Forum on international migration and health in Thailand: status and

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Forum on international migration and health in Thailand: status and
Forum on international migration and health in Thailand: status and challenges to controlling TB Bangkok, 4‐6 June 2013 1 ACRONYMS AEC ART ASEAN CCSDPT DHO DOT DOTS EPTB HIV IEC IDC IO IOM M+/M‐ MDG MDR‐TB MoH/MoPH MoU NGO NTP PHO PU‐AMI RTG TB TB‐RAM TTBI WHO ASEAN Economic Community
Antiretroviral Treatment Association of Southeast Asian Nations Committee for Coordination of Services to Displaced Persons in Thailand District Health Office
Directly Observed Treatment The basic package that underpins the Stop TB Strategy Extra Pulmonary Tuberculosis Human Immunodeficiency Virus
Information, Education and Communication Immigration Detention Center International Organization International Organization for Migration
Smear positive/smear negative Millennium Development Goal Multidrug‐resistant Tuberculosis (resistance to, at least, isoniazid and rifampicin) Ministry of Health/Ministry of Public Health
Memorandum of Understanding Non‐governmental organization National TB Control Program Provincial Health Office
Premier Urgence‐Aide Medicale Internationale
Royal Thai Government Tuberculosis TB Reduction Among non‐Thai Migrants
Tak TB Border Initiative Project
World Health Organization Acknowledgements The forum was funded with support from the European Union, WHO, and the US Centers for Disease Control. Staff from WHO/Thailand and the Bureau of TB provided highly efficient administrative support. Grateful thanks to all participants for their active inputs, and especially to presenters, chairs, group facilitators and rapporteurs; and to Dr. Virginia Macdonald, overall rapporteur. 2 Executive Summary WHO Thailand and the Bureau of Tuberculosis (BTB) of the Royal Thai Government’s Ministry of Public Health (MoPH) collaborated to organize a forum from 4‐6 June 2013 in Bangkok to address key issues surrounding the challenges of controlling TB among migrants in Thailand. The objective was to provide a systematic overview of relevant epidemiology and to examine control efforts from both patient centered and public health systems approaches. The 114 meeting participants (representing the Thai government at the national, regional, and provincial levels ; TB programs from Cambodia, Lao PDR and Myanmar; TB clinicians; non‐governmental organizations; international organizations; and donors), provided updates on their efforts and developed key recommendations for further action. In 2011, there were an estimated 110,000 ongoing TB cases and 86,000 new TB cases in Thailand, yielding an estimated prevalence rate of 161/100,000 and an incidence rate of 124/100,000 (see table 2). However, preliminary results (excluding Bangkok) from the 2012 Thailand National TB Prevalence Study indicate that the national prevalence of TB may be higher than these estimates. Still, the prevalence in Thailand is considerably lower than the latest available estimated prevalence rates for Cambodia (817/100,000), Myanmar (506/100,000), and Lao PDR (570/100,000), which are all considered high burden countries in the world. Additionally, available evidence presented at the forum indicates that TB prevalence in provinces bordering Thailand for all these three countries is generally above their respective national averages. This epidemiologic situation has direct implications for Thailand due to the large number (estimated at 2+ million) migrants from these surrounding countries who have crossed the border to live and work in Thailand. Surveillance gaps may lead to under‐reporting of TB among the non‐Thai population, but data available at the national level indicates a total of 2268 TB cases of all types were reported among this group in Thailand in 2011. The estimated range of new TB cases with MDR‐TB for non‐Thais is 1‐
4% compared to the latest drug resistance survey among Thai patients which indicates that national average was 1.9% in 2011. Provincial level epidemiologic data provided by four provinces (Tak, Kanchanaburi, Samut Sakhon, and Sa Kaeo) showed that newly reported M+ TB cases among the Thai population were lower than the estimated national incidence rate for all provinces. The overall incidence rates for migrants could not be determined due to lack of denominator data; however, health screening in Samut Sakorn in 2011 showed an incidence of 201/100,000 among migrants seeking health insurance. The four provinces reported that the cure rates for the latest cohort of M+ Thai TB patients ranged from 75‐84% compared to 65‐75% for non‐Thai patients. Default rates are consistently higher among non‐Thai TB patients. In addition to TB detection and treatment facilities at provincial hospitals, numerous NGOs and IOs provide services to migrants and special populations in displaced person shelters and detention centers. Identifying TB among migrants primarily relies on passive case detection. Data on migrant TB cases is entered into the Thai national data base; however, obtaining a comprehensive national assessment of TB among migrants through routine surveillance or even prevalence surveys remains a challenge. Funding to support TB drugs for both first and second line treatments for migrants is available through Global Fund support. However, providing DOTS for mobile populations remains particularly problematic. Follow‐up and referral mechanisms are a key challenge, particularly for undocumented migrants or those who cross the border into Thailand seeking medical care. 3 Extensive services for TB control are available in displaced person camps but providers in these settings can have additional challenges in sustaining care and linking to other national program efforts. There is only limited information available about health services available in detention centers. There was a common underlying conclusion that the key barrier to controlling TB among migrants is their limited access to health services due to relatively poor socio‐economic status, lack of health insurance, high mobility, language barriers, and real or perceived stigma and discrimination. Beyond addressing core systemic gaps in providing health services to migrants, key recommendations for strengthening TB control among migrants include: expand active case detection among migrant populations, develop a common cross‐border referral mechanism‐‐ including multi‐language referral forms and patient ID cards, provide HIV testing for all confirmed TB cases, and ensure relevant guidelines for migrants’ treatment are widely distributed to PHOs and hospitals and well understood by their program staff responsible for TB. All four countries represented agreed on the need to expand cross border collaboration and to develop a multi‐
