms, and more severe in TB condition were factors associated with BC. We recommend combination of tests to improve BC for pulmonary TB patients, especially who are in early stage of the disease or with conditions tend to be bacteriologically negative.

Underreporting of Notifiable Pulmonary Tuberculosis Cases to the National Tuberculosis Information Management System — China, 2015

What is already known about this topic? Tuberculosis (TB) notification data and the underreporting rate are major sources used in estimating TB incidence. China’s TB Information Management System (TBIMS) was launched in 2005 but has not yet been evaluated for sensitivity. What is added by this report? The average underreporting rate of pulmonary TB to TBIMS in selected facilities was 8.23%. However, provincial TB or infectious disease-specific health facilities, or general health facilities had higher underreporting rates. Children, migrants, and drug resistant TB patients had higher chances to be underreported than other populations. What are the implications for public health practice? Underreporting surveys should be routinely implemented in the future. This will be vital for enhancing TB reporting and the transfer mechanisms in TB or infectious disease-specific hospitals, or general hospitals and improving the case information registration procedures in designated health facilities (DHFs).

The epidemiology of pulmonary tuberculosis in children in Mainland China, 2009–2015

ObjectiveTo describe the incidence and epidemiological characteristics of child pulmonary tuberculosis (PTB) notified to the Chinese Center for Disease Control and Prevention (CDC) Tuberculosis Information Management System (TBIMS) from 2009...

Using electronic medication monitoring to guide differential management of tuberculosis patients at the community level in China

BackgroundIn settings such as China, where universal implementation of directly observed therapy (DOT) is not feasible, innovative approaches are needed to support patient adherence to TB treatment. The electronic medication monitor (EMM) is one of the digital technologies recommended by the World Health Organization (WHO), but evidence from implementation studies remains sparse. In this study, we evaluated acceptance of the EMM among health care workers and patients while implementing the device for differential TB patient management at the community level.MethodsZhenjiang City in Jiangsu Province was purposively selected for the study. All participating patients were allowed to select their preferred management approach. If patients declined to use the EMM, DOT was offered. The EMM was designed to hold 1 month of anti-TB drugs for once-daily dosing of fixed-dose combination (FDC) tablets. Patient EMM records were monitored monthly by a physician; if 20 to 50% of doses were missed twice, or more than 50% of doses were missed once, the patient was switched to DOT. The four physicians and five nurses involved in the study at four designated hospitals were surveyed using a structured questionnaire to assess their acceptance of the EMM.ResultsFrom October 2017 through January 2018, 316 pulmonary TB patients were notified in the TB information management system, and 231 (73.1%) met the study enrollment criteria. Although 186 patients (80.5%) initially consented to use the EMM, 17 later refused to use it. Among the 169 patients who used the EMM, 15 (8.9%) were switched to DOT due to poor adherence, and the other 154 completed the treatment course. The median adherence rate was 99.3%. Surveyed health care workers from designated hospitals found the EMM acceptable, although eight of nine felt use of the device moderately increased their workload. However, the EMM program significantly reduced the workload of community physicians by reducing patient visits by 87.9%.ConclusionsThis study demonstrated the acceptability of using an indigenously developed EMM for differential management of TB patients at the community level. However, more operational research should be conducted before introducing and scaling the technology throughout China.

High incidence and low case detection rate among contacts of tuberculosis cases in Shanghai, China

