Thailand - Stop TB Partnership

Prison populations
TB prevalence is markedly higher in prisons than in the general population. In one Bangkok
prison, the prevalence of new smear-positive cases was 1,226 per 100,000. 104
In October 1998, the NTP, MoPH, and the Ministry of Justice initiated a collaborative
effort to ensure implementation of the DOTS strategy in 11 prisons in Bangkok and
nearby provinces. 105 This effort, which involved working with prison TB clinical staff to
ensure close adherence to the DOTS strategy, 106 has posted a high treatment success rate
(68.7 percent from June 1999 to May 2002), and has been cited by the WHO as a model
for other countries. 107 The NTP’s successful prison outreach project should be expanded to
improve the system for follow-up with people after they have been released from prison.
According to one official, the biggest challenge to the success of the prison program
is the follow-up with people after they are released from prison. 108 The system for
transferring cases from prison clinics to public clinics is inefficient. Treatment for people
newly released is more likely to be interrupted or even discontinued, especially as many former
prisoners reportedly fail to show up at the hospitals to which they are directed, provide
false contact names and addresses, or just disappear. 109 NTP research on the reasons people
released from prison discontinue treatment should be used to develop a more streamlined
policy to ensure proper referral and follow-up. 110
TB and poverty
There is abundant evidence that poverty increases vulnerability to TB, and that having TB
can in turn make patients more vulnerable to poverty. According to a recent study, for those
with incomes at or below the poverty line, out-of-pocket expenditure for diagnosis and treatment
amounted to more than 15 percent of annual household income while incomes were
reduced by an average of 5 percent. 111 While TB treatment is free, travel to medical facilities,
lack of compensation for time off from work, purchase of food during hospital visits, and
diagnostic services such as x-rays and sputum examinations (for which patients are often
charged, despite official NTP policy) add up to expenses that may limit access to treatment
for the poor. (According to official NTP policy, patients have to pay for diagnostic and examination
services only if they can afford it.)
Some regional clinics reportedly provide subsidies to TB patients living in poverty,
but the funds available for these efforts have been gradually decreasing since the health care
reforms were enacted. 112 To increase treatment access for the poor, the government should
consider providing subsidized support on the basis of need to cover incidental expenses
such as transportation costs and meals.
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TB POLICY IN THAILAND