country funding proposal (possibly to the Global Fund) to address gaps in the response to TB control and treatment among migrants. 4 Forum on international migration and health in Thailand: status and challenges to controlling TB With financial support from the European Union, WHO, and the US CDC, WHO Thailand and the Bureau of Tuberculosis (BTB) of the Royal Thai Government’s Ministry of Public Health collaborated to organize a forum from 4‐6 June 2013 in Bangkok to address key issues surrounding the challenges of controlling TB among migrants in Thailand. The forum was designed to follow‐up the status of implementation of the 2009 recommendations made by the Strategy and Planning Cluster of the BTB to address this same concern and to provide input on the condition of TB among migrants to the Thai National TB Programme review being conducted by a Joint Monitoring Mission in August 2013. Discussions were put in the context of Thailand’s Border Health Development Master Plan and the increasing focus on border and migrant issues in the Greater Mekong Sub‐region (GMS)1. There were 114 meeting participants representing the Thai government from the national level, 5 regional offices, and 12 provincial health offices and hospitals; national TB programs from Cambodia, Lao PDR, and Myanmar; TB clinicians and private hospitals; non‐governmental organizations; international organizations; donors; and other stakeholders. (See Annex 2 for complete list of participants.) Objectives 1. To raise awareness among key stakeholders and public health policy makers about the challenges and importance of addressing infectious diseases among border and migrant populations; 2. To provide an update on the status of TB in Thailand, including epidemiology, current national programme implementation, and technical guidelines; 3. To learn about specific challenges of combating TB in border areas of Myanmar, Cambodia, and Lao PDR, and provide an opportunity for establishing a process of collaboration for cross‐border activities; 4. To provide a systematic overview, identify gaps, and recommend priority actions for the current programs directed to diagnosing and treating TB among border and migrant populations (e.g. health systems approach), and, 5. To provide an opportunity to raise and address technical questions, exchange ideas, and develop new approaches to address the challenges of diagnosing and treating TB patients among border and migrant populations (e.g. patient centered approach) 1
The Greater Mekong Sub‐region includes Myanmar, Thailand, Cambodia, Lao PDR, Vietnam, and the Yunnan province of the Republic of China. This forum concentrated on the issues of migrants in Thailand and contiguous countries. 5 Format (See Annex 3 for complete agenda) The forum provided a global and regional update on migration and TB issues to provide a context for the overlap between these two subject areas. Representatives from Thailand, Myanmar, Cambodia, and Lao PDR summarized the current status of their national TB programs with a focus on migrant specific data. Because circumstances and required diagnostic and treatment approaches may differ among migrant sub‐groups, working groups discussed three separate migrant population categories: 1) labor migrants—both documented and undocumented; 2) cross‐border migrants; and 3) special settings—including displaced persons in temporary shelters, those seeking re‐settlement, and migrants in detention centers. For each population category, participants reviewed a) specific diagnostic and treatment requirements; and b) the health system impact and requirements for addressing TB. The framework for the health system discussion followed the 2010 WHO/IOM Global Consultation on the Health of Migrants recommended priority action areas: a. monitoring migrant health, b. policy and legal frameworks, c. migrant sensitive health systems, and d. partnerships, networks, and multi‐country frameworks2. Context Global and regional tuberculosis situation Globally, there has been significant progress in tuberculosis (TB) control and treatment. The Millennium Development Goal (MDG) to halt and reverse the TB epidemic by 2015 has already been achieved, with a decrease in new cases of TB over several years and also decreasing TB mortality. However, TB still affects great numbers of people: in 2011 there were an estimated 8.7 million incident cases of TB (the majority of these occurring in Asia) and 1.4 million people died of TB3. Over 1 million (or 13%) of incident TB cases were HIV positive. While the prevalence rate has fallen by 36% globally since 1990, there were still an estimated 12 million people around the world living with TB in 20114. In 2011 National TB control programs (NTPs) were notified of 5.8 million newly diagnosed cases of TB or only about two thirds of the estimated total incident cases. The global treatment success rate among newly diagnosed cases was 85%5; however, there were an estimated 310,000 cases of multi‐
drug resistant TB (MDR‐TB) among notified TB cases. Progress in responding to MDR‐TB remains slow6. The Global Stop TB Strategy is the World Health Organization’s (WHO’s) currently recommended approach to TB control and treatment with a goal to dramatically reduce the global burden of TB by 2015. The strategies advocated for include:  Pursue high‐quality DOTS7 expansion and enhancement;  Address TB‐HIV, MDR‐TB, and the needs of poor and vulnerable populations;  Contribute to health system strengthening based on primary health care;  Engage all care providers; 2
