Table 1. Evolution of tuberculosis (TB) control models and approaches to eliminate TB following the COVID-19 pandemic.

	DOTS strategy as basis for old TB control model (2001−2010)	Transition to new national TB control model (2011−2020)	Post-pandemic acceleration toward TB elimination (2021−2035)
TB control network	County/district CDC and township/village clinics form TB control network: ● CDC: Responsible for diagnosis and treatment, reporting, and monitoring of township and village doctors in carrying out their TB control functions; traced TB suspects who did not come for evaluation after being referred; responsible for maintaining program quality and achieving program targets. ● Township and village clinics: Doctors referred TB suspects to CDC for evaluation, traced those who did not reach CDC, and monitored patient’s treatment in community. ● Hospitals: Required to report and refer TB suspects to CDC.	Designated hospitals for TB, county/district CDC, and township/village clinics form 3-in-1 TB control network: ● Hospitals: Designated county/district hospitals provide diagnosis, treatment and reporting of routine TB patients; city/prefectural hospitals responsible for MDR/XDR-TB diagnosis and treatment. Other hospitals required to report and refer TB suspects to designated hospitals ● CDC: Responsible for monitoring of township and village doctors in carrying out their TB control functions; traced TB suspects who did not come for evaluation after being referred; monitor reporting by hospitals. ● Township and village clinics: Doctors refer TB suspects to hospitals for evaluation, trace those who did not reach hospitals, and monitor patient’s treatment in community.	Strengthening of health system to address COVID-19 pandemic can help TB: ● Hospitals: Designated hospitals providing COVID-19 diagnosis and treatment will have the capabilities to treat complicated respiratory illnesses with improved infection control system; staff are more knowledgeable about respiratory infection control. Such capacities are now more decentralized down to county level and can improve TB treatment. ● CDC: Capabilities to identify, trace, screen, and quarantine contacts are widely available. These can be used for TB contract investigation. ● Township and village clinics: Doctors are much more aware of respiratory symptoms and diseases and are on the look out for patients with respiratory symptoms. They can help look for TB patients.
Technical approaches	Implemented in CDC clinics as DOTS strategy: ● Diagnosis: sputum smear microscopy and chest x-ray ● Treatment: Standard short-course chemotherapy with first-line TB drugs ● Management of treatment: Primarily provided by family members; some directly observed therapy, especially during intensive phase of treatment. ● TB surveillance system: internet-based disease reporting system allowed real-time reporting of TB suspects, and case-based electronic registry of notified TB cases.	Implemented in hospitals according to national TB diagnosis and treatment guidelines: ● Diagnosis: CT scan and chest x-ray; smear microscopy, culture, and rapid molecular tests to detect M. tuberculosisand drug resistance. ● Treatment: Standard short-course chemotherapy with first-line TB drugs for drug-sensitive TB; second-line TB drug regimen for rifampin-resistant/MDR TB. Bedaquiline introduced as a new TB drugs. ● Management of treatment: Primarily self-administered or monitoring by family members; use of digital adherence technologies. ● TB surveillance system: internet-based disease reporting system allowed real-time reporting of TB suspects, and case-based electronic registry of notified TB cases. Capture TB data directly from hospital medical information system. ● Use of the digital medium: Provide online training for health care workers, track TB patients using the medication monitor.	Technical and programmatic approaches used in COVID-19 pandemic can apply to TB: ● Diagnosis: Large-scale network of molecular testing down to county level; laboratory network of genomic sequencing available. This can be used for rapid molecular testing for TB on a large scale, including for drug resistance. ● Treatment: Specific COVID-19 treatment guidelines provided to hospitals and implemented rapidly. TB treatment, including for MDR/XDR-TB, can be implement the same way. ● Contact investigation: Health care workers are trained to elicit contact information and better understand the environments facilitating airborne transmission; patients are much more aware of who they have been in contact with. Use of electronic surveillance have improved contact identification. TB can use this for contact tracing, testing, and treatment for LTBI. ● Large-scale screening and testing of COVID-19 in communities: Health departments and health care workers have experience from community screening programs; this can be used to implement active case-finding for TB. ● Large-scale COVID-19 vaccination in communities: Health departments and health care workers gain experience from vaccination programs; this can be used to implement TB vaccination programs for adults. ● Information system: Data on COVID-19 cases quickly shared in real-time from health facilities to government and used to monitor pandemic. TB data from hospitals and other sources can be made available in real-time for monitoring.
Funding	Predominantly domestic funding but with significant international contribution; funding, mostly provided from national level: ● Increasing amount of dedicated TB funding by central government; provincial and prefectural/county TB funding also increased. ● Simple diagnosis and first-line TB drugs provided largely free of charge. Limited funds for township/village doctors to carry out TB services. ● Funding from international organizations (World Bank, DFID, GFATM, JICA, CIDA, WHO) supported scale-up of DOTS strategy.	Entirely domestic funding, mostly provided by provincial and local governments: ● Dedicated TB funding by central government for first-line drugs and basic TB diagnosis; variable level of dedicated TB funding from provincial and local governments. ● National health insurance important in paying for TB services provided by hospitals (including diagnosis, treatment, and hospitalization), but patient out-of-pocket (OOP) payment still substantial, especially for MDR-TB. ● Government funding for township/village clinics to carry out public health functions, including TB services. ● Supplemental funding provided by some government sources to reduce patient OOP expenses for TB services.	Government funding to strengthen pandemic preparedness and responsiveness can enhance support for TB: ● Funding to hospitals, CDC’s, laboratory network, primary health care clinics, and health promotion can all potentially benefit TB diagnosis and treatment. ● In addition to government insurance, government provided subsidies to reduce out-of-pocket payment for COVID-19 treatment. COVID-19 vaccinations free of charge. These can apply to provide entirely free diagnosis and treatment or substantially reduced cost of care for TB patients.