Presentation European Parliament Forum 2011

Welcome to TB/HIV Research Foundation (THRF), Chiang Rai, Rai Thailand Local Wisdom‌Global Knowledge

The visit of the delegates from the European Parliamentary Forum on Population and Development (EPF) and the International Advocacy Officer to THRF - 29 January 2011 Thailand.

Acknowledgement • The Research Institute of Tuberculosis, Anti( ) Tuberculosis Association (RIT/JATA) •Double barred cross seal donation of Japan • Japan Foundation for AIDS Prevention (JFAP) • Stop TB Partnership (CFCS grant) • The Th Mitsubishi Mit bi hi Foundation F d ti

10/11/2011

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Presentation outline - Knowing THRF - Knowing TB and TB/HIV - Knowing Chiang Rai and situations of TB and TB/HIV in g Rai Chiang - Challenges and opportunities for control TB and TB/HIV in Chiang Rai - Empowering community and people with TB and TB/HIV * Patient volunteers": The important human resource for TB/HIV care * Center for Sharing: Mobilizing women volunteers to support poor patients

- Comments,, recommendation and commitments from the delegates.

Knowing TB and TB/HIV

TB…one of the oldest di diseases (>4,000 (>4 000 years))

In the old days TB was the th di disease off VIP

Chopin, Pianist, composer Emperor Akihito Japan Nelson Mandela, former-president, South Africa

22 countries t i with high TB burden in the world.

(WHO, 2009)

1. India 2 - China 3.Indonesia 4 - Nigeria 5 - South Africa 6 - Bangladesh 7 - Ethiopia 8 - Pakistan 9.Philippines 10 - Democratic Republic of Congo 11 - Russian Federation 12 - Viet Nam 13 - Kenya y 14 - Brazil 15 - United Republic of Tanzania 16. Uganda 17 - Zimbabwe 18.Thailand 19 - Mozambique 20 M 20.Myanmar 21 - Cambodia 22 - Afghanistan

TB is transmitted by the tuberculosis patients who d nott receive do i treatment t t t (when coughing, sneezing, spitting, speaking)

1 untreated TB case will infect approximately 10-15 10 15 people every year (an untreated TB patients who have drug drug-resistant strain will also transmit the resistant resistant-strain to others)

A TB patient who does not receive TB treatment

The best way y to prevent TB transmission is to cure TB patients

TB/HIV Research Project(RIT Project(RIT-JATA)

The Travelling of TB Germs‌ TB without border

TB/HIV Research Project (RIT-JATA)

TB is curable by using 4 drugs f 6-8 for 6 8 months th http://www.textbookofbacteriology.net/tuberculosis p gy _3.html

isoniazid,

rifampicin, p

py pyrazinamide,

ethambutol.

Why y TB/HIV? • HIV is the most powerful known risk factor for reactivating latent TB infections into TB diseases • TB is the leading cause of death in PLHIV

Not TB infected

Latent TB infection

Active TB (disease)

HIV infection (70 - 113 ti times risk) i k)

Knowing Chiang Rai and situations of TB and TB/HIV

• Population ~ 67 million (2010) • Living with HIV ~ 610,000(2007) • HIV adult prevalence 1.4%(2007) • TB cases ~ 55,000 (2007) • TB incidence ~ 142/100,000 142/100 000 • ranked 18th of the 22 high burden countries (WHO 2010) Map of Thailand 10/11/2011

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China Vietnam

Chiang Rai Province •Migrants from Myanmar and Laos

Chiangg Rai Golden--Triangle Golden Bangkok Cambodia

•Hill Hill--tribe population : 13% 13%

• Population ~ ~1 1.3 millions • Areas 11 11,,678 sq.kms. q (~30 (~ 30% % mountain/forest) • 18 Districts

Population ~ 1.3 million Living with HIV 9922 TB notification tifi ti rate t 144/100,000 144/100 000 population l ti 2500

HIV positive in TB patients 46% in 1998 2000 1500 1000 500

46%

0

HIV positive 10/11/2011 TB/HIV Research Project (RIT(RIT-JATA)

HIV negative

HIV unknown 16

Number of reported TB cases among Th i hilltribes Thai, hillt ib and d migrants i t in i 2000-2009 2000 2009

Percentage of Thai, hilltribes and migrants TB patients ti t who h died di d during d i TB treatment t t t in i 2000-2009 2000 2009

Percentage of Thai, hilltribes and migrants TB patients who dropped pp out from TB treatment more than 2 moths in 2000-2009

Number of reported TB cases among male, f female l adults d lt and d children hild in i 2000-2009 2000 2009

Number of reported among children TB cases in 2000 2009 2000-2009

Percentage of male adult, female adult TB patients who dropped out from TB treatment more than 2 moths in 2000-2009 2000 2009

Number of reported TB cases with and without ith t HIV-co HIV i f ti infection in i 2000-2009 2000 2009

Percentage of TB cases with and without HIV-co infection who died during TB treatment in 2000-2009

Percentage of TB cases with and without HIV-co co infection ect o who od dropped opped out from o TB ttreatment eat e t more than 2 moths in 2000-2009

Children who died during TB treatment i Chi in Chiang R Raii

Children TB cases who died during TB treatment in 2000-2009

Characteristics

Children 0-4 years

Children 5-14 years

Died/Total(%)

Died/Total(%)

18/194 ((9.3%))

44/377 ((11.7%))

Girl

8/94 (8.5%)

22/199 (11.1%)

B Boy

10/100 (10%)

22/178 (12.4%) (12 4%)

Thai

7/98 (7.1%)

30/198 (15.2%)

Hilltribe

3/60 (5%)

10/102 (9.8%)

NonThai

8/36 (22.2%)

4/77 (5.2%)

Without HIV-co infection

6/92 (6.5%)

6/156 (3.8%)

With HIV-co infection

9/24 (37.5%)

32/98 (32.7%)

HIV unknown

3/78 (3.8%)

6/123 (4.9%)

Gender

Race

HIV co infection HIV-co

Children TB cases who died during TB treatment in 2000-2009

Characteristics Without HIV-co infection Thai Hilltribe NonThai With HIV-co infection Thai Hilltribe NonThai HIV unknown Thai Hilltribe NonThai

Children 0-4 years Died/Total(%) 18/194 ((9.3%))

Children 5-14 years Died/Total(%) 44/377 ((11.7%))

0/40 (0%) 1/32 (3.1%) (3 1%) 5/20 (25%)

1/62 (1.6%) 3/48 (6.3%) (6 3%) 2/46 (4.3%)

7/17 (41.2%) 1/2 (50%) 1/5 ((20%))

27/80 (33.8%) 4/7 (57.1%) 1/11 ((9.1%))

0/41 (0%) 1/26 (3.8%) (3 8%) 2/11 (18.2%)

2/56 (3.6%) 3/47 (6.4%) (6 4%) 1/20 (5%)