WHO/IOM. Health of Migrants—the Way Forward. Report of a global consultation, Madrid, Spain, 3‐5 March 2010. 3
Global Tuberculosis Report 2012 (2012) World Health Organisation 4
Ibid 5
Ibid 6
Ibid 7
Directly Observed Treatment, the basic package that underpins the Stop TB Strategy 6 

Empower people with TB, and communities through partnership, and, Enable and promote research. In terms of TB incidence, the South East Asian region accounts for 40% of the global burden of TB and India and China together account for 40% of the world’s TB cases8. There were an estimated 3.5 million incident TB cases and a prevalence of 5 million in South‐East Asia in 2011. Excluding those with HIV‐TB, an estimated 480,000 people died of TB in South‐East Asia in 2012, most of these in Bangladesh, India, Indonesia, Thailand and Myanmar9 In South‐East Asia in 2011 32% of TB patients had known HIV status, among them 7.2% were found to be HIV positive and 59% of HIV‐positive TB cases were on antiretroviral therapy (ART)10. Levels of MDR‐TB among newly diagnosed TB patients are still low at 3%11. All countries in the region have sustained country‐wide access to DOTS and treatment success has remained above 85% since 200512. Migration in the Greater Mekong Sub‐region (GMS) Internal and international migration is unprecedented throughout Asia, and, as in most parts of the world, will likely grow. Factors stimulating population movement include increasing levels of political and economic cooperation, increasingly free movement across borders and rapid development of the transport sector, leading to new socio‐economic opportunities. In the South East Asian region there is also a high demand for low‐skilled and inexpensive workers in more developed counties. Further, with increasing connectivity, other issues such as human trafficking and transnational crime are additional factors that need to be effectively managed. The ASEAN Economic Community (AEC) is the goal of Asian regional economic integration by 2015. As stated by ASEAN, AEC is expected to “transform ASEAN into a region with free movement of goods, services, investment, skilled labor and freer flow of capital”13. The result of AEC will be more movement across borders into Thailand and has potentially far‐reaching implications for the control of TB in border areas and the rest of Thailand. Governments in South East Asia are facing the challenge of integrating the health needs of migrants into national plans, policies and strategies taking into account the human rights of these individuals, including their right to health. Not doing so creates marginalized groups in society, is an infringement of human rights and constitutes poor public health practice. Income disparities in the region have provided incentives for migrants to find work in Thailand to the extent that Thailand is now considered one of the top destination countries for migrants in Asia. Economic development in Thailand has attracted foreign investors to the manufacturing sectors that employ both highly skilled and low‐skilled migrant workers. Myanmar, Cambodia and Lao PDR are the biggest groups of migrants in Thailand; at least 70% of migrants in Thailand are from Myanmar (see Table 1). The majority of migrants enter Thailand voluntarily but many lack full documentation which increases the risk for trafficking, labor exploitation, and health vulnerabilities. 8
Tuberculosis Control in South East Asia Region: Annual TB report 2013 (2013) WHO South‐East Asian Region Office (SEARO) 9
Global Tuberculosis Report 2012 (2012) World Health Organisation 10
Tuberculosis Control in South East Asia Region: Annual TB report 2013 (2013) WHO South‐East Asian Region Office (SEARO) 11
Ibid 12
Ibid 13
th
Accessed 24 June 2013 www.asean.org/communities/asean‐economic‐community 7 Table 1. Migrants in Thailand, 2011 Country of origin Population Data on Migrants in Thailand Most common occupation of migrants in Thailand Cambodia 181,579 documented, 80,000 undocumented migrants Fisherman, agriculture, mill workers, construction workers, low cost laborers Lao PDR Estimated 181,614 documented, 80,000 Truck drivers, factory workers, undocumented (no reliable statistics) agriculture workers, construction workers, sex workers, domestic workers and livestock workers. Myanmar 1.5 million documented migrants, 70% Factory workers, sex workers, of total migrant population in Thailand. fisherman and seafood processers, farm workers and domestic workers. 140,000 displaced persons in 9 temporary shelters along Myanmar border Source: Ministry of Labour, 2011 Policy context: TB and Migration in Thailand and the Region In 2009, the Strategy and Planning Cluster of the Thailand Bureau of TB convened a meeting of key stakeholders to review the status of TB among migrant in Thailand and to propose strategic areas for TB control programs aimed at this vulnerable population14. The meeting had the following recommendations for controlling of TB in migrants and in border areas: • Improve case detection/treatment; • Develop short, medium, and long term management plans; • Establish coordination among Mekong countries on trans‐nation TB control and MDR‐TB; • Cleary determine the roles of key actors on TB control at local level; • Improve monitoring and reporting; • Develop policy at central and provincial level; • Increase training, particularly for directly observed treatment (DOT) “watchers” The RTG MoPH has made comprehensive efforts to address the public health needs specific to border and migrant populations. Broad policies to address migrants’ health, including health insurance schemes to cover financing of these services, have been drafted. Other efforts have targeted the particular health requirements of populations in border areas. In August 2011, the Minister of Public Health released the Border Health Development Master Plan for 2012 to 2016 15 which proposed four key strategies: • Develop a quality health service system; • Promote access to basic health services; • Strengthen collaboration and participation in all sectors, and, • Provide an effective administrative system 14
