Treating the invisible: Gaps and opportunities for enhanced TB control along the Thailand-Myanmar border

Abstract

BackgroundIn Thailand’s northwestern Tak province, contextual conditions along the border with Myanmar pose difficulties for TB control among migrant populations. Incomplete surveillance data, migrant patient mobility, and loss to follow-up make it difficult to estimate the TB burden and implement effective TB control measures. This multi-methods study examined tuberculosis, tuberculosis and human immunodeficiency virus co-infection, and multidrug-resistant tuberculosis treatment accessibility for migrants and refugees in Tak province, health system response, and public health surveillance.MethodsIn this study we conducted 13 interviews with key informants working in public health or TB treatment provision to elicit information on TB treatment availability and TB surveillance practices. In addition we organized 15 focus group discussions with refugee and migrant TB, TB/HIV, and MDR-TB patients and non-patients to discuss treatment access. We analyzed the data using thematic analysis and created treatment availability maps with Google maps.ResultsThe study identified surveillance, treatment, and funding gaps. Migrant TB cases are underreported in the provincial statistics due to jurisdictional interpretations and resource barriers. Our results suggest that TB/HIV and MDR-TB treatment options are limited for migrants and a heavy reliance on donor funding may lead to potential funding gaps for migrant TB services. We identified several opportunities that positively contribute to TB control in Tak province: improved diagnostics, comprehensive care, and collaboration through data sharing, planning, and patient referrals. The various organizations providing TB treatment to migrant and refugee populations along the border and the Tak Provincial Public Health Office are highly collaborative which offers a strong foundation for future TB control initiatives.ConclusionsOur findings suggest the need to enhance the surveillance system to include all migrant TB patients who seek treatment in Tak province and support efforts by stakeholders on both sides of the border to continue to share data and engage in collaborative planning on TB, TB/HIV, and MDR-TB treatment provision for migrant populations.

Migrant tuberculosis patient needs and health system response along the Thailand–Myanmar border

“…Our multi-methods project utilized FGDs, KI interviews, and a survey of CHVs to explore access to TB treatment from multiple perspectives. We have described our FGD and KI methodology in detail in previous articles ( Tschirhart et al 2016a , b , 2017 ).…”

“…In this region NGOs established specific TB programmes to provide care for migrants who were not eligible for free healthcare from the Thai government hospitals or needed additional supportive services ( Tschirhart et al 2016a , b , 2017 ). World Vision Thailand (WVT) and the Shoklo Malaria Research Unit (SMRU) run community-based TB programmes.…”

“…Our research project aimed to investigate access to TB treatment for migrants and refugees, TB surveillance, and health systems response. We have published our findings on treatment accessibility, surveillance, and TB control elsewhere ( Tschirhart et al 2016a , b , 2017 ). In this article we address the research question: how have community and non-governmental healthcare providers responded to treatment barriers?…”

Planning pathways in the transfer of Directly Observed Treatment of Tuberculosis

“…The National Tuberculosis Control Program in Brazil, seeks to improve the qualification of processes such as planning, monitoring, evaluation of control actions, prevention, care, diagnosis, epidemiological surveillance, etc 16 . A study conducted in the Tak province, Thailand, demonstrated that planning, was one of the main elements for disease control in that setting, along with effective sharing of data and information, and improvement in the diagnosis process and care, among others things 19 .…”

Erratum to: Treating the invisible: Gaps and opportunities for enhanced TB control along the Thailand-Myanmar border

“…After publication of the original article [1] it was brought to our attention that some of the authors’ final corrections were not incorporated in the online version of the paper.Two references added by the author were not included in the reference list, resulting to several incorrect in-text citations. The omitted references are:

Churchyard GJ, Stevens WS, Mametja LD, McCarthy KM, Chihota V, Nicol MP, et al Xpert MTB/RIF versus sputum microscopy as the initial diagnostic test for tuberculosis: a cluster-randomised trial embedded in South African roll-out of Xpert MTB/RIF.

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