TB/HIV Treatment for Migrants

TB/HIV TREATMENT FOR MIGRANTS Aug 23, 2013

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CONTENT OUTLINE • • • • • •

Background of project Project phase I (DFID 2010-2012) Activities Issues identified Results of project phase I Modification in project phase II (DFID 2013-2015) Progress in phase II Summary of MDR TB activity Conclusion 2

BACKGROUND • Started in Oct 2009 when MSF-F closed the mission • Target population: migrants and displaced population in Tak province • Funded by EU (2011-2014) and DFID Phase II (20132015) • Implementing partners: SMRU, PU-AMI, IOM, 5 Thai Hospitals, Tak PHO

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LOCATION MAP • Many bordercrossing points (30), • Fluid population movement

TAK Province Myawadd y

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POPULATION IN TAK PROVINCE Thai: 605,413 NonThai: ̴ 289,773 Unregistered migrants: ̴ 200,000 Registered: 27,413 Refugees:58,429 Stateless: 3,931

Registered Migrants, 3.07%

Refugees, 6.53%

Unregister ed Migrants, 22.34%

Stateless, 0.44%

Thai, 67.63%

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TB situation in Tak Province 2011

2012

Thai N (%)

Non-Thai N (%)

Total N (%)

Thai N (%)

Non-Thai N (%)

Total N (%)

Muang

115 (92.0)

10 (8.0)

125 (16.3)

112 (98.2)

2 (1.8)

114 (14.9)

Ban Tak

23 (92.0)

2 (8.0)

25 (3.3)

36 (97.3)

1 (2.7)

37 (4.8)

Sam Ngao

23 (100)

0 (0)

23 (2.9)

25 (100)

0 (0)

25(3.3)

Mae Sot

140 (35.9)

250 (64.1)

390 (50.9)

106 (33.0)

215 (67.0)

321 (42.2)

Mae Ramat

31 (68.9)

14 (31.1)

45 (5.8)

33 (76.7)

10 (23.3)

43(5.6)

Thasong yang

27 (61.4)

17 (38.6)

44 (5.7)

45 (69.2)

20 (30.8)

65(8.5)

Phoppra

20 (27.7)

52 (72.3)

72 (9.4)

32 (39.5)

49 (60.5)

81(10.6)

Um phang

4 (9.3)

39 (90.7)

43 (5.7)

9(11.7)

68 (88.3)

77(10.1)

Total

383 (49.9)

384 (50.1)

767(100.0)

398 (52.2)

365 (47.8)

763 (100.0)

Source: Tak PHO presentation in Forum on TB among migrants in Thailand, June 2013 6

PROJECT ACTIVITIES IN PHASE I • Implementation period: 2010- 2012 by DFID grant

• Passive case finding through SMRU polyclinics, malaria field sites and referral from others (mainly Ko Ko Hospital, MTC ) • Diagnosis of TB by smear microscopy and CXR

• Systematic culture & DST for all sputum positive cases • Provider initiated HIV counselling and testing • Treatment of TB, TB/HIV and MDR TB

• Mixed model of treatment delivery (home-based DOT, Residential DOT in TB centers and SAT) • Therapeutic education and counselling

• Isoniazid Prophylactic therapy for contact children <5 yr 7

ISSUES IDENTIFIED IN PHASE I • • • • • • •

Prolonged diagnostic TAT for MDRTB Low case detection No established referral network mechanism Shortage of space in TB residence High defaulter rate in Thai Hospital High LFU in TB/HIV coinfected Fragmented TB actors

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SMRU PROJECT DATA (2010-2012) 2010

2011

2012

No of evaluated for TB

281

295

271

No diagnosed as TB

63

86

71

No enrolled for treatment

61

82

71

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ENROLLED TB CASES (N=216)

By Sex

By Type of TB

By Age

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PROPORTION BY TREATMENT LOCATION

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KO KO TB CLINIC AND RESIDENCE

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TREATMENT OUTCOMES SMRU 2010

2011

5 Thai Hospitals 2012

2011

2012

Success

54 (88.5%)

59 (70.2%)

57 (80.3%)

159 (80.3%)

117 (49.6%)

Default

1 (1.6%)

5 (6.0%)

3 (4.3%)

28 (17.6%)

15(6.4%)

Died

2 (3.3%)

9 (10.7%)

5 (7.0%)

7 (3.5%)

6 (2.5%)

Failure

2 (3.3%)

2 (2.4%)

1 (1.4%)

2 (1.1%)

1 (0.4%)

Treatment adapted

0 (0%)

2 (2.4%)

0 (0%)

0 (0%)

0 (0%)

Transfer out

2 (3.3%)

7 (8.3%)

5 (7.0%)

2 (1.1%)

1 (0.4%)

Still on treatment

0 (0%)

0 (0%)

0 (0%)

0 (0%)

96 (40.7%)

Total

61 (100%)

84 (100%)

71 (100%)

198 (100%)

236 (100%)

Reasonable outcomes despite challenges!

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TB&HIV ACTIVITY (SMRU)

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OUTCOMES OF TB/HIV CO-INFECTION 2010

2011

2012

Cum Rate

No of TB/HIV coinfected

7

18

9

34 (100%)

Died before ART

1

4

1

6 (18%)

LFU before ART

0

2

0

2 (6%)

Started on ART

6

11

8

25 (74%)

LFU on ART

3

2

0

5 (20%)

Died on ART

0

4

2

6 (24%)

Still on treatment

3

5

6

14 (60%)

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MODIFICATION IN PROJECT PHASE II • Project period: 2013-2015 by DFID grant • Formation of a consortium of TB actors (SMRU, PUAMI, IOM and Tak PHO) - TTBI • Integrated tACF (HCW, Contacts, HIV infected) • Integrated rapid diagnostic tool – MTB/Rif sys(GeneXpert), operational in April 2013 • Culture and DST for all GeneXpert positive cases • Expansion of TB residence capacity • Closer collaboration with NGOs (mainly with Mae Tao Clinic) 16

EXPANSION OF TB CLINIC & RESIDENCE IN WANGPHA

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PROGRESS DURING PHASE II Jan-June 2013 No screened under tACF activity

263

No of suspects identified under tACF

38

No of TB case detected under tACF

7

No of patients evaluated for TB under PCF

216

No of TB case detected under PCF

58

No of TB cases enrolled for treatment

54

No of presumptive MDR TB cases identified by GeneXpert

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No of patients started on ETR for MDRTB

6

No confirmed as MDR TB by conventional DST

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Uptake of HIV testing (%)

98.2%

HIV positivity rate

12.3%

CPT rate

85.7% 18

SUMMARY OF MDR TB ACTIVITY 2010 â&#x20AC;&#x201C; 2013 (as of June 2013) No cases tested for culture and DST

157

No culture positive cases

146

No of diagnosed MDR TB cases

12

No of MDR TB patients enrolled for treatment

12

No of MDR TB patients successfully finished treatment

4

No of MDR TB patients still on treatment

8

No of PDR TB cases identified

14

No of PDR cases successfully finished treatment

8

No of PDR TB cases on treatment

5

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CONCLUSION • Feasible to treat TB/HIV/MDR TB among this population without causing harm • Expect to increase case detection • Aim to establish cross-border referral network and mechanism • Ultimate goal is to handover the project to NTPs of Myanmar and Thailand

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Thank You!

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