Transcript Document

China TB Control Progress Report
The ninth Technical Advisory Group and National
TB Programme Managers meeting for TB control
in the Western Pacific Region
Manila, Philippines
9 -12 December 2014
TB Epidemiology in China
• China ranks second among the 22 high burden countries. It was estimated
980,000 new TB patients, accounting for 13.2% of the 22 high burden
countries and 61.3% of the Western Pacific Region in 2013.
• The estimated incidence rate of TB was 70/100000 in China which ranks
21st among the 22 high burden countries in 2013.
• In our national infectious internet report system 904, 434 PTB cases were
reported with the reporting rate of 66.8/100,000 in 2013.
• Estimates of MDR-TB burden in 2013 was 54000 (MDR-TB cases among
notified pulmonary TB cases) which ranks second and occupied 18%
globally respectively in 2013.
Dramatic reductions in TB cases and deaths
in China, 1990–2010
Incidence and
notifications
Prevalence
Mortality
Incidence
falling
3.4%/year
Halved in 20 years
1990
2010
1990
2010
Cut almost 80%
1990
Realizing the TB target of MDG in advance
• Promoting WPR realizing the MDG targets which was the only area
achieved the global control targets
2010
Major challenges
• Severe TB epidemic
– High TB burden
– High PTB prevalence：rural, western region, elderly
– MDR-TB, TB/HIV and floating population
• TB control strategies and measures
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–
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–
Control of infection sources：early diagnosis is difficult and cost much
Patient care: whole-course treatment management and compliance is hard to retain
Infection control：medical institutions and community both need to be improved
Free medical insurance policy need to be established
TB related health service system need to be strengthened
• R&D
– Diagnostic tools are not sensitive enough
– The vaccine protection force are still insufficient
– New anti-TB drugs are not available
• Insufficient fund and human resource of TB control
• Laboratory capacity need strengthening
National TB Strategy/Policies
• MOH are planning for the assessment of NTP(2011-2015), then will
develop NTP(2016-2020), establish our renewed strategy for TB control.
• Future national TB control strategy will target at reducing TB incidence
and mortality and will be incorporated into the national health development
plan.
• We will take every necessary measures to ensure achieving objectives of
WHO End TB strategy.
• Future TB control will be based on ensuring drug sensitive TB patients get
good health care service, while strengthening MDR-TB control as well.
Funding sources from 2001 to 2013
• Mechanism of the funding input: Strengthened all level government
commitment and funding input, multi-channel fund raising
国际项目
1600
1400
Other
RMB (million)
JICA
1200
GF
1000
WB/DFID
800
Central government
increased funding from
40 million in 2001 to
0.62 billion in 2013
Local Gov.
Cental Gov.
600
Funds (RMB) for TB
400
200
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
year
*Because of the GF project suspend payment, so
there was a gap from GF funding in 2011.
control was increased
from 0.13 billion in 2001
to 1.4 billion in 2013
Laboratory strengthening
• Laboratory developing target by 2015
– All counties have ability of culture
– All prefecture and provincial laboratories have ability of DST and
molecular test
• Rapid DTS test equipment
– LED FM: 1523
– Gene-xpert: 1054
– HAIN LPA: 150
• Quality control methods
– Blind rechecking, Proficiency test, Field Supervision
• Laboratory information management system
– Integrated into National TB information management system
• TA partner
– Hongkong SRL ,KIT
Reach the unreached
• Intensive case finding: National basic public health program did TB
symptom screening for elderly people, diabetes patients .
• Enhancing screening of close contacts of SS+ TB patients, especially in
schools, etc.
• Mutual screening in TB, HIV/ADIS cases. From 2007 to 2013，1, 050,
000 TB patients received HIV test , 5530 were HIV positive. 730, 000
HIV/AIDS cases received TB examination, 22 thousands was TB/HIV.
• Enhancing trainings for TB diagnosis in children，making better plans
for children’s TB control, establishing cooperation mechanisms with
pediatric hospitals.
Surveillance
• Using self-regulation of TB information system and site visit inspection
for quality control. Currently capture-recapture research were ongoing
for sensitivity evaluation of our information system.
• New TB definitions has been discussed in national TB expert group,
necessary changes will be done in our new TB control guideline and in
TB information system.
• Guidebook for TB surveillance data analyzing and using has been
published. NCTB release quarterly and yearly TB report according to
data analyzing result. Sub-national institutions do the same thing.
Occasional analyzing will be done responding to different need.
Design-stepwise approach
• Current situation
– launched in October 2006. Till Sep. 2014, the PMDT in China cover
90 prefectures(27%) in 30 provinces, will cover 50% prefectures by
2015.
– Till November 2014, 14267 MDR-TB cases have been
confirmed,9748 MDR-TB cases enrolled in treatment
• Barriers
– Coverage need expanding
– Screening rate was not high enough
– Treatment management was difficult
• Priority actions
– Adopting rapid screen methodology
– Establishing prefecture level designated hospitals
Bold policies and supportive systems
• National medical insurance system has covered TB diagnosis and
treatment partially, requiring NCMS to reach 70% reimbursement for
TB outpatients and inpatients(including MDR-TB patients).
• National basic public health program will provide funding to primary
health institutions, encouraging TB suspect referral, report and
treatment management.
• Second-line anti-TB drugs have been included in the" National
Essential Drugs List".
• MOH Issued "MDR-TB clinical path".
Patient centred care: involvement of
patients and civil society
• Society mobilization
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3.24 TB publicity day
Millions of volunteer activities
In 2013, 240, 000 volunteers were motivated
Using social media like micro-blog to carry out health promotion
and information dissemination
• Incentive mechanism
− Transport fee (in the project areas)
− Nutritional supplement fee (in some areas)
− Hardship allowance from civil affairs department
Thank you for your attention!