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van de Water BJ, Brooks MB, Matji R, Ncanywa B, Dikgale F, Abuelezam NN, Mzileni B, Nokwe M, Moko S, Mvusi L, Loveday M, Gimbel S. Systems analysis and improvement approach to optimize tuberculosis (SAIA-TB) screening, treatment, and prevention in South Africa: a stepped-wedge cluster randomized trial. Implement Sci Commun 2024; 5:40. [PMID: 38627799 PMCID: PMC11021007 DOI: 10.1186/s43058-024-00582-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/06/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The use of systems engineering tools, including the development and use of care cascades using routinely collected data, process mapping, and continuous quality improvement, is used for frontline healthcare workers to devise systems level change. South Africa experiences high rates of tuberculosis (TB) infection and disease as well as HIV co-infection. The Department of Health has made significant gains in HIV services over the last two decades, reaching their set "90-90-90" targets for HIV. However, TB services, although robust, have lagged in comparison for both disease and infection. The Systems Analysis and Improvement Approach (SAIA) is a five-step implementation science method, drawn from systems engineering, to identify, define, and implement workflow modifications using cascade analysis, process mapping, and repeated quality improvement cycles within healthcare facilities. METHODS This stepped-wedge cluster randomized trial will evaluate the effectiveness of SAIA on TB (SAIA-TB) cascade optimization for patients with TB and high-risk contacts across 16 clinics in four local municipalities in the Sarah Baartman district, Eastern Cape, South Africa. We hypothesize that SAIA-TB implementation will lead to a 20% increase in each of: TB screening, TB preventive treatment initiation, and TB disease treatment initiation during the 18-month intervention period. Focus group discussions and key informant interviews with clinic staff will also be conducted to determine drivers of implementation variability across clinics. DISCUSSION This study has the potential to improve TB screening, treatment initiation, and completion for both active disease and preventive measures among individuals with and without HIV in a high burden setting. SAIA-TB provides frontline health care workers with a systems-level view of their care delivery system with the aim of sustainable systems-level improvements. TRIAL REGISTRATION Clinicaltrials.gov, NCT06314386. Registered 18 March 2024, https://clinicaltrials.gov/study/NCT06314386 . NCT06314386.
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Affiliation(s)
- Brittney J van de Water
- Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
| | - Meredith B Brooks
- School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, USA
| | - Refiloe Matji
- AQUITY Innovations, 114 Sovereign Drive, Centurion, South Africa
| | - Betty Ncanywa
- AQUITY Innovations, Greenacres Park, Gqeberha, South Africa
| | - Freck Dikgale
- AQUITY Innovations, 114 Sovereign Drive, Centurion, South Africa
| | - Nadia N Abuelezam
- Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Bulelwa Mzileni
- Department of Health, Sarah Baartman District, 16 Grace Street, Gqeberha, South Africa
| | - Miyakazi Nokwe
- Department of Health, Eastern Cape, Dukumbana Building, Bisho, South Africa
| | - Singilizwe Moko
- Department of Health, Eastern Cape, Dukumbana Building, Bisho, South Africa
- Walter Sisulu University, Mthatha, South Africa
| | - Lindiwe Mvusi
- National Department of Health, 1112 Voortrekker Road, Pretoria, South Africa
| | - Marian Loveday
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town, South Africa
| | - Sarah Gimbel
- Department of Child, University of Washington, Family & Population Health Nursing, Gerberding HallSeattle, WA, 98195, USA
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Xie Y, Shum TT, Tian Z, Lin C, Chen L, Chen B, Huang D, Zhu L, Zou G. Diagnostic delay, treatment duration and outcomes since the implementation of integrated model of tuberculosis control and their associated factors in a county in East China. BMC Infect Dis 2023; 23:727. [PMID: 37880574 PMCID: PMC10601170 DOI: 10.1186/s12879-023-08561-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/24/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE This study assesses the diagnostic delay, treatment duration and treatment outcomes of tuberculosis (TB) patients since the implementation of the integrated model of TB control in a county in eastern China. It further identifies factors associated with diagnostic delay and treatment duration in the integrated model. METHODS We collected data through the Chinese Tuberculosis Information Management System (TBIMS) for Cangnan County in Zhejiang Province. Chi-square and Mann-Whitney tests were adopted to identify factors associated with duration of treatment and treatment delay for TB patients within the integrated model. Multiple regression analysis was subsequently performed to confirm the identified factors. RESULTS In the integrated model from 2012 to 2018, the median health system delay was maintained at 1 day, and the median patient delay decreased from 14 to 9 days and the median total delay decreased from 15 to 11 days. In addition, the proportion of patients who experienced patient delay > 14 days and total delay > 28 days decreased from 49% to 35% and from 32% to 29% respectively. However, the proportion of patients who had health system delay > 14 days increased from 0.2% to 13% from 2012 to 2018. The median treatment duration increased from 199 to 366 days and the number of TB patients lost to follow-up showed an overall upward trend from 2012 to 2018. The multivariable regression analysis indicated that migrant TB patients and TB patients initially diagnosed in hospitals at the prefectural level and above tended to experience total delay > 28 days (p < 0.001). Linear regression analysis confirmed that new TB patients>60 years tended to have longer treatment duration (p < 0.05). CONCLUSIONS While our study may suggest the potential of the integrated model in early detection and diagnosis of TB, it also suggests the importance of strengthening supervision and management of designated hospitals to optimize the treatment duration and improve retention of patients in TB care. Enhancing health education for TB patients, especially amongst migrant patients, and training in TB identification and referral for non-TB doctors are also key for early TB detection and diagnosis in the integrated model.
