title: Better care provided to patients with tuberculosis at county designated TB hospitals (CTD) compared to non-CTDs in rural China.
abstract: The primary unit of tuberculosis (TB) medical care in China is the county TB dispensary or county designated hospital (CTD), where patients can receive free diagnosis and treatment. However, a substantial number of patients seek their anti-TB treatment from general health facilities (Non-CTDs). This study aimed to investigate the first anti-TB treatment experience and choice of health facilities of retreated TB patients and their determinants.
  
  
  
  A cross-sectional study was conducted in Jiangsu, Shandong and Sichuan provinces. All registered re-treated TB patients were investigated using a structured questionnaire covering information on demographics, socio-economic characteristics, and previous anti-TB treatment experiences.
  
  
  
  Totally, 75.3% of 544 patients visited CTD directly for initial treatment. Patients who were female (OR:1.71, 95% CI: 1.01-2.87), over 40 years of age (OR:2.80, 95% CI: 1.24-6.33), from Jiangsu (OR:3.07, 95% CI: 1.57-6.01) and Sichuan (OR:4.47, 95% CI: 2.29-8.73) and those diagnosed before 2005 (OR:6.87, 95% CI: 4.24-11.13) had a significant higher risk receiving their initial treatment at a non-CTD. Patients were more likely to have standardized diagnosis and treatment regimens in CTD (89.8%) than in non-CTDs (65.9%). Patients treated in non-CTDs versus in CTD had a lower possibility to complete their treatment course during first TB episode (χ2= 3.926, P = 0.048), but there was no significant difference in the cure rate between different facilities (CTD 60.8%, Non-CTDs 59.1%). Patients in non-CTDs incurred higher costs (1,360 CNY) than those treated in CTD (920CNY).
  
  
  
  CTD play a key role in the National Tuberculosis Control Program. Patients should be guided to seek health care in county designated hospital, where they are more likely to receive appropriate examinations, treatment regimens and rigorous supervision, and to bear a lighter economic burden.
authors.affiliation: Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Rd, Shanghai, 200032, China.|Key Laboratory of Public Health Safety (Ministry of Education), 138 Yi Xue Yuan Rd, Shanghai, 200032, China.
authors.forename: Li
authors.initials: L
authors.lastname: Yuan
authors.affiliation: National Center for TB Control and Prevention, National center for TB control and prevention, 155 Changbai Road, Beijing, 102206, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Rd, Shanghai, 200032, China.|Key Laboratory of Public Health Safety (Ministry of Education), 138 Yi Xue Yuan Rd, Shanghai, 200032, China.
authors.forename: Changming
authors.initials: C
authors.lastname: Zhou
authors.affiliation: Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Rd, Shanghai, 200032, China.|Key Laboratory of Public Health Safety (Ministry of Education), 138 Yi Xue Yuan Rd, Shanghai, 200032, China.
authors.forename: Weili
authors.initials: W
authors.lastname: Jiang
authors.affiliation: Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Rd, Shanghai, 200032, China. zhaoqi@shmu.edu.cn.|Key Laboratory of Public Health Safety (Ministry of Education), 138 Yi Xue Yuan Rd, Shanghai, 200032, China. zhaoqi@shmu.edu.cn.|Centre for Global Health, Department of Public Health Science (IHCAR), Karolinska Institutet, S-171 77, Stockholm, Sweden. zhaoqi@shmu.edu.cn.
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhao
authors.affiliation: Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Rd, Shanghai, 200032, China.|Key Laboratory of Public Health Safety (Ministry of Education), 138 Yi Xue Yuan Rd, Shanghai, 200032, China.|Centre for Global Health, Department of Public Health Science (IHCAR), Karolinska Institutet, S-171 77, Stockholm, Sweden.
authors.forename: Xu
authors.initials: X
authors.lastname: Biao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002681:China; D003430:Cross-Sectional Studies; D005260:Female; D006761:Hospitals; D006782:Hospitals, Special; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care; D019233:Retreatment / Q000706:statistics & numerical data*; D012424:Rural Population; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: China; County TB dispensary; General health facility; Re-treated; Tuberculosis