TB care and control - combating the ancient disease in China 中国结核预防与控制-与致命传染病的对抗 Shenglan Tang, Global Health Research Center 汤胜蓝，全球健康研究中心

Overview 内容 Challenges in fighting against TB in China 中国的结核病挑战 DKU’s engagement in developing innovative model of TB care and control programs in China 昆山杜克大学在中国创新结核病防治模式领域的贡献

New challenge of an ancient disease 古老疾病，全新挑战 An ancient disease that’s still very deadly; currently 5 million TB patients in China; almost 1 million new cases each year; 古老的致命疾病; 现今中国有500万结核患者，每年新增约100万患者 Annual TB control budget CNY 5 billion. 每年中国有50亿人民币结核防治开支 Closely associated with poverty: poor people more likely to suffer 与贫穷直接相关的疾病: 患者主要为贫困人群 4 first-line drugs recommended by WHO developed long-ago: e.g. streptomycin in 1940s, Isoniazid in 1950s and Rifamycin in 1960s 目前WHO推荐的四种一线药是大半个世纪前的发明：比如链霉素在上 世纪40年代发明，异烟肼于50年代，利福平于60年代早期 TB is an ancient problem affecting the life of human being for more than thousand years. The threat of TB has not been disappeared, albeit effective anti-TB drugs developed some eighty years ago. This is due largely to the newly emerging problem of MDR-TB – we can put numbers of TB, and MDR-TB globally and in China

Challenges of TB care and control in China -中国结核控制面临的挑战 Slow decrease in incidence MDR-TB crisis 1/3 of world's MDR-TB burden is in China Over 6% of new TB cases in China are MDR-TB Over 25 % of previously treated TB cases are MDR-TB 4/5 of patients need MDR-TB treatment do not get treatment Use tableau to draw a few graph (pie chart, people chart) Insert photos related to the topic Source: TBIMS, 5th National TB Epidemiology Survey, WHO

Global efforts to combat TB in China 中国结核防治的国际支持 In 1993，WHO declared tuberculosis as a global public health emergency and advocated collective actions against TB at global and national level on the 46th World Health Assembly. 在1993年的世界卫生大会上，世界卫生组织宣布结核病是目前全球面临 的公共卫生紧急危机，并号召全球及各国国内为对抗结核协同努力。 Since then, China has been supported by the international organizations, such as World Bank, Global Fund, and bilateral organizations, such as DFID, JICA, etc. to develop and implement TB control programs/projects across the countries. 自那时起，中国开始获得来自国际机构，如世界银行、全球基金，以及 双边机构，比如英国国际发展部、日本国际协力机构的支持，以开发和 实施全国性的结核防控项目

Global efforts to combat TB in China 中国结核防控的国际支持 These programs have had positive impacts on: 这些项目对中国结核防控产生了积极影响： case finding, effective treatment, and case management 提高了患者发现，积极治疗以及规范管理率 reducing mortality and fatality rates of TB;. 降低结核的死亡率和病死率 But TB prevalence rate of TB in China has not reduced significantly due to complicated reasons, and TB control in China faces difficulties in many aspects: 但由于多种原因，中国结核流行率依然没有显著下降，结核防治 面临多方面困难： Lack of effective diagnostic tools until recently 直到近期才有有效诊断工具 Long treatment period and difficulty in patient management 患者疗程长，治疗全程管理困难 Patients are too poor to afford the treatment, and the health system does not function well 患者难以承担治疗费用，卫生体系有待改进

China-Gates supported innovative model of TB care and control 中国卫计委-盖茨基金会结核病防控综合模式项目

Adopting new tools & approaches 采用新技术和方法 Rapid diagnosis Rational treatment New case management Clinical pathway/package Reforming delivery system 服务体系 CDC Designated hospital Primary care Increasing financing & reduce payment by patients 降低患者灾难性 Health insurance Medical financial assistance Transport and nutrition allowance

China-Gates TB project-timeline and input 中盖结核项目时间表及经费投入 Insert location map, add evaluation grant amount Duke/DKU led team has received $2 million for the evaluation studies

Program evaluation study 项目评估研究 Duke Kunshan University has been conducting program evaluation studies with international and domestic collaborators 昆山杜克大学与国内外机构紧密合作，开展项目效果评估研究：

Fieldwork 现场调研 Baseline: Yichang Baseline: Zhenjiang 基线：宜昌 基线：镇江 Final: Zhenjiang 终末评估：镇江 Final: Hanzhong 终末评估：汉中

Findings and impact from Phase II 项目二期发现与影响 The program has positive impacts on access to TB services, treatment adherence, and patient satisfaction. 项目提升了患者的服务利用，治疗依从性以及治疗满意度 Results disseminated at global, national and provincial levels 项目结果向国家卫计委，盖茨基金会，学术界以及政策制定 者及时沟通汇报 Provided robust evidence for national TB control policy making 为全国性的结防政策制定提供的强有力的证据

SDG Project-TB case study Sponsored by Bill & Melinda Gates Foundation 可持续发展目标项目-结核病相关研究 由比尔-梅琳达盖茨基金会资助

SDG – TB related 结核相关联合国可持续发展目标 United Nation’s Global Development Agenda for 2015-2030 (post-MDG): 17 goals and 167 targets SDG 3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases SDG 3.3 在2030年前, 结束艾滋病，结核病，疟疾和其他被忽略热带疾病的蔓延，并减轻肝炎，水传播疾病和其他传染病的负担。 http://www.stoptb.org/assets/documents/global/plan/GlobalPlanToEndTB_TheParadigmShift_2016-2020_StopTBPartnership.pdf http://who.int/tb/post2015_TBstrategy.pdf?ua=1 Healthy China National Plan--By 2020, the nationwide tuberculosis incidence will drop to 58 per 100,000 结核病防治规划

Study Objectives 研究目的 Module 1. Conduct situation analysis to understand progress, cost, regional disparities and vulnerable populations and identify gaps 模块 1. 进行现状分析，以了解结防工作的进展，花费，地区间差异， 易受害人群，明确现状和目标的差距 Module 2. Analyze barriers and challenges in achieving SDG targets related to TB/MDR-TB 模块 2. 分析实现SDG结核/耐药结核相关目标所面临的阻碍和挑战 Module 3. Develop feasible evidence-based cost-effective tackling strategies 模块 3 :.开发基于证据并通过成本效益核算的应对策略 Module 4. Estimate the costs and benefits of TB/MDR-TB control 模块 4. 估算结核/耐药结核防控的成本和收益 Module 5. Propose policy recommendations 模块 5. 提出政策建议