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Overview of TB C ontrol Program in Yunnan Province

Overview of TB C ontrol Program in Yunnan Province. Yunnan Provincial Anti- Tuberculosis Association Yunnan Provincial Center for Disease Prevention and Control Xu Lin. August 2013. Outline. Tuberculosis in Yunnan Province Background of Yunnan Province

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Overview of TB C ontrol Program in Yunnan Province

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  1. Overview of TB Control Programin Yunnan Province Yunnan Provincial Anti-Tuberculosis AssociationYunnan Provincial Center for Disease Prevention and ControlXu Lin August 2013

  2. Outline Tuberculosis in Yunnan Province • Background of Yunnan Province • Tuberculosis in Yunnan Province Anti-Tuberculosis Efforts in Yunnan Province • Anti-tuberculosis efforts • TB/HIV Control Efforts • MDR-TB Control Efforts Main Challenges of TB control in Yunnan Province

  3. Yunnan Province Most southwestern province in China

  4. Yunnan Province • 16 Administrative Prefectures: • 8 prefecture level municipalities • 8 autonomous prefectures • Population: 45.9 million (12th) • 26 Ethnic Groups (67% Han) • 65.2% rural residents • Area: 394,100 km2 (8th) • 94% is mountainous areas • Lagged economic develepment • GDP per capita : 19,038 RMB in 2011

  5. Tuberculosis in Yunnan Province

  6. Tuberculosis in Yunnan Province Epidemiological survey results of TB in Yunnan

  7. Reported incidence and mortality rate of PTB in Yunnan (1997-2012) (/100,000)

  8. Reported PTB incidence of Yunnan compared with national average (1997-2012) (/100,000) Reported incidence(1/100,000) National average Yunnan The TB reported incidence have consecutively stand at the second place for seven years in Yunnan.

  9. PTB case detection progress of TB program( 2002-2012)

  10. Reported incidence of PTB by age group in 2012 Male All Female Age group of more than 60 years suffered higher PTB incidence

  11. Big difference of PTB burdens among 16 prefectures (2012) Cases 4663 3000- ﹤ 4000 2000- ﹤ 3000 1000- ﹤ 2000 500- ﹤ 1000 196- ﹤ 500 Di Qing Zhao Tong Li Jing Nu Jiang Qu Jing Da Li Kun Ming Chu Xiong Bao SHan De Hong Yu Xi Lin Cang Wen SHan Pu Er Hong He Total reported TB cases of first five prefectures were near 60% of whole province Xi Shuang Ban Na

  12. Big difference of PTB burdens among 129 counties (2012) Cases 1959 600- ﹤ 700 500- ﹤ 600 400- ﹤ 500 300- ﹤ 400 200- ﹤ 300 100- ﹤ 200 21- ﹤ 100 Zhao Yang Zhen Xiong Xuan Wei Xiang Yun Fu Yuan QiLin Guang Nan Fu Ning Hong He Lan Cang Yan SHan

  13. Big regional difference of TB burden in Yunnanfrom January to June in 2013 The first five region of high reported incidence of TB ①Nujiang（92.21/100,000） ②Zhaotong（60.28/100,000） ③Lincang（49.80/100,000） ④Wenshan（48.07/100,000） • Puer（47.00/100,000） The first five region of high reported number of TB ①Zhaotong（3134 cases） ②Qujing（1830 cases） ③Wenshan（1696 cases） ④Honghe（1656 cases） ⑤ Kunming （1309 cases）

  14. M/XDR-TB in Yunnan Province Baseline survey of TB drug resistance in Yunnan from 2008 to 2010

  15. Anti-tuberculosis Efforts in Yunnan Province

  16. Brief progress of TB control in Yunnan Province • 1947, Yunnan Chapter of China Anti-TB Association Founded in Kunming • 1978, No. 3 People’s Hospital Set Up as Designated Treatment Center • 2001, Yunnan Provincial CDC Founded • 2002, Scale-up of national “Free Diagnosis &Treatment” program in Yunnan Province • 2004 Dec, 100% DOTS coverage achieved • 2005, • Yunnan Provincial TB control program, funding from provincial government • National TB control program, funding from Central Government • Online TB reporting and recording system introduced • 2008/2010, Provincial Drug-Resistance Survey

  17. Expanding DOTS under NTP since 2002 -- Issued Yunnan TB control and prevention plan 2002-2010 and 2011-2015 by Yunnan provincial government

  18. Tuberculosis in Yunnan Province Health care system for TB diagnosis and treatment in Yunnan ---- Expanding basic DOTS under NTP since 2002 Provincial Hospital referring Prefecture-level Hospital County TB Center free diagnosis free treatment referring County-level Hospital Private Clinic Township-level Health Unit Community/ Village Health Worker Seeking health care Seeking health care TB Suspects and Patients

