Effective tuberculosis control is a priority for the Government of China. In Chongqing Province the numbers of registered TB patients has increased due to better detection and service provision. WHO and national policy makers recommend Directly Observed Treatment Short Course - DOTS to improve adherence. A small study in China looked at completion rates and why patients do not adhere with treatments.
In 4 counties in Chongqing, the research found that:
Completion rates were estimated at 74%. This compared to 91% according to the Ministry of Health and WHO figures for the study area.
Patient adherence could be improved. Over 10% of patients registered as on treatment were not taking the drugs at the time of the interview.
Direct observation by health workers is uncommon. More than two thirds of patients interviewed reported that they have never been directly observed taking their treatment; and less than 5% of patients were observed by a health worker.
Village doctors indicated that it was not feasible for them to supervise patients in most cases. Although doctors can receive incentives through World Bank projects, the extent to which this happened in practice varied.
Patients report treatment is expensive. Although TB diagnosis and drugs are provided free by the government, they have to pay for liver protection drugs which their doctors prescribe.
The implications of this research from Chongqing are:
- direct observation may not be a feasible policy, and more options for ensuring adherence could be sanctioned
- better data on completion rates will help identify those counties where completion of treatment may be a problem
- the concept of free treatment has become blurred with charges for additional tests and drugs, especially liver protection drugs
Government is already actively tackling these issues, and involvement of managers and others in this process will be helpful.
Staff from the Chongqing Institute of TB Prevention and Treatment, School of Public Health, Fudan University, School of Public Health, Chongqing Medical University and Liverpool School of Tropical Medicine did the research which was funded by DFID and a China World Bank Grant. The study was carried out as part of the activities of the Effective Health Care Research Programme Consortium.
See the DFID project records for the Effective Health Care Research Programme Consortium
Read the briefing document Adherence to TB treatment in Chongqing. Situational analysis and policy implications