See Ministry of Labour, 2011 Bureau of Policy and Strategy, RTG MoPH. Border Health Development Master Plan 2012‐2016. August 2011. 15
8 On a regional level, WHO’s Western Pacific Regional Office (WPRO) has collaborated with multiple national TB programs and stakeholders to draft broad guidelines‐‐ Tuberculosis Control in Migrant Populations: Guiding Principles and Proposed Actions. Although initially developed for countries in the Western Pacific region, the document has applicability for Thailand and the GMS in general. Update on TB epidemiology and programs in Thailand and border countries The selected TB indicators for Thailand, Cambodia, Lao PDR and Myanmar shown in Table 2 clearly show disparity of TB prevalence among these countries, with TB prevalence higher in all the bordering countries than it is in Thailand. As described above there is ever increasing and fluid migration into Thailand from these countries, highlighting the importance of addressing TB control and treatment in migrants and in border communities for Thailand’s national response to TB. Table 2. Select TB indicators for Cambodia, Myanmar, Thailand and Lao PDR, 201116 Prevalence rate (includes HIV+TB) * Incidence rate (includes HIV+TB)* Incidence HIV+TB rate * Mortality rate 2011 (excludes HIV/TB)* Cambodia Case detection, all forms, 1000’s (%, 817 424 22 63 64 (690‐954) (364 – 489) (18‐25) (29‐111) (55‐74) Myanmar 506 381 38 (31‐45) 48 (22‐84)
74 (64‐87)
(390‐637) (326‐439) Thailand 161 124 18 14 76 (73‐282) (102‐147) (15‐22) (6.1‐25) (64‐93) Lao PDR 540 213 7.4 11 32 (353‐767) (131‐313) (4.2‐12) (6.9‐17) (22‐52) * Rates per 100,000 population with 95% Confidence Interval Source: Global Tuberculosis Report 2012 (2012), World Health Organization Treatment success rate 2010 (%, new smear +ve &/or culture +ve) 94 86 85 91 % new TB patients with MDR‐TB 1.4 (0.7‐2.5) 4.2 (3.1‐5.6) 1.7 (1.0‐2.6) 4.9 Thailand Thailand is one of 22 “high‐burden” countries as listed in the WHO Global TB report for 2012. There are an estimated 110,000 ongoing TB cases in Thailand and 86,000 new cases in 2011, yielding an estimated prevalence rate of 161/100,000 and an incidence rate of 124/100,000 (see table 2). However, preliminary results (excluding Bangkok) from the 2012 Thailand National TB Prevalence Study indicate that the national prevalence of TB may be higher than previously estimated. Case notification data from the Thai Bureau of TB Control shows little change in the number of notified TB cases in Thailand over the past decade with 58,270 notified TB cases in 2012 of which 30,576 were new smear positive TB cases. However, there has been improvement in the case detection rate up from 56% in 2009 to 76% in 201117. There has also been steady improvement in TB treatment outcomes over the last 12 years, from a treatment success rate of 69% in 2001 to 85% in 2012, mainly because of decreasing numbers of defaulters and treatment failures. Preliminary data from the 4th Surveillance Study of TB Drug Resistance in Thailand (2012) show that the percentage of 16
17
Global Tuberculosis Report 2012 (2012), World Health Organization Ibid 9 new TB cases with MDR‐TB in Thailand in 2011 is low at 1.9%, however, the percentage of retreatment cases with MDR‐TB, at 16.6%, is high. In Thailand DOTS and TB services are available for free at any public hospital for the Thai population under multiple national health insurance schemes. Accessing these services is more problematic for migrants, especially for those who are undocumented and lack insurance. Global Fund support is available to provide TB drugs to all migrants through both government and non‐governmental organization (NGO) programs; however, many migrants are reluctant to present to health facilities for a variety of reasons. Table 3 provides data available at the national level for TB among the non‐Thai population. The ‘non‐Thai’ category primarily includes migrant populations, but may also include some cases among ‘stateless’ populations who have resided in Thailand for generations but do not yet have Thai citizenship. Surveillance gaps may lead to under‐reporting for the non‐Thai population and the lack of denominator data precludes determining prevalence rates. The latest published data on MDR‐TB among new migrant TB cases in one border province was 1‐4%, but more recent national data is sparse18. In any case, given the higher prevalence of TB among countries on its border, Thailand remains concerned about the implications of increased travel and migration that could accompany the initiation of the ASEAN Economic Community in 2015. Table 3. TB among non‐Thai population in Thailand, 2009‐2011 New M+ Relapse New M‐ Fiscal Year 2011 1182 44 789 2010 1028 27
652
2009 933 38
804
Source: Bureau of TB, Ministry of Public Health, Thailand EPTB 253 220
168
Total 2268 1927 1943 Cambodia Cambodia has the highest reported TB prevalence rate (817 per 100,000) and mortality rate (63 per 100,000) in the world19 with a TB incidence rate of 424 per 100,000 for 2012. Even so, Cambodia has successfully reached the 2015 MDG target of halving TB mortality and prevalence rates. The treatment success rate in Cambodia continues to be high in 2011 at 94%20. Five percent of TB patients tested for HIV were HIV positive in 2011 and the majority of these are receiving ART21. The percentage of newly diagnosed TB cases with MDR‐TB was 1.4 in 201122 (see table 2). In collaboration with the International Organization for Migration, the Cambodian Ministry of Public Health initiated active case finding for TB in Banteay Meanchey Province among Cambodia migrants being deported from Thailand. Banteay Meanchey Province is a key crossing point on the Thai‐
Cambodian border for the 71,000 documented and estimated 180,000 undocumented Cambodians migrating into Thailand for work. TB incidence as well as treatment and default rates in the 18
P Hemhongsa, et al. (2008) TB, HIV‐associated TB and multidrug‐resistant TB on Thailand’s border with Myanmar, 2006‐2007. Tropical Medicine and International Health. 13, 1288‐1296 19
