Case finding, treatment, care and support

1. Case finding, treatment, care and support Nevin Wilson 5th Joint International Monitoring Mission 23 August, 2013

2. Situation • Overall improvement in notification of new patients; however wide variation across country • Thai and non-Thai cohorts reported separately; Thai patient cohorts include large proportion of elderly patients • Low smear positivity in most sites; number of TB suspects examined increased without a notable concomitant increase in smear positive cases • Stigma, language barriers and capacity to pay can be significant barrier to access health services for non-Thai unregistered populations • Limited involvement of several institutions; under-reporting to the national programme • Case finding mostly passive; includes active case finding in some ‘at risk’ populations, referral from NGOs and screening at hospitals; appropriately sensitive algorithms not available or applied variably 5th Joint International Monitoring Mission

3. Situation • Overall improvement in treatment outcomes of new patients; wide variation across provinces, population groups, category of health provider • High death rates among Thai new patients; high default rates among non-Thai new patients, significant proportion not evaluated • Direct Observation of Treatment (DOT) variable; providers and patients not consistently aware of the gains from systematic DOT • Revised treatment guidelines not available; different FDCs and loose drugs available; FDCs not always used • Communication across health system network variable; potentially compromises diagnosis and treatment follow-up 5th Joint International Monitoring Mission

4. Recommendations • Review and define screening and diagnostic algorithms; target ‘at risk’ populations; track data to evaluate yield; consider more sensitive tests for ‘at risk’ populations • Make direct observation of treatment as the quality of care for all TB patients • Expand implementation of ‘Quality TB Clinics’ in the public and the private sector; allocate required human and financial resources to monitor and support patient diagnosis, treatment and follow-up • Review and resolve barriers to universal coverage of TB services to non-Thai populations • Set up dedicated unit within BTB to manage and coordinate collaboration across all stakeholders including academia, other ministries, NGOs and the private sector • Initiate operational research to address issues around diagnosis, treatment, and outcomes in elderly, migrant and other ‘at risk’ populations 5th Joint International Monitoring Mission