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Home All Specialties Infectious Disease

Nationwide treatment regimen more than halves tuberculosis prevalence in China

byMelissa McCoyandAndrew Bishara
March 21, 2014
in Infectious Disease, Public Health
Reading Time: 3 mins read
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Image: PD

1. Over a 20-year period, China reduced prevalence of smear-positive tuberculosis by more than half by shifting tuberculosis treatment from hospitals to public health centers that implemented the directly observed treatment, short-course (DOTS) strategy.

2. The directly observed treatment, short-course (DOTS) regimen was particularly effective at reducing prevalence of known cases of tuberculosis, implying that overall prevalence decrease was primarily due to better treatment rather than by earlier diagnosis of tuberculosis.

Evidence Rating Level: 2 (Good)

Study Rundown: In the 1990s, China extended tuberculosis control to half the population by providing directly observed treatment, short-course (DOTS). By 2000, DOTS was available to the entire population. This study assessed the impact of the DOTS scale-up over a 20-year period. Results of three national tuberculosis prevalence surveys from 1990, 2000, and 2010 were analyzed. In the 1990s, smear-positive disease prevalence decreased only in provinces that had implemented DOTS. After 2000, prevalence was decreased in all provinces, paralleling the extended implementation of DOTS. Overall, smear-positive prevalence fell by 65%. This study’s findings are strengthened by the large sample size and geographical area, which ensured a more accurate national representation of the population. A limitation of this study was that in 1990 and 2000, chest fluoroscopy was used for screening and in 2010 chest radiography was used. Due to the increased sensitivity of radiography reduction of pulmonary cases may have been masked.

Click to read the study in The Lancet

Relevant Reading: Progress in tuberculosis control and the evolving public-health system in China

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In-Depth [prospective study]: This study analyzed longitudinal data from the 1990, 2000, and 2010 national tuberculosis prevalence surveys in China. Individuals 15 years and older from 31 provinces were screened with chest imaging, and those with abnormal imaging findings and/or persistent cough were classified as having suspected tuberculosis. Results were confirmed with chest radiography, sputum-smear, and culture. From 1990 to 2010 smear-positive tuberculosis prevalence fell from 170 cases (95% CI 166-174) to 59 cases (49-72) per 100,000 population. 68 (87%) of these cases were known cases (diagnosed before the survey) comprised the majority of the reduction in overall prevalence. From 1990 to 2000 programmatic changes were minimal. Reporting of cases to the CDC system increased from 460 (19%) of 2453 to 93 (23%) of 374 (p=0.0055), and the proportion of patients who received tuberculosis treatment increased from 2313 (94%) of 2453 to 370 (99%) of 374 (p=0.00014.)

More from this author: Estimated three quarters of people with influenza are asymptomatic [Flu Watch study], Rotavirus vaccine 116E shown effective and affordable in India, Nursing staff cuts associated with increased risk of preventable deaths, Estimated 1 in 14 women worldwide survivors of sexual violence in lifetime

©2012-2014 2minutemedicine.com. All rights reserved. No works may be reproduced without expressed written consent from 2minutemedicine.com. Disclaimer: We present factual information directly from peer reviewed medical journals. No post should be construed as medical advice and is not intended as such by the authors, editors, staff or by 2minutemedicine.com. PLEASE SEE A HEALTHCARE PROVIDER IN YOUR AREA IF YOU SEEK MEDICAL ADVICE OF ANY SORT. 

Tags: chinaDOTSinfectious diseaseprevalencestudytreatmenttuberculosis
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