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Epidemiology and Surveillance

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Public Health Weekly Report 2021; 14(27): 1926-1933

Published online July 1, 2021

© The Korea Disease Control and Prevention Agency

Results of the Korean National Private-Public Mix Tuberculosis Control Project: Analysis of the indicators for tuberculosis management in 2017-2019

Min Jinsoo1, Kim Ju Sang1, Park Jae Seuk2, Song Chieeun3, Jang Yoojin3, Kim Jaetae3, Kwon Yunhyung3, Kim Youmi3

1College of Medicine, The Catholic University of Korea
2College of Medicine, Dankook University
3Division of Tuberculosis Prevention and Control, Korea Disease Control and Prevention Agency (KDCA)

Abstract

Sections

To manage tuberculosis (TB) patients treated by private medical institutions, the Korean government has been promoting a national Private-Public Mix (PPM) TB control project with the Korean Academy of Tuberculosis and Respiratory Diseases since 2011. This study analyzed the indicators for TB management reported by medical institutions participating in PPM TB control project from 2017 to 2019. The final treatment results were confirmed through observation for a total of five quarters by dividing the reported date by quarter.
As diagnositic tests and key indicators of the management rate of active TB patients, sputum smears (94.3%), culture tests (93.7%), and drug susceptibility tests (93.5%) were conducted. Major findings indicated that the compliance rate of initial standard treatment was high (93.6%). Further findings indicated that the treatment success rate for sputum acid-fast bacillus (AFB) positive patients was 84.9%; a decrease from 86.8% in 2018 to 84.7% in 2019.
Furthermore, the case investigation rate and contactor screening rate, which are indicators related to the early detection of active TB patients and TB prevention treatment, were high at approximately 98.4% and 90% (89.4% in adults and 91.8% in children) respectively. However, the rate of initiated latent tuberculosis infection (LTBI) treatment tended to be low at 53.8% in adults and 85.8% in children, requiring private and public cooperation to increase the rate of treatment for LTBI.
This study concluded that Korea's overall TB management indicators are improving, but some regions or institutions are still below the national average. To increase the success rate of TB treatment, measures to improve the target underachieving indicators through national PPM TB control project are required. In addition, improvements in TB management indicators will continue to be used as a basis for assessing the effectiveness of PPM control project.

Key words Tuberculosis (TB), Latent tuberculosis infection (LTBI), Private-public mix (PPM), TB control project, TB management indicators

Sections
Table 1. Status of the tuberculosis (TB) patient management under the national private-public mix (PPM) TB control project and new TB notification cases and rates, 2015-2019
20152016201720182019
New TB notification cases (persons)32,18130,89228,16126,43323,821
New TB notification rate (person/100,000 population)63.260.455.051.546.4
PPM hospitalsNew TB cases (person)21,12820,53119,34918,69818,624
Percentage management (%)65.766.568.770.778.2
Number of hospitals127128127127161
Number of TB specialist nurses193200200198258

Table 2. Status of the active tuberculosis (TB) patient management under the national private-public mix (PPM) TB control project, 2017-2019

(Unit: %)

Variable201720182019Total
Case investigationInvestigation performed rate98.798.598.198.4
Period compliance rate99.699.799.799.7
Sputum AFB smear testRate of tests performed93.494.994.894.3
Rate of positive results29.629.028.729.1
Sputum AFB culture testRate of tests performed92.294.694.493.7
Rate of positive results60.160.860.360.4
Drug susceptibility test (DST)Rate of total DST performed93.293.693.893.5
Rate of conventional method DST performed91.992.793.292.6
Compliance rate of initial standard treatment regimenCompliance rate of initial standard treatment regimen93.793.693.693.6
Treatment success rate among smear-positive TB patientsTreatment success rate among smear-positive TB patients83.486.884.784.9
Treatment discontinued/failedRate of treatment discontinuation2.32.42.22.3
Rate of treatment failed0.030.040.060.04

