Stopping Tuberculosis in China

The People’s Republic of China accounts for nearly 17 percent of the world’s tuberculosis burden, with estimated 1.5 million new cases and approximately 270,000 deaths each year. In addition, China has noted a significant increase in the incidence of multidrug-resistant tuberculosis, particularly in regions of the country without a directly observed treatment, shortcourse (DOTS) program. China therefore sought support from the Global Fund to expand its DOTS coverage and to substantially increase detection and cure rates by 2005.

With a Global Fund grant of US$25 million over two years, China will expand DOTS coverage from 68 to 90 percent of the population, increase the detection rate of new smear-positive cases from 29 to 70 percent and maintain a cure rate of at least 85 percent for smear-positive cases treated in the DOTS program. Financing from the Global Fund will ensure that eight provincial governments working in 536 counties can deliver diagnostic services to detect tuberculosis free of charge and offer DOTS free of charge for infectious cases.

Moreover, support from the Global Fund will boost efforts to train and remunerate health-care workers in provinces designated as poverty-stricken by the central administration in Beijing. Payment of the fees will strengthen reporting practices and case management; it will serve also as an incentive to health-care providers to monitor patients who follow DOTS regimens, to sustain monitoring over the prescribed period of time and to report those cases to tuberculosis dispensaries. The Chinese program demonstrates the massive scale-up efforts that the Global Fund can support. Within three years, China anticipates that an additional 930,000 infectious tuberculosis cases will be detected and treated in the counties where the DOTS program will be introduced. In addition, the Global Fund grant supplements existing efforts supported by the World Bank and the United Kingdom’s Department for International Development to expand DOTS coverage nationwide.

Since the start of disbursements from the Global Fund to the program, the Ministry of Health has produced and broadcast 900 tuberculosis programs in more than 1,000 counties nationwide to increase public awareness of tuberculosis and the availability of free diagnostic and treatment services; and it has expanded DOTS in the target provinces, diagnosing more than 39,000 new infectious cases.

While the SARS epidemic hindered the implementation of the program, the massive screening efforts conducted by the Chinese Center for Disease Control to diagnose that infection bore a parallel benefit: a large subset of tuberculosis patients were identified from the SARS group and then referred to DOTS programs at the newly introduced sites.