The hardest part of treating tuberculosis is widely regarded as getting patients to comply with the treatment regimen. In a mountainous region in Southwest China recording one of the highest TB incidence rates in the country, challenges in ensuring medicine adherence were further compounded by its remote location, lack of health awareness, and funding.
"To persuade patients to comply, we require rural doctors to pay in-person visits every 10 days in the beginning and at least once a month later," said Yang Long, an official at the disease control and prevention center in Yunnan province's Nujiang Lisu autonomous prefecture. "But a round-trip to a patient's home could take two to three hours, and when a doctor arrives, a patient might have already stopped taking medications for more than a couple of days."
A typical TB treatment usually involves taking pills every day for at least six months to as long as two years, and incorrect use of drugs could lead to drug-resistant strains that are even harder to cure. "But it was simply impossible for our health workers to see patients taking pills in front of them, and we were struggling to find a better way to increase adherence," he said.
The problem was noted during a TB control initiative jointly launched by the health commission of Yunnan province and the Merieux Foundation — an independent family foundation headquartered in Lyon, France — in 2019. The initiative pledged one million euros, or about 7.82 million yuan ($1.08 million), into reining in TB infections in impoverished regions with diverse ethnic groups in Nujiang.
Thanks to the funding from the program, Nujiang became the first region across Yunnan to promote the use of electronic medication monitors. "TB patients will be given a smart pill box with one month's worth of medications. The device will send alerts like an alarm clock at correct times and log medication intake each time the patient opens the box," said Yang.
Information of patients who have failed to comply will also be uploaded to an online platform. "When doctors spot an irregular medication record, they will get in touch with the patient directly through the platform and remind patients or ask about their situation," he said.
According to local health officials, more than 2,000 TB patients have been equipped with the electronic medication monitor free of charge as of recently. "The smart system has played an important role in prodding patients to take pills on time and advancing treatment outcomes," he said.
Insufficient funding had stymied efforts to control TB in Nujiang for years. In 2018, the prefecture saw nearly four in 10 people living below the official poverty line and the incidence rate for TB stood at about 263 per 100,000 population — the highest across Yunnan province.
In recent years, joint efforts from central government departments, developed provinces that offered consistent assistance, as well as domestic and foreign foundations have made a significant impact.
"When the Merieux Foundation stepped in, we strove to address the most outstanding barriers in tackling TB," he said.
In addition to deploying novel equipment to boost patient compliance, Yang said that the initiative has also introduced rapid diagnostic tests and testing tools for drug-resistant TB cases to five designated TB hospitals across the prefecture. As of recently, the program has funded the use of 3,000 rapid testing materials and two sets of testing equipment.
"New technologies have enabled us to return more sensitive and precise results, and helped us identify, detect and treat new TB infections as early as possible and halt the disease's spread," said Yang.
In addition, about 400 volunteers have been enrolled to spread knowledge and awareness about TB, and experts from the Chinese Center for Disease Control and Prevention have held three training sessions in Nujiang and trained over 180 local professionals.
As of the end of last year, the incidence rate of TB in Nujiang had fallen by nearly 45 percent compared to the level seen in 2018.
After a recent visit to China in early April, Alain Merieux, president of the Merieux Foundation, said during an interview with Xinhua News Agency that China and France have maintained a special bond in the medical sector over past decades, and the competence of Chinese partners and their strong desire to promote cooperation have always touched him.
