Presentation on theme: "Overview of TB Control Program in Yunnan Province August 2013 Yunnan Provincial Anti-Tuberculosis Association Yunnan Provincial Center for Disease Prevention."— Presentation transcript:
Overview of TB Control Program in Yunnan Province August 2013 Yunnan Provincial Anti-Tuberculosis Association Yunnan Provincial Center for Disease Prevention and Control Xu Lin
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 Outline
Yunnan Province Most southwestern province in China
Yunnan Province 16 Administrative Prefectures: 8 prefecture level municipalities 8 autonomous prefectures Population: 45.9 million (12 th ) 26 Ethnic Groups (67% Han) 65.2% rural residents Area: 394,100 km 2 (8 th ) 94% is mountainous areas Lagged economic develepment GDP per capita : 19,038 RMB in 2011
1979199020002010 Prevalence, All Pulmonary TB Cases (1/100,000) 380538.2496.81,192.9 Prevalence, Smear Positive (1/100,000) 6477.7171.3150.5 TB mortality （ 1/100,000) _17.6__ Epidemiological survey results of TB in Yunnan
Reported incidence and mortality rate of PTB in Yunnan (1997-2012) (/100,000)
Reported incidence(1/100,000) National average Yunnan Reported PTB incidence of Yunnan compared with national average (1997-2012) (/100,000) The TB reported incidence have consecutively stand at the second place for seven years in Yunnan.
Year Number of PTB cases Number of SS+ cases TotalLocal residentMobil population 20021113—— 560 200310686—— 5797 200424936—— 14324 2005213622062573713954 2006222292161561414323 2007231732261356014398 2008228142220361114094 2009226072171888913552 20102273321684104913560 20112442923012141713894 2012259872463913489575 PTB case detection progress of TB program ( 2002-2012)
Reported incidence of PTB by age group in 2012 Male Female All Age group of more than 60 years suffered higher PTB incidence
Big difference of PTB burdens among 16 prefectures (2012) Cases 4663 3000- ﹤ 4000 2000- ﹤ 3000 1000- ﹤ 2000 500- ﹤ 1000 196- ﹤ 500 Zhao Tong Qu Jing Wen SHan Hong He Da Li Kun Ming Di Qing Chu Xiong Pu Er Xi Shuang Ban Na Lin Cang Li Jing De Hong Bao SHan Nu Jiang Yu Xi Total reported TB cases of first five prefectures were near 60% of whole province
Big difference of PTB burdens among 129 counties (2012) Zhen Xiong Zhao Yang Xuan Wei Guang Nan Fu Yuan QiLin Lan Cang Fu Ning Xiang Yun Cases 1959 600- ﹤ 700 500- ﹤ 600 400- ﹤ 500 300- ﹤ 400 200- ﹤ 300 100- ﹤ 200 21- ﹤ 100 Hong He Yan SHan
The first five region of high reported number of TB ① Zhaotong （ 3134 cases ） ② Qujing （ 1830 cases ） ③ Wenshan （ 1696 cases ） ④ Honghe （ 1656 cases ） ⑤ Kunming （ 1309 cases ） The first five region of high reported incidence of TB ① Nujiang （ 92.21/100,000 ） ② Zhaotong （ 60.28/100,000 ） ③ Lincang （ 49.80/100,000 ） ④ Wenshan （ 48.07/100,000 ） ⑤ Puer （ 47.00/100,000 ） Big regional difference of TB burden in Yunnan from January to June in 2013
M/XDR-TB in Yunnan Province NationalYunnan New Cases (%) MDR 5.714.44 XDR 0.470.19 Retreatment Cases (%) MDR 25.6422.22 XDR 2.061.39 All Cases (%) MDR 8.327.46 XDR 0.680.39 Baseline survey of TB drug resistance in Yunnan from 2008 to 2010
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
-- Issued Yunnan TB control and prevention plan 2002-2010 and 2011-2015 by Yunnan provincial government Expanding DOTS under NTP since 2002
Provincial Hospital Provincial Hospital Seeking health care County TB Center free diagnosis free treatment County TB Center free diagnosis free treatment TB Suspects and Patients TB Suspects and Patients County-level Hospital County-level Hospital Prefecture-level Hospital Prefecture-level Hospital referring Township-level Health Unit Township-level Health Unit Community/ Village Health Worker Community/ Village Health Worker Private Clinic referring Tuberculosis in Yunnan Province Health care system for TB diagnosis and treatment in Yunnan ---- Expanding basic DOTS under NTP since 2002
19 Achieved Main Goals of DOTS since 2005 Successful treatment rate (Smear Positive)
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)
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% 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 (class Ⅱ ), 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
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
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.
M/XDR-TB Control Total 48 MDR-TB cases were diagnosed and 26 of them received anti-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.
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 Hong He Yu Xi Expanding two prefectures in 2013 and 2014 Population ： 13 million, occupy 28.46% of total population Supported by GF 、 NTP CAP-TB ？？ Expanding of MDR-TB control program 2013-2014
Main Challenges of TB control in Yunnan Province
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 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. 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 Year Median of total delay (day) Inter quartile of total delay (day) 200510044-258 20069042-208 20078640-186 20088142-188 20096331-126 20106029-110 20115828-106 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, Zhenxiong county ： total 2258 PTB cases including 299 re-treatment cases in 2012, which meant very poor follow-up and treatment. 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 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 Main Challenges of TB control in Yunnan
ChinaCasesCured The completion of treatment Failure loseDeathOther To continue treatment The success rate of Treatment （ % ） ADR Other reasons 合计 61425324451044958532845.1 For MDR-TB patients started on treatment in GF project area in 2008 in China Lessons of MDR-TB treatment from national CDC What will happen in Yunnan in future ?