Global Tuberculosis Report 2012 (2012) World Health Organisation 20
Ibid 21
Ibid 22
Ibid 10 province are higher than the national average. From 1 February 2012 to 30 January 2013, the project screened 6,680 Cambodian migrants upon deportation and detected 127 TB cases by Gene Xpert. The estimated prevalence rate among this migrant population was 1,150/100,000—slightly above the already high national rate. Figure 2 shows the wide age range and gender balance among the deportees detected with TB. Figure 1. Age and sex of Cambodian migrants deported from Thailand detected with MTB by GeneXpert, February 2012 until Jan 2013, (n = 126) Source: IOM‐TB Reach Program, Cambodia, 2013 11 Lao PDR In 2011 the TB prevalence rate in Lao PDR was 540 per 100,000 and incidence rate (for new and relapse cases of TB) was 213 per 100,00023. There was a low case detection rate of 32% in 201124. The treatment success rate in 2011 was 82%25. MDR‐TB rates in 2011 were 4.9% among TB patients never treated before and 23% among previously treated26. Although there is high coverage of DOTS in the community and at health centres in Lao PDR, there is still low access to TB care due to a lack of TB awareness, remoteness, costs of transportation and limited medical insurance. There is also limited capacity (human resource and equipment) for diagnosis and care of TB in peripheral health system. Seven of the 12 provinces bordering Thailand reported higher than the national average for notification of new smear position patients in 2012. (See Table 4) CROSS BORDER COLLABORATION BETWEEN LAO PDR AND THAILAND Collaboration for TB control between TB programmes in Vientiane Capital in Lao PDR and Nong Khai in Thailand started in 2006. This specific collaboration for TB control and treatment (under a memorandum of understanding for communicable diseases) works within the public hospital system in both countries and consists of regular exchange of information on registered TB patients from both sides with quarterly meetings held in either Nong Khai or Vientiane. Hospitals are able to follow‐up patients (by phone) as per the agreement between the hospitals. This is useful particularly if the patient is absent or late for treatment. Lao patients have to pay for TB drugs in Thai private clinics and public hospitals and often revert to Lao NTP due to resources limitations. The agreement also allows referral and transfer of TB patients from the Thai NTP to hospitals in Lao PDR. 23
Global Tuberculosis Report 2012 (2012) World Health Organisation Ibid 25
Ibid 26
Lao PDR Ministry of Health 24
12 Table 4. Notification of new smear + TB cases per 100,000 population, by province, Lao PDR, 2006‐2012
Province on the border with Thailand Source: Lao PDR National TB Center Myanmar Myanmar is one of 22 high burden countries as described in the WHO’s 2012 Global TB Report. The TB prevalence (including HIV+TB) in 2011 was 506 per 100,000 population; this has decreased over the last decade. However, the incidence rate has remained steady over the last five years (2011—
381 per 100,000 population). The treatment success rate was 86% in 2010 and the mortality rate in 2011 was 48 per 100,000 population (see table 2)27. In 2012, 147,984 new TB cases were notified to the NTP in Myanmar and 4% of these were in the 16 townships bordering Thailand. While the number of cases in border townships represents only a small proportion of the total national TB cases, the prevalence of TB in the key townships with border crossing points is higher than the national average. Figure 2 shows consistently higher case notifications rates for new smear positive TB cases in Tachileik—bordering Chiang Rai Province in Thailand, Myawaddy—bordering Tak Province, and Kawthaung—bordering Ranong Province, than for the country as a whole. 27
Ibid 13 In 2012, treatment success rates for these townships averaged only 80% compared to the national average of 87%. However, there are special efforts being made to strengthen programme efforts at the border areas, including quarterly evaluation meeting for improvement of case finding and case holding, health talks at rural health centers to increase community awareness, annual border health committee meeting. Figure 2 – Case Notification Rate for New Smear Positive TB cases in Myawady, Kawthaung, and Tachileik Townships vs. National average, 2008‐2012. Source: MoH Myanmar Update on migrant TB programs in border areas in Thailand Presentations from both government and NGOs provided updated epidemiologic data on TB among migrants in different provinces of Thailand and demonstrated programming strategies for, and common challenges in, addressing TB control and treatment in different migrant groups. (See Figure 3 for location of providers who presented at the forum). Provincial level epidemiologic data was provided by four provinces (Tak, Kanchanburi, Samut Sakhon, and Sa Kaeo. Newly reported M+ TB cases among the Thai population were lower than the estimated national incidence rate for all provinces. The overall incidence rates for migrants could not be determined due to lack of denominator data; however, health screening in Samut Sakorn in 2011 showed an incidence of 201/100,000 among migrants seeking health insurance. Cure rates for the latest cohort of M+ Thai TB patients ranged from 75‐84% compared to 65‐75% for non‐Thai patients. Default rates were consistently higher among non‐Thai TB patients. (More complete epidemiologic data by province is shown in Annex 1). Programmatic updates were presented according to several migrant categories. For the purpose of this meeting, types of migrants in Thailand were categorized as: 14 Labour migrants: Persons (and dependents) who cross an international border to seek work for more than 6 months. This includes both documented and undocumented migrants. • Causal cross‐border migrants: Persons (and dependents) who cross an international border for a limited period of time (less than 6 months) to seek work, obtain health care, visit relatives, etc. • Special settings: Persons residing in displaced person temporary shelters or in detention centers (regardless of length of stay). These categories are not inclusive of all international migrants; others include tourists, students and retirees; and some migrants may float between the groups at different times. Differentiation of migrant classifications may help identify specific targeted programme approaches for controlling TB. Yet, presentations from both government and NGOs demonstrated a high degree of overlap between programmes for labour and causal cross‐border migrants. Nevertheless, there do appear to be specific issues relevant for irregular or undocumented migrants due to their relative lack of access to health care services. Activities in special settings still appear to require more targeted interventions. TB programmes for labor and casual cross border migrants •