Table 3. Status of the close contacts management under the national private-public mix (PPM) TB control project, 2017-2019

(Unit: %, n)

Variable201720182019Total
Rate of Contacts investigation
/Rate of latent tuberculosis infection (LTBI)
/Rate of initiated LTBI treatment		Adult TB contactsContacts investigation rate87.089.591.989.4
LTBI screening rate25.727.626.326.5
Initiated LTBI treatment rate53.348.159.853.8
Childhood TB contactsRate of Contacts investigation89.493.193.491.8
LTBI screening rate18.820.321.320.0
Initiated LTBI treatment rate81.985.890.085.8
Proportion of suspected TB and TB patients after contacts investigationProportion of suspected TB and TB patients3.63.53.53.5
Sputum smear test for suspected TBRate of tests performed50.747.945.148.0
Rate of positive results5.54.94.95.1
Sputum culture test for suspected TBRate of tests performed42.242.241.341.9
Rate of positive results6.910.16.07.7
Final diagnosis of household Contact investigation program (n)Normal11,27112,93814,434-
Active TB1048894-
LTBI(Include inactive TB)4,2824,5704,492-
Other diseases285388429-
Not a contact100-
No. of individuals in an average household2.02.02.0-

References

Sections
  1. 민진수 등. 우리나라 민간 공공협력 결핵관리사업의 과거와 현재. 주간 건강과 질병 2020;13(38):2813-2818.
  2. Min J, et al. Tuberculosis Surveillance and Monitoring under the National Public-Private Mix Tuberculosis Control Project in South Korea 2016-2017. Tuberc Respir Dis 2020;83:218-227.
    Pubmed KoreaMed CrossRef
  3. 신지연 등. 제2차 결핵 적정성 평가 분석 결과. 주간 건강과 질병 2020;13(44):3143-3160.
  4. 김진선 등. 2020년 결핵 환자 신고현황. 주간 건강과 질병 2021;14(14):784-799.
  5. 박용준 등. 결핵환자 가족접촉자 검진 사업 분석. 주간 건강과 질병 2021;14(19):1245-1263.
  6. Min J, et al. Impact of COVID-19 Pandemic on the National PPM Tuberculosis Control Project in Korea: the Korean PPM Monitoring Database between July 2019 and June 2020. J Korean Med Sci 2020;35(40):e388.
    Pubmed KoreaMed CrossRef
  7. Min J, et al. Impact of COVID-19 on TB services in Korea. Int J Tuberc Lung Dis 2021;25(5):400-402.
    Pubmed CrossRef
  8. 보건복지부. 결핵 퇴치국가 도약을 위한 「결핵예방관리 강화대책」 (2019).

Epidemiology and Surveillance

Public Health Weekly Report 2021; 14(27): 1926-1933

Published online July 1, 2021

Copyright © The Korea Disease Control and Prevention Agency.

Results of the Korean National Private-Public Mix Tuberculosis Control Project: Analysis of the indicators for tuberculosis management in 2017-2019

Min Jinsoo1, Kim Ju Sang1, Park Jae Seuk2, Song Chieeun3, Jang Yoojin3, Kim Jaetae3, Kwon Yunhyung3, Kim Youmi3

1College of Medicine, The Catholic University of Korea
2College of Medicine, Dankook University
3Division of Tuberculosis Prevention and Control, Korea Disease Control and Prevention Agency (KDCA)