  19. Achieved Main Goals of DOTS since 2005 Successful treatment rate (Smear Positive) 19

  20. TB/HIV Co-infection Control • Screening TB for HIV/AIDS patients in 2012 • TB symptoms screening rate: 90.32 % (53914/59689) • Physical check-up with chest X-ray or sputum smear: 69.36 % (41403/59689) • The positive rate :0.84% (346/41403) • HIV antibody screening test for TB patients in 2012 • HIV screening rate: 73.59% (18898 /25678) • The positive rate : 0.47% (88 /18898)

  21. M/XDR-TB Control • Government commitment: set up very clear targets in Yunnan provincial TB control and prevention plan 2011-2015. • Improve TB lab capacity: Over 60% county-level labs with sputum culture skill, 100% prefecture-level labs with DST (solid medium). • Build up MDR-TB clinical centers for regular diagnosis and treatment: cover 50% prefectures. • MDR-TB suspects screening: 60%

  22. M/XDR-TB Control • Laboratory Capacity Strengthening • Building DST lab network in whole province • Purchased lab equipments for culture and DST in 2007 and 2008 for each county-level and prefecture-level lab • biosafety cabinet (classⅡ), autoclave, incubator, refrigerator etc. • Special training: 294 lab technicians were trained in 2009 and 2010 • By the end of 2012 • 128 county-level labs (99%) were qualified for sputum culture • 16prefecture-level labs (100%）were qualified for DST • Rapid identification of bacteria at the provincial level Gene-Xpert

  23. M/XDR-TB Control • Yunnan Provincial TB Treatment Center • With the support of Global Fund, set up first MDR-TB clinical center in Kunming in 2012 • Goal: Provide free diagnosis and treatment of MDR-TB cases in Kunming, and being a top center of M/XDR-TB of whole province

  24. M/XDR-TB Control Efforts • Commitment from Yunnan provincial government for CAP-TB program • All levels of health bureaus supported this program, and want to integrate it with NTP. • Provided 40 thousand RMB as counterpart funding for each year • Provided funding to purchase reagents for GeneXpert test • We are re-designing and rebuilding and isolating the wards for MDR-TB patients based on suggestion from CAP-TB. • Yunnan CDC paid the fee about 200 thousand RMB.

  25. M/XDR-TB Control • Total 48 MDR-TB cases were diagnosedand 26 of them receivedanti-TB treatment. • Reasons for not receiving treatment: patient decline, be too busy, living too far, afraid of stigma or default during waiting for DST result etc. • 2 XDR-TB cases were diagnosed and both of them received anti-TB treatment.

  26. Expanding of MDR-TB control program 2013-2014 The first MDR-TB program started in 2012 in Kunming Population： 6.28 million, occupy 13.74% of total population Supported by GF、 CAP-TB project Kun Ming Expanding two prefectures in 2013 and 2014 Population：13 million, occupy 28.46% of total population Supported by GF、 NTP CAP-TB？？ Yu Xi Hong He

  27. Main Challenges of TB control in Yunnan Province

  28. Main Challenges of TB control in Yunnan • High TB burden in Yunnan province • Near 25,000 PTB cases reported every year • Ranked second among 39 statutory reported infectious diseases since 2005 • Annual decrease rate of reported TB incidence is much slower than national average from 2002 to 2012 • Yunnan province: 1.89% • National average: 3.40% • Much bigger regional difference of TB burden • Remote rural area: Zhao tong

  29. Main Challenges of TB control in Yunnan • High-risk groups lack of active and efficient TB screening • TB examination of elder people has not integrated into community-based health service. • No special funds to support the active screening for migrant population . • TB screening among diabetes just began 2 month at 10 communities supported by CAP-TB project. • Lower case detection for HIV/AIDS population.

  30. Main Challenges of TB control in Yunnan • Very weak community support for TB control • Longer delay when seeing a doctor for TB patients and suspects

  31. Main Challenges of TB control in Yunnan • Low awareness of TB prevention and control in public • A KAP survey in 2010 showed: • Knowledge rate of the public was 43.5% in Yunnan • National average rate was 57%. • DOT can not be conducted due to lack of support of community in some region • For example, Zhenxiongcounty： total 2258 PTB cases including 299 re-treatment cases in 2012, which meant very poor follow-up and treatment.

  32. Main Challenges of TB control in Yunnan • There was no mature model of community-based TB/MDR-TB management. • Only focusing on technical part of medicine rather than patients feelings • Low detection of MDR-TB patients • Low rate of enrolled MDR-TB patients for receiving second-line anti-TB drug treatment

  33. Main Challenges of TB control in Yunnan • Most MDR-TB patients are very poor and feel desperate • based on face to face interview of total 24 MDR-TB patients supported by CAP-TB project • 61% cases with less than 300 dollars monthly income • 12% cases without any medical insurance • Only 30% cases with strong confidence of successful treatment in future

  34. Lessons of MDR-TB treatment from national CDC For MDR-TB patients started on treatment in GF project area in 2008 in China What will happen in Yunnan in future ?

  35. 谢谢！Thank You!

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