Duke/Duke Kunshan University Team Awarded $1.2 Million Grant from Gates Foundation for Research on Tuberculosis Care and Control in China

A Duke University/Duke Kunshan University research team led by Professor Shenglan Tang received a 3-year $1,200,000 grant from the Bill and Melinda Gates Foundation to monitor and evaluate the implementation of a new comprehensive model of tuberculosis (TB) care and control in China.

The Duke University/Duke Kunshan University evaluation team leads a large collaborative consortium consisting of experts from the UK Institute of Development Studies (IDS), China Center for Disease Control and Prevention (CDC), National Health and Family Planning Commission Centre for Health Statistics and Information(NHFPC-CHSI), Peking University, Zhejiang University, Beijing Chest Hospital, and the TB Clinical Centre of China CDC to undertake this ambitious and comprehensive project in 2016-19.

China has the world’s second largest tuberculosis epidemic

In 2013, one million new cases of TB were reported in China, accounting for 11.6% of the world’s total that year. Over 8% of TB patients in China have multi-drug resistant TB (MDR-TB), likely due to previous poor TB treatment. Control of TB and MDR-TB in China requires a systematic approach. Since 2012, the Gates Foundation has supported the China CDC to develop innovative models of TB care and control, and pilot in 3 cities. Pilot exercises have been undertaken to restructure the agencies and hospitals responsible for TB diagnosis and reporting, and new tools at all levels of TB control have also been introduced. The team was funded by the Gates Foundation to evaluate the policy impacts and identify implementation barriers. These pilot studies and the experiences gained are particularly important to understand if and how interventions work in different contexts, and to identify strategies to effectively implement the interventions in specific contexts and ultimately scale up nationwide.

In the current study, the Chinese Government plans to introduce and expand the new comprehensive model of TB control into 172 counties in three provinces based on lessons from the previous pilot studies. The Gates Foundation will continue to support the evaluation team, led by Dr. Shenglan Tang, professor at Duke Kunshan University and Duke University, and director of the Global Health Research Center at Duke Kunshan University, to conduct monitoring and evaluation activities from 2016 to 2019 to produce robust evidence to support the implementation of new TB control policies and the comprehensive service delivery model in China.

Major interventions and expected outcomes

Interventions targeting the TB service delivery system mainly include strengthening TB prevention and control, improving equity in access to and financing of TB care, and developing a new and more effective integrated TB information system. In addition, various new tools will be adopted. Electronic Medication Monitor (EMM) will be used for patient’s case management to improve patients’ adherence to TB treatment. Capacity building activities will be undertaken, including the development of training materials on TB prevention and control, such as a manual setting out the new Chinese Standards for Tuberculosis Care. These materials will be used to train public health professionals, clinical medical personnel, and primary health care workers. Interventions also aim to reduce the out-of-pocket payments by TB and MDR-TB patients using a multi-source financing strategy with increased government subsidies, higher reimbursement from health insurance, support from the National Public Health Equity Fund for TB prevention and treatment, better coordination among different health insurance schemes, and additional funding from the Medical Financial Assistance (MFA) funds. Moreover, transportation and nutrition subsidies will be provided to TB/MDR-TB patients. An innovative provider payment reform will also be implemented in pilot counties so as to incentivize high quality TB care provision, and control the rapid rise of medical cost.

Evaluation activities and current progress

Two evaluation strategies will be adopted – A comprehensive performance-based monitoring and evaluation (PBME) exercise will track the project roll-out and evaluate its effectiveness in all 172 project counties of the three project provinces using a specially compiled dataset based on a combination of existing routine data systems and information available from secondary sources. In parallel, an in-depth case-study based evaluation will be performed in 6 prefectures and 12 sample counties, where additional quantitative and qualitative data would be collected.

Evaluation team conducting workshop with experts from Gates Foundation, and other partner institutions to discuss project evaluation plan, Hangzhou, Zhejiang, China

Duke University/Duke Kunshan University team members and consultants, Hangzhou, Zhejiang, China. Back row, from left to right: Prof Dong Hengjin (Zhejiang University), Prof Henry Lucas (IDS), Ms Xu Ling (NHFPC-CHSI), Prof Shenglan Tang (Duke University/Duke Kunshan University), A/Prof Joy Noel Baumgartner (Duke University). Front row, from left to right: Ms Gu Yuxuan (Zhejiang University), Dr Dong Di (Duke Kunshan University), Ms Jiang Weixi (Duke Kunshan University), Dr Mao Wenhui (Duke University)

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Gareth McPherson

Email: gareth.mcpherson@dukekunshan.edu.cn

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