Abstract

To manage tuberculosis (TB) patients treated by private medical institutions, the Korean government has been promoting a national Private-Public Mix (PPM) TB control project with the Korean Academy of Tuberculosis and Respiratory Diseases since 2011. This study analyzed the indicators for TB management reported by medical institutions participating in PPM TB control project from 2017 to 2019. The final treatment results were confirmed through observation for a total of five quarters by dividing the reported date by quarter.
As diagnositic tests and key indicators of the management rate of active TB patients, sputum smears (94.3%), culture tests (93.7%), and drug susceptibility tests (93.5%) were conducted. Major findings indicated that the compliance rate of initial standard treatment was high (93.6%). Further findings indicated that the treatment success rate for sputum acid-fast bacillus (AFB) positive patients was 84.9%; a decrease from 86.8% in 2018 to 84.7% in 2019.
Furthermore, the case investigation rate and contactor screening rate, which are indicators related to the early detection of active TB patients and TB prevention treatment, were high at approximately 98.4% and 90% (89.4% in adults and 91.8% in children) respectively. However, the rate of initiated latent tuberculosis infection (LTBI) treatment tended to be low at 53.8% in adults and 85.8% in children, requiring private and public cooperation to increase the rate of treatment for LTBI.
This study concluded that Korea's overall TB management indicators are improving, but some regions or institutions are still below the national average. To increase the success rate of TB treatment, measures to improve the target underachieving indicators through national PPM TB control project are required. In addition, improvements in TB management indicators will continue to be used as a basis for assessing the effectiveness of PPM control project.

Keywords: Tuberculosis (TB), Latent tuberculosis infection (LTBI), Private-public mix (PPM), TB control project, TB management indicators

Body

Status of the tuberculosis (TB) patient management under the national private-public mix (PPM) TB control project and new TB notification cases and rates, 2015-2019
20152016201720182019
New TB notification cases (persons)32,18130,89228,16126,43323,821
New TB notification rate (person/100,000 population)63.260.455.051.546.4
PPM hospitalsNew TB cases (person)21,12820,53119,34918,69818,624
Percentage management (%)65.766.568.770.778.2
Number of hospitals127128127127161
Number of TB specialist nurses193200200198258

Status of the active tuberculosis (TB) patient management under the national private-public mix (PPM) TB control project, 2017-2019

(Unit: %).

Variable201720182019Total
Case investigationInvestigation performed rate98.798.598.198.4
Period compliance rate99.699.799.799.7
Sputum AFB smear testRate of tests performed93.494.994.894.3
Rate of positive results29.629.028.729.1
Sputum AFB culture testRate of tests performed92.294.694.493.7
Rate of positive results60.160.860.360.4
Drug susceptibility test (DST)Rate of total DST performed93.293.693.893.5
Rate of conventional method DST performed91.992.793.292.6
Compliance rate of initial standard treatment regimenCompliance rate of initial standard treatment regimen93.793.693.693.6
Treatment success rate among smear-positive TB patientsTreatment success rate among smear-positive TB patients83.486.884.784.9
Treatment discontinued/failedRate of treatment discontinuation2.32.42.22.3
Rate of treatment failed0.030.040.060.04

Status of the close contacts management under the national private-public mix (PPM) TB control project, 2017-2019

(Unit: %, n).

Variable201720182019Total
Rate of Contacts investigation
/Rate of latent tuberculosis infection (LTBI)
/Rate of initiated LTBI treatment		Adult TB contactsContacts investigation rate87.089.591.989.4
LTBI screening rate25.727.626.326.5
Initiated LTBI treatment rate53.348.159.853.8
Childhood TB contactsRate of Contacts investigation89.493.193.491.8
LTBI screening rate18.820.321.320.0
Initiated LTBI treatment rate81.985.890.085.8
Proportion of suspected TB and TB patients after contacts investigationProportion of suspected TB and TB patients3.63.53.53.5
Sputum smear test for suspected TBRate of tests performed50.747.945.148.0
Rate of positive results5.54.94.95.1
Sputum culture test for suspected TBRate of tests performed42.242.241.341.9
Rate of positive results6.910.16.07.7
Final diagnosis of household Contact investigation program (n)Normal11,27112,93814,434-
Active TB1048894-
LTBI(Include inactive TB)4,2824,5704,492-
Other diseases285388429-
Not a contact100-
No. of individuals in an average household2.02.02.0-
Status of the tuberculosis (TB) patient management under the national private-public mix (PPM) TB control project and new TB notification cases and rates, 2015-2019
20152016201720182019
New TB notification cases (persons)32,18130,89228,16126,43323,821
New TB notification rate (person/100,000 population)63.260.455.051.546.4
PPM hospitalsNew TB cases (person)21,12820,53119,34918,69818,624
Percentage management (%)65.766.568.770.778.2
Number of hospitals127128127127161
Number of TB specialist nurses193200200198258
Status of the active tuberculosis (TB) patient management under the national private-public mix (PPM) TB control project, 2017-2019

(Unit: %).

