Effect of a comprehensive programme to provide universal access to care for sputum-smear-positive multidrug-resistant tuberculosis in China: a before-and-after study

Abstract

Bill & Melinda Gates Foundation.

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

“…42,69,128 Indeed, some settings-from Estonia 129,130 to New York 131 -have seen steeper declines in the incidence of drug-resistant tuberculosis than in tuberculosis as a whole after adopting interventions to control the transmission of drug-resistant tuberculosis. Typically, these measures included universal DST, 132 individualised treatment, 133 access to tuberculosis care, 134 and sustained efforts to improve treatment completion, which is only achieved in two-thirds of cases, even in well functioning programmes. 135 The recent recommendation of a shorter-course MDR tuberculosis regimen in patients with rifampicinresistant or MDR tuberculosis not previously treated with second-line drugs and in whom resistance to fluoroquinolones and second-line injectable drugs has been excluded or is considered highly unlikely, could substantially improve treatment compliance and thus reduce transmission from patients who might otherwise fail to adhere to the standard 24-month toxic MDR tuberculosis regimen.…”

Scaling up multidrug-resistant tuberculosis care in China

“…The findings from Li and colleagues 4 add to the mounting evidence that the prioritisation of investments in operational coordination improvements is crucial for better outcomes of MDRTB. 4 , 5 , 6 Specifically, they show that a faster time to diagnosis has both clinical and cost benefits: elimination of hospital stay preceding diagnosis, which reduces potential nosocomial transmission of MDRTB along with hospital expenses, and faster initiation of MDRTB treatment. The investigators note that the National Center for Tuberculosis Control and Prevention will scale-up features of the programme nationwide, including free testing for MDRTB with molecular diagnostics and the standard care package for MDRTB.…”

“…2 However, MDRTB remains a formidable problem for China with an estimated 100 000 incident cases annually, a fifth of the global burden. 3 In The Lancet Global Health, Renzhong Li and colleagues report 4 on an intervention to provide a comprehensive programme of universal access to MDRTB care, which might offer a model of improved care for other high-burden countries. The programme was implemented in four cities and involved provision of a comprehensive diagnostic, care, and financial package, including financing for specimen shipment, resistance testing, costs of patient transportation and nutritional supplements, and a subsidy for directly observed therapy.…”

“…The financial scheme imposed a cap of US$4644 per treated case, with patients' expenses capped at 10% of the total, through creative use of government insurance funds and project resources. The results were impressive, 4 with a 90% decrease in time from testing to treatment initiation and substantial increases in the number of diagnosed patients, use of appropriate regimen, and retention at 6 months, largely due to major decreases in deaths and defaults. The findings from Li and colleagues 4 add to the mounting evidence that the prioritisation of investments in operational coordination improvements is crucial for better outcomes of MDRTB.…”

“…The results were impressive, 4 with a 90% decrease in time from testing to treatment initiation and substantial increases in the number of diagnosed patients, use of appropriate regimen, and retention at 6 months, largely due to major decreases in deaths and defaults. The findings from Li and colleagues 4 add to the mounting evidence that the prioritisation of investments in operational coordination improvements is crucial for better outcomes of MDRTB. 4 , 5 , 6 Specifically, they show that a faster time to diagnosis has both clinical and cost benefits: elimination of hospital stay preceding diagnosis, which reduces potential nosocomial transmission of MDRTB along with hospital expenses, and faster initiation of MDRTB treatment.…”