Assessment of Strategies and Epidemiological Characteristics of Tuberculosis in Henan Province, China: Observational Study

Background: In 2005, China established an internet-based Tuberculosis Information Management System (TBIMS) to monitor changes in tuberculosis (TB). Many scholars have conducted epidemiological research using TBIMS; however, few studies assessing control strategies have been performed based on this platform data. Henan province is a high TB incidence area in China where, in addition to following the nationwide TB strategies, a series of local intervention combinations have been implemented. Objective: Our study aims to evaluate the impact of nationwide TB intervention combinations on epidemiological changes and determine whether Henan province can achieve the World Health Organization's (WHO) goal of reducing TB incidence by 50% and TB mortality by 75% by the year 2025. Methods: We used descriptive statistical methods to show the spatial and temporal distribution of pulmonary tuberculosis (PTB) reported to the TBIMS database from 2005 to 2018, and logistic regression analysis was performed to identify the risk factors of bacteriological-positive TB. The dynamic compartmental model and Bayesian melding approach was adopted to estimate the burden of TB under the impact of different TB control policies. Results: In total, 976,526 PTB cases were notified to the TBIMS in Henan in a period of 14 years. Although the overall incidence of PTB declined from 91.4/105 to 58.5/10(5), and the overall incidence of bacteriological-positive PTB declined from 44.5/10(5) to 14.7/10(5), the WHO's 2025 goal could not be met. The distribution of high incidence and poverty-stricken counties were basically overlapped. Men, farmers and herdsmen (in rural areas), and subjects aged >= 60 years were more likely to develop bacteriological-positive PTB. The increasing treatment success for drug-susceptible tuberculosis and multidrug-resistant tuberculosis has not provided the desired reduction in incidence and mortality. Conclusions: To achieve the targeted goal, while improving the cure rate of TB, new active (rather than passive) detection and intervention strategies should be formulated based on epidemiological characteristics in Henan province.