Treatment quality and outcome for multidrug-resistant tuberculosis patients in four regions of China: a cohort study.

BACKGROUND: China incurs an extremely low treatment coverage of multidrug-resistant tuberculosis (MDR-TB). This study aimed to understand the experience of MDR-TB patients on quality of health care, and the clinical impact through an up to six-year follow-up. METHODS: Cohorts of MDR-TB patients were built in TB/MDR-TB designated hospitals in four regions of China from 2014 to 2015. Patients were followed up during treatment course, and yearly confirmation afterward until 2019. Delay in MDR-TB diagnosis and treatment was calculated upon bacteriological confirmation and treatment initiation. Risk factors for unfavourable outcomes were identified by multivariate logistic regression. RESULTS: Among 1168 bacteriological-positive TB patients identified from a 12-million population, 58 (5.0%) MDR-TB cases were detected. The median delay for MDR-TB diagnosis was 90.0 days, with 13.8% having a delay above 180.0 days. MDR-TB treatment was only recommended to 19 (32.8%) participants, while the rest continued with regimen for drug-susceptible TB. In MDR-TB treatment group, 36.8% achieved treatment success, while the others had incomplete treatment (21.1%), loss to follow-up (36.8%) and TB relapse (5.3%). For non-MDR-TB treatment group, 33.3% succeeded, 25.6% relapsed, 2.6% failed, 23.1% died, and 15.4% were lost to follow-up. Overall, only 35.7% (20/56) of detected MDR-TB patients had favourable outcomes and higher education level was positively associated with it (adjusted odds ratio [aOR]: 3.60, 95% confidence interval [CI]: 1.04-12.5). CONCLUSIONS: A large proportion of patients did not receive MDR-TB treatment and had unfavourable outcomes. Delayed MDR-TB diagnosis resulted in poor quality of MDR-TB care. Rapid diagnosis, regulated patient management and high-quality MDR-TB treatment should be enhanced in China.

Rising challenge of multidrug-resistant tuberculosis in China: a predictive study using Markov modeling.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) is on the rise in China. This study used a dynamic Markov model to predict the longitudinal trends of MDR-TB in China by 2050 and to assess the effects of alternative control measures. METHODS: Eight states of tuberculosis transmission were set up in the Markov model using a hypothetical cohort of 100 000 people. The prevalence of MDR-TB and bacteriologically confirmed drug-susceptible tuberculosis (DS-TB+) were simulated and MDR-TB was stratified into whether the disease was treated with the recommended regimen or not. RESULTS: Without any intervention changes to current conditions, the prevalence of DS-TB+ was projected to decline 67.7% by 2050, decreasing to 20 per 100 000 people, whereas that of MDR-TB was expected to triple to 58/100 000. Furthermore, 86.2% of the MDR-TB cases would be left untreated by the year of 2050. In the case where MDR-TB detection rate reaches 50% or 70% at 5% per year, the decline in prevalence of MDR-TB would be 25.9 and 36.2% respectively. In the case where treatment coverage was improved to 70% or 100% at 5% per year, MDR-TB prevalence in 2050 would decrease by 13.8 and 24.1%, respectively. If both detection rate and treatment coverage reach 70%, the prevalence of MDR-TB by 2050 would be reduced to 28/100 000 by a 51.7% reduction. CONCLUSIONS: MDR-TB, especially untreated MDR-TB, would rise rapidly under China's current MDR-TB control strategies. Interventions designed to promote effective detection and treatment of MDR-TB are imperative in the fights against MDR-TB epidemics.

Hepatitis E vaccine in China: Public health professional perspectives on vaccine promotion and strategies for control.

BACKGROUND: A hepatitis E (HepE) vaccine was developed and released in China in 2011. Uptake is currently very limited. The aims of this study were to characterize what public health professionals thought about promoting the HepE vaccine in Shanghai, China, and to develop realistic goals for the HepE vaccine based on this information. METHODS: Public health professionals from Shanghai and other jurisdictions of China were contacted to participate in in-depth qualitative interviews between October 2017 and August 2018. Participants were asked about their perception of the HepE vaccine roll-out. Codes were initially based on the structure of the questionnaire. Subsequently, similar ideas were further developed into themes based on what was present in the transcript data. RESULTS: Thirty-five individuals participated. Major topics of discussion included (1) clarifying the roles and responsibilities of private and public institutions in promoting and marketing the HepE vaccine, (2) identifying what methods of promotion were most efficient, and, (3) endeavoring to formulate a reasonable and realistic goal, if any, for HepE prevention and control in China. Participants emphasized that public sector sources can be trusted sources of information (although the private vaccination company can also be useful in disseminating information) and social media such as WeChat can be good ways to disseminate articles (although netizens may be worried about the spread of fake news). Vaccine promotion is restrained given limited levels of knowledge in the government, hospitals, and public health vaccination centers. CONCLUSION: Successful promotion and use of this vaccine in China, even in limited settings (for instance, certain workplaces, or certain groups) could provide additional information on long-term safety and could promote its adoption in other regions of the world where HepE has high morbidity among pregnant women and other populations.

How Do Experts and Nonexperts Want to Promote Vaccines? Hepatitis E Vaccine as Example.

Low- and middle-income countries receive limited guidance from external entities about how to introduce vaccines. This is especially true for the Hepatitis E (HepE) vaccine, which is currently only commercially available in China. The aims of this qualitative study are to identify which attributes of the HepE disease and vaccine are considered important, and to compare desired promotion methods between different stakeholders. Stakeholders included experts (Centers for Disease Control and Prevention staff, health care providers, and researchers), and nonexperts included members of high-risk populations, HepE cases, and vaccinees. Participants' thoughts were coded and broadly summarized. We contacted 63 persons-35 experts and 28 nonexperts. Safety and effectiveness (but not price) of the vaccine, along with severity of disease and transmission route of infection, were all listed as important attributes. Emphasizing the importance of sharing stories from cases, relying on personal experiences, staying away from statistical explanations, and using the government as a source of promotion were other points repeatedly raised by the participants. Qualitative interviews with experts and nonexperts has revealed that focusing on attributes of disease severity and susceptibility to infection, as well as vaccine safety and effectiveness within stories of cases, are preferred ways to promote the vaccine.