Shenglan Tang, professor of medicine and global health, has been awarded a three-year $1,200,000 Bill & Melinda Gates Foundation grant entitled “Monitoring, Learning & Evaluation for the Implementation of the Comprehensive Model of Tuberculosis (TB) Care & Control in China.” Joy Noel Baumgartner, assistant research professor and director of the DGHI Evidence Lab, is the co-principal investigator.
China Has the World’s Second Largest TB Epidemic
In 2013, one million new cases of TB were reported in China—more than 11 percent of the world’s incidence that year. Of people with TB in China, more than eight percent are estimated to have multi-drug resistant TB (MDR-TB), likely due to poor previous TB treatment in hospitals.
Control of TB and MDR-TB in China requires a systems approach. Pilot exercises have been undertaken to restructure the agencies and hospitals in charge of TB diagnosis and reporting, while simultaneously introducing new tools at all levels of TB control. These pilots and the lessons learned from them are particularly important due to the large population and geographic size of China; it’s important to know not only what policies to implement but how to implement them effectively before scaling up country-wide.
Gates Foundation a Long-Time Supporter of China CDC
Since 2012, the Bill & Melinda Gates Foundation has supported the China Center for Disease Control and Prevention (CDC) to develop innovative models of TB care and control and has funded the Duke-led team to evaluate policy changes and identify implementation barriers.
The Chinese government plans to introduce and expand the new comprehensive model of TB control into 172 counties in three provinces. The Gates Foundation will continue to support the DGHI research team to conduct monitoring, learning and evaluation activities from 2016-2018. It is anticipated that these activities will produce robust evidence to support the implementation of new TB control policies and the comprehensive service delivery model in China.
Major Interventions and Expected Outcomes
Interventions targeted at the TB service delivery system mainly include strengthening TB prevention and control, improving equity in access to and financing of TB care, and developing a new and more effective integrated TB information system.
A subsample of project counties from each province will pilot the roll-out of the Electronic Medication Monitor (EMM) on case management in 2017 to improve adherence to TB treatment, and the intervention will be scaled-up to all the counties in 2018.
Capacity building activities will include the development of training materials on TB prevention and control, including a manual setting out the new Chinese Standards for Tuberculosis Care. These materials will be used to train public health professionals, clinical medical personnel and primary health care workers.
The project also includes health financing interventions that aim to reduce the out-of-pocket payments of TB and MDR-TB patients, including increasing government subsidies, reimbursement from health insurance, support from the National Public Health Equity Fund for TB prevention and treatment, and coordination among different health insurance schemes and the Medical Financial Assistance (MFA) funds. Transportation and nutrition subsidies will also be provided to TB and MDR-TB patients.
An innovative provider payment reform will also be conducted in pilot counties to control the rapid rise of medical expenses and ensure quality of TB care provided.
Evaluation Activities and Current Progress
Two evaluation strategies will be adopted. A comprehensive performance-based monitoring and evaluation (PBME) exercise will track project roll-out and evaluate effectiveness in all 172 project counties of the three project provinces using a specially compiled dataset based on a combination of existing routine data systems and information available from secondary sources.
In parallel, an in-depth case study-based evaluation will be performed in 12 sample counties within six prefectures, where the team will undertake additional quantitative and qualitative data collection.
The evaluation team is collaborating with a number of partners, including:
- Duke Kunshan University
- UK Institute of Development Studies
- TB Prevention Unit of CDC Department of the National Health and Family Planning Commission
- Centre of Health Information and Statistics
- Peking University
- Zhejiang University
- Beijing Chest Hospital
- TB Centre of China CDC
This article was adapted from an article originally published by Duke Kunshan University.
In 2013, one million new cases of TB were reported in China—more than 11 percent of the world’s incidence that year.