The national health and family planning commission on further strengthening the tuberculosis control work

The 2016-07-25 national health and population and family planning commission of the People's Republic of China

The CDC hair [2016] no. 39

Provinces, autonomous regions and municipalities directly under the central government health and family planning commission, the xinjiang production and construction corps health bureau, the Chinese center for disease control and prevention:

Tuberculosis is respiratory tract infectious diseases which cause serious damage to the people's health. The party central committee and state council attaches great importance to the tuberculosis control work, the family planning administrative department of public health at all levels should perform their duties, the prevention and control measures to implement effectively, the tuberculosis epidemic downward trend year by year. However, the TB prevention and control situation is still grim. Our country is still one of 30 high TB burden countries around the world, especially in recent years, there exist many weak links, TB control work such as the prevention and treatment of no cohesion in prevention and treatment, patients' discovery, diagnosis and treatment, management does not reach the designated position, multidrug-resistant tuberculosis prevention and control is weak, the school such as aggregation outbreaks have occurred in key sites. To solve the problems that exist in the prevention and control work, to further strengthen TB control work, according to the law on the prevention and control of infectious diseases and the TB prevention and control measures for the administration, regarding the work order as follows.

A, strengthen TB patients found that further standardize the treatment and management

(a) further strengthen TB patients found. All kinds of medical and health institutions at all levels should be suspicious symptoms of tuberculosis, especially two weeks or more cough and expectoration, focus on screen, or the symptom such as coughing up blood, strengthen the first option is responsible for, improve the diagnostic accuracy and timeliness, reduce missed diagnosis, timely report outbreaks, and referral to TB fixed-point medical institutions. Fixed-point medical institutions at all levels to all tuberculosis patients and suspected patients with the examination of the sputum smear and sputum culture, improve the diagnostic rate of pathogeny. Find that the tuberculosis patients to organize timely tracking, and the etiology of close contacts, HIV positive patients and patients with tuberculosis (TB) screening. Gradually will be 65 or older, diabetes patients with tuberculosis (TB) screening work included in the scope of basic public health services.

(2) the standard diagnosis and treatment, strengthening quality management. The medical establishment that decide a dot to basic medical and health institutions at various levels and the medical establishment that decide a dot referral of patients to establish the green channel, arrange to see a doctor. Must be standardized according to the national tuberculosis diagnostic criteria, clinic diagnosis and treatment and clinical pathway and related technical guidelines, make a diagnosis and give treatment to specification, to carry out the review and follow-up examination, ensure to complete the full treatment, improve the cure rate. Especially multi-drug resistant tuberculosis patients to specification of hospitalization and after discharge into the outpatient registration and management. Conditional region to infectious tuberculosis patients hospitalized, strengthen infection control. Want to notice to play a role in TB treatment and rehabilitation of traditional Chinese medicine.

The family planning administrative department of public health at various levels shall improve TB care quality management mechanisms, TB diagnosis and treatment should be brought into the medical treatment quality control system, according to local actual, regulations, rules and concrete implementation scheme formulated. The provinces (autonomous regions and municipalities) established in the medical establishment that decide a dot at the provincial level to TB care quality control center, regularly organize relevant experts of the province (area, city) TB diagnosis and treatment quality assessment, and the evaluation results as the important basis for hospital evaluation. Around the medical establishment that decide a dot to explore tuberculosis prescription reviews, anti-tuberculosis drug use, auxiliary medication such as tracking monitoring system, further standardize medical personnel medical behavior.

(3) the implementation of the whole management. Grassroots medical institutions in accordance with the requirements for basic public health services to do the follow-up management of tuberculosis patients medication therapy at home, according to the requirements of specification to urge patients to the medical establishment that decide a dot to review on a regular basis. Advancing the signing TB patients family doctor service system, to explore innovative ways and means, make full use of the mobile Internet and other new technology to carry out the follow-up management, to improve treatment adherence and GuanLiLv full specification, reduce resistance. Institution of disease prevention and control to strengthen the training of basic medical and health institutions and technical guidance, urged the medical establishment that decide a dot, grassroots health institutions carry tuberculosis patient referral, tracking, and treatment management work, realize the whole seamless, avoid patients were lost to follow-up.

