Characteristics of Rifampicin-Resistant Tuberculosis Detection in China: 2015-2019
Abstract Background: The very high burden of rifampicin resistance tuberculosis (RR-TB) and the very low RR-TB cases detection are a major challenge that China has been faced since the implementation of Programmatic Management of Drug-resistant Tuberculosis in 2006. To deal with the challenge of inadequate detection of RR-TB cases, China expanded the scope of screening for RR and the application of rapid molecular drug susceptibility testing tools after 2015 and included it in the "13th Five-Year" National Tuberculosis Prevention and Control Program (2016-2020). This study analyzed the changes of RR-TB detection during 2015-2019.Method: We used data from the national Tuberculosis Information Management System to descriptively analyze characteristics of RR-TB detection from 2015 to 2019.Results: 68200 RR-TB cases were detected in 2015-2019, of which 48.1% were new cases. In 2019, the coverage rate of PMDT in prefectures nationwide reached 95.0%, an increase from 70.0% in 2015. The number and detection rate of RR-TB cases increased year by year, from 10019 and 14.3% in 2015 to 18623 and 28.7% in 2019, respectively. Of the bacteriologically confirmed TB cases, 81.9% were tested for RR, a considerable increase from 29.5% in 2015. Only 41.0% of RR-TB cases had FQs susceptibility testing performed in 2019, and this proportion has been declining year by year since 2016. The proportion of application of rapid molecular tools increased from 24.0% in 2015 to 67.1% in 2019, and the median days to obtain RR results was significantly shortened from 61 days (IQR 27–91) in 2015 to 15days (IQR 2–55) in 2019. In 2019, 76.0% of RR-TB cases were diagnosed as presumptive RR-TB in county-level hospitals.Conclusions: After China modified the RR-TB detection policies, the screening rate of RR and the number of RR-TB cases increased significantly, the RR testing methods have been transformed into the vast majority of the utilization of rapid molecular tools. However, comprehensive measures should be implemented to close the gap in the detection of RR-TB cases. It is imperative to take FQs susceptibility testing seriously and effectively strengthen the laboratory capacity of county-level hospitals.