Thailand - Stop TB Partnership

among people living with HIV/AIDS. 71 The interaction between TB drugs and ARVs is not
well understood among health practitioners, and the National AIDS Control Programme
is not always well equipped to cope with the needs of people living with HIV/AIDS who
become ill with TB. 72 Finally, people with HIV may be more likely to delay seeking TB
treatment, 73 underscoring the importance of outreach and active TB case-finding services at
HIV/AIDS treatment centers.
Some TB experts have asserted that the integration of TB and HIV/AIDS programs
happened too quickly, resulting in the dominance of the National AIDS Control Programme
over the NTP and the downgrading of TB services. For example, the director of one zonal
TB center has insisted that both programs must be independently effective for integration
to be mutually beneficial. In his view, an effective TB policy requires the employment of
specialized TB staff, and a “second health reform” is needed to reinstate an independent TB
division to prepare for more effective integration of services at the field level. 74
For community-based groups and NGOs that work at the field level, the integration
of services may seem logical because patients with both diseases have a clear continuum of
needs. 75 The NTP and National AIDS Control Programme should reexamine the infrastructure
of integration to ensure that proper support is provided to public health clinics and
HIV/AIDS community organizations for addition of TB care to their existing line of services
and to TB clinics for HIV counseling, testing, and referral services.
Isoniazid preventive therapy
One recent research study conducted in the northern provinces confirmed that isoniazid
preventive therapy (IPT) provides significant protection against TB infection among people
living with HIV/AIDS. Of the 412 people living with HIV/AIDS enrolled in the study, 50.5
percent persisted with IPT for nine months and showed no signs or symptoms of active TB
based on physical examination, chest radiography, and sputum examination; 12.9 percent
died; 33 percent defaulted; 2.2 percent developed active TB and dropped out; 0.5 percent
developed hepatitis; and 1 percent migrated to other provinces. 76
Health care providers, however, are still debating the efficacy of IPT. Some point out
that the effectiveness of IPT may wear off in about two years, 77 and express concerns about
drug toxicity and resistance developing as a result of prolonged IPT treatment. Because of
these concerns, and in the absence of clear national policy guidelines, many Thai physicians
do not recommend IPT, and Thai health clinics do not offer it systematically. 78 The NTP and
National AIDS Control Programme should consider developing national guidelines and
training on when and how to use IPT treatment.
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TB POLICY IN THAILAND