Country Update: Tuberculosis in Thailand

1. Country Update:Tuberculosis in Thailand Dr. Chawetsan Namwat NTP manager and Director of BTB, DDC, MOPH, Thailand

2. TB prevalence in high burden countries Source: WHO, Global TB report, 2012

3. Tuberculosis situation source: WHO, Global Tuberculosis Report 2012

4. 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

5. Thailand: Estimated TB incidence rates,Trends in estimated TB incidence rates (green) and estimated incidence rates of HIV-positive TB (red). source: WHO, Global Tuberculosis Report 2012

6. Trend of New smear-positive (New M+) case notification by all types of TB in Thailand, 2001 -2012 BTB-Updated : May 28, 2013

7. Treatment outcome, 2001-2011 BTB-Updated : May 28, 2013

8. Treatment outcome, 2001-2011 BTB-Updated : May 28, 2013

9. Treatment outcome, 2011 Missing < 80% 80%-84% < 5% < 1% 85%-89% 5%-10% 1%-2% ≥ 90% > 10% ≥3% BTB-Updated : May 28, 2013

10. Estimates of MDR-TB burden (2011),Thailand Source: WHO Global TB Report 2012

11. MDR TB in High Burden Countries and Thailand Sources: WHO, Global TB Report 2012 and Bureau of Tuberculosis, DDC, MOPH, Thailand

12. MDR TB in High Burden Countries and Thailand Sources: WHO, Global TB Report 2012 and Bureau of Tuberculosis, DDC, MOPH, Thailand

13. Percentage of new TB cases with MDR-TB

14. MDR TB in High Burden Countries and Thailand Sources: WHO, Global TB Report 2012 and Bureau of Tuberculosis, DDC, MOPH, Thailand

15. Percentage of previously treated TB cases with MDR-TB

16. Drug resistance surveillance 2012 (prelim)

17. National TB Prevalence Survey,2012 • Principal Investigator: Dr Sriprapa Nateniyom • Multi-stage cluster sampling • 100 clusters x 900 subjects = 90,000 subjects • BKK 17 clusters, Non-BKK 83 clusters • Study Population • age15+ years • At least 14 days resided in the survey area • Interview andCXR all subjectssputum smear & culture for all suspects

18. Prelim. Result: National TB Prevalence Survey,2012 (Non-BKK) PRELIMINARY RESULT. NOT FOR REFERENCE • 83 clusters in non-BKK • 61,651 participants (M=27,478; F=34,173) • 142 culture-confirmed TB cases (M=98, F=44) • Age: 44% age 60+yr. • Smear+ 41%, Smear- 59% • Symptom & CXR • Symptom+ 35% (Symptom score 3+) • CXR abnormal, no symptom 65%

19. Prelim. Result: National TB Prevalence Survey,2012 (Non-BKK) Participation by age group PRELIMINARY RESULT. NOT FOR REFERENCE Number

20. Prelim. Result: National TB Prevalence Survey,2012 (Non-BKK) PRELIMINARY RESULT. NOT FOR REFERENCE Age distribution of TB cases(N=142)

21. Age distribution of smear+ PTB, Report.506 Source: R506: Pulm TB New M+ /2008-2011, BOE

22. Age distribution of smear+ PTB, Report.506

23. Incidence rate (per 100,000) Challenge when the AEC starts AEC 2015

24. TB control in Thailand • Align with global stop TB strategy • “Zeroand Five to minimize MDR-TB” • ค้นให้พบ จบด้วยหายตายน้อยกว่าร้อยละ 5ขาดยาเป็น 0 • Political commitment & Universal coverage scheme

25. Plan for DR-TB • Magnitude of problem • DRS 2012 :MDR: 1.8% among new TB, 17% among retreatment TB • Case detection • C/ DST : Re – On – Pre • Network of lab

26. Plan for DR-TB • Treatment & Patient Support • Guideline & Training • MDR-TB treatment center (general & regional hospitals) – NHSO approved • Consultation mechanism • Lab for f/u • R&R – paper & electronic • DOT

27. Plan for DR-TB • Specific issues for migrants: • Multi-country proposal : for GF support • Referral system at border area : • Health insurance for migrants: documented and non-documented migrant labors

28. Plan for DR-TB

29. Plan for DR-TB

30. ขอบคุณครับ