Date post: | 01-Apr-2015 |
Category: |
Documents |
Upload: | priscilla-bolt |
View: | 223 times |
Download: | 1 times |
Overview of TB Control Programin Yunnan Province
August 2013
Yunnan Provincial Anti-Tuberculosis Association
Yunnan Provincial Center for Disease Prevention and Control
Xu Lin
Tuberculosis in Yunnan Province• Background of Yunnan Province• Tuberculosis in Yunnan Province
Anti-Tuberculosis Efforts in Yunnan Province• Anti-tuberculosis efforts• TB/HIV Control Efforts• MDR-TB Control Efforts
Main Challenges of TB control in Yunnan Province
Outline
Yunnan Province
Most southwestern province in China
Yunnan Province 16 Administrative Prefectures:
•8 prefecture level municipalities•8 autonomous prefectures
Population: 45.9 million (12th)•26 Ethnic Groups (67% Han)•65.2% rural residents
Area: 394,100 km2 (8th)•94% is mountainous areas
Lagged economic develepment• GDP per capita : 19,038 RMB in 2011
Tuberculosis in Yunnan Province
Tuberculosis in Yunnan Province
1979 1990 2000 2010
Prevalence, All Pulmonary TB Cases
(1/100,000)380 538.2 496.8 1,192.9
Prevalence, Smear Positive
(1/100,000)64 77.7 171.3 150.5
TB mortality ( 1/100,000)
_ 17.6 _ _
Epidemiological survey results of TB in Yunnan
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
0.000
0.050
0.100
0.150
0.200
0.250
0.300
0.350
0.400
30.38 33.45 32.72
37.28 37.73 38.67
43.70
53.67
73.70
60.42 62.12 62.22
59.29
55.60 58.01
59.58
0.094
0.066 0.056
0.077 0.084
0.060
0.170 0.172
0.347 0.330
0.323
0.235
0.275
0.247
0.300
0.242
Incidence Mortality rate
Started DOTS in 2002
DOTS coverage 100% in 2004
Reported incidence and mortality rate of PTB in Yunnan (1997-2012) (/100,000)
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120
20
40
60
80
100
120Reported incidence(1/100,000)
National average
Yunnan
Reported PTB incidence of Yunnan compared with national average (1997-2012) (/100,000)
The TB reported incidence have consecutively stand at the second place for seven years in Yunnan.
Year Number of PTB cases
Number of SS+ casesTotal Local resident Mobil population
2002 1113 —— —— 560
2003 10686 —— —— 5797
2004 24936 —— —— 14324
2005 21362 20625 737 13954
2006 22229 21615 614 14323
2007 23173 22613 560 14398
2008 22814 22203 611 14094
2009 22607 21718 889 13552
2010 22733 21684 1049 13560
2011 24429 23012 1417 13894
2012 25987 24639 1348 9575
PTB case detection progress of TB program( 2002-2012)
Reported incidence of PTB by age group in 2012
Male
Female
All
Age group of more than 60 years suffered higher PTB incidence
Big difference of PTB burdens among 16 prefectures (2012)
Cases
4663
3000- 4000﹤
2000- 3000﹤
1000- 2000﹤
500- 1000﹤
196- 500﹤
Zhao Tong
Qu Jing
Wen SHanHong He
Da Li Kun Ming
Di Qing
Chu Xiong
Pu Er
Xi Shuang Ban Na
Lin Cang
Li Jing
De Hong
Bao SHan
NuJiang
Yu Xi
Total reported TB cases of first five prefectures were near 60% of whole province
Big difference of PTB burdens among 129 counties (2012)
Zhen Xiong
Zhao Yang
Xuan Wei
Guang Nan
Fu Yuan
QiLin
Lan Cang
Fu Ning
Xiang Yun
Cases
1959
600- 700﹤
500- 600﹤
400- 500﹤
300- 400﹤
200- 300﹤
100- 200﹤
21- 100﹤
Hong He
Yan SHan
The first five region of high reported number of TB
① Zhaotong ( 3134 cases ) ② Qujing ( 1830
cases ) ③ Wenshan ( 1696
cases ) ④ Honghe ( 1656
cases ) ⑤ Kunming ( 1309
cases )
The first five region of high reported incidence of TB
① Nujiang ( 92.21/100,000 ) ②
Zhaotong ( 60.28/100,000) ③ Lincang
( 49.80/100,000 ) ④ Wenshan
( 48.07/100,000 )⑤ Puer ( 47.00/100,000 )
Big regional difference of TB burden in Yunnanfrom January to June in 2013