BackgroundTo assess the effect of a contact investigation strategy by assessing the incidence of tuberculosis and the case detection rate among contacts of tuberculosis patients.MethodsThe pulmonary tuberculosis incidence among contacts was determined retrospectively from a tuberculosis information management system. For each detection method (symptom examination only, symptom examination plus chest radiography or other alternatives), the detection rate of pulmonary tuberculosis patients among contacts was derived from contact investigation form records.ResultsSixty-nine cases of pulmonary tuberculosis were identified among a total of 8137 contacts after an average follow-up of 2.6 years (range: 0.25–5.25) during the period from 2010 to 2014. The incidence density was 329/100,000 person-years (PYs), and the 95% confidence interval (CI) was 256–419/100,000 PYs, which was significantly higher than the notification rate during the same period in the general population (29–30/100,000 PYs). The incidence density was higher (p < 0.0001) among male contacts (462/100,000 PYs) than among female contacts (236/100,000 PYs). The incidence density did not differ (p > 0.05) between contacts whose index case was sputum smear positive and those whose index case was sputum smear negative. Contacts who were biologically related family of the index cases exhibited a higher (p < 0.05) incidence density (475/100,000 PYs) than other contacts (281/100,000 PYs). Fifteen of the 69 incident cases were found through contact investigation, corresponding to a case detection rate via contact investigation of 22% (95% CI: 13–33%). The relevance ratio was 288/100,000 (12/4163) by both chest radiography and symptom survey, which was significantly higher than the rate detected by symptom survey alone, of 57/100,000 (2/3486), p = 0.028. The cumulative incidence in the contacts was 761/100,000 (62/8137) within 3 years from the time that the index cases were diagnosed with pulmonary tuberculosis, which was higher than the incidence rate of 210/100,000 (7/3328) recorded after 3 years (p < 0.001).ConclusionsThe contacts were at higher risk of pulmonary tuberculosis than the general population; however, only approximately 22% of the incident cases could be detected through contact investigation. Therefore, the contact investigation strategy must be improved for better detection of potential pulmonary tuberculosis cases.

Under-reporting of diagnosed tuberculosis to the national surveillance system in China: an inventory study in nine counties in 2015

ObjectiveThe WHO estimates that almost 40% of patients diagnosed with tuberculosis (TB) are not reported. We implemented this study to assess TB under-reporting and delayed treatment registration in nine counties...

What happens to migrant tuberculosis patients who are transferred out using a web-based system in China?

BackgroundIn China, internal migrants constitute one-fifth of tuberculosis (TB) patients registered for treatment in web-based TB information management system (TBIMS). Though China added a specific module in the web-based TBIMS in 2009, web-based transfer-out is not specifically recommended in the national guidelines.ObjectiveIn this country wide study among all registered migrant TB patients (2014–2015) that were transferred out using web-based TBIMS in China, to determine the i) timing of transfer-out in relation to period of treatment; ii) delay and attrition during transfer interval (between transfer-out and transfer-in); and iii) extent and risk factors for ‘not evaluated’ as the treatment outcome.MethodsThis was a cohort study involving review of web-based TBIMS data. Modified Poisson regression was used to build a predictive model for risk factors of ‘not evaluated’ as the treatment outcome.ResultsAmong 7 284 patients, 5 900 (81.0%) were transferred out during the first two months after initiation of treatment or before treatment initiation and 7 088 (97.3%) patients had arrived at transfer-in unit. The median transfer interval was three (interquartile range: 0–14) days. Sixteen percent (1 176/7 284) patients had ‘not evaluated’ as their treatment outcome. ‘Not evaluated’ contributed to 66% of the unfavourable outcomes. Patients transferred from referral hospitals, migrated from out of prefecture, transferred out of prefecture, with sputum smear negative pulmonary TB, with TB pleurisy and with long delay between symptom onset and treatment initiation had significantly higher risk of ‘not evaluated’ as the outcome.ConclusionWeb-based transfer helped as the delay and attrition during the transfer interval was quite short and treatment outcomes of more than four-fifths of transferred out migrant TB patients were available with transfer-out BMU. Once strategies to address the independent predictors of ‘not evaluated’ treatment outcome are devised, China may consider mandatory use of web-based TBIMS for transferring out migrant TB patients.

Patient and health system delays before registration among migrant patients with tuberculosis who were transferred out in China

