TUBERCULOSIS
EPIDEMIOLOGY
1
China
Estimates of TB burden 2011
Population
TB burden (2011 estimate)
1 348 million
Number (thousands)
Rate
(per 100 000 pop)
Mortality (excludes HIV+TB)
47 (45–49)
Prevalence (includes HIV+TB) 1 400 (1 200–1 600)
Incidence (includes HIV+TB)
3.5 (3.4–3.6)
104 (91–119)
1 000 (890–1 100)
75 (66–85)
Incidence (HIV+TB only)
13 (8.6–17)
0.93 (0.63–1.3)
Case detection, all forms(%)
89 (79–100)
(Resource: Global tuberculosis report 2012 – WHO)
2
Vietnam
Estimates of TB burden 2011
Population
TB burden (2011 estimate)
89 million
Number (thousands)
Rate
(per 100 000 pop)
Mortality (excludes HIV+TB)
30 (12–55)
33 (14–62)
Prevalence (includes HIV+TB)
290 (130–500)
323 (148–563)
Incidence (includes HIV+TB)
180 (140–220)
199 (153–250)
Incidence (HIV+TB only)
14 (119–18)
16 (12–20)
Case detection, all forms(%)
56 (44–73)
(Resource: Global tuberculosis report 2012 – WHO)
3
Mortality (excludes HIV+TB)
CHINA
VIETNAM
4
Prevalence (includes HIV+TB)
CHINA
VIETNAM
5
Incidence (per 100 000 pop)
CHINA
VIETNAM
6
Treatment success rate
CHINA
VIETNAM
7
Estimates of MDR-TB burden 2011*
Estimates of MDR-TB
New
Retreatment
% of TB cases with MDR-TB
5.7 (4.6–7.1)
26 (22–30)
MDR-TB cases among notified
49 000
(39 000–61 000)
12 000
(10 000–14 000)
% of TB cases with MDR-TB
2.7 (2–3.6)
19 (14–25)
MDR-TB cases among notified
2 000
(1 500–2 700)
1 700
(1 200–2 200)
burden 2011*
CHINA
pulmonaryTB cases
VIETNAM
pulmonaryTB cases
8
(Resource: Global tuberculosis report 2012 – WHO)
The policies and strategies
9
Policies
China
Vietnam
National TB Control Program National Tuberculosis Program
(1980s~ ) (2001-2010) (2011- development plan (1995~ )
2015) NTP
(2007-2011) (2011-2015) NTP
 Law of the PRC on the
Prevention and Treatment of
Infectious Diseases (2004)
 Tuberculosis Prevention and
Treatment Measures (2013
revision)
——
10
Goals of the NTP
China
11
Goals of the NTP
Vietnam
12
Strategies
Technical guidance, personnel
training, quality control,
China
Vietnam
Operational
guidance, and
technical
training,
control,
Diagnosis, treatment
management
ofquality
TB patients
monitoring, health education, evaluation
supervision
and management
• Increaseand
financial
input
• Increase human and financial
scientific
research.
• Establish a three-level network input
County-level Health Agency • Screening (symptoms of TB, HIV
Municipal Health Agency
infected, other high risk)
Sputum smear,
chest X-ray examination.
Provincial Health Agency
• Integration of TB control
RFP, INHactivities into the general health
• Improve TB Reporting System
• Free service (diagnosis and
system
drugs) for TB patients/potential • Reporting system (Continuous
patients
monitoring)
• DOTS (Directly Observed
• Standardized short course
Treatment Short-course)
chemotherapy for TB including
DOTS
13
Strategies
China
Vietnam
• Screening for TB in the HIV • Implementation of framework of
infected group
HIV/TB collaborative activities
Pathogenesis,
prevalence
of risk factors,
• Expand the coverage
of
• Development
and provision of
new diagnostic
techniques,
diagnosis and treatment
for
diagnosis
and treatment for
new drugs and
vaccines
patients
with MDR-TB
MDR-TB
• The MDR-TB will be included
in NCMS (新农合)
• Strengthen scientific research
for TB
• International cooperation and
communication
14
Combat HIV/AIDS, malaria, and other
diseases
What Did We Do ?
15
In China
16
1.Projects for TB control
Ministry of Health to strengthen and promote the
control of TB project
World Bank Loan / DFID grant assistant
China TB control project
Global Fund TB control project
China's Ministry of health - Gates fund TB
control project
17
The contribution of projects
1
Achieve the project objectives ahead of
schedual
2
Create a unique financing mode of global TB
control work
3
Realize the government's commitment to the
tuberculosis control work
18
4 Promote the balanced development of TB
control
55
6
7
Perfect China TB control system
Established model with Chinese character about
the discovery ,treatment and management of TB
patients
Significantly improve accessibility, fairness
and the degree of satisfaction of patients
with TB towards the health service
19
2. National TB control programme
implement dots
strategy
comprehensively
treat TB patients
free of charge.
specific help
aiming at
western areas
and people in
poverty
the formulation and
implementation of National
TB control programme
20
3.Financial support
China government
Based on the
government
investment,
implementing
multi-party
financing
principle
central
government
invested
4million
in2001to300
million in
2005
- treat patients
free of charge
- provide
medicine
- promote
health
education
- Improve
diagnosis
condition
financial help from
international society
+
-The Japanese
government aid
-The global fund of
tuberculosis
-The Damien
Foundation
-The Canadian
International
Development
Department
21
4
Tuberculosis management information system.