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Affiliation(s)
- Yuanxiang Xie
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ting Ting Shum
- Department of Social Anthropology, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Zhenming Tian
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chuanheng Lin
- Center for Public Health, Longgang County, Wenzhou, Zhejiang Province, China
| | - Lingyuan Chen
- Center for Disease Prevention and Control, Cangnan County, Wenzhou, Zhejiang Province, China
| | - Bin Chen
- Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, China
| | - Dajiang Huang
- Center for Public Health, Longgang County, Wenzhou, Zhejiang Province, China
| | - Lei Zhu
- School of Postgraduate Studies, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Guanyang Zou
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China.
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3
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van de Water BJ, Meyer TN, Wilson M, Young C, Gaunt B, le Roux KW. TB prevention cascade at a district hospital in rural Eastern Cape, South Africa. Public Health Action 2021; 11:97-100. [PMID: 34159070 DOI: 10.5588/pha.20.0055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/15/2021] [Indexed: 11/10/2022] Open
Abstract
SETTING Rural Eastern Cape, South Africa. OBJECTIVE To identify steps in the TB preventive care cascade from routinely collected data among TB patients at a district hospital prior to the implementation of a novel TB program. DESIGN This was a retrospective study. We adapted the TB prevention cascade to measure indicators routinely collected at district hospitals for TB using a cascade framework to evaluate outcomes in the cohort of close contacts. RESULTS A total of 1,722 charts of TB patients were reviewed. The majority of patients (87%) were newly diagnosed with no previous episodes of TB. A total of 1,548 (90%) patients identified at least one close contact. A total of 7,548 contacts were identified with a median of 4.9 (range 1-16) contacts per patient. Among all contacts identified, 2,913 (39%) were screened for TB. Only 15 (0.5%) started TB preventive therapy and 122 (4.4%) started TB treatment. Nearly 25% of all medical history and clinical information was left unanswered among the 1,722 TB charts reviewed. CONCLUSION Few close contacts were screened or started on TB preventive therapy in this cohort. Primary care providers for TB care in district health facilities should be informed of best practices for screening and treating TB infection and disease.
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Affiliation(s)
- B J van de Water
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - T N Meyer
- Department of Family Medicine, Walter Sisulu University, Mthatha, South Africa.,Zithulele District Hospital, Eastern Cape Department of Health, Mqunduli, South Africa
| | - M Wilson
- Advance Access and Delivery, Chapel Hill, NC, USA
| | - C Young
- Jabulani Rural Health Foundation, Mqanduli, South Africa
| | - B Gaunt
- Department of Family Medicine, Walter Sisulu University, Mthatha, South Africa.,Zithulele District Hospital, Eastern Cape Department of Health, Mqunduli, South Africa.,Primary Healthcare Directorate, University of Cape Town, Cape Town, South Africa
| | - K W le Roux
- Department of Family Medicine, Walter Sisulu University, Mthatha, South Africa.,Zithulele District Hospital, Eastern Cape Department of Health, Mqunduli, South Africa.,Primary Healthcare Directorate, University of Cape Town, Cape Town, South Africa
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Xiao W, Huang D, Li S, Zhou S, Wei X, Chen B, Zou G. Delayed diagnosis of tuberculosis in patients with diabetes mellitus co-morbidity and its associated factors in Zhejiang Province, China. BMC Infect Dis 2021; 21:272. [PMID: 33736610 PMCID: PMC7977257 DOI: 10.1186/s12879-021-05929-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 02/22/2021] [Indexed: 12/05/2022] Open
Abstract
Background Tuberculosis (TB) remains a significant global public health problem. China has the second highest TB burden in the world. With a growing TB population with diabetes mellitus (DM), the TB control system faces mounting challenges. To date, evidence remains inconclusive regarding the association between TB-DM co-morbidity and delayed diagnosis of TB patients. This study aims to assess the diagnostic delay of TB patients with known DM and identify the factors associated with this delay. Methods Data was collected from China’s Tuberculosis information management system in two counties of Zhejiang province, China. Patient delay, health system delay and total diagnostic delay are defined as follows: 1) the interval between the onset of TB symptoms and first visit to any health facility; 2) from the first visit to the health facility to the confirmed TB diagnosis in the designated hospital; 3) the sum of patient and health system’s respective delays. Comparison of these delays was made between TB patients with and without DM using Mann-Whitney U test and Chi-square test. Univariate and multivariate regression analysis was used to identify factors influencing delays among TB patients with DM. Results Of 969 TB patients, 67 (7%) TB patients had DM co-morbidity. Compared with TB patients without DM, TB patients with DM experienced significantly shorter health system delays (p < 0.05), and there was a significantly lower proportion of patients whose health system delayed> 14 days (7.0% vs. 18%, p < 0.05). However, no significant difference was observed between both patient categories regarding patient delay and total diagnostic delay. The multivariate regression analysis suggested that TB patients with DM who were aged < 60 years (AOR = 3.424, 95%CI: 1.008–11.627, p < 0.05) and non-severe cases (AOR = 9.725, 95%CI: 2.582–36.626, p < 0.05) were more likely to have a total diagnostic delay of> 14 days. Conclusions Our study suggests that DM does not contribute to further diagnostic delay as expected. Instead, we observed significantly improved health system delay among TB patients with DM. The findings indicate the importance of early screening and diagnosis for TB among diabetic patients and of strengthening the integrated control and management of TB and diabetic programs.
