Patient delay in accessing health care in China was lengthy; TB care and control needs to be improved.

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study to assess project implementation and case fi nding of new smear-positive TB during the FIDELIS project, and report the results of this study. METHODS Anhui ProvinceAnhui Province has a land mass of 139 000 km 2 Activities of the FIDELIS Anhui ProjectThe core activity of the FIDELIS Anhui Project was to mobilise students of elementary and junior high schools to identify individuals who might have TB within the family. A 3-page survey card was designed for this purpose ( Figure). The fi rst page collected basic information on the student's family, whether any family member had had TB in the past and whether any family member had a cough or had produced sputum for ⩾3 weeks. The second page indicated that those who had a cough or had produced sputum for ⩾3 weeks might have TB, and that free services were provided at the county TB dispensaries. The third page was for students to write down their weekly class schedule so that they could keep the survey card with the message of TB.Teachers provided health education on TB before distributing the survey cards, and collected them within a week of distribution. Survey cards identifying symptomatic individuals were sent by the teachers to the village doctors, who were trained to visit individuals with symptoms and, if necessary, advise them to submit sputum to the township health centres for examination. Three sputum samples were collected from each symptomatic individual. Sputum smear was prepared at the township hospital and read at county TB dispensaries. Confi rmed TB patients were registered for anti-tuberculosis treatment according to national TB guidelines. 12 Design: A survey card was designed for students to identify individuals who might have tuberculosis (TB) in their family. Teachers provided health education on TB before distributing the survey cards. Survey cards identifying individuals with respiratory symptoms for ⩾3 weeks were sent by the teachers to village doctors who were trained to visit symptomatic individuals and advise them to undergo sputum examination. Data were routinely collected in the implementation of the FIDELIS project, and quarterly reports from the National Tuberculosis Programme were analysed. The detection of new smear-positive TB cases before and after FIDELIS, as well as with and without FIDELIS, were compared. Interna onal Union Against Tuberculosis and Lung Disease Results:In the first year, a total of 2 387 405 students were involved and 23 079 symptomatic individuals were examined, among whom 2307 (10.3%) were diagnosed with smear-positive TB. Case detection in FIDELIS counties increased by a factor of 3.5 during the FIDELIS period compared with before FIDELIS, and that in non-FIDELIS counties by a factor of 3.1 (P = 0.001). Conclusion:It was feasible to massively mobilise students for TB case finding through collaboration between the health care and education systems.