Table of Content

10 February 2024, Volume 46 Issue 2

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Clinical practice guidelines for early detection of pulmonary tuberculosis in general medical facilities

National Center of Medical Quality Control for Respiratory Diseases , Tuberculosis Branch of Chinese Medical Association , Tuberculosis Control Branch of Chinese Antituberculosis Association , China-Japan Friendship Hospital

Chinese Journal of Antituberculosis. 2024, 46(2):  127-140.  doi:10.19982/j.issn.1000-6621.20230428

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The diagnosis delay of pulmonary tuberculosis not only results in aggravation and treatment challenges for patients but also leads to the continuously group spreading of tuberculosis. Early detection in general medical facilities, the main primary diagnosis healthcare contact for pulmonary tuberculosis patients, plays a crucial role in achieving the goal of “End tuberculosis strategy”. The National Center of Medical Quality Control for Respiratory Diseases, Tuberculosis Branch of Chinese Medical Association, Tuberculosis Control Branch of Chinese Antituberculosis Association, and China-Japan Friendship Hospital jointly organized experts to formulate the Clinical practice guidelines for early detection of pulmonary tuberculosis in general medical facilities based on the results of China’s tuberculosis prevention practice and the relevant guidelines of the World Health Organization and supplement relevant research evidence at home and abroad. This guide systematically summarizes the characteristics of different diagnostic techniques for pulmonary tuberculosis and proposes tuberculosis screening strategies for different target populations seeking treatment in comprehensive medical institutions, providing evidence for improving and optimizing early detection of pulmonary tuberculosis in national and regional comprehensive medical institutions.

Development and effectiveness of “Xinjiang Model” for tuberculosis prevention and control

Wang Senlu, Liu Nianqiang, Wang Xinqi, Cao Mingqin, Wang Le, Wang Xijiang

Chinese Journal of Antituberculosis. 2024, 46(2):  141-144.  doi:10.19982/j.issn.1000-6621.20230442

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Tuberculosis is a major public health problem concerned in Xinjiang Uygur Autonomous Region and even the whole country. The author reviewed and summarized the progress and effect of tuberculosis prevention and control in Xinjiang, systematically combed the problems and challenges of tuberculosis prevention and control in Xinjiang, especially the experience and practices of the “Three Biggest” in “Xinjiang Model” for tuberculosis prevention and control, and put forward the countermeasures and suggestions for the next step of “Xinjiang Model” for tuberculosis prevention and control.

Evaluation of the implementation effect of “Active Tuberculosis Screening+Full-Course Hospitalization” model for patient detection in Hotan Prefecture, Xinjiang Uygur Autonomous Region

Zhang Yan, Wang Senlu, Rizwanguli Rehman, Liu Nianqiang, Wang Xinqi, Mao Hongkai, Wang Xiaomin, Cao Mingqin

Chinese Journal of Antituberculosis. 2024, 46(2):  145-150.  doi:10.19982/j.issn.1000-6621.20230284

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Objective: To quantitatively evaluate the effectiveness of the “Active Tuberculosis Screening+Full-Course Hospitalization” model in the detection of tuberculosis patients in Hotan Prefecture of Xinjiang Uygur Autonomous Region, and to provide a scientific basis for the steady advancement of tuberculosis prevention and treatment in Xinjiang. Methods: The reported incidence data of tuberculosis patients in Hotan Prefecture of Xinjiang and other prefectures without full-course hospitalization strategy from January 2012 to December 2021 were collected. Joinpoint regression model was used to analyze the time trend of reported incidence of tuberculosis. Taking July 2018 as the policy intervention time point of the “Active Tuberculosis Screening+Full-Course Hospitalization” model, the interrupted time series (ITS) model and controlled interrupted time series (CITS) model were constructed according to whether the control area was set up or not, to analyze the effect of policy intervention. Results: The highest reported incidence of tuberculosis in Hotan Prefecture from 2012 to 2021 was 465.10/100000 (n=10278) in 2018, and the lowest incidence was 129.40/100000 (n=3241) in 2021, with an overall decreasing trend (AAPC=-4.5%, P<0.05); reported incidence of tuberculosis from 2012 to 2018 showed an increasing trend (APC=10.8%, P<0.05), while reported incidence of tuberculosis from 2018 to 2021 showed a rapid decreasing trend (APC=-29.0%, P<0.05). The ITS model analysis showed that one month after the implementation of the “Active Tuberculosis Screening+Full-Course Hospitalization” model in Hotan Prefecture (July, 2018), the reported incidence increased by 16.859/100000 (P=0.001), and the long-term effect of the implementation of the new model was a decreasing trend in the reported incidence of tuberculosis (β₃=-1.098, P<0.001). The CITS model analysis showed that reported incidence of tuberculosis in Hotan Prefecture increased significantly one month after the implementation of the new model (July, 2018), with an increase of 14.751/100000 (P<0.001) higher than that in the control area, and the long-term effect of the implementation of the new model was a decreasing trend in the reported incidence of tuberculosis, with an average monthly decrease of 0.815/100000 (β₅+β₇=-0.815, P<0.001), and the rate of decline was greater than that in the control area (β₇=-0.931, P<0.001). Conclusion: There is a dynamic causal relationship between the implementation of the “Active Tuberculosis Screening+Full-Course Hospitalization” model and reported incidence of tuberculosis in the Hotan Prefecture of Xinjiang, and the new model has contributed to a long-term trend of decreasing reported incidence after a short-lived increase. The implementation of this model has obvious advantages for controlling tuberculosis epidemics in areas with a high tuberculosis burden.

