关键词: 结核, 试点项目, 问卷调查, 基线调查

Abstract:

Objective: To analyze the tuberculosis prevention and control status of the first 40 pilot counties of the tuberculosis care action project before implementation, and provide baseline data for the implementation effect evaluation. Methods: From April to June 2023, the National Center for Tuberculosis Control and Prevention of China CDC issued a unified semi-structured electronic questionnaire to 40 pilot counties from 15 provinces which were the first batch to implement the “Tuberculosis Care Action Pilot Project”(hereinafter referred to as the “pilot project”), to understand and analyze the service capacity of tuberculosis designated medical institutions, and implementation of measures such as humanistic care for tuberculosis patients and screening for tuberculosis key populations in pilot counties before the start of the pilot project (in 2022). Results: Among the 40 pilot counties, tuberculosis designated medical institutions were mainly composed of comprehensive hospitals (23 (57.50%)), followed by specialized hospitals (8 (20.00%)) and centers for disease control and prevention (6 (15.00%)). There were total 1017 tuberculosis prevention and control personnel in designated medical institutions of 40 counties (with a median of 19.5 (12.5, 34.0) each, range 3 to 64), mainly composed of outpatient and resident doctors (326 (32.05%)), followed by nursing personnel (225 (22.12%)), imaging doctors and laboratory personnel (187 (18.39%) and 134 (13.18%) respectively). A total of 10123 tuberculosis patients were reported, including 9980 patients (98.59%) of pulmonary tuberculosis (including 6326 (63.39%) etiology positive patients) and 143 patients (1.41%) of extrapulmonary tuberculosis. The proportion of etiology negative pulmonary tuberculosis meeting clinical diagnosis standard was 85.69% (629/734) overall, however, the proportion of etiology negative tracheobronchial tuberculosis meeting clinical diagnosis standard was only 17.86% (5/28). Forty pilot counties all conducted acid fast bacterial smear microscopy and PPD tests. Among them, 39 (97.50%), 37 (92.50%), and 32 (80.00%) counties conducted Mycobacterium culture, Mycobacterium tuberculosis nucleic acid testing, and anti tuberculosis drug resistance screening, respectively. However, only 16 (40.00%) and 19 (47.50%) pilot counties conducted Mycobacterium tuberculosis fusion protein test and interferon gamma release assay (IGRA), respectively. Thirty-nine (97.50%), 31 (77.50%), 14 (35.00%), and 23 (57.50%) counties carried out X-ray photography, CT examination, artificial intelligence film reading technology, and remote diagnosis, respectively. Seventeen (42.50%) counties applied information technology to manage patients, and 15 (37.50%) counties provided transportation or nutrition subsidies for patients. Only less than 30% counties could provide service such as nutrition assessments, nutrition supportive treatments, and psychological support for tuberculosis patients; tuberculosis was included in the outpatient special diseases list in 36 (90.00%) counties, and drug-resistant tuberculosis was included in the major disease security list in 26 (65.00%) counties; and 26 counties (65.00%) provided reimbursement for tuberculosis molecular biological testing. The overall screening rate of chest imaging of HIV/AIDS patients and close contacts of tuberculosis patients were high (96.06% (17105/17807) and 92.81% (46884/50515) respectively), but the overall screening rate for elderly people aged 65 and above and diabetes patients was low (13.48% (377436/2800877) and 12.27% (93808/764416) respectively). The implementation rate of tuberculosis screening for freshmen in school among pilot counties was not high (60.00% (24/40)-80.00% (32/40)), and that for nurseries and welfare institutions was also low (20.69% (6/29) and 25.00% (8/32) respectively). Conclusion: All pilot counties have already had the basic hardware conditions required for tuberculosis diagnosis before the pilot project, but they still need to be further improved in the diagnosis ability of etiology negative pulmonary tuberculosis, the application of information management methods, the implementation of patient humanistic care measures and medical insurance policies, and the screening quality of tuberculosis key populations.

Key words: Tuberculosis, Pilot projects, Questionnaires survey, Baseline investigation