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Affiliation(s)
- Wenhui Xiao
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Dajiang Huang
- Center for Disease Prevention and Control, Cangnan County, Wenzhou, Zhejiang Province, China
| | - Saiqiong Li
- Center for Disease Prevention and Control, Yongjia County, Wenzhou, Zhejiang Province, China
| | - Shangcheng Zhou
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaolin Wei
- Division of Clinical Epidemiology & Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Bin Chen
- Zhejiang Provincial Center for Disease Prevention and Control, Hangzhou, China.
| | - Guanyang Zou
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Margineanu I, Louka C, Vincenti-Gonzalez M, Saktiawati AMI, Schierle J, Abass KM, Akkerman O, Alffenaar JW, Ranchor AV, Stienstra Y. Patients and Medical Staff Attitudes Toward the Future Inclusion of eHealth in Tuberculosis Management: Perspectives From Six Countries Evaluated using a Qualitative Framework. JMIR Mhealth Uhealth 2020; 8:e18156. [PMID: 33136052 PMCID: PMC7669445 DOI: 10.2196/18156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/20/2020] [Accepted: 07/26/2020] [Indexed: 11/21/2022] Open
Abstract
Background Digitally delivering healthcare services is very attractive for tuberculosis (TB) management as this disease has a complex diagnosis and lengthy management and involves multiple medical and nonmedical specialists. Especially in low- and middle-income countries, eHealth could potentially offer cost-effective solutions to bridge financial, social, time, and distance challenges. Objective The goal of the research is to understand what would make eHealth globally applicable and gain insight into different TB situations, opportunities, and challenges. Methods We performed focus group interviews with TB experts and patients from 6 different countries on 4 different continents. The focus group interviews followed the theory of planned behavior framework to offer structured recommendations for a versatile eHealth solution. The focus group interviews were preceded by a general demographic and technology use questionnaire. Questionnaire results were analyzed using basic statistics in Excel (Microsoft Corporation). Focus group interview data were analyzed using ATLAS.ti 8 (ATLAS.ti Scientific Software Development GmbH) by assigning codes to quotations and grouping codes into the 5 domains within the framework. Results A total of 29 patients and 32 medical staff members were included in our study. All medical staff had used the internet, whereas 31% (9/61) of patients had never been online. The codes with the most quotations were information in relation to eHealth (144 quotations) and communication (67 quotations). The consensus among all participants from all countries is that there are important communication and information gaps that could be bridged by an eHealth app. Participants from different countries also highlighted different challenges, such as a majority of asylum-seeker patients or lack of infrastructure that could be addressed with an eHealth app. Conclusions Within the 6 countries interviewed, there is high enthusiasm toward eHealth in TB. A potential app could first target information and communication gaps in TB, with additional modules aimed at setting-specific challenges.