Qualitative evaluation of the implementation status of tuberculosis prevention and control in Southern Xinjiang Uygur Autonomous Region: qualitative interviews based on grounded theories

Bao Liangliang, Wang Xinqi, Zhang Yan, Cao Mingqin

Chinese Journal of Antituberculosis. 2024, 46(2):  151-157.  doi:10.19982/j.issn.1000-6621.20230288

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Objective: The implementation status, problems and reasonable suggestions of tuberculosis prevention and control in Southern Xinjiang of Xinjiang Uygur Autonomous Region were investigates and analyzed through in-depth interviews, so as to provide basis for improvement and sustainable development of tuberculosis prevention and control in Xinjiang. Methods: A semi-structured interview was conducted in 27 systematic randomly sampled relevant staff engaged in tuberculosis prevention and control in four southern Xinjiang prefectures (Aksu Prefecture, Hotan Prefecture, Kashi Prefecture, and Kizilsu Kirgiz Autonomous Prefecture). Information was condensed based on the grounded theoretical framework, and interview texts were sorted, coded and refined. Results: Three themes of the effectiveness, problems and suggestions of the tuberculosis prevention and control in southern Xinjiang from the interview text were extracted, the effectiveness, shortcomings and problems of the implementation,and reasonable suggestions of the tuberculosis prevention and control in southern Xinjiang were deeply investigated and qualitatively analyzed. Conclusion: After the implementation of the new tuberculosis prevention and control in Southern Xinjiang, the way of patient detection, the number of patients and the management of treatment have been significantly improved. At present, there are still some deficiencies. It is still necessary to constantly improve and enrich the tuberculosis prevention and control in Southern Xinjiang, put forward scientific and effective strategies and paths for tuberculosis prevention and control in Xinjiang, to effectively control the occurrence and spread of tuberculosis, and achieve the goal of “End TB Strategy” in Xinjiang as soon as possible.

Evaluation of the application effect of digital therapeutics adherence technology in medication management of tuberculosis patients

Zhang Han, Wang Lixia, Wei Yushi, Zhao Rui, Wang Xinqi, Liu Nianqiang, Wang Senlu

Chinese Journal of Antituberculosis. 2024, 46(2):  158-164.  doi:10.19982/j.issn.1000-6621.20230283

