A Study On The Usage Of Second-line Anti-tuberculosis Drugs And Drug Susceptibility Testing For Anti-tuberculosis Drugs In China

Background:the emergence and prevalence of MDR-TB make a great challenge to China NTP. To diagnose MR-TB needs qualified culture and DST, but in China below the provincial level, the health care facilities which treat TB hardly do these. In China, some of the SLDs are widely used and may be misused, this makes macobacterium tuberculosis are resistant to SLD, and makes a bad effect on treatment result of patients.Objective:To investigate the useage of second-line anti-tuberculosis drugs in medical institutes at all levers, and provide scientific evidence for policy development in China.Method:A stratified purposive sampling method were adopted, and a total of 12 provinces were involved in the cross sectional survey. Questionnaires were performed to all TB prevention and control institutions, tuberculosis specialist hospitals, general hospitals and rural health clinics at each level.Results:1) A total of 4782 institutions were involved in the survey, and 72.6% of them have used SLD. The proportion of institutions using SLD decreased by level, as follows: 87.0% of provincial level, prefectural and city level 83.4%, county and district level 72.0%, township level 70.3%.2) The proportion of SLD use varied between different type of institutions, with 98.7% of TB institutions were based in tuberculosis, chest, pulmonary hospital, as well as designated hospitals,100% of TB special hospital,99.4% of general hospital. However only 22.9% of TB institutions which are based in CDC used SLD.3) For the usage of different kind of SLD, there were great variations in terms of proportion of institutions using. Among them, Amikacin(49.6%), Ofloxacin(42.3%), Levofloxacin(66.2%), Ciprofloxacin(39.5%) had a higher proportion.4) Of the 1960 institutions which have TB clinics and/or TB wards.92.6% of provincial level,89.1% of prefectural and city level 83.4%,64.7% of county and district level have used SLD, and mostly they were used for TB.5) Of the 1960 institutions which have TB clinics and/or TB wards, Only 210 (10.7%) institutions performed sputum culture. Only 83 (4.2%) institutions performed drug susceptibility testing (DST) for first-line TB drugs.31 (1.6%) institutions performed DST for SLD. Only 35 (16.7%) of institutions which performed sputum culture had external quality assessment (EQA), for institutions which performed DST for first-line TB drugs and SLD, is 11 (13.2%) and 3 (9.7%) respectively.6) 76.0% of 541 new TB patients and 84.0% previous treated patients had used one kind of SLD at least, and they didn't have DST.7) Factors affecting the use of SLD are:region, type of institution, whether there are TB clinics and wards, number of beds for tuberculosis patients, whether perform sputum smear, whether perform sputum culture (P all<0.001) and patients smear-positive rate (P<0.05) etc. Drug susceptibility testing is not the influence factors for SLD use (P=0.771)Conclusion:SLD is commonly used in China, some of them are misused, and qualified DST is seldom performed. Therefore China should develop a policy on the rational use of SLD, and promote sputum culture and DST, especially in the prefectural and city level, county and district level, also strengthen the quality control and external quality assessment of laboratory test.