BackgroundEarly diagnosis and treatment is vital for effective tuberculosis (TB) management especially among migrant populations who are a vulnerable group. We aimed to study factors associated with delay before registration at country level among registered migrant TB patients in China (2014–15) who were transferred out (during treatment) through web-based TB information management system (TBIMS).MethodsThis was a cross sectional study involving review of TBIMS data. Delays (in days) were classified as follows: patient delay (from symptom onset to first doctor visit), health system delay (from first doctor visit to treatment initiation, divided into health system diagnosis and treatment delay before and after date of diagnosis respectively), diagnosis delay (from symptom onset to diagnosis) and total delay (from symptom onset to treatment initiation). Linear regression was used to build a predictive model (forward stepwise) for the socio-demographic, clinical and health system related factors associated with delay: one model for each type of delay. Delays were log transformed and included in the model.ResultsThe median (IQR) patient delay, health system delay and total delay was 16 (6, 34), two (0, 6) and 22 (11, 41) days respectively. Factors associated with long patient, diagnosis and total delay were: female gender, age ≥ 65 years, sputum smear positive pulmonary TB and registration at referral hospital. Treatment initiation delay was significantly higher among those registered in referral hospitals, unemployed and previously treated. Among migrant patients having permanent residence out of province, health system diagnosis delay was significantly higher while treatment initiation delay after diagnosis was significantly lower when compared to patients having permanent residence within the prefecture.ConclusionAmong migrant population with TB, patient delay contributed to the total delay. The factors identified including the need for improved coordination between referral hospitals and national programme have to be addressed if China has to end TB.

Tuberculosis among Full-Time Teachers in Southeast China, 2005⁻2016.

Objective: To explore the incidence rate and characteristics of tuberculosis (TB) among full-time teachers from 2005 to 2016 in southeast China and to provide a basis for TB prevention and control measures in schools. Methods: Information about full-time teachers with TB was obtained from the National Tuberculosis Information Management System (NTIMS). Population data were collected from the Zhejiang Statistical Yearbook and the Zhejiang Education Yearbook. The TB incidence rates and epidemiological characteristics of full-time teachers were analyzed and the Chi-square test was used to analyze influencing factors of epidemiological characteristics and clinical characteristics, case-finding delay, and treatment outcomes. Results: A total of 1795 teachers with TB were reported from 2005 to 2016, and the annual incidence rate was 28.87 per 100,000. The average annual PTB (pulmonary TB) incidence rate among full-time teachers was 25.43/100,000 from 2005 to 2016 and the average annual PTB incidence rate among students was 15.40/100,000 from 2005 to 2016. The highest average incidence rates were observed in the QZ (Quzhou) and HZ (Hangzhou) districts. The male-to-female ratio of the patients was 0.95:1. Approximately half of the patients were 15–40 years old. The mean case-finding interval was 45.3 days. Multivariable logistic regression analysis of TB case-finding delay among full-time teachers revealed that the older (OR = 1.44, 95% CI = 1.18–1.76, p < 0.01), not local (OR = 1.81, 95% CI = 1.20–2.73, p < 0.01), retreatment (OR = 2.06, 95% CI = 1.39–3.08, p < 0.01) and extra-pulmonary tuberculosis (OR = 1.71, 95% CI = 1.13–2.61, p = 0.01) cases were at high risk of case-finding delay. Compared to physical examination, patients detected by referrals and tracking (OR = 2.26, 95% CI = 1.16–4.38, p = 0.02) and patients who directly visited the designated TB hospital (OR = 2.00, 95% CI = 1.03–3.88, p = 0.04) were more prone to case-finding delay. The cure rate of full-time teachers with TB was 77.10%. The cure rates differed significantly between groups classified based on age, case-finding patterns, diagnostic results, treatment classifications, and strategies of patient management. Conclusion: The TB incidence rate among full-time teachers decreased from 2005 to 2016, but teachers suffered a higher risk of TB than students. Western Zhejiang was a hotspot for TB incidence among full-time teachers. Female teacher and young and middle-aged teacher cases account for the majority of the reported patients. There was a case-finding delay among full-time teachers with TB. We should conduct regular physical examinations and strengthen full-course supervision to reduce the risk of TB patients with case-finding delay and increase the TB cure rate.

