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Abstract：
China has the third-largest burden of tuberculosis (TB) cases in the world with great challenges towards ending TB. Primary health care (PHC) sectors play a critical role in TB prevention and control in communities under the Chinese integrated TB control model. However, there is a lack of comprehensive review of research evidence on TB control in PHC sectors under the integrated TB control model in China.
This review was conducted following the PRISMA guidelines. Articles published from 2012 to January 2022 were searched from four international and three Chinese databases. Studies conducted inside mainland China and relevant with TB control service in PHC sectors under the integrated model were included. After study selection, data extraction, and quality assessment, the meta-analysis was performed with RevMan using a random-effect model.When I2 was more than 50%, subgroup analysis was performed to explore possible reasons for heterogeneity. We also conducted a post hoc sensitivity analysis for outcomes after meta-analysis by exclusion of studies with a high risk of bias or classified as low quality.
Forty-three studies from 16 provinces/municipalities in China were included in this review, and most studies included were of medium quality. PHC sectors in East China delivered TB control service better overall than that in West China, especially in tracing of patients and TB case management (TCM). In meta-analyses, both the pooled arrival rate of tracing and pooled TCM rate in East China were higher than those in West China. TB patients had a low degree of willingness to receive TCM provided by healthcare workers in PHC sectors nationwide, especially among migrant TB patients. There were 9 studies reporting factors related to TB control service in PHC sectors, 6 (2 in East and 4 in West China) of which indentified several characteristics of patients as associated factors. The context of PHC sectors was demonstrated to influence delivery of TB control service in PHC sectors in 5 studies (3 in East, 1 in Middle and 1 in West China). Most studies on strategies to promoting TB control services in PHC sectors were conducted in East China and some of these studies identified several online and offline interventions and strategies improving patients\' treatment compliance [pooled OR (95% CI): 7.81 (3.08, 19.19] and awareness of TB [pooled OR (95% CI): 6.86 (2.16, 21.72)].
It is of urgent need to improve TB control in PHC sector in China, particularly in West China. Formative and implementation research with rigorous design are necessary to develop comprehensive, context-specific, and patient-centered TB control strategies to promote ending TB in China.
This review was conducted following the PRISMA guidelines. Articles published from 2012 to January 2022 were searched from four international and three Chinese databases. Studies conducted inside mainland China and relevant with TB control service in PHC sectors under the integrated model were included. After study selection, data extraction, and quality assessment, the meta-analysis was performed with RevMan using a random-effect model.When I2 was more than 50%, subgroup analysis was performed to explore possible reasons for heterogeneity. We also conducted a post hoc sensitivity analysis for outcomes after meta-analysis by exclusion of studies with a high risk of bias or classified as low quality.
Forty-three studies from 16 provinces/municipalities in China were included in this review, and most studies included were of medium quality. PHC sectors in East China delivered TB control service better overall than that in West China, especially in tracing of patients and TB case management (TCM). In meta-analyses, both the pooled arrival rate of tracing and pooled TCM rate in East China were higher than those in West China. TB patients had a low degree of willingness to receive TCM provided by healthcare workers in PHC sectors nationwide, especially among migrant TB patients. There were 9 studies reporting factors related to TB control service in PHC sectors, 6 (2 in East and 4 in West China) of which indentified several characteristics of patients as associated factors. The context of PHC sectors was demonstrated to influence delivery of TB control service in PHC sectors in 5 studies (3 in East, 1 in Middle and 1 in West China). Most studies on strategies to promoting TB control services in PHC sectors were conducted in East China and some of these studies identified several online and offline interventions and strategies improving patients\' treatment compliance [pooled OR (95% CI): 7.81 (3.08, 19.19] and awareness of TB [pooled OR (95% CI): 6.86 (2.16, 21.72)].
It is of urgent need to improve TB control in PHC sector in China, particularly in West China. Formative and implementation research with rigorous design are necessary to develop comprehensive, context-specific, and patient-centered TB control strategies to promote ending TB in China.
