Plenary Session 1： TB in Asia-Pacific Region: Past, Present and Future TB in APR
| Time (GMT+8) |
Topic | Speaker | Country / Region |
|---|---|---|---|
| 10:10-10:40 | The Evolution of the Taiwan TB Program: A Historical Perspective | Dr. Jen Suo | Taiwan |
| Time (GMT+8) |
Topic | Speaker | Country / Region |
| 10:40-11:10 | Strategy to end tuberculosis in the Asia-Pacific Region | Prof. Guy Marks | Australia |
The Evolution of the Taiwan TB Program: A Historical Perspective
Abstract :
Taiwan tuberculosis (TB) program started with a Bacille Calmette-Guérin (BCG) campaign in 1950. In 1954, the program introduced its first mobile units for Mass Miniature Radiography (MMR), later evolved into comprehensive mobile teams. The first island-wide TB prevalence survey was conducted in 1957.
Significantly, 1957 also heralded the advent of case detection strategies employing sputum smear microscopy and MMR, followed by the initiation of complimentary TB drug treatment and the establishment of the Central TB Registry for case management. By 1967, a comprehensive vertical system was realized, featuring a central TB Control Bureau, three TB Regional Control Centers, twenty-one TB Centers in counties, and over three hundred TB workers in local health stations.
The program evolved in parallel with the country’s prosperity, advancements in medical resources, the expansion of health insurance coverage, and a decrease in the number of TB patients.
Over time, TB case finding and treatment gradually shifted from the specialized vertical TB system to the general health care system (GHCS). However, case management still relied on the former system. Since 1997, free diagnosis and treatment for all PTB and extrapulmonary TB are covered by the National Health Insurance (NHI). Efforts to promote TB case reporting from the GHCS including the “no reporting, no reimbursement” policy by NHI, have made the Central Registry dependable in monitoring TB incidence since 2005.
In 2001, the Government decided to abolish the vertical system. TB services were integrated into the GHCS. This integration posed several challenges: such as enhancing the quality of TB laboratory services by National TB Reference Laboratory, improving diagnosis and treatment protocols, and streamlining case management including the treatment of LTBI, by the implementation of the DOTS, DOTS-plus and DOPT strategies. These challenges were systematically addressed, culminating in the current state of TB control within Taiwan.
Dr. Jen Suo
Taiwan
Bachelor of Medicine, National Taiwan University, Medical College, 1972/09-1979/06
Strategy to end tuberculosis in the Asia-Pacific Region
Abstract :
The epidemiology of tuberculosis in the Asia-Pacific region is very heterogeneous with prevalence and incidence ranging from very low to very high. The most important goal for TB control in this region is to convert all high and moderate burden countries to low burden countries. The epidemiology of TB in high burden countries is characterised by:
• Endemic transmission -everyone is a risk of being infected with MTB, everywhere, all the time
• Most people who develop TB do so within a few months of being exposed and infected or reinfected, not due to re-activation of remotely acquired TB infection
• Most people with infectious pulmonary TB do not have symptoms; most of those who do have symptoms do not seek or cannot access care leading to a diagnosis and treatment
• TPT does not have a durable protective effect due the high risk of reinfection.
It follows that the first step in reducing the burden of TB in high burden settings is community-wide active case finding (screening), in which all people, regardless of symptoms or risk factors, are screened for active disease using a sensitive test (Ultraportable chest xray and molecular tests on sputum). People who are detected then must be linked into effective treatment programs with appropriate support to complete treatment. This strategy leads to a rapid decline in prevalence, incidence, and costs of TB.
Prof. Guy Marks
Australia
Dr. Jen-Hsiang Chuang
Taiwan
From 2003 to 2005, Dr. Chuang was the jointly appointed associate professor of the Institute of Public Health and the Institute of Health Informatics and Decision Making at NYMU. He is currently an adjunct associated professor at National Yang Ming Chiao Tung University (NYCU).
In 2005, Dr. Chuang began his career in public health as an associate researcher at Taiwan CDC. In this role, he led initiatives to reform the national infectious disease surveillance system and to recruit and train the staff to develop more advanced skills for analyzing the surveillance data. These initiatives improved Taiwan’s ability to detect and response the emerging infectious diseases. He was promoted to the Deputy Director-General of Taiwan CDC in 2013. During the COVID-19 pandemic over the past four years, he served as the spokesperson of National Epidemic Command Center to communicate with journalists and share relevant information with the public in a timely manner.
