OBJECTIVE: To analyse the five-point tuberculosis (TB) strategy, DOTS, 10 years after its implementation in one-half of China's population, and to suggest lessons for future implementation of the DOTS strategy. METHODS: We analysed trends in case-finding and treatment outcome over time following implementation of the DOTS strategy in each county, using routine reporting data from the Infectious and Endemic Disease Control (IEDC) project (1991 - 2000). We also determined the proportion of counties with different levels of case-finding for the fifth and sixth years of DOTS implementation. FINDINGS: From 1991 to 1995, DOTS expanded rapidly to cover more than 90% of target population and counties. By 2000, 8 million TB suspects had received free diagnostic evaluation: 1.8 million TB cases were diagnosed, free treatment was provided to 1.3 million smear-positive cases, and more than 90% were cured. During DOTS implementation, the percentage of previously treated cases decreased among all smear-positive cases and treatment outcomes improved. Despite these achievements, the detection rate for new smear-positive cases in the project was estimated to be only 54% in 1998, and 41.2% of the counties had a below average or low level of case-finding (with substantial variation between provinces). CONCLUSIONS: The IEDC project demonstrated that it is feasible to rapidly expand DOTS on a large scale. The global target of an 85% cure rate was quickly achieved, and the level of drug-resistance was probably reduced by this project. However, case-detection did not reach the 70% global target, and more research is needed on how to enhance this.
OBJECTIVE: To analyse the five-point tuberculosis (TB) strategy, DOTS, 10 years after its implementation in one-half of China's population, and to suggest lessons for future implementation of the DOTS strategy. METHODS: We analysed trends in case-finding and treatment outcome over time following implementation of the DOTS strategy in each county, using routine reporting data from the Infectious and Endemic Disease Control (IEDC) project (1991 - 2000). We also determined the proportion of counties with different levels of case-finding for the fifth and sixth years of DOTS implementation. FINDINGS: From 1991 to 1995, DOTS expanded rapidly to cover more than 90% of target population and counties. By 2000, 8 million TB suspects had received free diagnostic evaluation: 1.8 million TB cases were diagnosed, free treatment was provided to 1.3 million smear-positive cases, and more than 90% were cured. During DOTS implementation, the percentage of previously treated cases decreased among all smear-positive cases and treatment outcomes improved. Despite these achievements, the detection rate for new smear-positive cases in the project was estimated to be only 54% in 1998, and 41.2% of the counties had a below average or low level of case-finding (with substantial variation between provinces). CONCLUSIONS: The IEDC project demonstrated that it is feasible to rapidly expand DOTS on a large scale. The global target of an 85% cure rate was quickly achieved, and the level of drug-resistance was probably reduced by this project. However, case-detection did not reach the 70% global target, and more research is needed on how to enhance this.
Authors: Y Lin; D A Enarson; C-Y Chiang; I D Rusen; L-X Qiu; X-H Kan; Y-L Yuan; J Du; T-H Zhang; Y Li; X-F Li; C-T Du; L-X Zhang Journal: Public Health Action Date: 2015-03-21
Authors: Mercedes C Becerra; Iliana F Pachao-Torreblanca; Jaime Bayona; Rosa Celi; Sonya S Shin; Jim Yong Kim; Paul E Farmer; Megan Murray Journal: Public Health Rep Date: 2005 May-Jun Impact factor: 2.792
Authors: Yin Yin Xia; Dai Yu Hu; Fei Ying Liu; Xiao Meng Wang; Yan Li Yuan; De Hua Tu; Yi Xin Chen; Lin Zhou; Li Zhen Zhu; Wei Wei Gao; Hong Yuan Wang; Da Fang Chen; Li Yang; Ping Ping He; Xiao Ting Li; Ying Jian He; Feng Sun; Si Yan Zhan Journal: BMC Public Health Date: 2010-05-21 Impact factor: 3.295
Authors: Yu Rong Yang; Donald P McManus; Darren J Gray; Xiao Ling Wang; Shu Kun Yang; Allen G Ross; Gail M Williams; Magda K Ellis Journal: BMC Public Health Date: 2012-12-23 Impact factor: 3.295