Thailand - Stop TB Partnership

MDR-TB
National figures obscure local differences. . . . There are subepidemics by
regions and populations. Many groups are not included in the national
figures. For migrant workers, we don’t do cultures. We just treat them.
—Comment at Public Health Watch roundtable meeting 79
Most TB experts believe that MDR-TB is not a severe problem since the estimated national
prevalence is only 0.9 percent. 80 However, there is considerable concern that significantly
higher rates of drug resistance among vulnerable groups such as prisoners and migrants
could quickly lead to higher rates among the general population as well.
Though the national MDR-TB rate may be low, figures are significantly higher
among certain groups. For example, official MoPH data in 2003 revealed an average MDR
rate of 6 percent in prisons, 81 and one recent study of 154 TB patients in prisons revealed
resistance to any one drug at over 50 percent, and 19.5 percent multidrug resistance. 82
Comparable rates have been recorded among migrants. For example, one study carried out
along the Thai-Burmese border in 2001–2002 estimated an MDR-TB rate of 6.5 percent
among cross-border migrants. 83 Regular surveillance of MDR-TB rates among vulnerable
groups such as prisoners and migrants is critical to identifying areas for which the NTP
should design and implement targeted case-finding and treatment services.
There is no conclusive scientific evidence that MDR-TB and HIV/AIDS are linked.
However, several studies in Thailand based on small samples indicate higher rates of primary
drug resistance among people living with HIV/AIDS. 84 In northern Thailand MDR-
TB prevalence rates as high as 2.7 percent have been recorded among people living with
HIV/AIDS. Another study found a primary MDR-TB rate of 5 to 7 percent among people
living with HIV/AIDS compared to 0.9 percent for the general population. And a national
survey in 1997–1998 found a correlation between the high proportion of drug resistance to
TB treatment among people below age 34 and a high HIV burden for this group. 85 Though
more research may be justified to investigate whether or not a linkage exists, AIDS activists
in particular caution against reliance on these preliminary studies, which could have the
effect of further stigmatizing people living with HIV/AIDS. 86
To help track and treat MDR-TB, the government has recently established the
MDR-TB Network, which has completed a first set of guidelines for treatment. 87 The network,
which also helps with drug susceptibility testing, has a special budget for purchasing
laboratory supplies and second-line drugs to treat MDR-TB, and for training staff to support
implementation of MDR-TB guidelines. 88 However, according to a report by Médecins Sans
Frontières (MSF), the quality of second-line TB drugs produced in Thailand is less than
optimal, and indeed the WHO has not yet judged the drugs to be reliable. 89 The NTP should
PUBLIC HEALTH WATCH MONITORING REPORTS 51