title: Drug-resistant tuberculosis control in China: progress and challenges.
abstract: BACKGROUND
  China has the second highest caseload of multidrug-resistant tuberculosis (MDR-TB) in the world. In 2009, the Chinese government agreed to draw up a plan for MDR-TB prevention and control in the context of a comprehensive health system reform launched in the same year.
  
  
  CONCLUSIONS
  China is facing high prevalence rates of drug-resistant TB and MDR-TB. MDR-TB disproportionally affects the poor rural population and the highest rates are in less developed regions largely due to interrupted and/or inappropriate TB treatment. Most households with an affected member suffer a heavy financial burden because of a combination of treatment and other related costs. The influential Global Fund programme for MDR-TB control in China provides technical and financial support for MDR-TB diagnosis and treatment. However, this programme has a fixed timeline and cannot provide a long term solution. In 2009, the Bill and Melinda Gates Foundation, in cooperation with the National Health and Family Planning Commission of China, started to develop innovative approaches to TB/MDR-TB management and case-based payment mechanisms for treatment, alongside increased health insurance benefits for patients, in order to contain medical costs and reduce financial barriers to treatment. Although these efforts appear to be in the right direction, they may not be sufficient unless (a) domestic sources are mobilized to raise funding for TB/MDR-TB prevention and control and (b) appropriate incentives are given to both health facilities and their care providers. Along with the on-going Chinese health system reform, sustained government financing and social health protection schemes will be critical to ensure universal access to appropriate TB treatment in order to reduce risk of developing MDR-TB and systematic MDR-TB treatment and management.
authors.affiliation: Global Health Research Center, Duke Kunshan University, Kunshan, China. qian.long@dku.edu.cn.|Duke Global Health Institute, Duke University, Durham, NC, USA. qian.long@dku.edu.cn.
authors.forename: Qian
authors.initials: Q
authors.lastname: Long
authors.affiliation: China Center for Disease Control and Prevention, Beijing, China. quyan@chinatb.org.
authors.forename: Yan
authors.initials: Y
authors.lastname: Qu
authors.affiliation: Institute of Development Studies, Sussex University, Brighton, UK. h.lucas@ids.ac.uk.
authors.forename: Henry
authors.initials: H
authors.lastname: Lucas
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D002681:China / Q000453:epidemiology; D006801:Humans; D007348:Insurance, Health; D012423:Rural Health / Q000706:statistics & numerical data; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology*
chemical_list: D000995:Antitubercular Agents
references.citation: Lancet. 2009 Apr 18;373(9672):1328
references.pmid: 19382292
references.citation: Lancet. 2012 Mar 3;379(9818):833-42
references.pmid: 22386036
references.citation: Health Policy Plan. 2006 Sep;21(5):365-72
references.pmid: 16940302
references.citation: Int J Tuberc Lung Dis. 2010 Oct;14(10):1233-43
references.pmid: 20843413
references.citation: N Engl J Med. 2012 Jun 7;366(23):2161-70
references.pmid: 22670902
references.citation: Lancet. 2006 Mar 18;367(9514):952-5
references.pmid: 16546550
references.citation: Zhonghua Jie He He Hu Xi Za Zhi. 2009 Aug;32(8):561-3
references.pmid: 19958669
references.citation: Lancet. 2010 May 22;375(9728):1814-29
references.pmid: 20488524
references.citation: PLoS Med. 2012;9(11):e1001337
references.pmid: 23139644
references.citation: Lancet Glob Health. 2015 Apr;3(4):e217-28
references.pmid: 25794675
references.citation: Health Policy Plan. 2007 May;22(3):156-66
references.pmid: 17434870
references.citation: Trop Med Int Health. 2007 Dec;12(12):1464-71
references.pmid: 18076553
references.citation: N Engl J Med. 2010 Nov 4;363(19):1781-4
references.pmid: 21047219
references.citation: Int J Health Plann Manage. 2014 Apr-Jun;29(2):160-74
references.pmid: 23877959
references.citation: Emerg Infect Dis. 2011 Oct;17(10):1831-8
references.pmid: 22000352
references.citation: N Engl J Med. 2010 Sep 9;363(11):1050-8
references.pmid: 20825317
references.citation: BMC Infect Dis. 2013 Feb 20;13:93
references.pmid: 23425261
references.citation: Lancet Infect Dis. 2013 Jun;13(6):529-39
references.pmid: 23531391
references.citation: Thorax. 2012 Jul;67(7):632-8
references.pmid: 22403070
references.citation: BMC Public Health. 2011 May 26;11:393
references.pmid: 21615930
references.citation: Int J Infect Dis. 2010 Oct;14(10):e828-37
references.pmid: 20570541
references.citation: Trop Med Int Health. 2010 Jan;15(1):26-32
references.pmid: 19917035