MDR-TB and TB Update:
Rayong Province
CAP-TB Strategic Planning Meeting
August 1, 2013
Bangkok, Thailand
Chittima Thibbadee, M.D.
Presentation Outline
• Latest MDR-TB and TB prevalence
• At-risk populations
• Current effort
– Prevention
– Care and treatment
Presentation Outline
• Available resources/fundings
– Available resources e.g. equipment, human
resources, number of health facilities with the
diagnosis and treatment capacity, etc.
– Funding sources, period and focuses
• Challenges and Gaps
Pattaya
Rayong
Latest MDR-TB and TB Prevalence
TB Prevalence Rate in Rayong Province
Between 2008 - 30 June 2013*
Year
*2013 data is between 1 October 2012 – 30 June 2013
TB incidence (per 100,000) by WHO region,
and in Thailand, 2011
TB incidence in
Thailand is 2.5 –
4 times higher
than Europe &
America regions
source: WHO, Global Tuberculosis Report 2012
Number of case between 2008-June 2013
645 case 683 case 651 case 690 case 640 case 606 case
ที่มา : TB 07
MDR-TB Prevalence Rate in Rayong Province
Between 2008 - 30 June 2013
พ.ศ.
*2013 data is between 1 October 2012 – 30 June 2013
Number of MDR-TB Patients by District
Number of MDR-TB Patients
Districts
2007
(n=10)
2008
(n=19)
2009
(n=25)
2010
(n=8 )
2011
(n=11)
2012
(n=29)
2013
(October12-June13)
(n=19)
Muang
5
6
14
4
5
17
8
Klaeng
3
6
5
2
3
2
2
Ban Khai
2
1
2
1
3
1
2
Ban Chang
-
1
1
-
-
3
2
Pluak Daeng
-
3
1
-
-
-
2
Wang Chan
-
-
1
-
-
1
1
Nikom Pattana
-
1
1
-
-
-
-
Khao Cha-mao
-
-
-
-
-
-
-
Rayong Central
Prison
-
-
-
-
-
2
1
Other provinces
-
1
-
1
(Songkla)
-
3
(Chonburi)
1
(Chonburi)
(Chonburi
)
At-risk Populations
Population group
Number of Population
1. Elderly
67,987
2. Diabetics
17,779
3. Migrants
14,770
4. HIV infected persons
12,560
5. Inmates
6,211
Current Effort
Prevention
1. Early (MDR-TB) case detection, contact
investigation
2. Quality DOT in drug-sensitive TB (DS TB)
3. Proper management of MDR-TB
4. Increase public awareness
5. World TB Day campaign
Care and Treatment
1. TB clinics staffed with trained health
personnel
2. Active /intensified case finding in
different at-risk population groups
3. Sputum smear tests/culture to diagnose
pulmonary TB by the National TB
Program
4. Quality DOT
Care and Treatment (cont)
5. Uninterrupted supply of quality TB drugs
6. Infection control in hospital/household
levels
7. Integrated HIV/AIDS and TB program
8. Patient’s registration and reporting
completeness
9. MDR-TB patient register implemented
Available Resources
Health Facilities and Diagnosis Capacity
1.
65 culture and identification laboratories (Solid media
culture is performed at Rayong Hospital)
2.
35 DST laboratories (DST for FLDs/SLDs is also available at
Siriraj Medical School/BTB)
3.
24 Molecular Assay laboratories (14 GeneXpert machines in
Thailand, one at Rayong hospital with support from
USAID|Asia through CAP-TB Project)
Public and Private Health Facilities in
Rayong Province
Public Health Facilities
Private
Health
Facilities
District
regional
(n)
community
(n)
sub-district
(n)
Health
center
(n)
Private
hospital
(n)
Mueang
1
1
19
10
3
Klaeng
0
1
23
1
0
Ban Khai
0
1
15
0
0
Pluak Daeng
0
1
10
0
0
Ban Chang
0
1
9
0
0
Wang Chan
0
1
7
0
0
Khao Chamao
0
1
6
0
0
Nikhom Phatthana
0
1
5
0
0
Total
1
8
94
11
3
Human Resources
Health personnel who care for MDR-TB patients
at Rayong Hospital
• 2 Medical physicians (pulmonologist)
• 1 Paediatrician
• 1 Pharmacist
• 1 Register Nurse (& counselor)
Human Resources(cont)
Health personnel who care for MDR-TB patients
at Rayong Hospital
• 4 Medical Technologist (lab staff)
• 1 Counselor
• Health worker (home visit)
- Full time 2
- Part time 3
Current Funding Sources
• National Health Security Office (NHSO) –
ongoing
Objectives:
1. Active case findings/screening amongst at-risk
populations and close contacts of TB/MDR-TB patients
2. Directly-observed therapy (DOT) by trained personnel
for TB/MDR-TB patients
Current Funding Sources
• Global Fund – to be ended in September 2014
Objectives:
1. Support the implementation of DOTS in all
communities in three districts in Rayong Province
2.Facilitate TB/HIV activities
3.Empower community in TB prevention and control
4.Provide living support to patients
Current Funding Sources
• USAID | Asia through CAP-TB Project – to be ended
in September 2016
Objectives:
1. Strengthen MDR-TB prevention and management
among at-risk population groups
2. Support active case findings/screening among HIV
infected persons, diabetics, elderly persons and migrant
population in four communities in three districts in
Rayong Province.
3. Provide package of service to patients to support
treatment adherence.
Current Funding Sources
 Local administration organization – ongoing
Objectives:
– To support project implementation according to the
need and priority of the areas
Current Funding Sources
 Local administration organization – ongoing
Objectives:
– To support project implementation according to the
need and priority of the areas
Challenges and Gaps
Prevention
Challenges
Way forward
1. Prevention of acquired
MDR-TB
- Strengthen quality DOT
for TB patients
- Improve infection control
practice in household
2. Prevention the continuing
spread of MDR-TB strain
- Strengthen early MDR-TB
case detection in
community
3. Stop chain of transmission
- Strengthen MDR-TB
management
Diagnosis
Challenges
Way forward
1. Culture and DST test
reimbursement
- Number of tests (throughout
the treatment course) to be
reimbursed is in discussion
2. Use of GeneXpert to
diagnose MDR-TB beyond atrisk populations
Care and Treatment
Challenges
Way forward
1. Promote treatment
adherence and success
- Side effect management
- Provide socio-economic
support to patients
2. Stigmatization
- Public/community
education
3. Information sharing
- Improve communication
and record tracking and
keeping system
4. Quality DOT provision for
MDR-TB patients
- Community engagement
Thank you
For your attention