Tuberculosis Preventive Treatment in Thailand: Pilot project 27 provinces and Zero TB in Nakhon Si Thammarat
Strategy and Planning Division, Office of the permanent secretary, Ministry of public health, Thailand
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Government
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#SDGAction33610
Description
The WHO reported that Thailand was one - fourteenth in high TB burden countries. In 2019, the estimated was 105,000 new and relapse TB cases, as 150/100,000 populations. The data from the NTP Thailand shows TB case notification was 87,789 cases with 84 % treatment coverage. In 2018, we had TB treatment success rate among new and relapse cases of 85%. However, we are ongoing to achieve the target of ending TB. Thailand had the operational plan to end TB 2017-2021 with one of five strategies which is expedite TB case finding to ensure full coverage through TB screening in risk populations including conducting TB case finding among children under five years of age living with TB patients, close contact with TB patients, and HIV-infected people to ensure treatment of latent TB infection in order to prevent TB disease.
To pilot implement TB screening and providing TPT in 27 provinces. 1. Meeting for project’s planning among staffs of Tuberculosis Division 2. Meeting for multi-stakeholders and staffs which are sites of the project, in order to introduce the project and activities. 3.Collaborating with international institutes to introduce Zero TB Initiative project. Dr.Salmaan Keshvjee, Professor of Global Health and Social Medicine, Harvard Medical School and experts from Stop TB Partnership. The project was pilot implementing in Nakhon Si Thammarat and expanding in other 27 provinces over the country. 4. Collaborating with Medical faculty; Siriraj hospital and Mahidol university, Health Department, Bangkok Metropolitan. Implement, Bangkoknoi project is zero TB. Aim of the project is to active screening among contacts to TB patients in sector of Bangkoknoi area. Siriraj hospital provided mobile X-RAY for screening TB contacts and general populations who are interested. This provided an improvement access to services for all. 5. Screening for LTBIs and provide TPT in 27 provinces, collaboratively, with all multi-stake holders emphasizing active screening for contacts to TB patients and other risk groups. Chest X-rays were provided as well as confirmed with culture tests by Molecular Biology testing. Providing the treatment for TB infections. Providing screening and testing for LTBI by measuring level of Interferon-gamma blood (Interferon-gamma release assay: IGRA). 6. Developing and strengthening National TB program (NTP) to be functional and efficient. 7. M&E for LTBIs and M&E among LTBIs who are not treated with TPT to get sick from TB. 8. Expanding active screening and providing TPT among LTBIs, nationwide.
Screening TB infection and providing TPT among LTBIs and contacts (DATA: AUGUST 2019 – NOVEMBER 2020) 1. Result of testing of LTBIs (cases) Contact cases: 1,760 Positive: 376 (23.1%) Negative: 1,260 (71.5%) Border line: 77 (4.4%) Indeterminate: 47 (2.8%) 2. TPT among LTBIs (cases) TPT: 229 (60.9%) NO TPT: 120 (31.9%) TB: 9 (2.4%) Waiting to be confirmed: 18 (4.8%)
Success factors: 1. Stake-holders including, policy level, team leader, staffs concerns and know the value of this project. All participated to contribute the project with welcome. 2. Knowledge management and experiences sharing were happened during the time of the implementation of the project. 2.1 Services for LTBIs required well managements and functions. All involved hospitals needed to plan for providing healthcare services; screening, diagnosis and testing, drugs prescribing, following up for health and treatment. 2.2 Costs of services from both sides; healthcare providers and patients had happened, directly and indirectly; cost of healthcare services, transportation, food and living, opportunity of income from job-leave, and sick leave. 2.3 Selection for TPT required history of contacts of TB patients and resistant situations of index case. DR-TB patient could not be treated with TPT. 2.4 Drug stock management required well plan and good management; Stock, ware-house, distribution, and storage. 2.5 Data management needed to be planned and managed before an implementation of the project and also planned for maintenance in long term. 2.6 Management system for collaborations among networks of all levels needed to be set up. Limitations: 1. Laboratory testing of IGRA at sites required to strengthened. Some hospitals have limitations for providing services. Some of those limitations are managements of appointments of patients to see doctors and healthcare providers; moreover, the limitations to take sample from patients and limitations of staffs to have more workload. 2. Management of TPT drugs did not immediately provide at the sites of the project. The hospital had to wait for the drugs after submission the requirement to Tuberculosis Division. Hospitals then had to allocated some drugs from their hospitals and reimbursed the drugs to be supplement in their stock later. Sometimes the drugs from central level or higher level of allocations did not be provided full regimens. 3. Benefits supports for patient did not match to protocol of the project. Some patients who were out of those benefits had to paid themselves for some cost of services. 4. IGRA test for LTBIs takes time to wait for results and required high technology
Policy levels required to provide policy advocacy strongly and sustainably. Facilities required be full allocated and supported in right amount and right time. Thailand, as a membership of WHO, we have been conducting “The End TB Strategy”. We created national strategies and action plans of ending TB: 2017-2021. The national strategies and action plans were endorsed by the Thai cabinet for an implementation. LTIBs treatment, as TPT is included in the national strategies as a priority, emphasizing, among contacts of TB patients and HIV infections. We plan for expanding for specific priority for further as follow: 1. Preparing of improving laboratory capacities of six nodes for IGRA testing in order to cover all hospitals over the country 2. Including Rifapentine to be in a national essential drugs list for universal coverage for patients to take 3HP 3. Increase benefits to cover all ages groups of patients for free of charge.
Website, Facebook, and Line of Tuberculosis Division Publications, articles, video-link of Tuberculosis Division Brochure, and video clip providing knowledge and instructions
Pandemic of covid-19 provides negative impacts by delaying patients to be screened for TB at the hospitals. This also provided direct impacts to LTIBIs to access to TPT later than usual. A way to solve the problem Provide public communications and specific instructions to people about TB and LTBIs, basically via all kinds of effective media for communication; phone, Facebook, Line, YouTube and commination by formal routes from Tuberculosis division.
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Beneficiaries 1. TB patients, LTBIs and general populations received health services of TB infection screening and diagnosis, TPT, and TB treatment 2. Take the results of this project to be applied for expanding and improving Key stakeholders and partnership Harvard Medical School, National Health Security Office, Regional hospital, general hospital, Provincial Public Health Office, Office of Disease Prevention and Control 12 regions collaborated for this project and became strong networks for TB partnerships.
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