BANGKOK, Thailand — The World Health Organization (WHO) has classified Thailand as one of 22 countries with the highest number of tuberculosis (TB) cases. With a population of almost 67 million, there are roughly 93,000 new cases each of tuberculosis in Thailand each year and an estimated TB occurrence of nearly 130,000 cases, including 16 percent who are also HIV positive. Complicating these figures further is the rising threat of drug-resistant TB. This is a look at how Tuberculosis treatment in Thailand takes place and what the medical community is doing to bring the numbers of infected residents under control.
Treatment Options for Tuberculosis in Thailand
Tuberculosis treatment in Thailand involves taking antibiotics for a minimum of six months. As an increasing number of people are no longer able to receive treatment with previously effective medication, drug-resistant TB is a major concern. Moreover, patients can develop multi-drug resistant tuberculosis (MDR TB) due to the mistreatment of antibiotic therapies. If the second line of antibiotics is unsuccessful in curing multi-drug resistant infection, it becomes established as extensively drug-resistant tuberculosis (XDR TB).
USAID’s Control and Prevention of Tuberculosis (CAP-TB) plan trained 26 healthcare providers in Thailand to use motivational interviewing techniques. These providers have been using Motiv8 to promote treatment among TB and drug-resistant TB patients, since 2015, and this original method is growing in the Rayong province.
The goal of this seven-year effort which ran from October 2011 to October 2018 involved reducing the occurrence of multidrug-resistant tuberculosis in China and Thailand. In Thailand, from 2011 to 2017, supported provinces achieved greater success rates that surpassed the national average. The project team, along with the country’s Bureau of Tuberculosis, helped to introduce Bedaquiline for the treatment of extensively drug-resistant tuberculosis in Tuberculosis. Bedaquiline is the first new drug in Thailand to combat TB in almost 45 years.
The characteristic patient-provider relationship where patients comply with providers’ recommendations is where Motivational interviewing differs. With this approach, the provider and patient partner in the decision-making process. When TB patients interact in this way, consequently, those who are unsure or resistant to treatment move toward getting the care they need and more likely restored to health.
Motiv8’s proven success has led HIV and TB-HIV dual-infected patients, both with and without USAID support, as one part of the broader USAID CAP-TB patient-centered styles being applied in other countries throughout Asia.
According to the revised guidelines for 2018, in conjunction with WHO, ATS/CDC/IDSA and Ministry of Public Health of Thailand, the recommended screening for potential TB cases is the chest radiograph followed by sputum AFB smear. Residents who have coughs, fever, weight loss or night sweats might be suspected of having TB and those without these symptoms, but at high risk for TB infection as a result of interaction with TB or HIV patients will have this testing based on the abnormality of the results.
BE Health Association is a nonprofit association, organized under Swiss law, which facilitates awareness raising programs, diagnosis and treatment of infectious diseases for corporate sector members, their employees, families and local communities. From the Siam Kempinski Hotel in Bangkok, BE Health’s Peer Health Educators organized more than 144 workplace activities and 13,600 community members through social enlistment in Khlong Toei and interactive campaigns in town.
Peer Health Educators had training by BE Health and held more than 24 awareness campaigns, supported 125 patients until the completion of their treatment, provided 536 home visits to TB patients, ensured social protection for 24 TB patients in Khlong Toei by presenting them with daily food, transportation to the healthcare center and economic relief. In 2018, eight community health volunteers screened 929 households in the neighborhood for TB, with only five new TB patients registered.
It may be difficult to understand why TB continues to flourish in Thailand despite easy access to diagnosis and availability to effective medical treatment, but health is more than the simple absence of illness. Tuberculosis is a chronic disease that ordinarily affects lower socioeconomic classes when patients are unable to follow the treatment routines because of the financial burden involved. When hardship leads to weakness, therefore, to disease, TB often creates an escalation of life-threatening poverty. With no income, proper sanitation and lack of food, TB patients are simply not in control of their own health.
To avoid transmission of infection and drug resistance, it is important that patients know how to protect themselves and their relatives by receiving the proper TB treatment. In order to avoid distress or despair, TB patients require a support system, positive thinking, and togetherness. Making TB patients aware of their own disease and developing a healthy mind contributes to creating a healthy life.
– Colette Sherrington