Thailand - Stop TB Partnership

Background
Baseline statistics
Thailand has experienced rapid economic growth in the past few decades. Its average economic
growth rate was 5.4 percent a year from 1975 to 2001. 1 By 2002, its GDP per capita
had reached $2,060 (78,286 baht). By 2004, Thailand was widely considered a “middle
income country.” 2
Increasing prosperity has been matched by increased government expenditure on
health. Health expenditures rose from 3.5 percent of GDP in 1979 to 6.1 percent in 2000, 3
and the country has experienced significant improvements in health and other social indicators.
For example, in the period from 1960 to 2005, the infant mortality rate decreased from
84.3 to 17.3 per 1,000 live births; 4 by 2002, the adult literacy rate was 92.6 percent.
In this broader context of socioeconomic development and increased investment
in health, the National Tuberculosis Programme (NTP) succeeded in reducing TB incidence
by 50 percent in six years, from 150 cases per 100,000 people in 1985—a record for
the country—to 76 per 100,000 in 1991. 5 However, TB incidence rose again in the 1990s
with the emergence of the HIV/AIDS epidemic, 6 and the deadly interaction of TB and HIV
brought new challenges to TB control efforts. With an estimated annual TB incidence of
142 per 100,000, Thailand is 18th on the World Health Organization’s (WHO’s) list of
TB high-burden countries. 7 Experts have noted, however, that national estimates may be
compromised by the fact that a comprehensive survey to estimate incidence has not been
conducted in over 15 years. 8
TB/HIV and multidrug-resistant TB
The estimated prevalence of HIV in Thailand is among the highest in Southeast Asia, with
an infection rate of 1.5 percent among adults aged 15–49. 9 Sentinel surveys, which are based
on data gathered at selected clinics and hospitals, indicate that HIV prevalence among TB
patients ranges from 10 to 15 percent countrywide, but may reach 40 percent in the north. 10
According to a statement by Deputy Minister of Public Health Anutin Charnvirakul, about
one-third of people living with HIV also have TB—approximately 12 times higher than the
rate among people who do not have HIV. 11
Such high rates of TB/HIV coinfection are alarming, especially since the diagnosis
and treatment of TB in people who are also HIV-positive is a challenge. Many HIV-positive
patients either have sputum smear-negative or extrapulmonary TB, which are not detected
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TB POLICY IN THAILAND