DOTS IN CHINA
by
Dr Zhao Fengzeng
Control of tuberculosis (TB) requires well organized national programme. The political commitment by the government is very important for the success of national TB control programme.
National TB prevalence surveys showed that the TB epidemic is still serious. There were estimated 1.5 million smear positive TB patients and 220 thousand patients dying from TB annually according to 1990's nationwide survey. TB deaths are twice the number of deaths of all infectious diseases. The prevalence of TB fell slowly during the years between 1979 and 1990 due to the limited funds for TB control as well as inadequate implementation of modern TB control strategy in some provinces and regions. Thus, the annual reduction rate of smear positive TB prevalence was only 3%. There was even the resurgence of TB in some parts of China. In the past, only a small amount of the nation's health budget was available for TB control so that the impact of any control strategy was not strong enough.
In early 1991, the Chinese Government signed an agreement with the World Bank for the first disease-control project in China. Since the start of the World Bank loaned TB project in 1992, the funds for TB are enormously increased from 3 cents to 17 cents for each person per year. The government officials gave their highest priorities to the project. After five years implementation, the project has covered 522 million population out of total 1130 million population. The project follows WHO's TB control strategy focusing on diagnosing and treating infectious TB patients free of charge. Since its implementation, more than 600 thousand infectious TB patients have been treated.
Throughout implementation of the project, continued high sputum conversion and cure rates have justified attempts to expand the project as quickly as possible. Expansion was a little slower than expected in 1992, but quickly caught up in 1993. By June 1997, the project covers 522 million population. The project carried out by three stages. The first was establishment pilot countries, covering two million people, then established demonstrational counties, covering 34 million people, final expanded to all of the areas in the project. By June 1997, 3.9 million symptomatics have been examined, over 613 thousand smear positive TB cases were discovered, 388 thousands of which were new smear positive patients (Table 1), 76% of new smear positive TB patients were between the ages 15 and 54 years (Figure 1), the economically productive years of life.
The project provides an opportunity for patients to receive directly observed treatment short course, free of charge. In China, the village doctor send drug to patient's hand, then look at the patient take it every other day. That is the Directly Observed Treatment Short Course. Thus the regularity and adherence of drug intake has been maintained followed by high cure rates. The cure rate obtained is 91.0% compared with 52% before the project (Table 2-4). DOTS treatment has saved the lives of hundreds of thousands of China's citizens.
How to make sure that TB patients take all their drugs and complete their treatment?
Suspected TB patients identified by village doctors were given free diagnostic services and, if found ill, were provided free treatment. The village doctor was responsible for holding the drugs safely, observing the patient taking each dose and ensuring that sputum was checked by the laboratory to prove progress and cure.
Today nearly 100 million Chinese are covered by the DOTS strategy. New funds are now needed to continue and extend coverage of the DOTS programme to the whole country. Measures also must be taken to include hospitals and train the growing private health care sector so that their TB treatment efforts are equally successful and integrated with the DOTS strategy.
