INTRODUCTION: China has an estimated 5 million people with tuberculosis (TB). Official policy is that treatment of all patients is directly observed by health workers; completion rates are reported to be in excess of 90%, and drugs should be supplied for free. However, some research suggests there is a gap between the official policies and practice. METHODS: Survey of TB patients in four counties of one municipality; record assessment at one TB centre; patient and village doctor in-depth interviews. RESULTS: Sixteen per cent (64/401) reported being directly observed every time they took treatment; less than 5% of TB patients (17/401) were observed by health staff. Overall, 12.5% (50/401) reported they had not taken any TB drugs in the previous week, but this varied between the four counties (range 6.2 to 21.7%). We used survival analysis with medical records at one centre: 74.1% of new patients collected their drugs for their sixth month of treatment, and 50.3% attended the final visit at 6 months. Qualitative research indicated direct observation is neither well understood nor thought to be necessary, and that patients reported being charged expensive fees for ancillary treatments, such as liver protection drugs. CONCLUSION: In China, direct observation is not well implemented and may not be a feasible policy option. Official completion rates are higher than we found in this study. The concept of free treatment has become blurred, with charges for additional tests and drugs, especially liver protection drugs. The government is already actively tackling these issues, and involvement of managers and others in this process will be helpful.
INTRODUCTION: China has an estimated 5 million people with tuberculosis (TB). Official policy is that treatment of all patients is directly observed by health workers; completion rates are reported to be in excess of 90%, and drugs should be supplied for free. However, some research suggests there is a gap between the official policies and practice. METHODS: Survey of TB patients in four counties of one municipality; record assessment at one TB centre; patient and village doctor in-depth interviews. RESULTS: Sixteen per cent (64/401) reported being directly observed every time they took treatment; less than 5% of TB patients (17/401) were observed by health staff. Overall, 12.5% (50/401) reported they had not taken any TB drugs in the previous week, but this varied between the four counties (range 6.2 to 21.7%). We used survival analysis with medical records at one centre: 74.1% of new patients collected their drugs for their sixth month of treatment, and 50.3% attended the final visit at 6 months. Qualitative research indicated direct observation is neither well understood nor thought to be necessary, and that patients reported being charged expensive fees for ancillary treatments, such as liver protection drugs. CONCLUSION: In China, direct observation is not well implemented and may not be a feasible policy option. Official completion rates are higher than we found in this study. The concept of free treatment has become blurred, with charges for additional tests and drugs, especially liver protection drugs. The government is already actively tackling these issues, and involvement of managers and others in this process will be helpful.
Authors: Xianqin Ai; Ke Men; Liujia Guo; Tianhua Zhang; Yan Zhao; Xiaolu Sun; Hongwei Zhang; Guangxue He; Marieke J van der Werf; Susan van den Hof Journal: BMC Public Health Date: 2010-03-07 Impact factor: 3.295
Authors: Song Yao; Wen-Hui Huang; Susan van den Hof; Shu-Min Yang; Xiao-Lin Wang; Wei Chen; Xue-Hui Fang; Hai-Feng Pan Journal: BMC Health Serv Res Date: 2011-12-16 Impact factor: 2.655
Authors: Hua Jianzhao; Susan van den Hof; Xu Lin; Qiu Yubang; Hou Jinglong; Marieke J van der Werf Journal: BMC Health Serv Res Date: 2011-05-11 Impact factor: 2.655