Summit in Rayong points way for innovative strategy on TB/HIV in Thailand

20 March, 2014

This week, Rayong Province welcomed the MOPH DDC’s Deputy Director General, Dr. Somsak, for an exciting TB/HIV team meeting to discuss integrated care for these two diseases.  

Dr. Somsak commended the province’s current performance and also urged the Bureau of Tuberculosis (BTB) at the central level, and the Office of Disease Prevention and Control 3 Chonburi at the regional level, to continue close coordination with the provincial TB network in Rayong. Dr. Somsak specifically tasked the central, regional, and provincial levels to support the TB and HIV teams in Rayong to identify creative strategies for mobilizing human resources to care for complex patients who are co-infected with TB/MDR-TB and HIV. 

Rayong Province’s prevalence for MDR-TB and HIV is among the highest in the country of Thailand.  The province also has unique challenges due to the highly mobile and sometimes transient population who live and work in Rayong’s many industries.  Limited human resources therefore add a significant burden to an already stretched network. 

As a result of this week’s meeting, CAP-TB will help Rayong’s HIV and TB teams to conduct a task-shifting analysis, with the goal to identify the precise responsibilities and current workload in caring for patients with TB and HIV; to describe the expertise of existing staff; and to define current gaps as well as potential solutions to address these gaps. 

The CAP-TB project’s focus on TB patients co-infected with HIV has come as a result of our monthly MDR-TB cohort review and case conference, during which the Rayong TB team has highlighted many complexities of caring for MDR-TB patients with HIV.  These patients are known to have high early mortality, thus timely diagnosis and treatment for MDR-TB is critical, as is early ARV initiation.  One of Thailand’s priorities in the coming year is to initiate ARVs for patients co-infected with TB or MDR-TB, regardless of CD4 count.  However, this change of practice will have a big impact on the current capacity of the health system to care for these additional patients, and it is with this in mind that Dr. Somsak and others at the central level in Thailand — namely, BTB Director Dr. Chawetsan, and the National AIDS Program, are supporting an analysis of task-shifting for Rayong. 

An important element of this potential task-shifting will be to build capacity “from the ground up,” to enable those with less formal health care training to absorb tasks from the higher levels.  With Thailand’s increasing focus on integrating and coordinating TB/MDR-TB and HIV care, we hope that our work in Rayong can help to strengthen the health system, maximize utilization of health care resources, and ultimately benefit patients living with these diseases.     o