Spatial-temporal analysis on pulmonary tuberculosis in Beijing during 2005-2015

Objective: To analyze the spatial distribution and identify the high risk areas of pulmonary tuberculosis at the township level in Beijing during 2005-2015. Methods: Data on pulmonary tuberculosis cases was collected from the tuberculosis information management system. Global autocorrelation analysis, local indicators of spatial association and Kulldorff's Scan Statistics were applied to map the spatial distribution and detect the space-time clusters of the pulmonary tuberculosis cases during 2005-2015. Results: Spatial analysis on the incidence of pulmonary tuberculosis at the township level demonstrated that the spatial autocorrelation was positive during the study period. The values of Moran's I ranged from 0.224 3 to 0.291 8 with all the P values less than 0.05. Hotspots were primarily distributed in 8 towns/streets as follows: Junzhuang, Wangping, Yongding and Tanzhesi in Mentougou district, Yancun in Fangshan district, Wangzuo town in Fengtai district, Tianqiao street in Xicheng district and Tianzhu town in Shunyi district. Spatiotemporal clusters across the entire study period were identified by using Kulldorff's spatiotemporal scan statistic. The primary cluster was located in Chaoyang and Shunyi districts, including 17 towns/streets, as follows: Cuigezhuang, Maizidian, Dongfeng, Taiyanggong, Zuojiazhuang, Hepingjie, Xiaoguan, Xiangheyuan, Dongba, Jiangtai, Wangjing, Jinzhan, Jiuxianqiao, Laiguangying, Sunhe towns/streets in Chaoyang district, Houshayu and Tianzhu town in Shunyi district, during January to December 2005. Conclusion: Incidence rates of pulmonary tuberculosis displayed spatial and temporal clusterings at the township level in Beijing during 2005-2015, with high risk areas relatively concentrated in the central and southern parts of Beijing.

Epidemiologic feature of pulmonary tuberculosis in students from Shandong province

To explore the reported incidence and epidemic features of pulmonary tuberculosis in students of Shandong province in 2013. Population data from the Statistical Yearbook, and the number of reported pulmonary tuberculosis (PTB) patients (students and whole populations) were gathered from the Chinese Infectious Disease Information Management System while the information of prognosis on student patients was from the Chinese Tuberculosis Information Management System. Epidemiological characteristics of the disease was analyzed. The overall reported PTB incidence of Shandong province in 2013 was 37.55/100 000, including the reported PTB incidence in students as 9.67/100 000, with a significant peaks seen in students PTB, in April and September. Number of students PTB patients was seen more in males than in females, with half of the number seen in the age groups between 15 to 20, Smear-negative PTB was most frequently used to classify the types of patients. Prognosis and outcomes of treatment on patients with smear-positive tuberculosis were good. High school and college students, especially at freshmen years, were under high risk that could cause the epidemics to occur. Recommendions should be targeted on the joint efforts made by both sectors of education and health, to work on this populaton to control the epidemics of PTB.

Association between Multidrug-Resistant Tuberculosis and Risk Factors in China: Applying Partial Least Squares Path Modeling.

BackgroundMultidrug-resistant tuberculosis (MDR-TB) resulting from various factors has raised serious public health concerns worldwide. Identifying the ecological risk factors associated with MDR-TB is critical to its prevention and control. This study aimed to explore the association between the development of MDR-TB and the risk factors at the group-level (ecological risk factors) in China.MethodsData on MDR-TB in 120 counties were obtained from the National Tuberculosis Information Management System, and data on risk-factor variables were extracted from the Health Statistical Yearbook, provincial databases, and the meteorological bureau of each province (municipality). Partial Least Square Path Modeling was used to detect the associations.ResultsThe median proportion of MDR-TB in new TB cases was 3.96% (range, 0–39.39%). Six latent factors were extracted from the ecological risk factors, which explained 27.60% of the total variance overall in the prevalence of MDR-TB. Based on the results of PLS-PM, TB prevention, health resources, health services, TB treatment, TB detection, geography and climate factors were all associated with the risk of MDR-TB, but socioeconomic factors were not significant.ConclusionsThe development of MDR-TB was influenced by TB prevention, health resources, health services, TB treatment, TB detection, geography and climate factors. Such information may help us to establish appropriate public health intervention strategies to prevent and control MDR-TB and yield benefits to the entire public health system in China.

