Thailand - Stop TB Partnership

According to one AIDS activist, many people living with HIV/AIDS—who are often
smear-negative—die from TB without ever being diagnosed with TB or treated for it. 60 Others
assert that an overriding focus on achieving targets may result in insufficient attention to
country-specific issues such as the need to strengthen health systems and improve the service
delivery infrastructure. 61 However, many Thai TB experts consider the global TB targets
critical in motivating government progress, and express confidence in the national capacity
to achieve or exceed them. 62
DOTS implementation
We think of ARV [antiretroviral drug] distribution among people living
with HIV/AIDS as a model. People living with HIV/AIDS become
actively involved [in their own treatment]: they do home visit projects;
they join committees at hospitals; they have a role in encouraging and
supporting their fellow people living with HIV/AIDS to stick to treatment.
This is the crucial role local communities have played in making AIDS
programs successful [and] this . . . story could be replicated for TB patients.
—Rev. Sanan Wutti, The Church of Christ in Thailand 63
DOTS implementation is decentralized to the district and the subdistrict levels, the lowest units
of management for TB control. District and provincial hospitals offer diagnostic services, and
house TB clinics that register and track the treatment of all patients. The 19 Zonal TB centers
coordinate the activities of the provincial and district hospitals and the subdistrict health
centers and provide technical supervision and drug supplies.
According to NTP guidelines, all TB patients can choose to receive DOT from a
government health care worker, a village health volunteer, or a family member. One major
study found that DOT was most effective when administered by professional health care
workers, but that high turnover rates limited the efficacy and accessibility of this option.
On the other hand, DOT administered by family members frequently deviated from NTP
guidelines, which is reflected in higher levels of noncompliance with treatment. 64 This may
be due to family members’ lack of understanding of the treatment protocol and the complexities
of interpersonal dynamics. 65 However, according to some observers, since district
hospital staff are overburdened, “it’s simply not practical to expect public health officials to
look after patients who have to take drugs for six months.” 66 Moreover, many patients seem
to prefer the family-administered DOT option.
In order to improve treatment success rates, there is an urgent need for more
effective strategies to retain and train professional health care workers and to build capacity
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TB POLICY IN THAILAND