At a recent salon themed "Technological Upgrades Accelerate China's Efforts to End Tuberculosis Epidemic" hosted by the Social Media Research Center at Peking University, Zhao Yan, Director of the Tuberculosis Control Center of the Chinese Center for Disease Control and Prevention, highlighted the main challenge facing tuberculosis prevention and control: early detection. Tuberculosis possesses a certain degree of stealthiness, with approximately 20% of suspected cases showing no symptoms. Yan emphasized the importance of early detection of subclinical tuberculosis patients and active tuberculosis patients to interrupt transmission and reduce community spread.
According to the "Global Tuberculosis Report 2023" released by the World Health Organization, China estimated 748,000 new tuberculosis patients in 2022, ranking third among the 30 high-burden tuberculosis countries and accounting for 7.1% of global incidence.
Despite significant achievements in tuberculosis prevention and control in China, challenges persist. While the detection rate has improved over the years, with 70%-80% of new cases diagnosed annually and a cure rate of over 90% for drug-sensitive tuberculosis patients, the annual number of new cases remains high at approximately 748,000. The decline in incidence is slow, although China's tuberculosis incidence has been decreasing at an annual rate of 3.4%, double the global average decline rate. However, there is still a considerable gap to achieve the goal of ending the tuberculosis epidemic by 2030, with an 80% reduction in incidence.
Technological advancements offer unprecedented opportunities for tuberculosis prevention and control in China. Yan noted the improvement in diagnostic technologies and infrastructure for active screening, including rapid saliva testing and AI-assisted chest X-ray interpretation. These advancements, coupled with targeted screening strategies in areas with high tuberculosis burdens, can enhance efficiency and reduce testing costs.
In Jiangsu Province, one of the provinces with the lowest tuberculosis prevalence, new technologies have been leveraged to facilitate early detection and improve detection rates. Since 2021, Jiangsu Province has established a Provincial Health Cloud Imaging Platform, where all imaging data from public hospitals and some private hospitals in Jiangsu are stored, quality-controlled, and accessed uniformly. Last year, AI-powered image reading systems were integrated into this platform, aiming to achieve early detection of pulmonary diseases, including tuberculosis, across the province through AI-assisted image interpretation.
The application of new technologies also enables the early detection of drug-resistant tuberculosis patients. By the end of 2024, Jiangsu Province plans to equip 20 communities with molecular biology testing equipment for drug resistance, providing free and accurate testing for all suspected tuberculosis patients visiting tuberculosis clinics.
In Yunnan Province, information technology has simplified patient journeys across medical institutions, significantly reducing economic burdens. Through the Basic Public Health Management System, Yunnan Province has integrated patient screening pathways and results, allowing all medical institutions to access patient information. To improve diagnostic accuracy, Yunnan Province has decentralized rapid diagnostic technologies to grassroots medical institutions, achieving full coverage of molecular biology testing technology at the county level by 2020.
Huan Shitong, Senior Program Officer at the Bill & Melinda Gates Foundation, emphasized that innovative diagnostic tools can significantly enhance case detection and improve the feasibility of active screening. For instance, rapid molecular diagnostics can increase diagnostic accuracy and the detection rate of drug-resistant tuberculosis, enabling more patients to receive appropriate treatment. As traditional sputum sample collection is challenging, with over half of screened patients unable to produce sputum samples, saliva-based sampling offers a convenient, quick, and biologically safer alternative.
With the assistance of new technological means, how can we achieve the goal of ending tuberculosis?
Zhao Yanlin pointed out that the three major actions implemented in the field of tuberculosis prevention and control in China in recent years are patient care, tuberculosis-free community initiatives, and community mobilization. The "tuberculosis-free community" refers to communities with a tuberculosis incidence rate lower than one per hundred thousand residents. Current measures mainly include active screening and preventive interventions to achieve comprehensive control.
"Now we're rolling out the TB-Free Community Action in 400 districts nationwide. With a comprehensive approach of proactive screening and preventive treatment, we anticipate reducing TB incidence by 50% to 90% within three to five years," he stated. "Looking ahead, our goal is to gradually expand from points to lines, from lines to areas, transforming TB-Free Communities into TB-Free districts, cities, and eventually provinces, ultimately achieving the goal of ending TB in China."
Guests from the frontlines of TB prevention and control across the country also shared their respective regions' experiences in strengthening TB screening and control measures.
In Zhejiang, TB-Free Communities serve as the main focus for enhancing proactive screening and preventive treatment efforts. Chen Bin, Director of the Tuberculosis Prevention and Control Institute at the Zhejiang Provincial Center for Disease Control and Prevention, stated that Zhejiang Province was the first in the country to propose the construction of "TB-Free Communities" with full coverage at the provincial level. From a governmental perspective, policies and mechanisms, along with diverse funding channels, have facilitated constructive synergy in the construction of TB-Free Communities in Zhejiang. Huzhou City pioneered the goal of building a TB-Free city nationwide, with seven cities aiming for full coverage of TB-Free Communities at the municipal level, ensuring the implementation of proactive screening and early preventive treatment.
Meanwhile, in Jiangsu Province, the focus isn't just on detecting drug-resistant TB patients early but also on promptly curing them. "Drug-resistant TB is like cancer with wings—it's not only difficult to treat but also contagious," said Zhu Limei. Jiangsu Province provides all A and B group second-line drugs, including bedaquiline, free of charge to all drug-resistant patients, achieving a success rate of 85.6%, the highest in the country and well above the global average of 63%.