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Affiliation(s)
- Ioana Margineanu
- Department of Clinical Pharmacy and Pharmacology, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands.,Pneumology Hospital Iasi, Iasi, Romania
| | - Christina Louka
- Department of Internal Medicine, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands
| | - Maria Vincenti-Gonzalez
- Department of Medical Microbiology and Infection Prevention, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands
| | - Antonia Morita Iswari Saktiawati
- Department of Internal Medicine, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands.,Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Johannes Schierle
- University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands
| | - Kabiru Mohammed Abass
- Department of Internal Medicine, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands.,Agogo Presbyterian Hospital, Agogo, Ghana
| | - Onno Akkerman
- Department of Pulmonary Diseases and Tuberculosis, Tuberculosis Centrum Beatrixoord, University Medical Centrum Groningen, University of Groningen, Haren, Netherlands
| | - Jan-Willem Alffenaar
- Department of Clinical Pharmacy and Pharmacology, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands.,University of Sydney, Camperdown, Australia.,Westmead Hospital, Sydney, Australia.,Marie Bashir Institute of Infectious Diseases, University of Sydney, Sydney, Australia
| | - Adelita V Ranchor
- Health Psychology Section, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands
| | - Ymkje Stienstra
- Department of Internal Medicine, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands
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6
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Ogbuabor DC. Through service providers' eyes: health systems factors affecting implementation of tuberculosis control in Enugu State, South-Eastern Nigeria. BMC Infect Dis 2020; 20:206. [PMID: 32143584 PMCID: PMC7060534 DOI: 10.1186/s12879-020-4944-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/02/2020] [Indexed: 01/06/2023] Open
Abstract
Background Well-functioning health systems are essential to achieving global and national tuberculosis (TB) control targets. This study examined health system factors affecting implementation of TB control programme from the perspectives of service providers. Methods The study was conducted in Enugu State, South-eastern Nigeria using qualitative, cross-sectional design involving 23 TB service providers (13 district TB supervisors and 10 facility TB focal persons). Data were collected through in-depth, semi-structured interviews using a health system dynamic framework and analysed thematically. Results Stewardship from National TB Control Programme (NTP) improved governance of TB control, but stewardship from local government was weak. Government spending on TB control was inadequate, whereas donors fund TB control. Poor human resources management practices hindered TB service delivery. TB service providers have poor capacity for data management because changes in recording and reporting tools were not matched with training of service providers. Drugs and other supplies to TB treatment centres were interrupted despite the use of a logistics agency. Poor integration of TB into general health services, weak laboratory capacity, withdrawal of subsidies to community volunteers and patent medicine vendors, poorly funded patient tracking systems, and ineffectual TB/HIV collaboration resulted in weak organisation of TB service delivery. Conclusion Health systems strengthening for TB control service must focus on effective oversight from NTP and local health system; predictable domestic resource mobilisation through budgets and social health insurance; training and incentives to attract and retain TB service providers; effective supply and TB drug management; and improvements in organization of service delivery.
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Affiliation(s)
- Daniel Chukwuemeka Ogbuabor
- Department of Health Administration and Management, University of Nigeria Enugu Campus, Enugu, Enugu State, Nigeria. .,Department of Health Systems and Policy, Sustainable Impact Resource Agency, Enugu, Enugu State, Nigeria.
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Ma X, Mirutse G, Bayray A, Fang M. Tuberculosis treatment outcome: The case of women in Ethiopia and China, ten-years retrospective cohort study. PLoS One 2019; 14:e0219230. [PMID: 31738780 PMCID: PMC6860933 DOI: 10.1371/journal.pone.0219230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/14/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Every year tuberculosis kills above half million women all over the world. Nonetheless, the factor affecting TB treatment outcome of women was less frequently studied and compared among countries. Hence, this study was aimed to measure and compare outcome of treatment and the death size of these two countries. METHOD Socio demographic and clinical data of women treated for all form of tuberculosis in the past ten years 2007-2016 were collected from total of eight hospitals and six treatment centers of Tigray and Zigong respectively. Then, we measured the magnitude of TB, level of treatment success and identify factors associated with the unsuccessful TB outcome. RESULT In the past ten years, a total of 5603(41.5%) and 4527 (24.5%) tuberculosis cases were observed in Tigray and Zigong respectively. Of those with treatment outcome record a total of 2602(92%) in Tigray and 3916(96.7%) in Zigong were successfully treated. Total of 170 (6%) cases in Tigray and 36(0.8%) cases in Zigong were dead. In Tigray, retreatment cases (aOR, 0.29; 95% CI: 0.16-0.53) and MDR-TB cases (aOR, 0.31; 95% CI: 0.003, 0.27) were less likely to show treatment success. However,, HIV co-infected TB cases (aOR, 3.58; 95% CI: 2.47, 5.18) were more likely to show treatment success compared with unknown HIV status. In Zigong, women with MDR TB (aOR, 0.90; 95%CI: 0.24, 0.34) were less likely to show treatment success and women in the age category of 15-49 (aOR, 1.55; 95% CI: 1.08, 2.206) were more likely to show treatment success. CONCLUSION Big number of tuberculosis cases and death were observed in Tigray comparing with Zigong. Hence, a relevant measure should be considered to improve treatment outcome of women in Tigray regional state.
