Rising challenge of multidrug-resistant tuberculosis in China:a predictive study using Markov modeling

Background:Multidrug-resistant tuberculosis(MDR-TB)is on the rise in China.This study used a dynamic Markov model to predict the longitudinal trends of MDR-TB in China by 2050 and to assess the effects of alternative control measures.Methods:Eight states of tuberculosis transmission were set up in the Markov model using a hypothetical cohort of 100000 people.The prevalence of MDR-TB and bacteriologically confirmed drug-susceptible tuberculosis(DS-TB+)were simulated and MDR-TB was stratified into whether the disease was treated with the recommended regimen or not.Results:Without any intervention changes to current conditions,the prevalence of DS-TB+was projected to decline 67.7%by 2050,decreasing to 20 per 100000 people,whereas that of MDR-TB was expected to triple to 58/100000.Furthermore,86.2%of the MDR-TB cases would be left untreated by the year of 2050.In the case where MDR-TB detection rate reaches 50%or 70%at 5%per year,the decline in prevalence of MDR-TB would be 25.9 and 36.2%respectively.In the case where treatment coverage was improved to 70%or 100%at 5%per year,MDR-TB prevalence in 2050 would decrease by 13.8 and 24.1%,respectively.If both detection rate and treatment coverage reach 70%,the prevalence of MDR-TB by 2050 would be reduced to 28/100000 by a 51.7%reduction.Conclusions:MDR-TB,especially untreated MDR-TB,would rise rapidly under China’s current MDR-TB control strategies.Interventions designed to promote effective detection and treatment of MDR-TB are imperative in the fights against MDR-TB epidemics.

Post-2015,why delay to seek healthcare?Perceptions and field experiences from TB healthcare providers in northern Malawi:a qualitative study

Background:Malawi is a low-income country with high Tuberculosis(TB)burden.TB diagnosis delay and untimely initiation of treatment is still a major problem in Malawi which could increase the risk of tuberculosis transmission in the communities.This study investigated factors related to the diagnostic delay of tuberculosis from TB healthcare providers in the northern region of Malawi.Methods:Nine focus group discussions were conducted with 57 participants in total.The participants were healthcare cadres including district TB officers,clinical officers,TB nurses,laboratory technicians and Health Surveillance Assistants(HSAs).NVivo(11.0)software was used for data analysis.Results:The factors related to diagnostic delay were categorized into three themes:client factors,institutional factors and healthcare provider related factors.Client’s stigma and fear for HIV test,resource shortage within healthcare institutions and the healthcare workers’poor attitude against potential patients were among the most influential factors behind the TB diagnostic delay.Conclusions:The TB control strategies should aim to reduce HIV stigma,improve resource supply and improve TB healthcare workers’morale in order to achieve timely TB diagnosis.