Process and Products of TB/HIV Operational Research Chiang Rai, Thailand Jintana Ngamvithayapong-Yanai, PhD. JSPS-Fellow, Research Institute of Tuberculosis,

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Process and Products of TB/HIV Operational Research Chiang Rai, Thailand Jintana Ngamvithayapong-Yanai, PhD. JSPS-Fellow, Research Institute of Tuberculosis, Japan TB/HIV Research Foundation, Chiang Rai, Thailand Ittipol Chaita, M.D. Director, Chiang San Hospital, Chiang Rai, Thailand Seventh International Congress on AIDS in Asia and the Pacific Kobe 2005, July 1-5, 2005

Acknowledgement Japanese Foundation for AIDS Prevention (JFAP) support the operational research activity staff of Chiang San and Mae Chan Hospitals People with HIV/AIDS volunteers in Chiang San and Mae Chan

WHO Interim policy on collaborative TB/HIV Activities, 2004

How to implement TB/HIV activities in Thailand where “district hospitals” are well established in every district?

District (Community) Hospital in Thailand (10-90 beds --- for 30,000 – 100,000 + population)

Operational Research (OR) Operations research is concerned with the day-today operations of programs. It is intended to provide the information for improving service delivery activities and plan for the better future service. It seeks practical solutions to problem situations (Fisher et.al 1981) INT J TUBERC LUNG DIS 2005;2:145–150

Cambodia Myanmar China La os Vietnam Bangkok Chiang Rai Pilot Area for TB/HIV Operational Research (OR) Chiang Rai province Chiang San district (about 56,000 population) Mae Chan district (about 120,000 population)

Process of OR for TB/HIV Research team -Operational researchers (PHA leaders, doctor, TB staff, HIV staff, lab, pharmacist, ICN) -External researchers Research fund and incentive Evaluation and monitoring (meeting and presentation by analysis of medical records and registration)

Integrating TB/HIV care in district hosp. TB is detected HIV Testing HIV Education HIV-positive HIV-negative DOT for TB treatment and HIV care (cotrimoxazole and ARV) DOT for TB treatment and HIV education HIV-positive is detected TB education TB screening Active TB disease Non-TB DOT for TB treatment and HIV care IPT HIV care -ARV TB education and Information about IPT

The three-100% targets for TB/HIV activities in Chiang San Hospital 100% VCT among TB patients (100% of TB patients receive VCT) 100% Knowing TB (100% of People with HIV (PHA) to receive TB education) 100% TB Screening (100% of PHA to receive TB screening)

One stop service - VCT - Drug counseling and dispensary 100%-Voluntary Counseling and Testing (VCT) for TB patients

TB education and TB screening for PHA (hospital and community based approach) Hospital -- by hospital staff Community -- by PHA-Leaders in collaboration with the hospital and community council TB education and TB screening for PHA (hospital and community based approach) Hospital -- by hospital staff Community -- by PHA-Leaders in collaboration with the hospital and community council

Method (community based)  PHA leaders provided TB knowledge through an interactive discussion using local language  Before and after TB education session, PHA performed the 15-minute test

 TB knowledge Posters  TB patient’s chest x-ray films  A microscopic with slides showing TB germs  Pre and Post-test (11questions with 4 multiple-choices) Teaching materials

Test of TB knowledgePre- testPost- testP-value 1. What is Tuberculosis (TB)? What is common site of TB disease which can be transmitted to others? How TB germs enter to the human’s body? What is the highest risk scenario for TB transmission? How TB is associated with AIDS? What is the symptom of Pulmonary TB (TB at lung)? How do you know whether you have Pulmonary TB ? Which one is the correct answer? (Knowledge about medicine for TB and TB/HIV) Which one is correct? (Knowledge of TB preventive therapy and TB treatment medicine) What is the best way for preventing TB transmission? What is the meaning of TB infection? Total mean scores (N = 118) Table 2 Mean scores of pre and post-test for each question

Table 3: Result of TB screening among New- PHA at Chiang Saen Hospital YearHIV counselingHIV+TB screeningActive TBIPT

Result of TB screening in the community by PHA leaders in PHA were screened for TB by a questionnaire 14 PHA were referred to Hospital 1 PHA was diagnosed with Pulmonary TB

Targets for TB/HIV activities Before OR Impact of OR 100% VCT for TB patients 71% - No system and no policy to ensure HIV testing 100% among Thai patients 100% PHA receive TB education No data - No system to record or assess TB education among PHA 74% - System in the hospital and in the community are developed 100% PHA are screened for TB No data - No system to ensure TB screening 74% - System in the hospital and in the community are developed Targets and achievement

Please help my PHA friends not to die with TB…. Ms.Petcharin...PHA volunteer in the closing of TB/HIV Symposium, International AIDS Conference, July 2004, Bangkok

‘Give a man a fish and you feed him for a day. Teach him to fish and you feed him for a lifetime.’ Chinese proverb. (quoted by Laserson et al., INT J TUBERC LUNG DIS 2005;2:145–150)