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Affiliation(s)
- Xiao Ma
- Department of Health-Related Social and Behavioral Science, West China School of Public Health, Sichuan University, Chengdu, China
| | - Gebremeskel Mirutse
- Schools of Public Health, College of Health Science, Mekelle University, Tigray, Ethiopia
| | - Alemayehu Bayray
- Schools of Public Health, College of Health Science, Mekelle University, Tigray, Ethiopia
| | - Mingwang Fang
- West China Hospital, Sichuan University, Chengdu, China
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Mao W, Jiang W, Hamilton C, Zhang H, Huang F, Lucas H, Huan S, Tang S. Over- and under-treatment of TB patients in Eastern China: an analysis based on health insurance claims data. Trop Med Int Health 2019; 24:1078-1087. [PMID: 31299130 PMCID: PMC6851836 DOI: 10.1111/tmi.13287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective Poor compliance with existing guidelines for tuberculosis (TB) care and treatment is an issue of concern in China. We assessed health service use by TB patients over the entire treatment process and compared it to the recommended guidelines. Methods We collected insurance claims data in three counties of one province of Eastern China. Patient records with a diagnosis of ‘pulmonary TB’ in 2015 and 2016 were extracted. Treatment duration, number of outpatient (OP) visits and hospital admissions, as well as total cost, out‐of‐pocket (OOP) payments and effective reimbursement rates were analysed. Results A total of 1394 patients were included in the analysis. More than 48% received over the 8 months of treatment that TB guidelines recommend, and over 28% received less. 49% of Urban and Rural Resident Basic Medical Insurance (URRBMI) TB patients were hospitalised while 30% of those with Urban Employee Basic Medical Insurance (UEBMI) had at least one admission. Median total cost for patients with hospital admission was almost 10 times that of patients without. By comparison, the average OOP was 5 times higher. UEBMI patients had a shorter treatment period, more outpatient visits but considerably fewer hospital admissions than URRBMI patients. Conclusions We found an alarming extent of TB over‐ and under‐treatment in our study population. There is an urgent need to improve compliance with treatment guidelines in China and to better understand the drivers of divergence. Extending the coverage of health insurance schemes and increasing reimbursement rates for TB outpatient services would seem to be key factors in reducing both the overall cost and financial burden on patients.
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Affiliation(s)
- Wenhui Mao
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Weixi Jiang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | | | - Hui Zhang
- National Center for TB Control and Prevention, China CDC, Beijing, China
| | - Fei Huang
- National Center for TB Control and Prevention, China CDC, Beijing, China
| | - Henry Lucas
- Institute of Development Studies, Sussex University, Brighton, UK
| | | | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Global Health Research Center, Duke Kunshan University, Kunshan, China
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Zou G, Wei X. A qualitative study of two management models of community health centres in two Chinese megacities. Glob Public Health 2017; 13:1612-1624. [PMID: 29182049 DOI: 10.1080/17441692.2017.1407812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Two common public models of community health centres (CHCs) exist in China, i.e. the 'government-owned and government-managed' CHCs (G-CHCs) and the 'government-owned and hospital-managed' CHCs (H-CHCs). Shanghai and Shenzhen are two Chinese megacities that lead the primary care development on the G-CHC and H-CHC models, respectively. Using a qualitative case study design, this study compares the management of the G-CHC model in Shanghai and H-CHC model in Shenzhen, through perspectives of a range of health providers. In each city, we randomly selected four CHCs and in total conducted 31 interviews with officers from the municipal health authorities, directors, GPs, nurses and public health doctors of the CHCs. When comparing with the H-CHC model in Shenzhen, the G-CHC model in Shanghai, a model with more simplified but accountable structure tended to present better management conditions, in terms of financial transparency, recruitment autonomy, community health workforce development (CHC staffing and family medicine training), funding and priority for public health. However, regardless of the models, staff retention remained a challenge. While our study tends to suggest that the G-CHC model in Shanghai presents better management conditions, future study can test whether and to what extent the model itself can lead to such differences.
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Affiliation(s)
- Guanyang Zou
- a 21st Century Silk Road Research Institute , Jinan University , Guangzhou , People's Republic of China
| | - Xiaolin Wei
- b Division of Clinical Public Health & Institute of Health Policy, Management and Evaluation , Dalla Lana School of Public Health, University of Toronto , Toronto , Ontario , Canada
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10
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Chimbatata NBW, Zhou C, Chimbatata CM, Mhango L, Diwan VK, Xu B. Barriers to prompt TB diagnosis-a comparative study between northern Malawi and eastern rural China. Trans R Soc Trop Med Hyg 2017; 111:504-511. [PMID: 29425379 DOI: 10.1093/trstmh/try002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 01/07/2018] [Indexed: 11/12/2022] Open
Abstract
Background Tuberculosis (TB) case detection in China has improved remarkably, partly benefiting from the reducing delay to TB care, whereas the timeliness of TB care in Malawi remains problematic. Methods This study investigates barriers hindering timely TB diagnosis in Malawi and China, and attempts to share the experience in high burden countries. A cross-sectional study on TB diagnostic delay was conducted among 254 Malawian and 146 Chinese TB patients. Results The medians of patient's delays were 22 and 20 days (p>0.05), and provider delays were 12 and 11.5 days (p>0.05) in Malawi and China, respectively. Malawian patients had a higher proportion (72.05% vs 67.12%) of patient's delay longer than 14 days (p=0.042), which was significantly associated with initial visits to lower-level health providers in the villages (aOR=1.989, 95% CI: 1.075-3.682), and patients conducting casual/piece work (aOR=3.318, 95% CI: 1.228-8.964). Initial healthcare visits at village level also led to longer provider delay in both Malawi (aOR=2.055, 1.211-3.487) and China (aOR=5.627, 2.218-14.276). Conclusion Establishing a good communication and referral mechanism between different levels of health facilities is crucial to timely TB diagnosis. China's experience on pro-poor interventions could be useful to its Malawian counterpart and other similar settings with high TB burden.