(4) carry information submitted to the work. Around to, according to the principle of local administrator and initial diagnosis system, the detection of tuberculosis patients and suspected patients should be in accordance with the rules in a timely manner in accordance with the network straight newspaper, on a regular basis to carry out the omission of the investigation, investigate and report to find problems in time. Further perfecting information registration and management system for the prevention and control of tuberculosis (TB) and the diagnosis and treatment of tuberculosis patients and the whole management information to timely recorded national TB management information system. Around to clear as soon as the registration of the medical establishment that decide a dot TB prevention and control of information management and access to, according to the principle of whoever make a diagnosis and give treatment to register, make sure that patients with tuberculosis diagnosis, treatment, reduction of drug resistance, timely follow-up review and other information. Of institution of disease prevention and control to do every day to browse the epidemic information, strengthen the education of the supervision, to urge medical institutions to improve pulmonary tuberculosis patients, especially patients with multi-drug resistant the timeliness, integrity and accuracy of the information provided. Combined with the regional population health information platform construction, and gradually integrate TB information reporting system, realize the TB screening, referral, diagnosis, treatment and follow-up tracking information management system of the whole process of review, medication management, etc.

(5) to further intensify multidrug-resistant tuberculosis prevention and control work. The Chinese center for disease control and prevention for registration in China as quickly as possible of sputum smear and sputum culture, molecular biology detection and drug resistance testing new technologies and methods, such as organization, recommendations are put forward. Around to speed up the promotion mature mdr-tb rapid detection technology, full schedule and make good use of the global fund donation diagnostic equipment, shortening the time of diagnosis, increase the rate of multi-drug resistant tuberculosis patients found and timeliness. Has yet to carry out the work of multi-drug resistant tuberculosis make a diagnosis and give treatment area, to determine fixed-point medical institutions to carry out the work as soon as possible. Multidrug-resistant tuberculosis patients in a timely manner will be information for infectious disease information correction, and registration in the information management system for TB, found multi-drug resistant patients into the treatment in time management. To increase in patients with multidrug-resistant information registration, diagnosis, treatment and follow-up review of inspections, to ensure the full specification of multi-drug resistant patients diagnosis and treatment management, reduce transmission. Can adjust measures to local conditions around the set up of multi-drug resistant tuberculosis patients hospitalized, in stable condition but still contagious patients hospitalized for specification.

Second, to further strengthen the key populations and the prevention and control work in the key areas

(6) to strengthen the school around the TB epidemic monitoring, to strengthen the early discovery and treatment, improve school tuberculosis information report, timeliness and standardization of diagnosis and treatment and management, strengthen the school for TB prevention and control knowledge training and technical support of health education. The family planning administrative department of public health at various levels shall, in conjunction with the department of education to establish a zone spreading mechanism, and regularly report information, strengthen the supervision inspection school tuberculosis prevention and control work, earnestly implement the entrance examination to urge school register, morning noon and absent because of illness prevention and control measures, such as the outbreak of the school in recent years, especially the boarding school to focus on supervision, prevent school tuberculosis outbreak of clustering. We need to according to the requirements of national immunization programmes, to do a good job of BCG vaccination, effectively reduce the occurrence of childhood tuberculosis.

(7) to continue to tuberculosis (TB) screening of HIV infected people and patients, the AIDS epidemic key (city), to provide HIV testing for TB patients. Responsible for tuberculosis and HIV/AIDS diagnosis and treatment of the medical establishment that decide a dot to establish and improve the cooperation mechanism, make double infection in patients with TB/HIV screening, diagnosis and treatment, and management. Strengthening apanage management, completes the floating population of patients with tuberculosis diagnosis, report, referral tracking, information registration and treatment, and follow-up management. Patients treated for cross-regional, turn out to be the sufferer timely diagnosis and treatment information provided to turn into the ground, do a good job in information. To strengthen publicity and education as a gathering place of the floating population, improve the TB prevention and control consciousness and ability of the floating population.

