title: Access to Bacteriologic-Based Diagnosis in Smear Positive Retreatment Tuberculosis Patients in Rural China: A Cross-Sectional Study in Three Geographic Varied Provinces.
abstract: OBJECTIVE
  To determine factors influencing the utilization and accessibility to bacteriologic-based tuberculosis (TB) diagnosis among sputum smear positive (SS+) retreatment TB patients, and to develop strategies for improving the case detection rate of MDR-TB in rural China.
  
  
  METHODS
  A cross-sectional study of SS+ TB retreatment patients was conducted in eight counties from three provinces with different implementation period and strategy of MDR-TB program in China. Demographic and socioeconomic parameters were collected by self-reporting questionnaires. Sputum samples were collected and cultured by the laboratory of county-designated TB clinics and delivered to prefectural Centers for Disease Prevention and Control (CDC) labs for DST with 4 first-line anti-TB drugs.
  
  
  RESULTS
  Among the 196 SS+ retreatment patients, 61.22% received culture tests during current treatment. Patients from more developed regions (OR = 24.0 and 3.6, 95% CI: 8.6-67.3 and 1.1-11.6), with better socio-economic status (OR = 3. 8, 95% CI: 1.3-10.7), who had multiple previous anti-TB treatments (OR = 5.0, 95% CI: 1.6-15.9), and who failed in the most recent anti-TB treatment (OR = 2.6, 95% CI: 1.0-6.4) were more likely to receive culture tests. The percentage of isolates resistant to any of first-line anti-TB drugs and MDR-TB were 50.0% (95% CI: 39.8%-60.2%) and 30.4% (95% CI: 21.0%-39.8%) respectively.
  
  
  CONCLUSIONS
  Retreatment SS+ TB patients, high risk MDR-TB population, had poor utilization of access to bacteriologic-based TB diagnosis, which is far from optimal. The next step of anti-TB strategy should be focused on how to make bacteriological-based diagnosis cheaper, safer and more maneuverable, and how to assure the DST-guided treatment for these high-risk TB patients.
authors.affiliation: Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.|Key Laboratory of Public Health Safety (Ministry of Education), Shanghai, China.
authors.forename: Changming
authors.initials: C
authors.lastname: Zhou
authors.affiliation: Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.|Key Laboratory of Public Health Safety (Ministry of Education), Shanghai, China.
authors.forename: Weili
authors.initials: W
authors.lastname: Jiang
authors.affiliation: Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.|Key Laboratory of Public Health Safety (Ministry of Education), Shanghai, China.
authors.forename: Li
authors.initials: L
authors.lastname: Yuan
authors.affiliation: Jiangsu Provincial Center for Disease Control, Nanjing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Lu
authors.affiliation: Sichuan Provincial Center for Disease Control, Chengdu, China.
authors.forename: Jinge
authors.initials: J
authors.lastname: He
authors.affiliation: Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.|Key Laboratory of Public Health Safety (Ministry of Education), Shanghai, China.|Centre for Global Health, Karolinska institutet, Stockholm, Sweden.
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhao
authors.affiliation: Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.|Key Laboratory of Public Health Safety (Ministry of Education), Shanghai, China.|Centre for Global Health, Karolinska institutet, Stockholm, Sweden.
authors.forename: Biao
authors.initials: B
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D005843:Geography; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis; D019233:Retreatment; D019035:Rural Health Services; D012424:Rural Population; D012923:Social Class; D013183:Sputum / Q000382:microbiology; D011795:Surveys and Questionnaires; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents