The Global Fund in China: Multidrug-resistant tuberculosis nationwide programmatic scale-up and challenges to transition to full country ownership

摘要

China has the world's second largest burden of multidrug-resistant tuberculosis (MDR-TB;resistance to at least isoniazid and rifampicin), with an estimated 57,000 cases (range,48,000±67,000) among notified pulmonary TB patients in 2015. During October 1, 2006±June 30, 2014, China expanded MDR-TB care through a partnership with the Global Fundto Fight AIDS, Tuberculosis, and Malaria (Global Fund). We analyzed data on site expansion,patient enrolment, treatment outcomes, cost per patient, and overall programmeexpenditure. China expanded MDR-TB diagnostic and treatment services from 2 prefecturesin 2006 to 92 prefectures, covering 921 of the country's 3,000 counties by June 2014.A total of 130,910 patients were tested for MDR-TB, resulting in 13,744 laboratory-confirmedcases, and 9,183 patients started on MDR-TB treatment. Treatment success was48.4% (2011 cohort). The partnership between China and the Global Fund resulted in enormousgains. However, changes to health system TB delivery and financing coincided withthe completion of the Global Fund Programme, and could potentially impact TB and MDRTBcontrol. Transition to full country financial ownership is proving difficult, with a decline inenrollment and insufficient financial coverage. [...]