(8) of xinjiang, Tibet and other regions with high tuberculosis burden to intensify prevention and control work. Relying on health poverty alleviation projects, improve the level of patients with poor regions with high tuberculosis burden security, improve the medical establishment that decide a dot service facilities and the diagnosis and treatment tuberculosis condition, strengthen the cultivation of the TB prevention and control professionals. By implementing the national tertiary hospital and poverty-stricken county hospitals stability constant one-to-one counterpart support, improve the support area prevention and control ability. TB control work should be brought into the counterpart support xinjiang province (city) Tibet "much starker choices-and graver consequences-in planning, increase the investment in TB control work. The Chinese center for disease control and prevention to strengthen the help and guidance of xinjiang, Tibet and other places, in the planning and scheme formulated, laboratory tests and clinical diagnosis and treatment, epidemic situation analysis and information management for key support, increase the intensity of training, improve technical supervision frequency, help promote prevention team professional quality and ability.

Three, promote tuberculosis prevention and control of the implementation of the safeguard measures

(9) improve the level of patients with security. The provinces, autonomous regions and municipalities directly under the family planning administrative department of public health and concerned departments to actively do a good job in the basic medical insurance, serious illness insurance, medical treatment, such as policy and public health project as a whole the cohesion, lightens the burden of TB patients health costs. Around to gradually bring tuberculosis (including multidrug-resistant tuberculosis) into new farming and outpatient service as a whole and special disease outpatient service of insurance of primary medical treatment pays limits, reimbursement ratio increase. Continue to implement the tuberculosis (TB) screening and first-line anti-tb drug subsidy policy, etc. Include poor TB patients in medical precise poverty alleviation plan shift and disease relief scope, avoid because of the tuberculosis catastrophic spending because of sickness poor Chinese. Tuberculosis medical expense payment positive innovation, strengthen quality supervision and control the unreasonable expenses.

(10) to ensure TB drug supply. The provinces, autonomous regions and municipalities directly under the family planning administrative department of public health should actively coordinate related departments will be necessary for clinical anti-tb drugs incorporated in the basic medical insurance reimbursement. The provinces (autonomous regions and municipalities) to give play to the role of provincial public resources trading platform, the difference between different drugs classified purchasing, through direct hanging net, bidding or negotiations negotiation way to form a reasonable purchase price, ensure drug quality and clinical application needs. Continue to promote TB fixed dose compound preparation (FDC). Can be used across multiple ways of using anti-tuberculosis drugs for pulmonary tuberculosis patients.

(11) to ensure that the medical establishment that decide a dot medical conditions. Tuberculosis around to make sure that the medical establishment that decide a dot respiratory infectious disease diagnosis and treatment and protective ability, able to carry out tuberculosis diagnostic molecular biology, sputum smear and sputum culture check, multidrug-resistant fixed-point medical institutions to carry out drug sensitive test of n/med tuberculosis bacterium and strain identification. The medical establishment that decide a dot will have to be borne in the promotion and performance salary allocation to the tuberculosis diagnosis and treatment of medical staff to tilt, pay should not under this institution staff average.

The TB team (12). Disease prevention and control institutions at all levels to ensure that TB control professionals number, we will continue to strengthen professional and technical training, security of TB prevention and control ability. Around to rely on residency and general practitioner training programs, strengthening prevention and control of TB knowledge and skills training, focus on increasing fixed-point medical institutions and grassroots medical institutions for diagnosis and treatment of tuberculosis and the prevention and control of management staff service ability and level. Use of remote medical and remote education network, for TB prevention and control technical guidance and training, enhance the prevention and control ability. Should implement the prevention and treatment of infectious diseases around the personnel health and epidemic prevention allowance policy, TB prevention and control of personnel may occur during the course of a work should be given free treatment and reasonable allowance.

Fourth, further strengthen the prevention and control institutions responsibilities and tasks, perfect service system

(13) of patients with tuberculosis diagnosis and treatment of early detection and standard and the whole process management is the key to TB control measures, to medical institutions, and public health institutions and grassroots medical and health institutions close cooperation between. Family planning administrative department of public health at all levels should further improve and refine of institution of disease prevention and control, fixed-point medical institutions and grassroots medical and health institutions of responsibilities and tasks, a clear division of labor and work link connecting mechanism, explore the perfect service for the prevention and control of TB diagnosis and mode. Unclear TB diagnosis and treatment of the medical establishment that decide a dot area, at the county level according to the local epidemic, geographical factors such as traffic, population as soon as possible to determine at least one in the medical establishment that decide a dot, prefecture-level to specify one mdr-tb medical establishment that decide a dot, encourage tertiary hospital, undertake the task of TB diagnosis and treatment, patients complicated severe tuberculosis. The medical establishment that decide a dot list to publish to the society, in principle, sensitivity of diagnosis and treatment of pulmonary tuberculosis in a county. For area set up independent TB prevention and control of professional agencies, to TB prevention (courtyard) into the local management of the medical establishment that decide a dot, such as do not have treated in hospital, to specify the qualified medical institutions within their respective jurisdictions for TB patients in hospital diagnosis and treatment work, and according to the management of the medical establishment that decide a dot.

