Evolution of MDR-TB Control Strategy in Taiwan

Su-Hua Huang, Kwei-Feng Wang, Pei-Chun Chan, Chin-Hui Yang, Chang-Hsun Chen

2012 Vol.28 NO.18

Correspondence Author： Su-Hua Huang

Abstract：

Tuberculosis (TB) is the most serious communicable disease in Taiwan, with about 13000 newly identified cases yearly. A long period of treatment and the side effects of the drugs very often make TB patients take their drugs irregularly, and eventually lead to the development of drug-resistant tuberculosis. The World Health Organization alerted in 2007 that the spread of drug-resistant TB is a major public health problem with potential global threats and called for countries in the world to adopt the directly observed treatment, short-course, plus (DOTS-plus) strategy to effectively control the multi-drug resistant TB. The DOTS program was first implemented in Taiwan in 2006, with hired observers to monitor the patient in compliance with TB treatment. In December 2006, the Taiwan CDC began monitoring the anti-TB drugs which TB strains have developed resistance and use of the second-line anti-TB drugs. Later, the MDR-TB Health Care System was established in May 2007, five contract health care teams were funded and required to strictly follow the WHO guideline to administer the management and treatment of MDR-TB patients and conduct community-based DOTS-plus activities, providing patients with complete and non-stop care. In July 2007, the MDR-TB was added to the list of the Category 2 notifiable communicable diseases and, in August, the Taiwan CDC started to collaborate with the National Health Insurance to perform the control of the fluoroquinolone drug class. Moreover, in May 2008, which required health care facilities nationwide are required to send the isolated TB strains from the notified MDR-TB patients to the Research and Diagnostic Center at Taiwan CDC for confirmation. In addition, in order to shorten the time of diagnosis, the rapid genotyping test for high risk population was provided in September 2009. Through a series of control programs and the enforcement of DOTS strategy in Taiwan, the patient who in compliance with TB treatment was promoted, the probability of development of MDR-TB in these patients was decreased, the occurrence of MDR-TB was timely updated, and the number of MDR-TB patients to be treated has decreased from 440 cases in May 2007 to 245 cases in April 2012