Whole course quality of tuberculosis care in rural China: challenges in diagnosis, treatment, and management

Background: Little is known about the whole-course quality of tuberculosis (TB) care in China, one of the highest TB burdens countries. Methods A retrospective study using chart abstraction for the whole course was conducted in two underserved counties. All registered TB patients from 1 July 2020 to 31 December 2020 were included. Medical records for the whole course (6–8 months) were examined to abstract information using pre-determined checklists. Descriptive analysis was used to present the characteristics of included medical records, and multivariable logistic regression was used to investigate factors associated with TB treatment completion. Results This study included 268 outpatient medical records and 126 inpatient records. For diagnostic quality, 257 (96.3%) patients received sputum tests (2.6 times per person on average). 94.2% of the diagnosis were based on adequate evidence. For treatment quality, 240 (91.6%) outpatients and 100 (85.5%) inpatients took the standard chemotherapy regimens. 234 (87.3%) patients completed treatment. There were 67 (53.2%) inpatients prescribed second-line drugs, 85.1% of which were inappropriate. For management quality, 128 (47.9%) patients received midterm assessments. Only 47 (19.7%) received sufficient services for the whole course. Patients with TB symptoms were significantly more likely to complete treatment (OR = 1.80 P = 0.011). Conclusion This study measured the quality of TB care during the whole course including diagnoses, treatment, and management in rural China. TB patients received high-quality diagnosis and treatment services, but low-quality whole-course management. Integration of medical and public health services should be strengthened to improve whole-course quality.