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Objective: To evaluate the implementation effect of digital treatment adherence technologies (DAT) and further improve the quality of treatment and service management for active pulmonary tuberculosis patients in Changji Prefecture, Xinjiang Uygur Autonomous Region (referred to as “Xinjiang”).Methods: A retrospective study was conducted. Clinical data of active pulmonary tuberculosis patients registered with current addresses in “Changji Prefecture, Xinjiang (5 counties and 2 cities)” from January 1, 2021, to March 31, 2023, were exported from the “Tuberculosis Information Management System” and the “Easy Supervision” website of the Chinese Center for Disease Control and Prevention. Based on the patient management method, 403 patients registered as pulmonary tuberculosis from January 1 to December 31, 2021, but not using the “Easy Supervision” system were included in the traditional management group (traditional group). Additionally, 313 patients registered as pulmonary tuberculosis from January 1, 2022, to March 31, 2023, and using the “Easy Supervision” system were included in the DAT management group (DAT group). The DAT utilization rate was 89.68% (313/349). Further categorization of the DAT group based on the use of electronic tools resulted in the Electronic Medication Box management group (Medication Box group; 81 cases (25.88%)) and the WeChat official account management group (WeChat group; 232 cases (74.12%)). The population demographics, medication adherence, treatment outcomes, DAT usage in the DAT group, and management conditions in different regions were analyzed. Results: The WeChat group had significantly lower proportions in the age group ≥60 years (30.60% (71/232)) and among farmers and herdsmen (40.95% (95/232)) compared to the Medication Box group (77.78% (63/81) and 76.54% (62/81)), and the differences were statistically significant (χ²=54.780, P=0.000; χ²=32.666, P=0.000). The Traditional Group had higher overall medication adherence rates (97.78% (99053/101299)) and regular medication adherence rates (96.03% (387/403)) than the DAT management group (93.23% (62601/67146) and 85.62% (268/313)), the Medication Box group’s overall medication adherence rate (95.89% (15808/16486)) was higher than the WeChat group (92.37% (46793/50660)), and the differences were statistically significant (χ²=2162.210, 24.481, 244.306, all P values=0.000). However, there was no statistically significant difference in regular medication adherence rates between the WeChat group (84.48% (196/232)) and the Medication Box group (88.89% (72/81))(χ²=0.947, P=0.331). The treatment success rate (95.85% (300/313)), sputum examination rate at the end of the 2nd/3rd month (99.36% (311/313)), and sputum smear conversion rate (98.76% (159/161)) in the DAT group were not statistically different from those in the traditional group (94.29% (380/403), 98.26% (396/403), and 97.83% (271/277)), respectively (χ²=0.891, P=0.345; χ²=0.941, P=0.332; χ²=0.106, P=0.744). However, the WeChat group’s treatment success rate (98.28% (228/232)) was higher than that of the Medication Box group (88.89% (72/81)), and the difference was statistically significant (χ²=11.036, P=0.001). The regular medication adherence rates in different regions of the DAT management group ranged from 61.22% (30/49) to 97.30% (36/37), and the difference was statistically significant (χ²=39.320, P=0.000). Conclusion: The proportion of pulmonary tuberculosis patients in Changji Prefecture, Xinjiang, accepting DAT management is relatively high, with WeChat official account management being the primary method. This method can more accurately reflect patient medication conditions, and the management effect is consistent with traditional management methods. Different DAT management measures should be developed for different counties, cities, management methods, ages, and occupational groups in order to improve regular medication adherence rates. The application of DAT should be gradually promoted in Xinjiang.

Analysis of willingness of receiving preventive treatment in patients with latent tuberculosis infection among close contacts of pulmonary tuberculosis in high-burden areas

Zhang Jing, Fu Ruonan, Wang Senlu, Feng Jianyu, Zhang Ling, Gulina Badeerhan, Zulikatiayi Abudula, Wang Xinqi

Chinese Journal of Antituberculosis. 2024, 46(2):  165-172.  doi:10.19982/j.issn.1000-6621.20230395

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Objective: To understand the willingness of accepting tuberculosis preventive treatment (TPT) and its influencing factors among patients with latent tuberculosis infection (LTBI) in tuberculosis high-burden areas of Xinjiang Uygur Autonomous Region and to provide evidence for policy making. Methods: A cross-sectional study was conducted to select 3023 patients with tuberculosis confirmed in Awati County and Wushi County, Aksu Prefecture, Xinjiang Uygur Autonomous Region, from August 1, 2021 to December 31, 2022, as index cases, then 6407 close contacts of index cases were screened for LTBI after which 529 LTBI patients were identified. A questionnaire survey was conducted on the willingness of accepting TPT. Information on population characteristics, daily habits, living environment, contact information, health status was collected too. 516 valid questionnaires were retrieved. A binomial-logit linked generalized linear model was constructed to explore the influencing factors. Results: 497 cases were willing to receive TPT, with an acceptance rate of 96.32% (497/516). Those LTBI patients who do not live together with the indicated case were more likely to receive preventive treatment (OR=5.713,95%CI: 1.477-22.097), and those who do not contact other tuberculosis patients except the indicated case were more likely to refuse preventive treatment (OR=0.142,95%CI: 0.039-0.516). Conclusion: LTBI patients among close contacts in high tuberculosis burden areas have a high willingness to receive TPT, which is influenced by their own economic level and contact with tuberculosis patients.

The effect of GeneXpert MTB/RIF detection technology in tuberculosis prevention and control program in Xinjiang

Gulina Badeerhan, Liu Nianqiang, Yipaer Aihaiti, Wang Le, Wang Senlu, Zulikatiayi Abudula, Wang Mingzhe, Zhang Jing, Wang Xinqi, Bi Hongbo

Chinese Journal of Antituberculosis. 2024, 46(2):  173-177.  doi:10.19982/j.issn.1000-6621.20230321

