Thailand - Stop TB Partnership

mortality, and HIV/AIDS are highlighted in current poverty reduction schemes, TB is not
mentioned. The government should explicitly acknowledge the linkage between TB and poverty
and the significance of TB control efforts in all of its policies and programs to prevent
and ameliorate poverty.
DOTS expansion
These are policies that we receive from the government, and from the
international community. . . . [T]hey say that people must receive DOT
in every single case . . . [b]ut . . . we can’t do this 100 percent. . . .
We have a nurse to do home visits. [But n]urses have a lot of duties and
many diseases to take care of—so no, they don’t get to everyone. We try to
utilize community workers. . . . But if the TUC [U.S. Centers for Disease
Control Collaboration] doesn’t provide us with financial support, this won’t
necessarily be sustainable.
—Pruthi Israngkul Na Ayudya, director, Health Center 21, Bangkok 55
Prior to national implementation of the DOTS strategy, supervised TB treatment was not
available throughout the country. Though the NTP reported 100 percent DOTS coverage
by 2002, the accessibility and quality of services available varies significantly in practice, as
reflected in variable case detection and treatment success rates among different communities
and regions.
There are indications that the administration of directly observed therapy (DOT)—
an essential component of the DOTS strategy—is not observed strictly in practice. For example,
statistics from the 10th Zonal TB and Chest Disease Center in Chiang Mai indicate that
42.1 percent of patients self-administer treatment. 56 Moreover, though DOTS may be available
in all districts, access appears to be difficult for marginalized groups such as migrant
workers and injection drug users. 57
Some Thai experts also indicate doubts about the comprehensiveness and reliability
of reported data on case detection and treatment success. For instance, the reported
71 percent case detection rate may include non-TB cases such as bacterial pulmonary infection,
and the national treatment success rate of 73 percent masks rates as low as 25 percent
among some vulnerable groups. 58 Perhaps more importantly, the current targets relate to
detection and treatment of active, sputum smear-positive cases only. The WHO, however,
states that the smear-positive test captures only about 44 percent of all those with active TB.
For Thailand, this means that despite fairly positive national progress toward meeting the
detection and treatment success targets, in fact only about 23 percent of those with active
TB are being cured. 59
PUBLIC HEALTH WATCH MONITORING REPORTS 47