TB/HIV TREATMENT FOR MIGRANTS Aug 23, 2013
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CONTENT OUTLINE • • • • • •
Background of project Project phase I (DFID 2010-2012) Activities Issues identified Results of project phase I Modification in project phase II (DFID 2013-2015) Progress in phase II Summary of MDR TB activity Conclusion 2
BACKGROUND • Started in Oct 2009 when MSF-F closed the mission • Target population: migrants and displaced population in Tak province • Funded by EU (2011-2014) and DFID Phase II (20132015) • Implementing partners: SMRU, PU-AMI, IOM, 5 Thai Hospitals, Tak PHO
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LOCATION MAP • Many bordercrossing points (30), • Fluid population movement
TAK Province Myawadd y
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POPULATION IN TAK PROVINCE Thai: 605,413 NonThai: ̴ 289,773 Unregistered migrants: ̴ 200,000 Registered: 27,413 Refugees:58,429 Stateless: 3,931
Registered Migrants, 3.07%
Refugees, 6.53%
Unregister ed Migrants, 22.34%
Stateless, 0.44%
Thai, 67.63%
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TB situation in Tak Province 2011
2012
Thai N (%)
Non-Thai N (%)
Total N (%)
Thai N (%)
Non-Thai N (%)
Total N (%)
Muang
115 (92.0)
10 (8.0)
125 (16.3)
112 (98.2)
2 (1.8)
114 (14.9)
Ban Tak
23 (92.0)
2 (8.0)
25 (3.3)
36 (97.3)
1 (2.7)
37 (4.8)
Sam Ngao
23 (100)
0 (0)
23 (2.9)
25 (100)
0 (0)
25(3.3)
Mae Sot
140 (35.9)
250 (64.1)
390 (50.9)
106 (33.0)
215 (67.0)
321 (42.2)
Mae Ramat
31 (68.9)
14 (31.1)
45 (5.8)
33 (76.7)
10 (23.3)
43(5.6)
Thasong yang
27 (61.4)
17 (38.6)
44 (5.7)
45 (69.2)
20 (30.8)
65(8.5)
Phoppra
20 (27.7)
52 (72.3)
72 (9.4)
32 (39.5)
49 (60.5)
81(10.6)
Um phang
4 (9.3)
39 (90.7)
43 (5.7)
9(11.7)
68 (88.3)
77(10.1)
Total
383 (49.9)
384 (50.1)
767(100.0)
398 (52.2)
365 (47.8)
763 (100.0)
Source: Tak PHO presentation in Forum on TB among migrants in Thailand, June 2013 6
PROJECT ACTIVITIES IN PHASE I • Implementation period: 2010- 2012 by DFID grant
• Passive case finding through SMRU polyclinics, malaria field sites and referral from others (mainly Ko Ko Hospital, MTC ) • Diagnosis of TB by smear microscopy and CXR
• Systematic culture & DST for all sputum positive cases • Provider initiated HIV counselling and testing • Treatment of TB, TB/HIV and MDR TB
• Mixed model of treatment delivery (home-based DOT, Residential DOT in TB centers and SAT) • Therapeutic education and counselling
• Isoniazid Prophylactic therapy for contact children <5 yr 7
ISSUES IDENTIFIED IN PHASE I • • • • • • •
Prolonged diagnostic TAT for MDRTB Low case detection No established referral network mechanism Shortage of space in TB residence High defaulter rate in Thai Hospital High LFU in TB/HIV coinfected Fragmented TB actors
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SMRU PROJECT DATA (2010-2012) 2010
2011
2012
No of evaluated for TB
281
295
271
No diagnosed as TB
63
86
71
No enrolled for treatment
61
82
71
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ENROLLED TB CASES (N=216) By Sex
By Type of TB
By Age
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PROPORTION BY TREATMENT LOCATION
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KO KO TB CLINIC AND RESIDENCE
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TREATMENT OUTCOMES SMRU 2010
2011
5 Thai Hospitals 2012
2011
2012
Success
54 (88.5%)
59 (70.2%)
57 (80.3%)
159 (80.3%)
117 (49.6%)
Default
1 (1.6%)
5 (6.0%)
3 (4.3%)
28 (17.6%)
15(6.4%)
Died
2 (3.3%)
9 (10.7%)
5 (7.0%)
7 (3.5%)
6 (2.5%)
Failure
2 (3.3%)
2 (2.4%)
1 (1.4%)
2 (1.1%)
1 (0.4%)
Treatment adapted
0 (0%)
2 (2.4%)
0 (0%)
0 (0%)
0 (0%)
Transfer out
2 (3.3%)
7 (8.3%)
5 (7.0%)
2 (1.1%)
1 (0.4%)
Still on treatment
0 (0%)
0 (0%)
0 (0%)
0 (0%)
96 (40.7%)
Total
61 (100%)
84 (100%)
71 (100%)
198 (100%)
236 (100%)
Reasonable outcomes despite challenges! 13
TB&HIV ACTIVITY (SMRU)
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OUTCOMES OF TB/HIV CO-INFECTION 2010
2011
2012
Cum Rate
No of TB/HIV coinfected
7
18
9
34 (100%)
Died before ART
1
4
1
6 (18%)
LFU before ART
0
2
0
2 (6%)
Started on ART
6
11
8
25 (74%)
LFU on ART
3
2
0
5 (20%)
Died on ART
0
4
2
6 (24%)
Still on treatment
3
5
6
14 (60%)
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MODIFICATION IN PROJECT PHASE II • Project period: 2013-2015 by DFID grant • Formation of a consortium of TB actors (SMRU, PUAMI, IOM and Tak PHO) - TTBI • Integrated tACF (HCW, Contacts, HIV infected) • Integrated rapid diagnostic tool – MTB/Rif sys(GeneXpert), operational in April 2013 • Culture and DST for all GeneXpert positive cases • Expansion of TB residence capacity • Closer collaboration with NGOs (mainly with Mae Tao Clinic) 16
EXPANSION OF TB CLINIC & RESIDENCE IN WANGPHA
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PROGRESS DURING PHASE II Jan-June 2013 No screened under tACF activity
263
No of suspects identified under tACF
38
No of TB case detected under tACF
7
No of patients evaluated for TB under PCF
216
No of TB case detected under PCF
58
No of TB cases enrolled for treatment
54
No of presumptive MDR TB cases identified by GeneXpert
6
No of patients started on ETR for MDRTB
6
No confirmed as MDR TB by conventional DST
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Uptake of HIV testing (%)
98.2%
HIV positivity rate
12.3%
CPT rate
85.7% 18
SUMMARY OF MDR TB ACTIVITY 2010 â&#x20AC;&#x201C; 2013 (as of June 2013) No cases tested for culture and DST
157
No culture positive cases
146
No of diagnosed MDR TB cases
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No of MDR TB patients enrolled for treatment
12
No of MDR TB patients successfully finished treatment
4
No of MDR TB patients still on treatment
8
No of PDR TB cases identified
14
No of PDR cases successfully finished treatment
8
No of PDR TB cases on treatment
5
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CONCLUSION • Feasible to treat TB/HIV/MDR TB among this population without causing harm • Expect to increase case detection • Aim to establish cross-border referral network and mechanism • Ultimate goal is to handover the project to NTPs of Myanmar and Thailand
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Thank You!
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