No abstract

The study is a part of the research project entitled, 'Development of an operations manual and tools for enhancing the coverage of TB contact investigations and reducing their social burden and stigma', funded

Problem Despite implementation of universal health coverage in Thailand, gaps remain in the system for screening contacts of tuberculosis patients. Approach We designed broader criteria for contact investigation and new screening practices and assessed the approach in a programmebased operational research study in 2017-2018. Clinic staff interviewed 100 index patients and asked them to give household and nonhousehold contacts an invitation for a free screening and chest X-ray. Contact persons who attended received 250 Thai baht (about 8 United States dollars) allowance for transport. Local setting Chiang Rai province, Thailand, has high rates of tuberculosis notification and a high number of people living in poverty. The coverage of contact investigation in under 5-year-olds was only 33.2% (222 screened out of 668 contacts) over 2011-2015. Relevant changes Index patients identified 440 contacts in total and gave invitation cards to 227 of them. The contact investigation coverage was 81.1% (184/227) and tuberculosis detection among contacts screened was 6.0% (11/184). Of the 11 contacts with active tuberculosis, three did not have tuberculosis symptoms, three were non-household contacts and three were contacts of non-smear-positive tuberculosis patients. The contact investigation coverage of the contacts younger than 5 years was 100% (14/14) and the yield of tuberculosis detection in this age group was 21.4% (3/14). Lessons learnt High coverage of contact investigation with a high yield of tuberculosis detection among contacts can be achieved by applying broader criteria for contact investigation and providing financial support for transportation.

Problem:The 2008 tuberculosis (TB) surveillance of Chiang Rai Hospital, Chiang Rai, Thailand reported that 8.4% of Thai, 22.7% of hill tribe minority and 25% of migrant patients (n = 736) defaulted from treatment.Context: TB patient management in Chiang Rai is complicated due to poverty and HIV stigma. A previous study shows unaffordable travel expense was one of the reasons of patient default. Action:We engaged Chiang Rai women's organizations whose members are of high socioeconomic status to support poor TB patients financially and socially. A group of women formed a team to support these TB patients (n = 192) by raising and sustaining funds and providing home visits (n = 37). TB surveillance and patient-fund register data were used to evaluate TB treatment outcomes.Outcome: The success of TB treatment was significantly higher for patients receiving financial support (relative risk [RR]: 1.351; 95% confidence interval [CI] 1.20-1.53; P < 0.000). Lower death rates in all groups were observed among patients receiving financial support. However, financial assistance alone did not improve treatment outcomes for migrant patients. Thirty-seven patients (25 Thai, eight hill tribe, four migrants) who were visited by women volunteers at home achieved 95% TB treatment success. Discussion:It is possible to involve volunteers to support poor TB patients. Willingness to support TB patients was driven by presenting provincial TB epidemiology information, research data on the experience of poor patients and the inspiring experiences of other women volunteers. Future research should investigate the reasons for the high treatment success among patients who received home visits.

In this study, the authors identify opportunities for and challenges in reducing the risks of tuberculosi (TB) and HIV/AIDS transmission in Thailand. They carried out more than six repeated in-depth interviews with each of 13 participants who have been newly diagnosed with TB, 7 of whom were HIV positive, and their caregivers, until the patient recovered from TB or died. They performed extensive observations during relevant private and public activities and analyzed the data using grounded theory, focusing on behaviors affecting risk of transmission. Out of strong virtue, many caregivers felt a responsibility to care for their ill loved ones, thus putting themselves at risk of transmission. For the older generation, this was unimportant, as they had already completed their life cycle ("let it be"). However, strong human bonds encouraged the patients to complete TB treatment until cured or deceased. The authors discuss strategies to build on appropriate behaviors.