M/XDR-TB in Yunnan Province
National Yunnan
New Cases (%)
MDR 5.71 4.44
XDR 0.47 0.19
Retreatment Cases (%)
MDR 25.64 22.22
XDR 2.06 1.39
All Cases (%)
MDR 8.32 7.46
XDR 0.68 0.39
Baseline survey of TB drug resistance in Yunnan from 2008 to 2010
Anti-tuberculosis Efforts in Yunnan Province
Brief progress of TB controlin Yunnan Province
• 1947, Yunnan Chapter of China Anti-TB Association Founded in Kunming
• 1978, No. 3 People’s Hospital Set Up as Designated Treatment Center
• 2001, Yunnan Provincial CDC Founded
• 2002, Scale-up of national “Free Diagnosis &Treatment” program in Yunnan Province
• 2004 Dec, 100% DOTS coverage achieved
• 2005, • Yunnan Provincial TB control program, funding from provincial government• National TB control program, funding from Central Government• Online TB reporting and recording system introduced
• 2008/2010, Provincial Drug-Resistance Survey
-- Issued Yunnan TB control and prevention plan 2002-2010 and 2011-2015 by Yunnan provincial government
Expanding DOTS under NTP since 2002
Provincial Hospital
Seeking health
care
Seeking health
care
County TB Centerfree diagnosisfree treatment
TBSuspects and Patients
County-levelHospital
Prefecture-level Hospital
referring
Township-levelHealth Unit Community/
Village Health Worker
Private Clinic
referring
Tuberculosis in Yunnan ProvinceHealth care system for TB diagnosis and treatment in Yunnan
---- Expanding basic DOTS under NTP since 2002
19
Achieved Main Goals of DOTS since 2005
Successful treatment rate (Smear Positive)
2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
10
20
30
40
50
60
70
80
90
100
0
10
20
30
40
50
60
70
80
90
100
DOTS Coverage Case Detection Rate (New Smear Positive) Treatment Success Rate (New Smear Positive)
Perc
enta
ge (
%)
Perc
enta
ge (
%)
Successful treatment rate (Smear Positive)
TB/HIV Co-infection Control
Screening TB for HIV/AIDS patients in 2012 TB symptoms screening rate: 90.32 % (53914/59689) Physical check-up with chest X-ray or sputum smear:
69.36 % (41403/59689)The positive rate :0.84% (346/41403)
HIV antibody screening test for TB patients in 2012 HIV screening rate: 73.59% (18898 /25678)The positive rate : 0.47% (88 /18898)
Government commitment: set up very clear targets in Yunnan provincial TB control and prevention plan 2011-2015.
– Improve TB lab capacity: Over 60% county-level labs with sputum culture skill, 100% prefecture-level labs with DST (solid medium).
– Build up MDR-TB clinical centers for regular diagnosis and treatment: cover 50% prefectures.
– MDR-TB suspects screening: 60%
M/XDR-TB Control
M/XDR-TB Control
Laboratory Capacity Strengthening
• Building DST lab network in whole province• Purchased lab equipments for culture and DST in 2007 and 2008 for
each county-level and prefecture-level lab• biosafety cabinet (class ), autoclave, incubator, refrigerator etc.Ⅱ
• Special training: 294 lab technicians were trained in 2009 and 2010
• By the end of 2012• 128 county-level labs (99%) were qualified for sputum culture • 16prefecture-level labs (100% ) were qualified for DST• Rapid identification of bacteria at the provincial level Gene-Xpert
M/XDR-TB Control
Yunnan Provincial TB Treatment Center
With the support of Global Fund, set up first MDR-TB clinical center in Kunming in 2012
Goal: Provide free diagnosis and treatment of MDR-TB cases in Kunming, and being a top center of M/XDR-TB of whole province
M/XDR-TB Control Efforts
Commitment from Yunnan provincial government for CAP-TB program
• All levels of health bureaus supported this program, and want to integrate it with NTP.