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Objective: To explore the effect of using GeneXpert MTB/RIF (“GeneXpert” for short) to detect pulmonary tuberculosis and rifampicin resistant pulmonary tuberculosis in the implementation of the “Xinjiang model” of tuberculosis prevention and treatment. Methods: The registration data of pulmonary tuberculosis in Xinjiang Uygur Autonomous Region (“Xinjiang” for short) from 2017 to 2020 were collected from the “Tuberculosis Management Information System”, a subsystem of the “China Disease Prevention and Control Information System”, and the effect of the comprehensive application of GeneXpert detection was analyzed. The etiologically positive rate, rifampicin resistance detection rate, rifampicin resistance cases detected from 2017 to 2020 were evaluated. Results: The coverage rate, detection rate of GeneXpert devices, and overall etiologically positivity rate of all patients increased from 20.00% (22/110), 0.32% (126/39261), and 20.17% (7919/39261) in 2017 to 100.00% (110/110), 75.16% (19610/26090), and 57.94% (15116/26090) in 2020, respectively, and the differences were statistically significant (χ²=40.705, P<0.001; χ²=174.087, P<0.001; χ²=47.569, P<0.001). The number of etiologically positive patients increased from 7919 in 2017 to 15116 in 2020, and the number of GeneXpert positive patients alone increased from 6 in 2017 to 7194 in 2020, accounting for an proportion from 0.08% (6/7919) to 47.59% (7194/15116), with a statistically significant difference (χ²=83.824, P<0.001). The screening rate of rifampicin resistance and the resistance screening rate with GeneXpert in etiologically positive pulmonary tuberculosis patients increased from 44.49% (3523/7919) and 1.85% (65/3523) in 2017 to 99.79% (15084/15116) and 96.13% (14501/15084) in 2020, respectively, and the differences were statistically significant (χ²=133.333, P<0.001; χ²=250.893, P<0.001). Conclusion: The application of GeneXpert detection technology can significantly improve the detection level of etiologically positive and rifampicin resistant pulmonary tuberculosis cases, help the rapid decline of local tuberculosis epidemic in Xinjiang.

Analysis of screening of close contacts of pathogenic positive pulmonary tuberculosis patients in Sichuan Province from 2018 to 2022

Xia Lan, Liu Shuang, Li Ting, Lu Jia, Wang Danxia, Zhang Linglin

Chinese Journal of Antituberculosis. 2024, 46(2):  178-182.  doi:10.19982/j.issn.1000-6621.20230315

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Objective: To analyze the tuberculosis screening of close contacts of pathogenic positive pulmonary tuberculosis patients in Sichuan Province from 2018 to 2022, and to provide a theoretical basis for the screening and management of close contacts. Methods: The pathogenic positive pulmonary tuberculosis patients and the close contacts (those who have direct contact with the pathogenic positive pulmonary tuberculosis patients from within 3 months after the diagnosis to 14 days after the start of anti-tuberculosis treatment) registered in the “Tuberculosis Information Management System” between January 1, 2018 and December 30, 2022 were selected as the survey objects. Of them, the close contacts were all screened, and the close contacts registered in 2022 were the follow-up subjects. The screening of tuberculosis and the detection of active tuberculosis in close contacts at different times and of different types were analyzed. Results: From 2018 to 2022, a total of 99273 pathogenic positive pulmonary tuberculosis patients were reported in Sichuan Province, and 260661 close contacts were registered, of which 260291 (99.86%) were screened for suspected symptoms of tuberculosis, and 2623 active pulmonary tuberculosis patients were detected, with an average detection rate of 1.01%. The tuberculosis inspection rate (98.50%, 6425/6523) and detection rate (4.54%, 292/6425) of close contacts with suspected tuberculosis symptoms were significantly higher than those of close contacts without suspected tuberculosis symptoms (86.40%, 219247/253768) and detection rate (1.06%, 2331/219247), with a statistically significant difference (χ² values were 807.587 and 658.621, respectively, both P<0.001). The examination rate of tuberculosis in close contacts outside the family (96.53%, 82173/85129) was significantly higher than that in close contacts inside the family (81.92%, 143499/175162), with a statistically significant difference (χ²=10595.710, P<0.001). The detection rate of active pulmonary tuberculosis in close contacts within the family (1.58%, 2264/143499) was significantly higher than that of close contacts outside the family (0.44%, 359/82173), and the difference was statistically significant (χ²=591.968, P<0.001). The 42078 close contacts of newly registered pathogenic positive pulmonary tuberculosis patients in 2022 were screened for symptoms at the time of diagnosis, 39056 (92.82%) were examined for tuberculosis, and 719 (1.84%) active pulmonary tuberculosis patients were detected; 35.39% (9705/27423) completed the second follow-up (6 months after the first screening); 55.31% (5368/9705) received tuberculosis examination, and 2 (0.04%) active tuberculosis patients were detected; only 7.08% (4072/57474) completed the third follow-up (one year after the first screening), 38.33% (1561/4072) received tuberculosis examination, and one (0.06%) active tuberculosis patient was detected. Conclusion: From 2018 to 2022, the screening proportion of close contacts of pathogenic positive pulmonary tuberculosis patients in Sichuan Province was relatively high, but the screening effect was unsatisfactory. We should pay attention to the screening of tuberculosis of close contacts outside the home, and pay attention to the follow-up work of close contacts 6 months and 1 year after the first screening.

