been treated with the above-mentioned regimen and the sputum negative conversion rate at the end of second month was 90.8% and it increased further to 95.9% at the end of third month. The results of the outcome of treatment by cohort analysis for new smear positive patients were: cured-92.9%; completion of treatment-1.6%; died-1.8%； failed-1.7%. The cure rate for retreated smear positive cases was 86.3%. The relapse rate of retreated smear positive cases was 86.3%. The relapse rate of initially treated patients within two years' follow-up period was 3.4% and it was 5.8% for re-treated smear positive patients.
A "promoting and Strengthening Tuberculosis Control Project, M. O. H." was conducted in another 15 provinces and municipality since 1993. The chemotherapy regimen 2HRZE/4H,R, was used for new smear positive pulmonary tuberculosis cases and the regimen 2HRZSE/6H,R,E, was used for re-treated smear positive cases. The cure rates for new smear positive patients and re-treated were 93.4% and 83.3% respectively.
2.5.2 CASE-MANAGEMENT
At the later seventh decades of this century, ambulantly chemotherapy became the predominant approaches for controlling tuberculosis infectious sources in China. At the middle of eighth decades, two main approaches of case-management on treatment were gradually formed with specialized Chinese model. One was fully supervised chemotherapy and another one was whole course monitoring chemotherapy.
In fully supervised chemotherapy, all the drugs intake was directly under the observation of health workers both in initial intensive phase and continual phase. Such approach has been successfully carried out in some big cities and all 13 provinces supported by World Band loan. Fully supervised ambulant chemotherapy had been extensively carried out in Beijing Municipality since eight decades of this century. 99.4% of initially treated patients completed the whole treatment course and the regularity of drug intake was 96.2%. Fully supervised chemotherapy is the unique approach of case-management in all 13 provinces involved in Word Bank loan project. The cure rate of new smear positive cases was 94.1% and the regularity of treatment was 96.4% as reported by Hubei Province.
In whole course monitoring style, some approaches have been used to assure the regular and continuous intake of drugs. First of all, all patients delivered only two week's drug on one clinical consultation during initial intensive phase and deliver one month's drug during continual phases. If the patients did not return to the clinic to deliver the next dosage of drugs on the appointed date, various tracing actions should be taken on time until the patients return to the clinic. Secondly, both regular and surprising home visit should be carried out to investigate the color of urine and count the drug packages. In this model, the sputum negative conversion rate at the end of treatment varies from 66% to 97% depending on the regularity of drug intake. Among those patients who did not regularly intake the drugs, the cure rate was only 67.8% and it was 97% for patients with regular intake of drugs. In this connection, the percentage of treated patients with DOTS in Promoting and Strengthening Tuberculosis Control Project has been increased from 42% in 1994 to 63.3% in 1996.
2.5.3 OCCURRENCE OF DRUG RESISTANCE
A report of 456 tuberculosis patients with anti-tuberculosis drug sensitivity test examined in 1981-1990 in Shanghai. 96 cases (21.1%) were resistant cases. The resistant drugs were listed as follows: Isoniazid (INH)-45 cases (9.8%), streptomycin (SM)- 57 (12.5%), para-amino salicylic acid (PAS)- 19 (4.1%), kanamycin (KM)- 14 (3.1%), rifampicin (RFP)-23 (5.1%), ethambutol (EMB)- 7 (1.5%), prothionamide (TH1321)-13 (2.8%). 96 cases were initially treated cases and 11.4% of them failed from six month's treatment. The fail rate was as high as 33.3% among patients who were resisted to RFP and it was only 5.4% among sensitive patients. The fail rate among patients who only resisted to single drug was 7.1% and it was 55.6% among patients who resisted to two drugs.
The results of drugs sensitivity test examined in various cities and provinces i.e. Beijing, Hainan, Helongjiang, Xinjiang and Chongging since 1986 to 1987. A total of 314 initially treated tuberculosis cases was involved. Five drugs, e.g., INH, SM, RFP, PAS and EMB, were included in sensitivity test. 55 strains showed primary (initial) resistance. Among these resistant strains, 9.6% of strains were resistant to one drug; 6.4% resistant to 2 drugs; and 1.3% resistant to 3 drugs. The sequences of frequency of initial resistance for these five drugs were: SM, INH, RFP, PAS, EMB.
The results of drug sensitivity test of 312 hospitalized tuberculosis patients admitted during 1986-1988 in Beijing. 26 out of 92 initially treated patients (28.3%) had initial resistance and 174 out of 220 re-treated patients (79.1%) had acquired (secondary) resistant. As far as initial resistance was concerned, 14.1% were resistant to SM, 12.0% to INH and 9.8% to RFP. Among re-treated patients, the percentages of resistance to INH, RFP and SM were 63.6%, 57.7% and 54.5% respectively. The sputum negative conversion rate of initial resistant patients who were treated by sensitive drugs was 65.2% at the end of third month and increased to 100.0% at the end of ninth month. Among secondary resistant patients, the negative conversion rate at end of third month and ninth month were only 26.7% and 38.3% accordingly.
Drug sensitivity test was carried out among 1,595 tuberculosis cases during the third nationwide random sampling survey on tuberculosis in the Country in 1990. 219out of 779 initially
