Open Access Open Badges Research article

Improving detection and notification of tuberculosis cases in students in Shaanxi province, China: an intervention study

Tianhua Zhang1*, Liujia Guo1, Shaoru Zhang2, Weiping Liu1, Guanghua Chen1, Ma Hui2, Guangxue He3, Marieke J van der Werf45 and Susan van den Hof45

Author Affiliations

1 Shaanxi Provincial Institute for TB Control and Prevention, Xi'an, Shaanxi province, PR China

2 Medical school, Xi'an Jiao Tong University, Xi'an, Shaanxi province, PR China

3 National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention (CDC), Beijing, PR China

4 KNCV Tuberculosis Foundation, The Hague, The Netherlands

5 Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, The Netherlands

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BMC Public Health 2011, 11:147  doi:10.1186/1471-2458-11-147

Published: 4 March 2011



Cooperation between different public and private health institutes involved in tuberculosis (TB) control has proven to enhance TB control in different settings. In China, such a mechanism has not been set up yet between Centers for Disease Control (CDCs) and university hospitals despite an increased TB incidence among students. This study aims to improve arrival of TB suspects identified by universities at the CDCs in order to manage them under standardized, directly observed treatment-short course (DOTS) conditions according to the National Tuberculosis Programme (NTP) guidelines.


Five matched pairs of universities were randomly assigned to the control and intervention group. After a baseline survey, a cooperation mechanism between local CDCs and university hospitals was set up in the intervention group. The effects on referral of TB suspects to the local CDC, tracing by the local CDC, and arrival at the local CDCs were assessed. Differences were tested by means of the chi-square test.


During the baseline survey, the referral, tracing and arrival rates were between 37% and 46%. After implementation of the cooperation mechanism, these rates had not changed in the control group but increased significantly in the intervention group: the referral, tracing and arrival rates were 97%, 95%, and 93%, respectively.


It is feasible and effective to set up cooperation between CDCs and university hospitals to increase the number of TB suspects examined by CDCs and increase the number of TB patients treated under DOTS conditions. These public-public mix (PPM) activities should be expanded to cover all other university hospitals in China.