Variable201720182019Total
Case investigationInvestigation performed rate98.798.598.198.4
Period compliance rate99.699.799.799.7
Sputum AFB smear testRate of tests performed93.494.994.894.3
Rate of positive results29.629.028.729.1
Sputum AFB culture testRate of tests performed92.294.694.493.7
Rate of positive results60.160.860.360.4
Drug susceptibility test (DST)Rate of total DST performed93.293.693.893.5
Rate of conventional method DST performed91.992.793.292.6
Compliance rate of initial standard treatment regimenCompliance rate of initial standard treatment regimen93.793.693.693.6
Treatment success rate among smear-positive TB patientsTreatment success rate among smear-positive TB patients83.486.884.784.9
Treatment discontinued/failedRate of treatment discontinuation2.32.42.22.3
Rate of treatment failed0.030.040.060.04
Status of the close contacts management under the national private-public mix (PPM) TB control project, 2017-2019

(Unit: %, n).

Variable201720182019Total
Rate of Contacts investigation
/Rate of latent tuberculosis infection (LTBI)
/Rate of initiated LTBI treatment		Adult TB contactsContacts investigation rate87.089.591.989.4
LTBI screening rate25.727.626.326.5
Initiated LTBI treatment rate53.348.159.853.8
Childhood TB contactsRate of Contacts investigation89.493.193.491.8
LTBI screening rate18.820.321.320.0
Initiated LTBI treatment rate81.985.890.085.8
Proportion of suspected TB and TB patients after contacts investigationProportion of suspected TB and TB patients3.63.53.53.5
Sputum smear test for suspected TBRate of tests performed50.747.945.148.0
Rate of positive results5.54.94.95.1
Sputum culture test for suspected TBRate of tests performed42.242.241.341.9
Rate of positive results6.910.16.07.7
Final diagnosis of household Contact investigation program (n)Normal11,27112,93814,434-
Active TB1048894-
LTBI(Include inactive TB)4,2824,5704,492-
Other diseases285388429-
Not a contact100-
No. of individuals in an average household2.02.02.0-

References

  1. 민진수 등. 우리나라 민간 공공협력 결핵관리사업의 과거와 현재. 주간 건강과 질병 2020;13(38):2813-2818.
  2. Min J, et al. Tuberculosis Surveillance and Monitoring under the National Public-Private Mix Tuberculosis Control Project in South Korea 2016-2017. Tuberc Respir Dis 2020;83:218-227.
    Pubmed KoreaMed CrossRef
  3. 신지연 등. 제2차 결핵 적정성 평가 분석 결과. 주간 건강과 질병 2020;13(44):3143-3160.
  4. 김진선 등. 2020년 결핵 환자 신고현황. 주간 건강과 질병 2021;14(14):784-799.
  5. 박용준 등. 결핵환자 가족접촉자 검진 사업 분석. 주간 건강과 질병 2021;14(19):1245-1263.
  6. Min J, et al. Impact of COVID-19 Pandemic on the National PPM Tuberculosis Control Project in Korea: the Korean PPM Monitoring Database between July 2019 and June 2020. J Korean Med Sci 2020;35(40):e388.
    Pubmed KoreaMed CrossRef
  7. Min J, et al. Impact of COVID-19 on TB services in Korea. Int J Tuberc Lung Dis 2021;25(5):400-402.
    Pubmed CrossRef
  8. 보건복지부. 결핵 퇴치국가 도약을 위한 「결핵예방관리 강화대책」 (2019).

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