Over the last 20 years, China has more than halved its tuberculosis (TB) prevalence, 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, published online on March 18, 2014 in The Lancet. "One of the key global TB targets set by the Stop TB Partnership aims to reduce tuberculosis prevalence by 50% 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," says study leader Dr. Yu Wang from the Chinese Center for Disease Control and Prevention in Beijing, China. "Huge improvements in TB treatment, driven by a major shift in treatment from hospitals to local public health centers implementing the DOTS strategy, were largely responsible for this success." China is a major contributor to the TB pandemic, with 1 million new TB cases every year, accounting for 11% 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% in the 13 provinces where the DOTS program was adopted. However, national TB prevalence fell by just 19% 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 program. 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 showed that between 2000 and 2010, national TB prevalence fell by 57%—tripling the reduction of the previous decade.
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