Analysis of delayed detection and the related influencing factors of pulmonary tuberculosis patients in Chongqing from 2015 to 2021

Chen Jian, Shi Lin, Lei Rongrong, Yu Ya, Wang Qingya, Wu Chengguo, Liu Xiaoqiu

Chinese Journal of Antituberculosis. 2024, 46(2):  183-189.  doi:10.19982/j.issn.1000-6621.20230303

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Objective: To analyze the delayed detection of pulmonary tuberculosis (PTB) patients in Chongqing from 2015 to 2021 and the influencing factors, to provide scientific basis for reducing detection delay of PTB. Methods: Relevant informations of 174067 pulmonary tuberculosis patients in Chongqing from 2015 to 2021 were collected from the subsystem “Infectious Disease Reporting Information Management System” of the China Information System for Disease Control and Prevention, including report time, demographic characteristics (gender, age, occupation), region, origin, diagnosis, date of onset, and date of diagnosis. The Joinpoint regression model was used to describe the change of detection delay rate from 2015 to 2021, the influencing factors of the detection delay were analyzed using logistic regression model. Results: From 2015 to 2021, the median and quartile of detection delay were 31 (10,73) d, with the average annual delay rate of 53.25% (92695/174067); the detection delay rate decreased from 58.20% (15093/25935) in 2015 to 50.18% (11026/21974) in 2021. From 2015 to 2021, detection delay rate showed a decreasing trend (AAPC=-2.5%, t=-2.095, P=0.036); from 2015 to 2019, a statistically significant decrease in delay rate was observed (APC=-4.1%, t=-4.313, P=0.049); while from 2019 to 2021, no statistically significant change in delay rate was found (APC=0.8%, t=0.248, P=0.827). The results of multivariate analysis showed that female (OR=1.036, 95%CI: 1.015-1.059), aged 45-64 years (OR=1.095, 95%CI: 1.065-1.125), unemployed or retired (OR=1.233, 95%CI: 1.177-1.294), farmers or herdsmen or fishermen or migrant worker (OR=1.624, 95%CI: 1.546-1.710), preschool (OR=3.581, 95%CI: 2.271-5.761), workers (OR=1.134, 95%CI: 1.062-1.213), lived in northeast region of Chongqing (OR=1.270, 95%CI: 1.244-1.312), being outside the urban area of Chongqing (OR=1.136, 95%CI: 1.087-1.187), and pathogenic positivity (OR=1.033, 95%CI: 1.013-1.055) were common risk factors for detection delay of PTB. Conclusion: The rate of detection delay of PTB in Chongqing is relatively serious, but the overall trend was decreasing with the time. More attention and comprehensive measures should be paid to key areas and populations.

Investigation on health literacy of tuberculosis patients in tuberculosis demonstration area of Jiangsu Province and its influencing factors

He Chu, Wu Zhaojun, Peng Hong, Qian Jiao, Jiang Jie, Zhai Xiangjun

Chinese Journal of Antituberculosis. 2024, 46(2):  190-198.  doi:10.19982/j.issn.1000-6621.20230335

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Objective: The purpose of this study was to ascertain the level of health literacy among tuberculosis patients in the demonstration areas of Jiangsu Province and to analyze the factors influencing their health literacy, to provide a reference for advancing health literacy related to tuberculosis. Methods: A survey was conducted from July 3 to July 24, 2020, using the “2020 National Health Literacy Monitoring Survey Questionnaire (Tuberculosis)” to investigate 988 tuberculosis patients in the demonstration areas of Jiangsu Province (Danyang, Taixing, and Zhangjiagang). A total of 988 questionnaires were distributed and effectively retrieved. In the assessment of health literacy, the study adopted indicators of three domains of general health literacy, namely, fundamental health knowledge and conceptual literacy, health-promoting lifestyle and behavioral literacy, and essential skills literacy, as well as six categories of health issue-specific literacy(literacy of scientific health perspectives, infectious disease prevention and control, chronic disease management, safety and emergency response, basic medical care, and health information comprehension). Multivariable logistic regression analysis was employed to identify the factors affecting the health literacy of tuberculosis patients. Results: In the demonstration areas, 36.2% (358/988) of the patients possessed health literacy. The proportions of patients with literacy in the three health aspects, from highest to lowest, were as follows: basic health knowledge and concept literacy (47.5% (469/988)), healthy lifestyle and behavior literacy (40.9% (404/988)), and basic skills literacy (33.4% (330/988)). The proportions of patients with literacy in the six health issues, from highest to lowest, were as follows: safety and first aid literacy (65.9% (651/988)), scientific health view literacy (62.2% (615/988)), health information literacy (49.5% (489/988)), chronic disease prevention literacy (44.2% (437/988)), basic medical care literacy (34.2% (338/988)), and infectious disease prevention literacy (28.5% (282/988)). The multivariable logistic analysis indicated that, compared to the 15-44 age group, the proportions of patients with health literacy in 45-64 age group (OR=0.527, 95%CI:0.371-0.748) and in 65 and above age group (OR=0.406, 95%CI:0.268-0.615) were lower. Compared to Danyang, the proportions of patients with health literacy were higher in Taixing (OR=1.612, 95%CI:1.127-2.306) and Zhangjiagang (OR=1.539, 95%CI:1.080-2.195). Regarding educational levels, compared to those with primary school education or below, the proportions of patients with health literacy were higher among those with junior high school, senior high school/professional high school/technical school (OR=2.872, 95%CI:1.909-4.320), and those with a junior college education/bachelor’s degree or higher (OR=8.050, 95%CI:4.502-14.395). Conclusion: The overall level of health literacy among tuberculosis patients in the demonstration areas of Jiangsu Province is relatively high, yet the literacy level for infectious disease prevention is low. It is essential to strengthen health promotion and education for middle-aged and elderly patients over the age of 45 and those with lower educational levels, particularly in the area of infectious disease prevention and control education.

