Challenges and countermeasures of the "Xinjiang Model" in tuberculosis prevention and control: a qualitative study...

Tuberculosis (TB) remains a significant public health threat, particularly in Xinjiang Uygur Autonomous Region of China, showing a high incidence. The "Xinjiang Model" is a TB service delivery system integrating universal chest X-ray screening, hospitalization for infectious patients, community-based follow-up for non-infectious cases, and nutritional support. Since 2018, Xinjiang has implemented the "Xinjiang model" for TB prevention and control to improve early screening and cure rates, but it continues to face challenges in long-term implementation.

This qualitative study aimed to explore the challenges encountered during the implementation of the "Xinjiang Model" and identify sustainability strategies to optimize and enhance TB prevention and control efforts.

Semi-structured interviews were conducted with 26 healthcare professionals from the Centers for Disease Control and Prevention across various Xinjiang prefectures, selected through purposive sampling. Data collection followed a tailored interview outline, and thematic analysis using Colaizzi's method was applied.

Six significant challenges were identified: workforce fragility and insufficient incentives for TB providers; physical and psychological vulnerabilities affecting patients' treatment continuity; gaps in funding standards and policy alignment; limited public awareness and TB-related health literacy; capacity pressures affecting the quality and timeliness of universal health check-ups; and delays across referral pathways. Participants expressed confidence in the sustainability of the model and proposed strategies grouped into three domains: strengthening system inputs, including financial and policy support and provider compensation; improving patient-centered care, such as patient management, follow-up, and psychosocial or social support; and enhancing service delivery capacity by optimizing the TB workforce and improving the quality of universal health check-ups.

This study revealed key operational barriers to sustaining the "Xinjiang Model" and underscores the need for strengthened financing, workforce incentives, and patient-centered support within ongoing health system reforms. These findings are essential for maintaining TB control efforts in Xinjiang, serve as a reference for similar regions in China, and offer contextual insights for comparable low- and middle-income countries seeking to implement integrated TB control strategies.