Policy changes and the screening, diagnosis and treatment of drug-resistant tuberculosis patients from 2015 to 2018 in Zhejiang Province, China: a retrospective cohort study
Objectives To examine changes in the screening, diagnosis, treatment and management of drug-resistant tuberculosis (DRTB) patients, and investigate the impacts of DRTB-related policies on patients of different demographic and socioeconomic characteristics.Design A retrospective cohort study using re...
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BMJ Publishing Group
2021-04-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/4/e047023.full |
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| author | Shenglan Tang Bin Chen Frank Cobelens Fei Huang Ying Peng Weixi Jiang Xiaomeng Wang Chris Elbers |
| author_facet | Shenglan Tang Bin Chen Frank Cobelens Fei Huang Ying Peng Weixi Jiang Xiaomeng Wang Chris Elbers |
| author_sort | Shenglan Tang |
| collection | DOAJ |
| description | Objectives To examine changes in the screening, diagnosis, treatment and management of drug-resistant tuberculosis (DRTB) patients, and investigate the impacts of DRTB-related policies on patients of different demographic and socioeconomic characteristics.Design A retrospective cohort study using registry data, plus a survey on DRTB-related policies.Setting All prefecture-level Centres for Disease Control in Zhejiang Province, China.Main outcome measures Alongside the care cascade, we examined: (1) reported number of presumptive DRTB patients; (2) percentage of presumptive patients with drug susceptibility testing (DST) records; (3) percentage of DRTB/rifampicin-resistant (RR) patients registered; (4) percentage of RR/multidrug-resistant TB (MDRTB) patients that received anti-DRTB treatment; and (5) percentage of RR/MDRTB patients cured/completed treatment among those treated. Multivariate logistic regressions were conducted to explore the impacts of DRTB policies after adjusting for other factors.Results The number of reported presumptive DRTB patients and the percentage with DST records largely increased during 2015–2018, and the percentage of registered patients who received anti-DRTB treatment also increased from 59.0% to 86.5%. Patients under the policies of equipping GeneXpert plus expanded criteria for DST had a higher likelihood of being registered compared with no GeneXpert (adjusted OR (aOR)=2.57, 95% CI: 1.20 to 5.51), while for treatment initiation the association was only significant when further expanding the registration criteria (aOR=2.38, 95% CI: 1.19 to 4.79). Patients with registered residence inside Zhejiang were more likely to be registered (aOR=1.96, 95% CI: 1.52 to 2.52), treated (aOR=3.83, 95% CI: 2.78 to 5.28) and complete treatment (aOR=1.92, 95% CI: 1.03 to 3.59) compared with those outside.Conclusion The policy changes on DST and registration have effectively improved DRTB case finding and care. Nevertheless, challenges remain in servicing vulnerable groups such as migrants and improving equity in the access to TB care. Future policies should provide comprehensive support for migrants to complete treatment at their current place of residence. |
| format | Article |
| id | doaj-art-5b68c1bbf9e942c5b3aa7ea7d3a6a711 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-04-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-5b68c1bbf9e942c5b3aa7ea7d3a6a7112025-08-20T02:32:46ZengBMJ Publishing GroupBMJ Open2044-60552021-04-0111410.1136/bmjopen-2020-047023Policy changes and the screening, diagnosis and treatment of drug-resistant tuberculosis patients from 2015 to 2018 in Zhejiang Province, China: a retrospective cohort studyShenglan Tang0Bin Chen1Frank Cobelens2Fei Huang3Ying Peng4Weixi Jiang5Xiaomeng Wang6Chris Elbers7Duke Global Health Institute, Duke University, Durham, North Carolina, USA1 Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UKAmsterdam Institute for Global Health & Development (AIGHD) and Department of Global Health, Amsterdam University Medical Centers, Amsterdam, The NetherlandsNational Center for Tuberculosis Control and Prevention, Centers for Disease Control and Prevention, Beijing, ChinaZhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, ChinaSchool of Public Health, Fudan University, Shanghai, ChinaSchool of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, ChinaSchool of Business and Economics, Vrije Universiteit Amsterdam, Amsterdam, The NetherlandsObjectives To examine changes in the screening, diagnosis, treatment and management of drug-resistant tuberculosis (DRTB) patients, and investigate the impacts of DRTB-related policies on patients of different demographic and socioeconomic characteristics.Design A retrospective cohort study using registry data, plus a survey on DRTB-related policies.Setting All prefecture-level Centres for Disease Control in Zhejiang Province, China.Main outcome measures Alongside the care cascade, we examined: (1) reported number of presumptive DRTB patients; (2) percentage of presumptive patients with drug susceptibility testing (DST) records; (3) percentage of DRTB/rifampicin-resistant (RR) patients registered; (4) percentage of RR/multidrug-resistant TB (MDRTB) patients that received anti-DRTB treatment; and (5) percentage of RR/MDRTB patients cured/completed treatment among those treated. Multivariate logistic regressions were conducted to explore the impacts of DRTB policies after adjusting for other factors.Results The number of reported presumptive DRTB patients and the percentage with DST records largely increased during 2015–2018, and the percentage of registered patients who received anti-DRTB treatment also increased from 59.0% to 86.5%. Patients under the policies of equipping GeneXpert plus expanded criteria for DST had a higher likelihood of being registered compared with no GeneXpert (adjusted OR (aOR)=2.57, 95% CI: 1.20 to 5.51), while for treatment initiation the association was only significant when further expanding the registration criteria (aOR=2.38, 95% CI: 1.19 to 4.79). Patients with registered residence inside Zhejiang were more likely to be registered (aOR=1.96, 95% CI: 1.52 to 2.52), treated (aOR=3.83, 95% CI: 2.78 to 5.28) and complete treatment (aOR=1.92, 95% CI: 1.03 to 3.59) compared with those outside.Conclusion The policy changes on DST and registration have effectively improved DRTB case finding and care. Nevertheless, challenges remain in servicing vulnerable groups such as migrants and improving equity in the access to TB care. Future policies should provide comprehensive support for migrants to complete treatment at their current place of residence.https://bmjopen.bmj.com/content/11/4/e047023.full |
| spellingShingle | Shenglan Tang Bin Chen Frank Cobelens Fei Huang Ying Peng Weixi Jiang Xiaomeng Wang Chris Elbers Policy changes and the screening, diagnosis and treatment of drug-resistant tuberculosis patients from 2015 to 2018 in Zhejiang Province, China: a retrospective cohort study BMJ Open |
| title | Policy changes and the screening, diagnosis and treatment of drug-resistant tuberculosis patients from 2015 to 2018 in Zhejiang Province, China: a retrospective cohort study |
| title_full | Policy changes and the screening, diagnosis and treatment of drug-resistant tuberculosis patients from 2015 to 2018 in Zhejiang Province, China: a retrospective cohort study |
| title_fullStr | Policy changes and the screening, diagnosis and treatment of drug-resistant tuberculosis patients from 2015 to 2018 in Zhejiang Province, China: a retrospective cohort study |
| title_full_unstemmed | Policy changes and the screening, diagnosis and treatment of drug-resistant tuberculosis patients from 2015 to 2018 in Zhejiang Province, China: a retrospective cohort study |
| title_short | Policy changes and the screening, diagnosis and treatment of drug-resistant tuberculosis patients from 2015 to 2018 in Zhejiang Province, China: a retrospective cohort study |
| title_sort | policy changes and the screening diagnosis and treatment of drug resistant tuberculosis patients from 2015 to 2018 in zhejiang province china a retrospective cohort study |
| url | https://bmjopen.bmj.com/content/11/4/e047023.full |
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