Thailand TB Situation Dr. Chawetsan Namwat Director Bureau of Tuberculosis 23 August

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Case notification from Source : Bureau of TB, Dept.of Diseases Control, MOPH (updated 31 July 2013) 3

Cases notification rate from

Tuberculosis (All Forms) Notification Rate, Thailand,

Tuberculosis Cases (All Forms) Notification, Thailand,

TB/HIV (2009/2011) TB patients with known HIV status49,95552,75350,457 % of TB patients with known HIV status TB patients that are HIV-positive8,2028,5447,394 % of tested TB patients that are HIV-positive16 15 % HIV-positive TB patients started on CPT % HIV-positive TB patients started on ART HIV-positive people screened for TB25,17225,27819,687 HIV-positive people provided with IPT127NA Source : Bureau of TB, Dept. of Disease Control, MOPH (updated on May 2012) 7

Cases notification by type of patients, 2012 (Thai) Source : Bureau of TB, Dept.of Diseases Control, MOPH (updated 31 July 2013) 8

Cases notification by type of patients, 2012 (Non-Thai) Source : Bureau of TB, Dept.of Diseases Control, MOPH (updated 31 July 2013) 9

Cases notification by type of patients, 2012 (Inmates) Source : Bureau of TB, Dept.of Diseases Control, MOPH (updated 31 July 2013) 10

Trend in TB case notification, (Thai) Source : Bureau of TB, Dept.of Diseases Control, MOPH (updated 31 July 2013) 11

Trend in TB case notification, (Non-Thai) Source : Bureau of TB, Dept.of Diseases Control, MOPH (updated 31 July 2013) 12

Trend in TB case notification, (Inmates) Source : Bureau of TB, Dept.of Diseases Control, MOPH (updated 31 July 2013) 13

Trends in notified new smear-positive TB cases by age group among males, Source : Bureau of TB, Dept.of Diseases Control, MOPH (updated 31 July 2013) 14

Trends in notified new smear-positive TB cases by age group among females, Source : Bureau of TB, Dept.of Diseases Control, MOPH (updated 31 July 2013) 15

Treatment outcomes of new smear-positive cases, 2011 cohort (Thai) Source : Bureau of TB, Dept.of Diseases Control, MOPH (updated 31 July 2013) 16

Treatment outcomes of new smear-positive cases, 2011 cohort (Non-Thai) Source : Bureau of TB, Dept.of Diseases Control, MOPH (updated 31 July 2013) 17

Treatment outcomes of new smear-positive cases, 2011 cohort (Inmates) Source : Bureau of TB, Dept.of Diseases Control, MOPH (updated 31 July 2013) 18

Trend in treatment outcomes of new smear-positive cases, (Thai) Source : Bureau of TB, Dept.of Diseases Control, MOPH (updated 31 July 2013) 19

Trend in treatment outcomes of new smear-positive cases, (Non-Thai) Source : Bureau of TB, Dept.of Diseases Control, MOPH (updated 31 July 2013) 20

Trend in treatment outcomes of new smear-positive cases, (Inmates) Source : Bureau of TB, Dept.of Diseases Control, MOPH (updated 31 July 2013) 21

Drug resistance surveillance 2012 (prelim) 22

Laboratory capacity for TB diagnosis of DDC, 2013 PlaceSmearCultureDSTMolecular ODPCZN LED FM SolidMGITSolidMGITXpertSeegeneHainYD 1XX X XYr XXX XX 3XXXX X X 4XXXX X XX 5XXXX X X 6XXX X Yr XXXXXXXXXX 8XXXXXX 9XXXX X X 10XX XX XX X 11XXXX X Yr 2014 X 12XXXX XXYr 2014 Bamraj. Ins NTRLXXXXXXX X 23

Distribution of MDR-TB Cases, Thailand Note: Data in

GF and TB projects in Thailand Round 1Round 6Round 8Round 10 SSF -Urban Poor -TB in Prison -TB/HIV -Border TB -TB control in the Workplace -Private hospitals PPM -Lab. - Migrant TB -QDOTS -Community TB Care -HIV/TB -Gender -Prisons -MDR-TB -Migrants -ACSM -Prevalence survey -QDOTS -Community TB Care -HIV/TB -Prisons -MDR-TB -Migrants -ACSM -Slum -Homeless -SW/MSM -Hill tribes -Unrest areas

Sub Recipient (4 SRs) BTB PIHWD Raks Thai -ODPC1-12 -DOC - NCCM IA: PHO 76 IA: Mahidol U. SSR AP W - AIDS Network Development Foundation (AIDSNet) - Chiang Khong Catholic Center - Foundation for AIDS Rights (FAR) - Plan Thailand (Plan) - Population and Community Development Association and AIDS Program (PDA) - World Vision Foundation of Thailand - Stella Maris Center Songkhla PR-DDC APW WVFT - Health Association of Thailand (HAT) - Social Development Association (SDA) - American Refugee Committee International (ARC) - World Vision Foundation of Thailand (WVFT) - Inter Mountain Peoples Education and Culture in Thailand (IMPECT) - Premiere Urgence - Aide Médicale Internationale (PU-AMI) SSR IA: Buddahakaset Chiang Mai (BCF) - (QOLKK) under ODPC.6 Structure of TB SSF - BMA under BTB. SSR

ParticipationTB cases Unweighted TB rate (%) 95% Confidence Limit P ( LL - UL ) N61, %( %) Sex Male27, %( %)p<.001 Female34, %( %) Age , %( %)p< , %( %) , %( %) , %( %) 75+3, %( %) Cluster type Urban8, %( %)p=0.80 Rural52, %( %) 27 TB Prevalence Survey 2012 (Non-BKK area) PRELIMINARY RESULT (crude analysis)

Key Achievements 50% of 77 provinces use electronic TB program in all health facilities Increase ART among TB/HIV patient from 53% to 59% Systematic development of Programmatic Management of Drug-resistant TB(PMDT) Conducted a National Prevalence Survey Conducted a Drug Resistance Surveillance Annually assess “Quality TB Clinic” 30

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Major Challenges Decentralized health system Migration due to AEC2015 Sustainability of human capacity to perform TB activities Capacity building of lab staff to support MDR-TB case detection and care Managing TB lab zoning to support MDR-TB case detection and management by reducing Turn Around Time Increasing the involvement of non-MOPH hospitals in Bangkok and non-Bangkok area 32

Plan for 2014 Strengthen lab capacity for culture and DST in 12 Regions and culture in provincial hospital with collaboration with NHSO Expansion of the electronic TB R/R system Strengthen TB services in all public hospitals through auditing “Quality TB Clinic” SSF phase II : focus more on DR-TB 33

Q&A Discussion 34