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Affiliation(s)
- Nathan B W Chimbatata
- School of Public Health, Fudan University, Shanghai.,Key Laboratory of Public Health Safety (Ministry of Education), Shanghai, China.,Mzuzu University, Mzuzu
| | - Changming Zhou
- School of Public Health, Fudan University, Shanghai.,Key Laboratory of Public Health Safety (Ministry of Education), Shanghai, China
| | | | | | - Vinod K Diwan
- Department of Public Health Sciences (Global Health/IHCAR), Karolinska Institutet, Stockholm, Sweden
| | - Biao Xu
- School of Public Health, Fudan University, Shanghai.,Key Laboratory of Public Health Safety (Ministry of Education), Shanghai, China.,Department of Public Health Sciences (Global Health/IHCAR), Karolinska Institutet, Stockholm, Sweden
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Zhu Y, Wu J, Feng X, Chen H, Lu H, Chen L, Luo L, Rui C. Patient characteristics and perceived health status of individuals with HIV and tuberculosis coinfection in Guangxi, China. Medicine (Baltimore) 2017; 96:e6475. [PMID: 28383411 PMCID: PMC5411195 DOI: 10.1097/md.0000000000006475] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
To explore demographics, clinical and medication profiles, patients' social support, and perceived health status in HIV/TB coinfected patients in Guangxi, China.We performed a cross-sectional study in the HIV clinic of the Guigang City People's Hospital (N = 150). Health professionals conducted face-to-face interviews and collected data from patients' electronic medical records regarding patients' demographic, clinical, and medication information, as well as their social support and perceived health status. We classified all HIV/AIDS patients into HIV monoinfected and TB coinfected, at a ratio of 2:1.Compared with the HIV monoinfected, patients with HIV/TB coinfection were more likely to be older, male, less educated, unemployed, carrying health insurance, having advanced stage of HIV infection, longer history with HIV, and other opportunistic infections. Patients coinfected with TB were also more likely to hold a negative belief that their HIV treatment could prevent exacerbations, and reported significantly worse emotional/informational support, social interaction, and perceived health status. Better social support and better self-efficacy to the HIV treatment adherence was significantly associated with better perceived health status among patients with HIV and TB coinfection.Having HIV/TB coinfection was associated with poorer perceived general well-being and mental health, particularly in those undergoing TB therapy. Our findings suggest the need for mental health referrals and medication management for coinfected individuals, as well as further efforts and policies to improve coordinated care.
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Affiliation(s)
- Yujia Zhu
- Department of Infection, Eighth Affiliated Hospital of Guangxi Medical University, Guigang City People's Hospital, Guigang
| | - Jizhou Wu
- Department of Infection, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xue Feng
- School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Huanhuan Chen
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning
| | - Huaxiang Lu
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning
| | - Li Chen
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning
| | - Liuhong Luo
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning
| | - Chao Rui
- Department of Infection, Eighth Affiliated Hospital of Guangxi Medical University, Guigang City People's Hospital, Guigang
- Guangxi University of Chinese Medicine, Nanning, Guangxi, China
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Popolin MP, Touso MM, Yamamura M, Rodrigues LBB, da Cunha Garcia MC, Arroyo LH, Ramos ACV, Berra TZ, Santos Neto M, de Almeida Crispim J, Chiaravalotti Neto F, Pinto IC, Palha PF, da Costa Uchoa SA, Lapão LV, Fronteira I, Arcêncio RA. Integrated health service delivery networks and tuberculosis avoidable hospitalizations: is there a relation between them in Brazil? BMC Health Serv Res 2016; 16:78. [PMID: 26931507 PMCID: PMC4774126 DOI: 10.1186/s12913-016-1320-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 02/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The early identification of the Breathing Symptoms within the scope of Primary Health Care is recommended, and is also one of the strategies of national sanitary authorities for reaching the elimination of tuberculosis. The purpose of this study is to consider which attributes and which territories have shown the most significant progress in Primary Health Care, in terms of coordination of Health Care Networks, and also check if those areas of Primary Health Care that are most critical regarding coordination, there were more or less cases of avoidable hospitalizations for tuberculosis. METHODS This is an ecological study that uses primary and secondary data. For analysis, coropletic maps were developed through the ArcGIS software, version 10.2. There was also the calculation of gross annual and Bayesian rates for hospitalizations for tuberculosis, for each Primary Health Care territory. RESULTS There were satisfactory results for attributes such as Population (n = 37; 80.4 %), Primary Health Care (n = 43; 93.5 %), Support System (n = 45; 97.8 %); the exceptions were Logistics System (n = 32; 76.0 %) and Governance System, with fewer units in good condition (n = 31; 67.3 %). There is no evidence of any connection between networks' coordination by Primary Health Care and tuberculosis avoidable admissions. CONCLUSION The results show that progress has been made regarding the coordination of the Health Care Networks, and a positive trend has been shown, even though the levels are not excellent. It was found no relationship between the critical areas of Primary Health Care and tuberculosis avoidable hospitalizations, possibly because other variables necessary to comprehend the phenomena.