January
2005
based on the
Infectious
disease
information
network report
system
every
patient’s
information
is included
22
5.Improving health service system
Enrich the
number of
professional and
technical
personnel at all
levels
stabilize the
control team
training of
community
doctors and rural
doctors
Raise the salaries
of the personnel of
TB control
23
6
Advocacy of TB prevention
Health
education
Mass media
Health
promotion
activities
24
In Viet Nam
25
1. Diagnosis: Passive/Active
The proportion of
districts covered by the
NTP increased
from 40% in 1986 to
100% in 2000
•‘Case finding is passive
•‘Active only on high risk
group like HIV people,
prioners, people in reeducation institutions
26
2. Collaboration: with 2 main plan
TB/HIV
collaborated
control
plan
PPM (Public-PrivateMix; Public-Public Mix;
in Viet Nam, means
“engaging all health
care providers”)
27
3.treatment
1
2
The proportion of districts applying
SCC -Short-course chemotherapy was 28% in
1993, 50% in 1995, 87% in 1997
and 100% from 1999 onward (now 100%)
TB patients are provided DOT at
communal health stations.
28
4.Planning,supply
Standardizing
Mobilizing
and
advocacy
PAL,
GARD
strategy
all training materials and courses
for recruiting more TB staff
Adding lung disease component to TB control to
give TB staff more opportunities and therefore
being more attractive
29
5.Research
National
prevalence
survey
Combining
surveys on TB
and COPD
Chronic
obstructive
pulmonary
disease
Collecting data
in the fields of
70 study
clusters with
# 100 000
people has
beencomplete
d successfully.
30
6.Supervision, Management & Evaluation, Recording,
reporting, Strengthening surveillance system
1
Electronic program for recording and reporting
at provincial level
2
Revised register form – adapted WHO forms
3
Planning to establish internet-based system for
recording and reporting (2008 onward)
4
5
Strengthening monitoring, supervision and
evaluation.
Nationwide applying LQAS
31
CURRENT SITUATION
STRENGTHS
CHINA
CHALLENGES
SUGGESTIONS
VIETNAM
CONCLUSIONS
32
VIETNAM
STRENGTHS
Organization
aspects
Technical
aspects
33
VIETNAM
High Political commitment – setup NTP since 1994
TB network nation-wide, integrated to general health
system and collaboration with private sector.
Organization
aspects
Well functioned TB laboratory network with quality
assurance according to WHO criteria
Supply, management system for TB drugs, materials for
diagnosis and treatment
Established Vietnam Stop TB partnership, with the support
of the Global Stop TB partnership.
34
VIETNAM
3.Implementing the
new components
1.Standardized technical
guidelines,
issued by MOH
Technical
4. Vietnam TB
information management
electronic systems VITIMES
aspects
2.Nation-wide TB recording
and reporting system
5.Techniques certified
by WHO
35
Challenges
VIETNAM
1
2
The NTP’s great reliance on external sources of funding for its
activities is in jeopardy. The fact that it is now a low-middle
income country will also make it less attractive to international
donors, who also have to conserve and re-direct their own
diminishing resources.
With the expansion of the original DOTs Strategy to the Stop TB
Strategy, the vertical nature of the NTP poses a challenge to engage
the ministries, organizations for the cross-cutting issues of MDRTB,
TB/HIV and PPM to increase case finding.
36
VIETNAM
Challenges
3
While 43% of TB patients in Vietnam are now being
screened for HIV and receiving appropriate care,
including preventive therapy, the remaining 57%
are not currently covered, leaving them without the
benefit of life-saving interventions . In addition,
these services are project-centered rather than
patient-friendly .
37
Challenges
NO.4
TB case finding continues to stagnate, partly due to the fact
that many individuals are seeking TB diagnosis and
treatment outside of the NTP, but are not being reported.
The currently used model of having private providers
refer persons suspected of TB to the NTP has many
limitations and is very labor-intensive.
NO.5
The NTP is inundated with technical assistance missions,
which disrupts its day-to-day work and ability to plan for
the future.
38
VIETNAM
Recommendations
:
The MOH and partner agencies need to advocate for TB to national
politicians and local authorities, with the technical assistance of
external advocacy experts and organizations
The Vietnam Stop TB Partnership may serve as a hub of
communication and advocacy for partners regarding crosscutting
activities
Government needs to increase the percentage of its budget
allocations for TB/HIV activities within its routine budget allocations
Starting immediately, the NTP should assume its role as the driver of
technical assistance and implement a plan that outlines its objectives and
priority needs.
39
CHINA
STRENGTHS
SUGGESTIONS
CONCLUSION
CHALLENGES
CURRENT SITUATION
40
CHINA
STRENGTHS
health
system
reform
political
financial
working
ability
Organization
aspects
Establish
information
system
Technical
aspects
Medical
institutions
cooperation
Medical
Strengthen
institutions
the health
cooperation
promotion
Detect
Text in
infectious
here
TB patients.
Laboratory
building
Tracking
and
Textfollow
in
up the
here
patients
41
CHINA
CHALLENGES
1
Low detection rate of TB patients
2
Low public awareness about TB
3
Low rate of TB patients medication rules
4
High TB prevalence
5
TB has a high resistance rate
6
Mycobacterium TB and HIV co-infection
42
CHINA
NO.1
NO.2
Effectively increase
investment in TB control
NO.3
StrengthenTB and other
aspects of basic and clinical
research
Accelerate human resource
development, accelerate the
cultivation of talents, implement
preferential policies,TB
prevention and treatment team
SUGGESTION
NO.4
Improve the popularization of
knowledge of TB prevention
and control
43
CONCLUSION
Overall, the prevention and control of TB should
meet the new situation prevention needs .
Prevention and treatment of TB task is still
arduous, it requires long-term efforts.
44
THANK YOU !
45