1. Contribution of operational research in China National Center for TB Control and Prevention, China CDC Jiang Shiwen 2009.12.3 Cancun

2. Background China is one of high TB(MDR) burden countries in the world

3. TB Situation Second largest number of TB patients in the world 44.5% of the population infected TB Internet-based Communicable Disease Reporting System in 2008 – 1.17 million TB patients reported, Ranks the second largest diseases Prevalence: 4.5 million PTB patients / 1.5 million SS+ TB patients in 2000 130,000 TB death in 1999 120,000 MDR-TB cases occurred in 2008

4. Achievements of NTP main targets

5. Challenges for MDG Millennium Development Goals DOTS quality need to be improved Insufficient supporting mechanism Migrant, MDR- TB and TB/HIV challenges Weak infection control Inadequate social mobilization AddressingChallenges

6. What do we need to reach the MDG? DOTS quality need to be improved Migrant, MDR-TB and TB/HIV challenges to be solved …… Operational research is one very important issues of our need?

7. Activities taken for operational research Established a operational mechanism  Submit the proposals  Review the proposals  Supervision of research  Audit the research reports Implemented operational researches

8. What do we done for operational research in China Epidemical survey Socio – economic study on TB patients Survey of the status of knowledge, attitude and practice of TB among common people M&E indicators FDC treatment and drug management MDR-TB TB/HIV Incentives ……

9. Example of contribution of operational researches for NTP in China National random survey for the epidemiology of TB in 2000 Socio – economic study on TB patients Collaboration between hospitals and TB dispensaries M&E indicators

10. National random survey for the epidemiology of TB in 2000 In order to realize the dynamic epidemiological situation of tuberculosis as well as to identify, access and evaluate the effect of the implementation of the national tuberculosis control program The first, the second and the third nationwide random sampling survey for the epidemiology of tuberculosis was conducted respectively in 1979,1990 and 2000

11. National random survey for the epidemiology of TB in 2000 Main results In this survey, the prevalence of active, smear positive and bacteriological positive pulmonary tuberculosis were 367/100,000, 122/100,000 and 160/100,000 respectively. The estimated numbers of patients for above-mentioned categories of pulmonary tuberculosis were 4.51 millions, 1.5 millions and 1.96 millions respectively. The annual reduction rate of the prevalence of SS+ pulmonary tuberculosis between 1979 and 2000 was 3.8% and it was 3.2% between 1990 and 2000. In general, the declining in the Country in the past twenty years was sluggish. Utilization and contribution To provide the information to central government State council issued the NATIONAL TUBERCULOSIS CONTROL PROGRAME (2001 – 2010) Central government Increasing the funding from 5 million USD in 2001 to 76 million USD in 2009

12. Government financial input Harmonizing all available financial resources for NTP 2001-2008 – Central government: 2.16 billion RMB Yuan – Local government: 2.0 billion RMB Yuan

13. National random survey for the epidemiology of TB in 2000 Results The prevalence of tuberculosis was higher in middle and western than the eastern areas. Utilization Following activities are supporting for the middle and western areas.  Central government project  WB/DFID project  GF project (R1,R4 and R8)  JACA project  DFB project

14. Socio – economic study on TB patients Results Among 1278 patients, the average annual income per person of the families with tuberculosis patients who were engaged in countryside field occupation was 941 Yuan and 80% of them were lower than the average annual income per person at same locality in 2000 Among 1278 patients, 91.9% had no any kind of medical insurance and have to pay medical expense by themselves. The various causes for escaping from clinical consultation, 55.2% of escaping was due to not mind by patients themselves and financial problem was the next cause (37.3%). The causes of irregular and/or interrupted treatment,the main causes were economic difficulty (44.5%) and patients did not mind themselves (42.6%). Utilization Government provide funding to free the diagnosis(X films and sputum smear examination) and TB drugs

15. All active PTB 1278 （ 100% ） With symptoms 1096 （ 85.8%) Visited doctor 469 （ 49.1% ） Diagnosed TB 378 （ 29.6% ） Registered 93 （ 7.3% ） Onion of case finding in China data from TB survey in 2000

16. Aim of case finding The thin-skinned onion 70%+

17. All active PTB 1278 （ 100% ） With symptoms 1096 （ 85.8%) Visited doctor 469 （ 49.1% ） Diagnosed TB 378 （ 29.6% ） Registered 93 （ 7.3% ） Based on the results to take the policies and strategies Incentive basic medical staff to refer the TB symptom suspects Training the medical staff to identify the TB symptom suspects Implementing the refer and tracing strategy in medical institutes and TB dispensaries

19. NTP M&E indicators system in China Results Method  Firstly,drafted and listed the indicators used the Brainstorming and expert experiences  Second, use the delphi method to product the indicators and indicator standard by experts in different level Results: the number of key indicators is 35, : the number of assistant indicators is 38 Utilization Put the indicators to NTP indicators handbook