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Affiliation(s)
- Marcela Paschoal Popolin
- Maternal-Infant and Public Health Nursing Department, College of Nursing of Ribeirão Preto, University of São Paulo, Av dos Bandeirantes 3900, 14040-902, Ribeirão Preto, São Paulo, Brazil.
| | - Michelle Mosna Touso
- Maternal-Infant and Public Health Nursing Department, College of Nursing of Ribeirão Preto, University of São Paulo, Av dos Bandeirantes 3900, 14040-902, Ribeirão Preto, São Paulo, Brazil.
| | - Mellina Yamamura
- Maternal-Infant and Public Health Nursing Department, College of Nursing of Ribeirão Preto, University of São Paulo, Av dos Bandeirantes 3900, 14040-902, Ribeirão Preto, São Paulo, Brazil.
| | - Ludmila Barbosa Bandeira Rodrigues
- Institute for Health Sciences, Federal University of Mato Grosso, Av Alexandre Ferronato 1200, Reserve 35, 78550-000, Sinop, Mato Grosso, Brazil.
| | - Maria Concebida da Cunha Garcia
- Maternal-Infant and Public Health Nursing Department, College of Nursing of Ribeirão Preto, University of São Paulo, Av dos Bandeirantes 3900, 14040-902, Ribeirão Preto, São Paulo, Brazil.
| | - Luiz Henrique Arroyo
- Maternal-Infant and Public Health Nursing Department, College of Nursing of Ribeirão Preto, University of São Paulo, Av dos Bandeirantes 3900, 14040-902, Ribeirão Preto, São Paulo, Brazil.
| | - Antônio Carlos Vieira Ramos
- Maternal-Infant and Public Health Nursing Department, College of Nursing of Ribeirão Preto, University of São Paulo, Av dos Bandeirantes 3900, 14040-902, Ribeirão Preto, São Paulo, Brazil.
| | - Thais Zamboni Berra
- Maternal-Infant and Public Health Nursing Department, College of Nursing of Ribeirão Preto, University of São Paulo, Av dos Bandeirantes 3900, 14040-902, Ribeirão Preto, São Paulo, Brazil.
| | - Marcelino Santos Neto
- Centre of Social Sciences, Health and Technology of the Federal University of Maranhão (UFMA), Rua Turqueza, 65900-410, Imperatriz, Maranhão, Brazil.
| | - Juliane de Almeida Crispim
- Maternal-Infant and Public Health Nursing Department, College of Nursing of Ribeirão Preto, University of São Paulo, Av dos Bandeirantes 3900, 14040-902, Ribeirão Preto, São Paulo, Brazil.
| | - Francisco Chiaravalotti Neto
- Department of Epidemiology, Faculty of Public Health, University of São Paulo, Avenida Dr. Arnaldo, 715, 01246-904, São Paulo, São Paulo, Brazil.
| | - Ione Carvalho Pinto
- Maternal-Infant and Public Health Nursing Department, College of Nursing of Ribeirão Preto, University of São Paulo, Av dos Bandeirantes 3900, 14040-902, Ribeirão Preto, São Paulo, Brazil.
| | - Pedro Fredemir Palha
- Maternal-Infant and Public Health Nursing Department, College of Nursing of Ribeirão Preto, University of São Paulo, Av dos Bandeirantes 3900, 14040-902, Ribeirão Preto, São Paulo, Brazil.
| | - Severina Alice da Costa Uchoa
- Department of Group Health, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, 3000, Rio Grande do Norte, 59078-970, Natal, Brazil.
| | - Luís Velez Lapão
- WHO Collaborating Centre for Health Workforce Policy and Planning, International Public Health and Biostatistics, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua Junqueira 100, Lisbon, P-1349-008, Portugal.
| | - Inês Fronteira
- International Public Health and Biostatistics, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua Junqueira 100, Lisbon, P-1349-008, Portugal.
| | - Ricardo Alexandre Arcêncio
- Maternal-Infant and Public Health Nursing Department, College of Nursing of Ribeirão Preto, University of São Paulo, Av dos Bandeirantes 3900, 14040-902, Ribeirão Preto, São Paulo, Brazil.
