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Communicable Diseases Department
Tuberculosis
TB in South-East Asia
Epidemiology
Goals and
Objectives
Achievements
Key Milestones achieved in
2008
Country
Profiles
Country Profiles – Thailand
With a population of approximately 64 million Thailand ranks 18th in the list of 22 high TB burden
countries. The prevalence of TB was estimated at 192 per 100 000 population for all forms in 2007,
with an incidence rate of 62 new smear-positive cases per 100 000 population. The country has
achieved full DOTS coverage, maintaining the global target for case detection since 2003. A case
detection rate of 72 % was achieved in 2007.The treatment success rate for the cases reported for
2006 was 77%. The low treatment success rate is attributed to high default and mortality rates and
incomplete reporting from the city of Bangkok.
Based on a national drug resistance survey in 2006, MDR-TB rates were reported to be 1.65 %
among newly diagnosed cases and 34.5 % among previously treated cases. Thailand has an
extensive and well developed laboratory network. However, due to the decentralized nature of
laboratory services and the presence of several private sector laboratories also undertaking TB
diagnosis, maintaining quality assurance is one of the major challenges faced by the NTP. Most
patients with drug-resistant tuberculosis are diagnosed and managed by university,
regional/provincial and some private hospitals, which procure second-line anti-TB drugs using local
resources. National guidelines for MDR-TB, in line with international recommendations, have been
developed and adopted by the national experts. Culture and DST is recommended for all patients
who fail Category I and II regimens, contacts of MDR-TB cases, all patients commencing retreatment regimens, HIV infected TB cases, migrants and prisoners. The capacity for first-line DST is
being expanded through the establishment of culture facilities at selected regional laboratories. The
national reference laboratory has capacity for second-line DST, and has recently been formally
designated as the second SNRL in the South-East Asia Region.
Substantial progress has been made in implementing TB/HIV collaborative activities throughout the
country. A national working group for TB/HIV has been established and the NTP provides guidance
for collaborative TB/HIV activities. Diagnostic HIV testing of TB patients has been incorporated into
national guidelines and is being increasingly implemented throughout the country. Routine HIV
screening is recommended nationally for all registered TB patients. In 2007, the HIV counseling and
testing rate among TB patients was 68 %, and 20 % among all those tested were found to be HIVinfected. Care and treatment for HIV-infected persons is highly subsidized and widely available.
Cotrimoxazole preventive therapy and anti-retroviral treatment was provided to 67 % and 32 %
respectively, of HIV-positive TB patients. Improved identification of HIV-infected TB patients,
together with effective linkage to care and treatment will be required to significantly reduce TB
mortality rates.
An HRD plan has been developed and a focal point for HR designated at the central level. TB
services are fully integrated within primary health care. Thailand has made remarkable progress in
involving NGOs and the private sector. Recently a Memorandum of Understanding was signed with
the National Health Security Office, Ministry of Labour and Médecins Sans Frontières (MSF) for
implementation of TB in workplaces, prisons and among migrants. The programme has involved
private hospital associations, NGOs (World Vision, American Refugee Committee, and Thailand
Business Coalition of AIDS to control TB) to provide TB care according to ISTC.
The country’s TB programme is supported by GF and other bilateral partners and additional funding
has been allocated by the National Health Security Office.
Major achievements
The National Health Security Office has provided additional funds to support TB activities at the
provincial and local levels;
TB/HIV collaborative activities have been scaled up countrywide;
TB services among marginalized populations such as migrants and cross-bordered population have
been maintained by collaborating with NGOs through GFATM support;
Establishing TB services in 138 prisons;
Greater commitment from the Ministry of Public Health: designation of a “Mr/Ms TB” at all hospitals
and provisional health offices;
Managing Information for Action (MIFA) course introduced; and
Global Fund support through Rounds 6 and 8.
Major challenges and constraints
Improving quality of DOTS in decentralized situation and in big cities;
Further strengthening TB/HIV integrated activities;
Better managing systematic and regular supervision of programme activities;
Ensuring systematic MDR-TB care and recording and reporting on these cases;
Involving private hospitals in TB control;
Obtaining adequate commitment for implementing TB control activities in Bangkok; and
Addressing Human resource constraints at the central and Regional levels.
Planned Activities
Capacity building of health care volunteers in decentralized settings and in big cities to ensure
treatment adherence;
Strengthening of regular supervision, monitoring and evaluation of the programme;
Piloting MDR-TB treatment under the programme; procurement of second-line drugs through GLC;
Increasing the involvement of private hospitals and ensuring practices are in line with the national
guidelines;
Advocating with the Bangkok Metropolitan Administration for greater commitment for TB Control;
and
Updating the database of health staff in place and developing a strategic plan according to the
need.
TB epidemiological profile, Thailand
TB Unit of the WHO Regional Office for South-East Asia
Last update: 12 March 2009
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