Evaluation on the implementation effect of different tuberculosis prevention and control management models during the 13th Five-Year Plan period in Guangzhou

Zheng Guangmin, Wang Ting, Zhang Danni, Lei Yu, Yang Jieying, Wu Guifeng, Du Yuhua, Xiao Xincai

Chinese Journal of Antituberculosis. 2024, 46(2):  199-205.  doi:10.19982/j.issn.1000-6621.20230373

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Objective: To evaluate the implementation effect of the existing tuberculosis management mode in Guangzhou, and to provide the evidence and examples for improving the tuberculosis prevention and control service system. Methods: From 2016 to 2020, the tuberculosis epidemic data under four tuberculosis prevention and control management models (chronic disease management model, “trinity” model, general hospital management model and entrusted service mode) in Guangzhou were collected from the tuberculosis surveillance information reporting management system of Guangzhou and the final evaluation report of the 13th Five-Year Plan for tuberculosis prevention and control in Guangzhou. The registration rate, etiological positive rate, successful treatment rate, management rate and standardized management rate of pulmonary tuberculosis patients under different modes were calculated, and the cost-effectiveness analysis of the implementation effect was carried out. Results: In 2016—2020, the average annual registration rate of tuberculosis in Guangzhou was 51.78/100000 (46228/89280200), the average annual registration rate of the four models from high to low, was entrusted service mode (74.37/100000 (10522/14148900)), “trinity” (50.17/100000 (11349/22619500)), chronic disease management (47.37/100000 (14588/30793700)) and general hospital management (44.98/100000 (9769/21718100)), statistically significant difference (χ²=222.422, P<0.001). The total etiological positive rate was 49.33% (22806/46228), the rate of chronic disease management model was the highest (50.98% (7437/14588)), and the entrusted service model was the lowest (48.07% (5058/10522)); the overall treatment success rate was 93.26% (43113/46228), the rate of general hospital management model was the highest (95.73% (9352/9769)), and the “trinity” model was the lowest (90.30% (10248/11349)); the total standard management rate was 89.08% (13254/14879), the rate of entrusted service mode was the highest (95.40% (2573/2697)), and the “trinity” model was the lowest (82.69% (3100/3749)); the differences were statistically significant (χ²=27.302, P<0.001; χ²=306.666, P<0.001; χ²=294.272, P<0.001). The per capita investment was 0.86 yuan (76477200/89280200), the maximum investment for one DALY loss was the “trinity” model (RMB 188.20 yuan (20326600/108003.67)), and the general hospital management model is the lowest (153.77 yuan (15155800/98560.73)). Conclusion: During the period, the four tuberculosis control management models in Guangzhou have its own advantages and disadvantages. In the future, it is still necessary to take active measures to improve the deficiencies in the existing tuberculosis prevention and control service system based on the demand orientation of various districts, from government departments, systems to talent construction, so as to further improve the patient registration rate, the etiological positive rate and the total standardized management rate.

An analysis on the core knowledge, attitudes, and practices regarding tuberculosis prevention and control among college students in four provinces of China

Dong Longyu, Wang Jia, Ni Shuaihu, Chen Gang, Wang Ni, Luo Xiaofeng, Qu Yan, Zhao Yanlin

Chinese Journal of Antituberculosis. 2024, 46(2):  206-212.  doi:10.19982/j.issn.1000-6621.20230368

