China has more than halved its tuberculosis (TB) prevalence over the last 20 years, with rates falling from 170 to 59 per 100,000 population.
This unrivalled success has been driven by a massive scale-up of the directly observed, short-course (DOTS) strategy, from half the population in the 1990s to the entire country after 2000, according to findings from a 20-year-long analysis of national survey data.
"One of the key global TB targets set by the Stop TB Partnership aims to reduce tuberculosis prevalence by 50 percent between 1990 and 2015. This study in China is the first to show the feasibility of achieving such a target, and China achieved this 5 years earlier than the target date", study leader Dr Yu Wang from the Chinese Center for Disease Control and Prevention in Beijing, China said.
"Huge improvements in TB treatment, driven by a major shift in treatment from hospitals to local public health centres implementing the DOTS strategy, were largely responsible for this success," Wang said.
China is a major contributor to the TB pandemic, with 1 million new TB cases every year, accounting for 11 percent of all new cases globally.
Two national surveys of tuberculosis prevalence in 1990 and 2000 showed that levels of TB were reduced by around 30 percent in the 13 provinces where the DOTS programme was adopted. However, national TB prevalence fell by just 19 percent over the decade.
Another survey was done in 2010 to re-evaluate the national TB burden, providing an opportunity to assess the effect of the nationwide expansion of the DOTS programme. Nearly 253,000 individuals aged 15 years and older were surveyed in 2010 at 176 investigation points chosen from all 31 mainland provinces.
The results show that between 2000 and 2010, national TB prevalence fell by 57 percent —tripling the reduction of the previous decade.
The survey is published in The Lancet.