Table 1 Overview of pilot interventions to improve case detection in underdeveloped multi-ethnic regions in China, 2014-2015

Improve case detection by outreach TB education

1. Development of tailor-made TB educational materials

The tailor-made TB information sheet which contained TB knowledge and policy of early detection and insurance were developed in mandarin. Given a large proportion of the Uygur in ethnic minorities, it was accordingly translated by provincial TB experts, revised and finalized by discussion with professionals of Uygur language and Muslim.

2. Health promotion to preach TB knowledge to the Muslims by Imams regularly in Masjids

In the Muslims, imam plays a key role in religion preach and promotion of knowledge, attitude and practice from public health perspective. In the pilot, the imams were organized and trained by TB experts. In Masjids, they read and explained TB knowledge and policy to the Muslims in regular preach for at least four times, distributed the TB information sheet, asked them to deliver the information to their family members and friends, as well as referred TB suspects for further diagnosis.

3. Health promotion to educate students by school teachers and deliver TB knowledge to their family members

TB education for students is acknowledged as another effective approach not only benefits the students in their whole lives but also benefits their family members. In the pilot, the teachers in elementary and junior high schools were organized and trained by TB experts. All students were accordingly educated by the teachers, promoted to read the TB information sheet to their family members and to feed back the completion performance by receipts (See in Additional file 4). TB suspects in the students were referred for further diagnosis by the school teachers.

4. Health promotion to each household by village doctors

In village communities, the outreach TB education in each household was conducted along with screening activities. All the residents, regardless of age and ethnics, were educated by trained village doctors in investigation teams using the TB information sheet. Each investigation team also included village coordinator and township doctor. For those who were not at home during the household education, their family members were promoted to conduct an education on behalf of the investigation teams.

Improve case detection by household screening

5. Household screening of people younger than 65 years old by suspicious pulmonary TB symptoms

According to the household registration, eligible resident population was investigated for symptoms by the investigation teams. For those who were not at home during the household screening, the symptoms investigations were conducted by mobile phone or a second investigation. The symptomatic persons were promoted to TB hospital for chest X-ray and sputum smear microscopy. The defaulters were regularly followed up by continuous investigation and health promotion.

6. Household screening of older people by promoting to chest X-ray examination

All older people were promoted for free chest X-ray in the township health center by the investigation teams along with symptoms screening. Assistance from their family members or a second investigation was adopted for older people who were not at home during the screening. The defaulters were regularly followed up by continuous investigation and health promotion. Those identified with abnormal symptoms and/or chest X-ray results were referred to TB hospital for sputum smear microscopy. Chest X-ray test result within 1 year can be taken as reference.