Efforts to reduce the disparity between permanent residents and temporary migrants: Stop TB experiences in Shanghai, China

Eight of 17 districts of Shanghai have offered transportation and living allowances subsidies to patients with tuberculosis (TB) among the migrant population. The study aimed to assess the impact of the subsidising initiative on the treatment success rate (TSR) and identify the social determinants of treatment outcomes. The participants included 7072 residents and 5703 migrants who were registered in the TB Information Management System with smear-positive pulmonary TB from January 2006 to December 2010. The Cochran-Armitage test was employed to test the trends of TSR and logistic regressions to identify the factors associated with treatment outcome. Without subsidies, migrant TB cases had lower odds of successful treatment [OR = 0.20 (95% CI 0.18-0.23)] than resident cases. Subsidisation was associated with a 65% increased odds ratio of success [1.65 (1.40-1.95)] among migrant cases. The TSR has stabilised at 87% for both permanent residents and temporary migrants since 2009. Living in districts with a population density ≥20,000/km(2) was associated with a low odds ratio [0.42 (0.26-0.68)] among resident cases, whereas among migrant cases those living in districts out of central downtown had a higher odds ratio of treatment success [peripheral downtown: 1.73 (1.36-2.20), suburban: 1.69 (1.16-2.46)]. The TB cases in districts with 2.0-2.9 TB specialists/100 cases had a higher odds ratio [2.99 (1.91-4.69)] of successful treatment than cases from districts with fewer specialists. Besides free medical services, transport and living allowance subsidies to migrant patients with TB improved the treatment outcome significantly.

Tuberculosis among healthcare workers in southeastern China: A retrospective study of 7-year surveillance data.

The baseline prevalence and characteristics of tuberculosis (TB) among general healthcare workers (HCWs) in southeastern China remains unknown. We conducted a retrospective study based on the TB surveillance data in Zhejiang Province from 2005 to 2011, which were extracted from the national Tuberculosis Information Management System (TIMS). We calculated and compared annual notification rates of different occupational groups and analyzed the epidemiological and clinical characteristics. The annual TB notification rates among general HCWs declined steadily from 2005 to 2011. On average, HCWs showed annual TB notification rates lower than the general population but higher than teachers. Recorded HCW TB patients averaged 35.5 years of age, with females outnumbering males (58.0% > 42.0%). The proportion of pulmonary tuberculosis (PTB) was higher among male than in the female patients (88.5% > 83.4%, P = 0.031). Our study suggested that general HCWs run a higher occupational risk than teachers although the two groups are socioeconomically comparable and that the priority should be given to the young female HCWs for TB prevention in healthcare institutions.

Electronic recording and reporting system for tuberculosis in China: experience and opportunities

Tuberculosis (TB) surveillance in China is organized through a nationwide network of about 3200 hospitals and health facilities. In 2005, an electronic Tuberculosis Information Management System (TBIMS) started to be phased in to replace paper recording. The TBIMS collects key information on TB cases notified in TB care facilities, and exchanges real-time data with the Infectious Disease Reporting System, which covers the country's 37 notifiable diseases. The system is accessible to authorized users at every level of the TB network through a password-protected website. By 2009 the TBIMS achieved nationwide coverage. Completeness of data on patient bacteriological end points improved remarkably over time. Data on about a million active TB cases, including drug-resistant TB, are included each year. The sheer scale of the data handling and the intricate functions that the China TBIMS performs makes it stand apart from the electronic information systems for TB adopted in other countries.

Delays in care seeking, diagnosis and treatment among pulmonary tuberculosis patients in Shenzhen, China

Continued improvements in early diagnosis and treatment are critical in the management of tuberculosis (TB). To assess delays in care seeking, diagnosis and treatment among TB patients in the city of Shenzhen, China, and to explore factors associated with delay. A total of 4677 TB patients were diagnosed and treated under the TB information management system in 2009 and 2010 in Bao'an District, Shenzhen, China. Multivariate logistic regression was used to analyse factors associated with delay among TB patients. The median time from onset of cough and sputum to the first medical visit was 10 days (range 0-2530); from the first medical visit to TB diagnosis it was 2 days (range 0-2193); and from TB diagnosis to initiation of anti-tuberculosis treatment it was 0 days (range 0-73). On logistic regression, adjusting for other factors, female sex and older age were significantly associated with higher odds of delay in care seeking, first episode of tuberculosis and smear positivity were significantly associated with lower odds of delay in diagnosis, and smear positivity was significantly associated with higher odds of delay in treatment. In Bao'an District, Shenzhen, TB is diagnosed and treated in a fairly timely fashion in comparison with reports from other developing countries.