Adapting and Innovating to Control Tuberculosis in the PRC: Resilience during the COVID-19 Pandemic

The coronavirus disease (COVID-19) pandemic threatened to reverse the recent gains made in tuberculosis (TB) control in the People’s Republic of China (PRC). The pandemic and the public health measures enforced to contain it adversely affected TB service provision and uptake, especially in high-burden countries. The PRC has the third-highest TB burden and the second-highest burden of multidrug-resistant TB (MDR-TB) globally—the number of TB cases diagnosed decreased sharply during intensive implementation of public health interventions against COVID-19. ^{1 2}

The fall in number of people diagnosed with TB was attributed mainly to (i) disruptions in TB service delivery because workers were reassigned to centers for disease control and prevention (CDCs) and primary health-care units (PHCs) to fight the COVID-19 epidemic, the temporary closure of TB outpatient clinics, and the designation of TB hospitals as COVID-19 hospitals to handle the pandemic surge, which affected care-seeking behavior; and (ii) lack of access to TB care as most counties restricted intercity and intra-county travel, making it difficult to visit health facilities and seek medical care.^{3 4}

The TB control network is composed of CDCs, TB-designated hospitals, and PHCs in each county. ⁵ With most prefecture and provincial TB hospitals designated as COVID-19 hospitals, hospital-based services had to be modified to maintain continuity of essential TB care services during the pandemic. The adjustments included changes in hospitalization and treatment-monitoring policies, approaches to TB patient support, and infection prevention and control protocols. ⁶

Hospitalization and treatment. During the pandemic a number of TB hospitals set stricter criteria for hospitalization. Longer-term prescriptions were widely used to lessen the number of outpatient visits while ensuring that TB patients had enough TB medicines. Most hospitals provided 2–3 months’ supply of TB medicines during the pandemic, while some provided enough for a month, compared with 1–2 weeks’ supply before the pandemic. Ensuring that TB patients would adhere to treatment was a challenge, which health-care providers faced by sending them regular follow-up instant messages. Hospitals switched from injectable treatments to oral regimens for patients with MDR-TB, not only reducing the frequency of patient visits but also minimizing the risk of exposure to the virus. Hospitals started delivering medication to patients to make it easier for them to continue their treatment without putting their health at risk. ⁷

Patient support. TB patients became more anxious during the pandemic and needed counseling and mental health support. Given the limited in-person interactions with health-care workers and increasing patients’ unease caused by COVID-19, patient support was important to ensure continuity of TB care. The TB hospitals adopted multiple interventions, including access to patient-friendly web- and paper-based educational materials on TB and COVID-19. A hospital developed a mobile application for personal consultation. ⁸

Infection prevention and control. Consistent with World Health Organization (WHO) guidelines, all TB patients were screened for COVID-19 through a triage system. Those negative for COVID-19 were sent directly to TB services, while those positive were segregated in a COVID-19 investigation area. All patients and hospital visitors were required to wear a surgical mask. All hospitals strengthened their environmental disinfection and ventilation systems. Some hospitals reduced the use of bronchoscopy for TB patients. ⁹

Accessible cutting-edge diagnostic technologies and standardized treatment procedures have significantly improved TB diagnosis and treatment. By training health-care providers and closely monitoring TB clinical services, provinces that strengthened project-based TB control and systems have seen significant improvements in the quality of TB and MDR-TB diagnosis and treatment. ¹⁰

Innovation and adaptation are proving to be effective in the fight against TB. The WHO found that the PRC was one of the few high-burden countries where monthly TB case notifications in 2020 had recovered from the initial decline caused by the pandemic. ¹¹ Of the 30 high TB burden countries, The PRC continued to be among those with the highest levels of treatment coverage in 2020 and 2021. ¹² By embracing new technologies and approaches, the PRC is turning the tide against TB.