Tak Provincial Health Office ‐ Tak province in Thailand shares a long border with Myanmar. The Provincial Health Office (PHO) in Tak estimates that there are around 27,000 registered and more than 200,000 undocumented migrants from Myanmar working in Tak. The following joint activities are planned between Tak and Myawaddy township in Myanmar: sharing of disease surveillance information; Mae Sot hospital in Tak will support TB sputum culture tests coming from Myawaddy with diagnosis provided within 24 hours, and collaboration on TB outbreak control. There is a one‐
stop TB clinic service available at all public hospitals in Tak province and DOT is provided with the majority of observers being family members. Sputum culture tests and TB detection using GeneXpert platform are provided at Mae Sot provincial hospital. Case finding reports from Tak province show that 83.9% of confirmed TB cases among non‐Thai patients are undocumented migrants. They also note a high defaulter rate among non‐Thai patients. TB Reduction Among non‐Thai Migrants (TB‐RAM) project of World Vision Foundation ‐ In response to estimated higher prevalence among non‐Thai migrants than in the Thai population and limited access to health care and TB medicine among this migrant population, World Vision works at four border and adjacent provinces along the Thai‐Myanmar border (Tak, Kanchanaburi, Chumphon, Ranong) as well as Phang Nga and Phuket under the TB Reduction Among non‐Thai Migrants (TB‐
RAM) project. Through collaborative activities and regular meetings with provincial level organisations (PHOs, hospitals and NGOs) TB‐RAM works as an advocate for the health of the non‐
Thai population. They work with migrant health volunteers to provide health information and counselling and use information and education materials developed in Myanmar. They provide TB diagnosis and treatment (DOT), nutrition, transportation and psychosocial support. 15 IOM IOM
Tak PHO World Vision (TB‐RAM) Sa Kaeo PHO Tak TB Border Initiative (TTBI) World Vision (TB‐RAM) Kwai River Christian Hospital Premier Urgence‐Aide Medicale Internationale (PU‐AMI) IOM Kanchanaburi PHO Samut Sakhon PHO World Vision (TB‐RAM) World Vision (TB‐RAM) Figure 3 ‐ Location of services provided by meeting participants
16 Samut Sakhon Provincial Health Office Samut Sakhon province is located in the central part of Thailand and only 30km from Bangkok. Of an estimated total population of 722,152 in Samut Sakhon, 213,340 (30%) are migrants. Most (97%) of migrants are from Myanmar, Lao PDR and Cambodia. Although 155,599 migrants enrolled in the MOPH Compulsory Migrant Health Insurance Scheme (CMHIS) in 2009, the number sharply dropped to only 19,429 in 2012. The latest data from 2011 found 284 TB cases among 134,860 migrants screened for work permits (incidence of 210/100,000). Tak TB Border Initiative Project (TTBI) The Tak TB Border Initiative Project (TTBI) aims to improve migrant health in Tak province, on the Thai/Myanmar border. It is a consortium of NGO, UN and government partners responding to a fragmented a TB control program, ooverloaded Thai Hospitals, lless attention given to TB in the casual cross border migrant population and difficult terrain to access to the TB program in Myawaddy in Myanmar. They work in 5 sites on the Thai side of the border and at the time of the forum had been operating for 5 months. TTBI works to improve case finding activities and diagnostic capacity of both TB and MDR‐TB through introduction of the GeneXpert system and systematic culture and drug susceptibility testing for all GeneXpert positive cases. They also provide treatment for TB and TB/HIV co‐
infection and MDR‐TB through community and home‐based DOTS and operate a residential TB treatment centre. ACTIVE CASE FINDING THROUGH DEPORTATION CHANNELS IN CAMBODIA Poipet in Banteay Meanchey province in Cambodia is a major return channel for casual cross border migrants who have travelled to Thailand for work without documentation and subsequently been detained and deported by Thai immigration authorities. About 98,000 casual cross border migrants are deported through Cambodian Border Immigration Centre each year. For many, a period of stay in a detention center will increase their risk of TB exposure due to crowded conditions. The IOM TB‐REACH project, in partnership with the Cambodian NTP, provincial health and immigration authorities, targets migrants returning to Cambodia through the border immigration center. Migrants are separated into two groups based on more than one month (Group A) or less than one month (Group B) detention history. Group A are referred directly to the hospital by the project van. For Group B those that show or indicate any TB symptoms are referred to the hospital by the project van. At the border hospital, all referred migrants receive a detailed TB symptom and chest X‐ray screening using a diagnostic screening ticket. The doctors and radiologists evaluate the screening tickets for eligibility for sputum collection. For Group A eligibility is based on a either a cough more than two weeks or an abnormal chest X‐ray, or both. For Group B eligibility for GeneXpert is only based on the abnormal chest X‐ray indicative of active TB. All migrant TB suspects provide one sputum sample for the GeneXpert MTB/R assay. Actively screening migrants upon