• Provided 40 thousand RMB as counterpart funding for each year
• Provided funding to purchase reagents for GeneXpert test
• We are re-designing and rebuilding and isolating the wards for MDR-TB patients based on suggestion from CAP-TB.
• Yunnan CDC paid the fee about 200 thousand RMB.
M/XDR-TB Control
• Total 48 MDR-TB cases were diagnosed and 26 of them received anti-TB treatment.– Reasons for not receiving treatment: patient
decline, be too busy, living too far, afraid of stigma or default during waiting for DST result etc.
• 2 XDR-TB cases were diagnosed and both of them received anti-TB treatment.
The first MDR-TB program started in 2012 in KunmingPopulation : 6.28 million, occupy 13.74% of total population Supported by GF 、 CAP-TB project
Kun Ming
Hong HeYu Xi
Expanding two prefectures in 2013 and 2014Population : 13 million, occupy 28.46% of total population Supported by GF 、 NTP
CAP-TB ??
Expanding of MDR-TB control program 2013-2014
Main Challenges of TB control in Yunnan Province
• High TB burden in Yunnan province– Near 25,000 PTB cases reported every year– Ranked second among 39 statutory reported infectious
diseases since 2005– Annual decrease rate of reported TB incidence is much
slower than national average from 2002 to 2012• Yunnan province: 1.89%• National average: 3.40%
– Much bigger regional difference of TB burden• Remote rural area: Zhao tong
Main Challenges of TB control in Yunnan
High-risk groups lack of active and efficient TB screening
– TB examination of elder people has not integrated into
community-based health service.
– No special funds to support the active screening for migrant
population .
– TB screening among diabetes just began 2 month at 10
communities supported by CAP-TB project.
– Lower case detection for HIV/AIDS population.
Main Challenges of TB control in Yunnan
• Very weak community support for TB control– Longer delay when seeing a doctor for TB patients and
suspects
Year Median of total delay
(day)Inter quartile of total
delay (day)
2005 100 44-258
2006 90 42-208
2007 86 40-186
2008 81 42-188
2009 63 31-126
2010 60 29-110
2011 58 28-106
Main Challenges of TB control in Yunnan
• Low awareness of TB prevention and control in public– A KAP survey in 2010 showed:– Knowledge rate of the public was 43.5% in Yunnan – National average rate was 57%.
• DOT can not be conducted due to lack of support of community in some region– For example, Zhenxiong county : total 2258 PTB cases
including 299 re-treatment cases in 2012, which meant very poor follow-up and treatment.
Main Challenges of TB control in Yunnan
• There was no mature model of community-based TB/MDR-TB management.
– Only focusing on technical part of medicine rather than patients feelings
– Low detection of MDR-TB patients– Low rate of enrolled MDR-TB patients for receiving second-
line anti-TB drug treatment
Main Challenges of TB control in Yunnan
• Most MDR-TB patients are very poor and feel desperate – based on face to face interview of total 24 MDR-TB
patients supported by CAP-TB project– 61% cases with less than 300 dollars monthly income– 12% cases without any medical insurance– Only 30% cases with strong confidence of successful
treatment in future
Main Challenges of TB control in Yunnan
China Cases Cured The
completion of treatment
Failure
lose Death OtherTo
continue treatment
The success rate of
Treatment( %)
ADROther
reasons
合计 614 253 24 45 104 49 58 53 28 45.1
For MDR-TB patients started on treatment in GF project area in 2008 in China
Lessons of MDR-TB treatment from national CDC
What will happen in Yunnan in future ?
谢谢!Thank You!