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Objective: To understand the core knowledge, attitudes, and practices related to tuberculosis (TB) prevention and control among college students in China, and to provide evidence for scientific and effective health education strategies in colleges. Methods: From April to July 2022, stratified cluster sampling method and self-designed network questionnaire were used to investigate freshmen and sophomores from 80 colleges in Zhejiang, Sichuan, Hubei, and Gansu Provinces. A total of 18438 questionnaires were collected, of which 17491 were valid, and the efficiency was 94.86%. Chi-square test was used to analyze differences in total awareness rates. Results: The total awareness rate of core knowledge of TB among college students was 82.20% (115019/139928). In the single awareness rates, that of “If suspected of having TB, individuals need to contact a local TB medical institution for care” was highest (97.14% (16991/17491)) and that of “TB is a chronic infectious disease” was lowest (53.68% (9390/17491)). Higher total awareness rates were observed among female students (83.80% (65333/77960), χ²=309.733, P<0.001), medical students (84.79% (27701/32672), χ²=194.870, P<0.001), students who came from undergraduate colleges (83.25% (66017/79296), χ²=139.249, P<0.001), students who infected TB previously (84.82% (760/896), χ²=4.239, P=0.040), and students who ever received health education (83.62% (97111/116128), χ²=948.032, P<0.001). There were 96.23% (16831/17491) agreed that it was important for colleges to conduct TB health education, 92.37% (16156/17491) were willing to participate in these activities, and 94.66% (16557/17491) were willing to share the knowledge they learned with others among college students surveyed. Supposing they infected TB, 10.99% (1923/17491) responded with indifference/depression/despair/helplessness. If familiar people were suffering from TB, 11.49% (2009/17491) chose to alienate/refuse to communicate with them. There were 12.00% (2099/17491) college students were a current or ever smoker, 66.47% (11627/17491) used to stay up late, 55.33% (9677/17491) experienced insufficient sleep, 30.88% (5401/17491) observed classmates spitting and 37.57% (6572/17491) could not cover their mouth and nose when coughing or sneezing. Conclusion: The core knowledge of TB prevention and control in schools has not been fully widespread among college students. TB health education should be further carried out for male, junior college and non-medical students, etc. Meanwhile, it is imperative to guide students to establish a belief of caring for TB patients and develop a healthy lifestyle.

Investigation and analysis of 196 newly diagnosed etiologically positive pulmonary tuberculosis patients on knowledge of tuberculosis infection control

Jiang Xiaoying, Liu Jing, Zhang Zhiguo, Zhang Wen, Gao Mengqiu, Yang Xinting, Mi Fengling

Chinese Journal of Antituberculosis. 2024, 46(2):  213-220.  doi:10.19982/j.issn.1000-6621.20230227

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Objective: To investigate the knowledge of tuberculosis (TB) infection control among newly diagnosed etiologically positive pulmonary TB patients, and to provide basis for effective TB infection control and health education. Methods: From January 2019 to January 2023, 196 newly diagnosed TB patients with positive etiological test results from Beijing Chest Hospital, Capital Medical University, Tuberculosis Prevention and Control Institute of Changping District, Disease Prevention and Control Center of Daxing District in Beijing were investigated with a questionnaire on knowledge about TB infection control, including basic information of patients, TB infection control questionnaire, clinical information, etc.; 196 questionnaires were sent out, with 196 valid questionnaires and a 100.0% effective rate. Then we summarized the knowledge of TB infection control among respondents, and analyzed the factors affecting their awareness of core information of TB prevention and control. Results: The total awareness rate among the surveyed subjects was 64.4% (2649/4116). Multivariable logistic regression showed that compared to those with junior high school or lower education, those with a college/undergraduate degree or above were more likely to meet the standard of TB infection control knowledge (OR=6.659, 95%CI: 1.995-22.220); compared with those with TB contact history, those without were less likely to reach the TB infection control knowledge standard (OR=0.218, 95%CI: 0.054-0.886). Conclusion: The awareness of TB infection control knowledge among newly diagnosed etiologically positive pulmonary TB patients still needs to be improved, and the awareness of those with junior high school education and below and those without TB contact history are relatively low, on whom targeted TB prevention and control health education should be performed in the future.

Auxiliary diagnosis value of interferon gamma-induced protein 10 mRNA release assay for tuberculosis in different age groups

Song Ruixue, Dong Jing, Yao Mingxu, Jia Hongyan, Li Zihui, Sun Qi, Zhu Chuanzhi, Du Boping, Xing Aiying, Pan Liping

Chinese Journal of Antituberculosis. 2024, 46(2):  221-227.  doi:10.19982/j.issn.1000-6621.20230351