return via immigration is an opportunity for early TB detection and treatment initiation and the rapid turnaround time of GeneXpert is appropriate for highly mobile cross‐border migrants 17 Sa Kaeo Provincial Health Office – Sa Kaeo province shares a 165km border with Cambodia. The Sa Kaeo PHO employs both active and passive case finding among Thai and non‐Thai populations. They provide TB treatment via home based care teams and village health volunteers. Registered migrants are eligible for treatment in Thailand, funded either through employers or Global Fund support. For undocumented migrants, the PHO will provide advice and refer patients back to Cambodia for treatment. Kanchanaburi Provincial Health Office ‐ Kanchanaburi province shares a 370km border with Myanmar and is only 130km from Bangkok. Of a population of around 950,000, 11% are migrants. The PHO supervises and monitors all TB control activities and employs both active and passive case finding and screening, particularly in migrant workers in the large factories in the province. They provide education for high risk groups through community health volunteers and TB treatment with home visits to support DOT. Kwai River Christian hospital ‐ The Kwai River Christian hospital operates in Kanchanaburi province on the Thai/Myanmar border and serves poor migrants from Myanmar. They operate a TB house where patients can live for the duration of their treatment with shelter and food. They also provide DOT through mobile health teams and clinics that travel by motorbike or boat where necessary to reach patients. They have extended their DOTS programme into Myanmar and also employ health workers in neighbouring Myanmar towns. TB programmes in special settings Premier Urgence‐Aide Medicale Internationale (PU‐AMI) ‐ PU‐AMI operates at three temporary shelters which house displaced people in Tak province (Mae La, Umpiem Mai and Nu Po). After initially conducting passive case finding in the camps, in 2013 PU‐AMI has expanded to conduct active case finding in each shelter. TB treatment is provided at Mae La camp and those in Umpiem and Nu Po are referred to local hospitals for treatment. Community DOT is provided in all three shelters. They also provide diagnosis and treatment of HIV co‐infection for camp residents. Patients reside in the TB “village” or wards for a period of 1‐2 months and then are supported through a community DOTS programme. Patients are also supported with supplementary feeding, care packages and food support, pre‐treatment and adherence counselling, and livelihood and social inclusion activities. International Organization of Migration (IOM) – Migration health assessments are a statutory requirement for entry to many destination countries for displaced people in Thailand. Part of these assessments is the detection of communicable diseases, including TB. The IOM operates 3 Biosafety Level 3 laboratories which perform sputum microscopy and cultures, drug susceptibility testing and molecular analysis. Within the resettlement programmes active case detection is conducted with a low threshold for referral for sputum tests (10% of all screened) and high sensitivity of testing using sputum culture. The prevalence of culture‐positive pulmonary TB among refugees for the US re‐
settlement programme has remained steady for the last three years at around 550 per 100,000. Thai Department of Disease Control – Many people enter Thailand illegally or overstay their visas and are arrested for confinement in immigration detention centres in Thailand. Most of them are migrant workers, victims of human trafficking, asylum seekers or refugees and the majority come from Cambodia. In general, between 50 and 100 people are detained in each cell with an area of 114 18 to 156 square meters. TB screening at the detention centres consists of physical exam and history and chest X‐ray and those suspected to have TB infection are referred to the hospital for further investigation and treatment. Discussion and conclusions on status of TB control among migrant populations The objective of further discussion was to address specific questions on the overall status and required interventions to control TB among migrants in Thailand. Several working groups focusing on a health care systems approach examined four key priority action areas: monitoring migrant health, migrant sensitive health systems, policy and legal frameworks, and partnerships/networks/multi‐country frameworks. Other groups took a clinical approach focusing on the health of the migrant patient from the perspective of case detection and diagnosis, treatment, and follow‐up and referral. There was a common underlying conclusion for all working groups that the key barrier to controlling TB among migrants is their limited access to health services due to relatively poor socio‐economic status, lack of health insurance, high mobility, language barriers, and real or perceived stigma and discrimination. Even the minority of migrants who do have Compulsory Migrant Health Insurance face systemic challenges which may preclude actively seeking care. 19 Monitoring migrant health (surveillance, data availability) Key question: To what extent does the health information we collect, routinely and through surveys, help us plan and measure progress TB control? Labour Migrants Casual Cross border Migrants Special Settings Displaced Person Shelters Status 

Gaps and 
Challenges 



Migrant TB patients detected at hospitals and migrant screenings are entered into the Thai national data base using Form TB01 (the same as used for Thai patients) which collects demographic data, country of origin, length of stay, contact information, reference person, etc. TB programs are monitored through key indicators (e.g. # of new smear + cases, cure rate, default rate, HIV determination, etc.); however data may not be routinely analyzed separately for migrants in all areas Challenge to obtain comprehensive national assessment of 
TB among migrants through routine surveillance or even prevalence surveys Data collection depends on the skill and language capacity of the interview staff. 