摘要：
背景：中国是世界上结核病（TB）病例的第三大负担，在结束结核病方面面临巨大挑战。在中国结核病综合控制模式下，初级卫生保健（PHC）部门在社区结核病预防和控制中发挥着关键作用。然而,我国在结核病综合控制模式下，缺乏对PHC部门结核病控制研究证据的全面综述。
方法：本综述遵循PRISMA指南进行。从四个国际数据库和三个中文数据库中检索了2012年至2022年1月发表的文章。包括在中国大陆进行的研究以及在综合模型下与PHC部门的结核病控制服务相关的研究。经过研究选择，数据提取,和质量评估，采用随机效应模型对RevMan进行meta分析.当I2大于50%时，进行亚组分析以探讨异质性的可能原因.我们还通过排除具有高偏倚风险或被分类为低质量的研究，对荟萃分析后的结果进行了事后敏感性分析。
结果：本综述纳入了来自中国16个省/市的43项研究。大多数研究都是中等质量的。华东地区的PHC部门总体上比西部地区提供更好的结核病控制服务，特别是在患者追踪和结核病病例管理（TCM）方面。在荟萃分析中，华东地区的归集率和归集率都高于西部地区。结核病患者接受全国PHC部门医护人员提供的中药的意愿较低，尤其是移民结核病患者。有9项研究报告了与PHC部门结核病控制服务相关的因素，其中6例（东部2例，西部4例）确定了患者的几个特征为相关因素。在5项研究中，PHC部门的背景被证明会影响PHC部门的结核病控制服务的提供(3在东部，中部1个，西部1个）。大多数关于在PHC部门促进结核病控制服务的策略的研究在华东地区进行，其中一些研究确定了一些在线和离线干预措施和策略，以改善患者的治疗依从性[汇总OR（95％CI）：7.81（3.08，19.19]和结核病意识[汇总OR（95％CI）：6.86（2.16，21.72）]。
结论：迫切需要改善中国PHC部门的结核病控制，尤其是在中国西部。形成和实施研究与严谨的设计是必要的,特定于上下文的，以患者为中心的结核病控制策略，以促进中国结核病的终结。
方法：本综述遵循PRISMA指南进行。从四个国际数据库和三个中文数据库中检索了2012年至2022年1月发表的文章。包括在中国大陆进行的研究以及在综合模型下与PHC部门的结核病控制服务相关的研究。经过研究选择，数据提取,和质量评估，采用随机效应模型对RevMan进行meta分析.当I2大于50%时，进行亚组分析以探讨异质性的可能原因.我们还通过排除具有高偏倚风险或被分类为低质量的研究，对荟萃分析后的结果进行了事后敏感性分析。
结果：本综述纳入了来自中国16个省/市的43项研究。大多数研究都是中等质量的。华东地区的PHC部门总体上比西部地区提供更好的结核病控制服务，特别是在患者追踪和结核病病例管理（TCM）方面。在荟萃分析中，华东地区的归集率和归集率都高于西部地区。结核病患者接受全国PHC部门医护人员提供的中药的意愿较低，尤其是移民结核病患者。有9项研究报告了与PHC部门结核病控制服务相关的因素，其中6例（东部2例，西部4例）确定了患者的几个特征为相关因素。在5项研究中，PHC部门的背景被证明会影响PHC部门的结核病控制服务的提供(3在东部，中部1个，西部1个）。大多数关于在PHC部门促进结核病控制服务的策略的研究在华东地区进行，其中一些研究确定了一些在线和离线干预措施和策略，以改善患者的治疗依从性[汇总OR（95％CI）：7.81（3.08，19.19]和结核病意识[汇总OR（95％CI）：6.86（2.16，21.72）]。
结论：迫切需要改善中国PHC部门的结核病控制，尤其是在中国西部。形成和实施研究与严谨的设计是必要的,特定于上下文的，以患者为中心的结核病控制策略，以促进中国结核病的终结。
