SHANDONG - CHINA

TB contact tracing Fidelis pilot project evaluation, Shandong

Fidelis is an initiative sponsored by Canadian International Development Agency and managed by the International Union Against Tuberculosis and Lung Disease. Its objective is to support innovative tuberculosis control activities in order to increase detection of new sputum smear positive (SS+) cases of tuberculosis, while maintaining high cure rates within the DOTS strategy. Shandong Center for Tuberculosis Control has conducted a Fidelis project, which was implemented in 35 counties of Shandong province for a period of 12 months since 1st January 2007. Before the Fidelis project, systematic close contacts screening was not routinely carried out in Shandong. The objective of this project was to increase finding of new smear positive cases through tracing and screening symptomatic close contacts of sputum positive TB cases. TB dispensaries in the 35 project counties produced a list of SS+ cases who were registered in two years before the project as well as during the project year, then village doctors were supposed to collect and send three sputum samples from each of them to TB dispensaries for Acid Fast Bacilli test. Before the project formally launched, provincial TB centre trained doctors from county TB dispensaries, who, then with the facilitation of township doctors, as trainers trained village doctors about the intervention procedures and standards.

 

Fidelis invested US$214,353 for this project. The majority of spending was on county TB dispensary training sessions, cash incentive and cost coverage for village doctors collecting and sending sputum. Each time a village doctor sends sputum samples to county TB dispensary he/she gets US$1 to cover their travel and time loss. For each confirmed new SS+ case, the village doctor gets an extra US$5 cash reward. This study aims to evaluate experience and lessons of this pilot project and its feasibility for scale up in Shandong and China at large. The study assessed resource inputs, case detection outcomes; the relationship of case detection rates of screened close contacts with the characteristics of the index cases; and documents the roles of village doctors, public health staff and county doctors. The study collects the views of index cases and their close contacts regarding the performance of doctors at village, township and county levels. Documentary study, routine data collection and in-depth interviews will be conducted in this research.