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Huang F, Zhang H, Lv Q, Sato KD, Qu Y, Huan S, Cheng J, Zhao F, Wang L. Use of anti-tuberculosis drugs among newly diagnosed pulmonary tuberculosis inpatients in China: a retrospective study. Infect Dis Poverty 2016; 5:2. [PMID: 26792535 PMCID: PMC4720996 DOI: 10.1186/s40249-016-0098-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 01/04/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND China's national tuberculosis control program (NTP) provides free, first-line anti-tuberculosis (TB) drugs to pulmonary TB patients. This treatment regimen follows the World Health Organization's (WHO) guideline. The objective of this paper is to evaluate the current status of anti-TB drug use for newly diagnosed pulmonary TB inpatients treated in prefecture- and county-level designated hospitals. METHODS Three prefecture-level hospitals and nine county-level hospitals were selected for the study. All newly diagnosed pulmonary TB inpatient medical records from 2012 were reviewed and doubly examined by two national senior physicians. The rational use of anti-TB drugs was evaluated based on criteria in line with WHO's guideline. RESULTS Of the 2,060 total treatment regimens for TB, 53.1 % were found to be rational (1093/2060). The percentages in prefecture-level and county-level hospitals were 50.3 % (761/1513) and 60.7 % (332/547), respectively. The difference between the two levels of hospitals was statistically significant (Chi-square value = 17.44, P < 0.01). The percentages of rational treatment regimens for first-time hospitalizations and for two or more hospitalizations were 59.5 % (983/1653) and 27.0 % (110/407), respectively, with a statistically significant difference (Chi-square value = 138.00, P < 0.01). The overall use of second-line drugs (SLD) was 54.9 % (1131/2060). The percentages for prefecture-level and county-level hospitals were 50.6 % (766/1513) and 66.7 % (365/547), respectively. A statistically significant difference was found (Chi-square value = 42.06, P < 0.01). The use of SLD for inpatients hospitalized once and inpatients hospitalized twice or more was 58.4 % (966/1653) and 40.5 % (165/407), respectively, with a statistically significant difference (Chi-square value = 42.26, P < 0.01). CONCLUSIONS Half of inpatients might be treated with irrational regimens, and the use of SLD was more appropriately dispensed in city-level hospitals than in county-level hospitals. Trainings and guidelines for health personnel, supervision led by health authorities and increased investment to designated hospitals may help to improve the rational use of anti-TB drugs.
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Affiliation(s)
- Fei Huang
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Hui Zhang
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Qing Lv
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | | | - Yan Qu
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Shitong Huan
- Bill & Melinda Gates Foundation, Beijing office, Beijing, China.
| | - Jun Cheng
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Fei Zhao
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Lixia Wang
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
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Hu H, Chen J, Sato KD, Zhou Y, Jiang H, Wu P, Wang H. Factors that associated with TB patient admission rate and TB inpatient service cost: a cross-sectional study in China. Infect Dis Poverty 2016; 5:4. [PMID: 26786599 PMCID: PMC4719743 DOI: 10.1186/s40249-016-0097-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background China has recently adopted the “TB designated hospital model” to improve the quality of tuberculosis (TB) treatment and patient management. Considering that inpatient service often results in high patient financial burden, and therefore influences patient adherence to treatment, it is critical to better understand the TB patient admission rate and TB inpatient service cost, as well as their influential factors in this new model. Methods Quantitative and qualitative studies were conducted in two cities, Hanzhong in Shaanxi Province and Zhenjiang in Jiangsu Province, in China. Quantitative data were obtained from a sample survey of 533 TB patients and TB inpatient records from 2010–2012 in six county designated hospitals. Qualitative information was obtained through interviews with key stakeholders (40 key informant interviews, 14 focus group discussions) and reviews of health policy documents in study areas. Both univariate and multivariate statistical analyses were applied for the quantitative analysis, and the thematic framework approach was applied for the qualitative analysis. Results The TB patient admission rates in Zhenjiang and Hanzhong were 54.8 and 55.9 %, respectively. Qualitative analyses revealed that financial incentives, misunderstanding of infectious disease control and failure of health insurance regulations were the key factors associated with the admission rates and medical costs. Quantitative analyses found differences in hospitalization rate existed among patients with different health insurance and patients from different counties. Average medical costs for TB inpatients in Jurong and Zhenba were 7,215 CNY and 4,644 CNY, which was higher than the 5,500 CNY and 3,800 CNY limits set by the New Rural Cooperative Medical System. No differences in medical cost or length of stay were found between patients with and without comorbidities in county-level hospitals. Conclusions TB patient admission rates and inpatient service costs were relatively high. Studies of related factors indicated that a package of interventions, including health education programs, reform of health insurance regulations and improvement of TB treatment guidelines, are urgently required to ensure that TB patients receive appropriate care. Electronic supplementary material The online version of this article (doi:10.1186/s40249-016-0097-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hongyan Hu
- Center for Health Policy Studies, Nanjing Medical University, Hanzhong Road 140, 210029, Nanjing, P. R. China.
| | - Jiaying Chen
- Center for Health Policy Studies, Nanjing Medical University, Hanzhong Road 140, 210029, Nanjing, P. R. China.
| | - Kaori D Sato
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Yang Zhou
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu Province, China.
| | - Hui Jiang
- Zhenjiang Center for Disease Control and Prevention, Zhenjiang, Jiangsu Province, China.
| | - Pingbo Wu
- Hanzhong Center for Disease Control and Prevention, Hanzhong, Shaanxi Province, China.
| | - Hong Wang
- Bill & Melinda Gates Foundation, Seattle, WA, USA.
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