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Objective: To evaluate the auxiliary value of interferon gamma-induced protein 10 (IP-10) mRNA release assay in the diagnosis for tuberculosis in different age groups. Methods: Totally 1590 suspected tuberculosis patients who were admitted to the Beijing Chest Hospital, Henan Infectious Diseases Hospital, and the Third People’s Hospital of Shenzhen from March 2018 to July 2022 and who finished IP-10 mRNA release assay before anti-tuberculosis therapy were prospectively recruited. A total of 1390 cases were included in the final analysis, and were divided into definite TB group (n=475), probable TB group (n=518) and non-TB group (n=397), according to the clinical diagnosis results. Other 200 cases with unclear diagnosis were excluded from the analysis. Furthermore, all the patients included in the analysis were further divided into two groups according to the age, the younger group (n=1062, 18-59 years) and the elderly group (n=328, 60-95 years). The diagnostic performance of IP-10 mRNA release assay were analyzed in the different age groups, based on the final diagnosis in clinic. Results: The sensitivity and specificity of IP-10 mRNA release assay were 90.2% (721/799, 95%CI: 87.9%-92.1%) and 68.8% (170/247, 95%CI: 62.6%-74.4%), respectively in the younger group, while 87.8% (159/181, 95%CI: 82.0%-92.0%) and 54.7% (76/139, 95%CI: 46.0%-63.1%), respectively in the elderly group. The specificity of IP-10 mRNA release assay in the younger group was significantly higher than that in the elderly group (χ²=7.704, P=0.006). However, there were no significant difference in the sensitivity between the two groups (χ²=0.922, P=0.337). There was no significant difference in the trend of diagnostic sensitivity of IP-10 mRNA release assay with the increasing age (Z=-1.063, P=0.288), but the diagnostic specificity was decreased significantly with the increasing age (Z=-2.846, P=0.004). Conclusion: IP-10 mRNA release assay is a promising test for auxiliary diagnosis of tuberculosis in younger patients; while considering the less impact of age on diagnostic sensitivity of IP-10 mRNA release assay, it may be helpful to use this technique for screening Mycobacterium tuberculosis infection in the elderly population.

Construction of a tuberculosis patient follow-up program based on the “internet+” hospital-community-home linkage model

Gao Dan, Wang Linghua, Huang Jinpeng, Lang Yazhen

Chinese Journal of Antituberculosis. 2024, 46(2):  228-238.  doi:10.19982/j.issn.1000-6621.20230344

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Objective: To construct a follow-up plan for tuberculosis (TB) patients based on the “internet+” hospital-community-family linkage model. Methods: Drawing upon the “Donabedian structure-process-result” theory, a follow-up plan for TB patients was developed within the framework of the “internet+” hospital-community-family linkage model through comprehensive literature analysis and semi-structured interviews. Using Delphi method, 30 experts were consulted from January to July in 2023. The indicators were then modified to determine the final plan. The mean difference of importance scores from the last round of expert correspondence was used for the Saaty evaluation scale, and the weight for each index was calculated with the Analytic Hierarchy Process. Results: Three rounds of Delphi expert consultation were completed with effectively retrieve rates of 90.0% (27/30), 92.6% (25/27) and 92.0% (23/25), respectively, and the recommendation rates were 59.3% (16/27), 24.0% (6/25) and 8.7% (2/23), respectively. The Cr values of expert authority coefficients were 0.87, 0.91 and 0.92, respectively, and the coefficients of variation were 0.082-0.326, 0.060-0.114, 0-0.123, respectively. The Kendall’s coefficient of concordance (W) increased from 0.058 to 0.122, and the Chi-square tests were all P<0.01. The final index system included 3 first-level indicators (hospital-community-family linkage module, health education module, evaluation module), 19 second-level indicators, 47 third-level indicators, and the weight of each index was determined. The weights of the three first-level indicators were 0.387, 0.443, 0.170, respectively, all CR<0.1. Conclusion: Drawing upon the Donabedian theory, the “internet+” hospital-community-family linkage model of TB patient follow-up program is feasible, reliable, practical and of good clinical value. The weight of each indicator is quantized and the consistency is high, which increases the logic of the program and provides a standardized process for the follow-up of TB patients.

Role of tissue kallikrein family in pathogenesis of microorganism infection

Shang Xuetian, Pan Liping

Chinese Journal of Antituberculosis. 2024, 46(2):  239-244.  doi:10.19982/j.issn.1000-6621.20230377

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Tissue kallikrein-related peptidase (KLK) is a subgroup of proteolytic enzymes with trypsin or chymotrypsin properties in the serine protease family, consisting of 15 family proteins, respectively named as KLK1 to KLK15. In recent years, more and more studies have shown that KLK can participate in various physiological activities by cutting key proteins of viruses and bacteria, activating various host receptors, regulating the kinin system, etc., affecting the course of affecting the course of various pathogenic microorganisms infection in viruses, bacteria and fungi, and the mechanism of action is complex and extensive. In this paper, the role and mechanism of KLK family proteins in microbial infection in recent years were reviewed, so as to better explore the important role of KLK in microbial infection, especially to provide ideas for their research in Mycobacterium tuberculosis infection, and to provide a theoretical basis for KLK family proteins to be used as anti-tuberculosis therapeutic targets.