Characteristics of rifampicin-resistant tuberculosis detection in China, 2015-2019.

BACKGROUND: The very high burden of rifampicin resistance tuberculosis (RR-TB) and the very low detection of RR-TB cases are a major challenge that China has been facing. This study analyzed the characteristics of RR-TB detection in China after the change of RR-TB detection strategy since 2015, aiming to provide reference and evidence for the development of more precise national drug resistance tuberculosis prevention and control policy. METHODS: We extracted data related to rifampicin resistance screening from the national Tuberculosis Information Management System (TBIMS) from 2015 to 2019, and used descriptive research methods to analyze the screening rate of presumptive RR-TB, the number and duration of RR-TB patients detected and drug resistance testing methods in each year. Chi-square test was used to compare the differences in component ratio or rate between years, and Kruskal Wallis test was used to compare the differences in median days for detection of RR-TB patients in each year. RESULTS: A total of 68,200 RR-TB cases were detected during 2015-2019, of which 48.1% were new cases. The number and detection rate of RR-TB cases increased year by year, from 10 019 and 14.3% in 2015 to 18 623 and 28.7% in 2019, respectively. Of the bacteriologically confirmed TB cases, 81.9% were tested for RR in 2019, a considerable increase from 29.5% in 2015. In 2019, only 41.0% of RR-TB cases had fluoroquinolones (FQs) susceptibility testing performed, and this proportion has been declining year by year since 2016. The proportion of application of rapid molecular tools increased from 24.0% in 2015 to 67.1% in 2019, and the median days to obtain RR results was significantly shortened. In 2019, 76.0% of RR-TB cases were diagnosed as presumptive RR-TB in county-level hospitals. CONCLUSIONS: After China modified the RR-TB detection strategy, the screening rate of RR and the number of RR-TB cases increased significantly. The RR testing methods now predominantly utilize rapid molecular tools. However, comprehensive measures should be implemented to close the gap in the detection of RR-TB cases. It is imperative to take FQs susceptibility testing seriously and effectively strengthen the laboratory capacity of county-level hospitals.

[Analysis of the cost of public health service items in four centers for disease control and prevention in county level in China].

OBJECTIVE: To analyze the unreasonable part of full cost of the public health service items in county level. METHODS: On basis of typical survey in 2005, 18 questionnaires were released and the response rate was 100%. The whole cost and ladder apportionment of expense methods were employed to account the full cost of items including practice items, items required by government and nationwide items required by government provided by 4 centers for disease control and prevention in county level. RESULTS: It was found that 28.4% - 54.9% nationwide items required by government had not been provided, but 2.8% - 10.2% items being not required by government had been provided. Furthermore the frequency of the items required by government was not up to par from 8 topmost to 2 bottommost on average every year. The efficiency was not high because of lacking in the vehicle for work, and 33.3% - 43.6% shortage of equipments for laboratory, and 18.1% - 45.8% logistic staff and technicians only 2/3 time of the whole year had a full workload. All the above resulted in the bias from the standard cost of items required by government. CONCLUSION: For compensating the cost of items reasonable and accurate by government, a kind standard cost of the items according to the government request should be established.