Thailand - Stop TB Partnership

through appropriate, ongoing support and training for family member observers and village
health volunteers. Some community groups assert that the NTP and TB experts should study
the involvement of people living with HIV/AIDS and support groups in the distribution
of antiretroviral drugs as a model for encouraging and involving TB patients (and former
patients) in taking responsibility for their own treatment.
TB/HIV
After initiating efforts to develop a national TB/HIV policy in 1999, the MoPH established
a national TB/HIV coordinating body in 2001, which began implementing a strategy to
increase TB/HIV collaborative services in 2004. Critics contend that the strategy is still
incomplete; that health workers have not been trained or resourced to implement it; that
“integrating” TB and HIV has often meant that the NTP is subsumed within the more
powerful and better resourced National AIDS Control Programme; and that there is an
urgent and unfulfilled need for better coordination between TB and HIV/AIDS services at
the field level.
The 2004 strategy stipulates that HIV/AIDS programs should include TB counseling
and screening services; TB treatment should be provided to all HIV patients with active
TB; and efforts should be made to identify latent TB cases, particularly among people living
with HIV/AIDS, and to provide prophylactic treatment. 67 The content of the strategy, with
its emphasis on provision of TB services to people living with HIV/AIDS, perhaps reflects
the effectiveness of advocacy efforts by HIV/AIDS NGOs. There are almost 900 groups
for people living with HIV/AIDS nationwide, and the network has been vocal, active, and
successful in obtaining nearly universal access to ARVs for people with HIV. 68 This strategy
should be developed further to facilitate early detection of HIV, free HIV testing, and
routine CD4-count testing among TB patients as well. Recent population-based surveillance
indicates that 90 percent of TB patients have compromised CD4 counts (below 200). The
death rate for HIV-infected TB patients is 20–30 percent, and ARV therapy provided during
TB treatment can reduce the relative risk of death by 90 percent. 69
As implementation of the national TB/HIV strategy began relatively recently, reliable
data on its results and impact are not yet available. However, a number of challenges
have become immediately apparent. Health workers are not well informed about or trained
on how to put the policy into operation. According to one TB doctor, TB clinical workers have
not been trained on how to conduct HIV counseling and testing, while HIV clinical workers
have little experience with TB. 70 Particularly in the northern region, health officials contend
that the lack of integrated services and the difficulties in diagnosing TB among people living
with HIV/AIDS have led to a drop in treatment success rates and rising mortality rates
PUBLIC HEALTH WATCH MONITORING REPORTS 49