(14) the disease prevention and control institutions at various levels shall earnestly perform their duties, do a good job in the tuberculosis epidemic monitoring and information analysis report, epidemic disposal, pulmonary tuberculosis patients or suspected patients and close contacts of epidemiological investigation and referral tracking, the prevention of tuberculosis focus groups and health education, organization to carry out the patients during treatment of normative management. Will the fixed-point medical institutions and grassroots medical institutions of training, technical guidance and supervision evaluation as a regular key constancy, and constant attention.

(15) of various medical institutions at all levels must strengthen the responsibility consciousness, improve the ability of recognition and diagnosis of tuberculosis (TB), to do a good job of finding and referral report. TB fixed-point medical institutions at all levels should improve the system of work, specifications on TB diagnosis and treatment, the registration report, in order to strengthen the management of hospital infection control, constantly improve the standardization of diagnosis and treatment level.

(16) the basic medical and health institutions should earnestly implement the patients found, referral, and disease prevention and control institutions and medical establishment that decide a dot closely for case tracking, and according to the medical establishment that decide a dot to determine treatment plan, manage the home treatment in patients with jurisdiction and follow-up, etc. Around to give full play to the basic medical and health institutions in TB prevention and control of the population, to improve service ability, timely find suspicious patients and referral by the requirement, all TB patients diagnosed by its basic public health services to standardize the management.

Fifth, strengthen TB control work of organizational leadership and supervision and inspection

(17) to further strengthen organization and leadership. Around the family planning administrative department of public health should actively strive for the local government provides powerful fund for TB prevention and control work. To strengthen TB control work of organizational leadership, found in patients with pulmonary tuberculosis, the epidemic report, medical quality and follow-up work request clear goals, and with the institution of disease prevention and control, the medical establishment that decide a dot, sign the goal responsibility of grassroots medical and health institutions. Pressure to layers of conduction, find the weak link, the prominent key, strengthen the supervision inspection, set up a notification mechanism, problems should be timely reported to the government, urged all relevant institutions to implement the prevention and control measures.

(18) to further strengthen TB control effect of propaganda. The family planning administrative department of public health at various levels shall strengthen propaganda work of tuberculosis (TB) prevention multi-sectoral cooperation, strengthen the whole society to participate in. World tuberculosis day as an opportunity to focus conduct propaganda activities, social atmosphere conducive to TB prevention and treatment. Innovative methods, give full play to the 12320 health hotline, the role of the new media and other publicity platform, comprehensive, multidimensional propaganda work. Millions more volunteers TB knowledge dissemination action of TB patients and their family members and close contacts, medical institutions, medical groups, student, dual infected with TB/HIV, the floating population, the elderly, people with diabetes and other key crowd, targeted to carry out publicity and education, strengthen the propaganda education actual effect, to further enhance the level of the whole society tuberculosis prevention knowledge and skills.

(19) to further strengthen TB prevention and control of the supervision and inspection. Family planning administrative department of public health and its comprehensive supervision and law enforcement agencies at all levels must, in accordance with the law on the prevention and control of infectious diseases, tuberculosis (TB) prevention and control measures for the administration and other relevant laws, regulations and requirements, strengthen the outbreak of tuberculosis epidemic situation report, control, infection control, supervision and school tuberculosis prevention and control work. The illegal behavior is investigated according to law, the supervision and inspection results and bad practice behavior score of medical institutions, calibration and evaluation of material. National health and family planning commission will regularly organize comprehensive supervision and inspection results according to the circumstances about the provinces (autonomous regions and municipalities) government.

The national health and family planning commission

On July 20, 2016