OBJECTIVETo filter the indicators of evaluation on the diagnosis, treatment and management of MDR-TB through Delphi.

METHODSThree rounds Delphi was implemented by asking for the 30 experts'score and suggestion of 60 evaluation indicators. The experts were selected from experienced MDR-TB workers. Then the concentration degree (with each indicator's score average and full mark rate to reflect) and coordination degree (with coordination coefficient w to reflect) were analyzed, and the coefficient of variation of each indicator, enthusiasm and authority coefficient Cr etc were calculated. After that, new indicators system was constructed and the experts' were asked for suggestion again. The enthusiasm and coordinate coefficient were used to measure the effect of Delphi.

RESULTSAll of the enthusiasm coefficients of experts in three rounds were 100% (30/30), and 40% (12/30), 53% (16/30) and 10% (3/30) of the experts gave suggestions. The degrees of experts' authority in the first 2 rounds were high and the averages were 0.82 and 0.86, respectively. A total of 34 indicators were left after 6 indicators modified and 26 indicators deleted. The 10 indicators were the core indicators, and the average scores of 34 indicators were all higher than 4.7 and the coefficients of variation were less than 0.1, respectively. The coordination coefficients of specialists' opinion were 0.36, 0.25 and 0.68, respectively.

CONCLUSIONThe final evaluation indicator system include 34 indicators, and the result of the filtering indicators on the diagnosis, treatment and management of MDR-TB through Delphi is good.

Delphi Technique ; Expert Systems ; Humans ; Tuberculosis, Multidrug-Resistant ; diagnosis ; prevention & control ; therapy

Multidrug-resistant tuberculosis (MDR-TB) has become one of the major challenges in the global tuberculosis (TB) control.Despite years of efforts on MDR-TB control,the treatment success rates in China have increased slowly,which indicates possible deficiencies in the management of prevention and control work.Therefore,it is necessary to analyze the current status of MDR-TB prevention and treatment based on the patient pathway.This review summarizes the current drop-out situation of MDR-TB patients in the diagnosis and treatment pathway and the factors affecting patients' outcomes in the whole pathway,so as to provide a scientific reference for the prevention and control of MDR-TB.
Humans ; Antitubercular Agents/therapeutic use* ; Tuberculosis, Multidrug-Resistant/prevention & control* ; Treatment Outcome ; China

Tuberculosis (TB) prophylactic therapy for latent infection, which can reduce the risk for the development of active TB, is an important measure in TB control. China recommends prophylactic therapy for latent tuberculosis infection (LTBI) in some key populations to reduce the risk for TB. Contacts of patients with multi-drug and rifampicin-resistant TB (MDR/RR-TB) are at high risk for the infection with drug-resistant pathogen, however, no unified prophylactic therapy regimen has been recommended for LTBI due to exposure to MDR/RR-TB patients. This paper summarizes the current MDR/RR-TB prophylactic therapy regimen and its protection effect based on the results of the retrieval of literature, guidelines, expert consensus and technical specifications to provide reference for the prevention and control of LTBI.
Humans ; Rifampin/therapeutic use* ; Tuberculosis, Multidrug-Resistant/prevention & control* ; Tuberculosis/drug therapy* ; Latent Tuberculosis/chemically induced* ; China ; Antitubercular Agents/therapeutic use*

OBJECTIVETo evaluate the effect and safety of BCG vaccine on initially treated pulmonary tuberculosis and its controlling effect on multidrug-resistant tuberculosis.

METHODSAll 360 volunteers with initially treated pulmonary tuberculosis of positive smear and culture were divided into immunotherapy group (180 cases, also BCG group) and control group (180 cases) at random pair. The patients in BCG group were treated with chemotherapy of a regimen of 2HRZ/2HR and immunotherapy with BCG for 4 months,and the first BCG vaccine was given a month after chemotherapy. Meanwhile, the patients in the control group were treated with chemotherapy of 2HRZ/4HR only.

RESULTS(1) The negative conversion rate of sputum smear in BCG group was 98.3% (177/180), and it was 97.2% (175/180) in control group. There was no significant difference between the two groups both at the ends of 4 and 6 months after treatment (chi2 = 0.1278, P > 0.05). (2) The positive conversion rate of sputum smear in BCG group was 2.3% (4/177), and it was 6.9% (12/175) in control group followed up for 5 years. The successful rate was 96.1% (173/180) in BCG group, and it was significantly higher than that of 90.6% (163/180) in control group (chi2 = 4.4643, P < 0.05). (3) In the 5-year follow up, bacteriologic result was similar to that of X-ray. (4) The occurrence rate of multidrug-resistant tuberculosis was 2.3% (4/177) in BCG group,significantly lower than that of 7.3% (13/178) in the control group (chi2 = 4.9513, P < 0.05).

CONCLUSIONAs an adjunct chemotherapy,immunotherapy with BCG vaccine should be helpful for patients with initially treated pulmonary tuberculosis. It would further strengthen the effects of chemotherapy and reduce the occurrence rate of multidrug-resistant tuberculosis.

Adjuvants, Immunologic ; therapeutic use ; Adolescent ; Adult ; Aged ; Antitubercular Agents ; therapeutic use ; BCG Vaccine ; therapeutic use ; Child ; Female ; Follow-Up Studies ; Humans ; Immunotherapy, Active ; Male ; Middle Aged ; Tuberculosis, Multidrug-Resistant ; prevention & control ; Tuberculosis, Pulmonary ; therapy