Often difficult to obtain information from un‐documented migrants and those who casually cross the border to seek health care. These categories of migrants also do not have official numbers which would facilitate registration or tracking. Lack of general data on migrant populations precludes determination of overall incidence/prevalence rates Cross border sharing of TB data is highly dependent on local circumstances. 

Data collected by NGO medical staff and sent to PHO using BoE/CCSDPT forms. Analysis by NGOs and CCSDPT NGOs may have only informal or indirect links to National TB programme which limits data analysis and feedback Small number of cases precludes extensive analysis Detention Centers (IDC) In some case, migrants screened on arrival or after 2 months detained (a case of Suan Plu IDC) and sent to PHO or Royal Thai Police if TB is suspected. Uncertain whether TB data is available for detention center cases 20 Migrant Sensitive Health System (Service delivery, Human Resources, Medicines) Key questions: • To what extent are there good quality services being delivered and taken up by the people who need them? • To what degree do we have the right drugs available, distributed where and when they are needed? • To what extent are there the right levels of staff, with the right levels of training and support, in posts where they are needed? Labour Migrants Casual Cross border migrants Special settings Displaced Person Shelters
Status 


Gaps and Challenges 





TB diagnostic services are available for migrants through initial work permit screenings or in public hospitals. In general, diagnostic capacity and first line treatment (with Global Fund support) appears to be adequate but may not be readily available in all locations. Most migrant TB cases are still identified in hospitals through passive case finding; however, some active case finding efforts, including use of community migrant health volunteers, are ongoing with Global Fund support and recent initiative from TTBI. Undocumented and casual cross border migrants in particular do not readily access the health system. Language barriers for medical staff can hamper patient care and IEC materials are not always available in the appropriate language HIV testing of new TB patients is not conducted for migrants in all areas due to limited access to ARV treatment Challenge to sustain and expand active case finding Follow‐up and referral systems are not in place to track migrants across the border Few employers understand the implications of TB or are involved in supporting health services for their employees Detention Centers (IDC)
NGOs provide TB Suspect cases are referred to PHO. diagnosis and treatment services, including long term stay facilities in some shelters 

High turn‐over rate of medical staff Absence of guidelines for active case finding Availability of services, including screening beyond initial arrival, is unknown. 21 Policy and Legal Frameworks (financing, legal access to care, links to non‐health sectors) Key questions: • Is there enough money available for this health issue, given the burden of disease and the need to ensure adequate access? • Are policies in place which will facilitate access to TB care for migrants? Labour Migrants Casual cross border migrants Special settings Displaced person shelters
Status Compulsory Migrant Health Insurance (CMHI) is available to all migrants with national verification and work permits. However, cost and other administrative barriers preclude many migrants from purchasing.  Hospitals or NGOs may provide care to those without insurance through local discretionary funds, Global Fund, or international donations. 



Gaps and challenges 

Large number of migrants without insurance or other financial resources results in financial burden on local hospitals Lack of funding to sustain second line drugs for migrants 
Detention centers (IDC)
TB services covered through Global Fund and/or int’l donors to NGOs Third country re‐settlement option for selected displaced persons, but long term status remains problematic for most in the temporary shelters. Migrants from GMS countries usually spend only a few weeks in detention centers before deportation. Displaced persons seeking re‐
settlement may be reluctant to access care Challenges for long term sustainability of funding Lack of formal system to inform neighboring countries when deportees are being released may hamper border screening 22 Partnerships, Networks, Multi‐country frameworks (stakeholders, leadership, X border communication) Key question: To what extent is the necessary leadership, policy, planning and organizational support in place to adequately address TB control among migrants? Labour Migrants Casual cross border migrants
Special settings
Displaced person shelters Status 

Thailand has national level bi‐lateral MOUs supporting communicable NGOs involved with TB care are disease control, including TB, with neighboring GMS countries. Some linked through the CCSDPT. data sharing occurs through platform of the Mekong Basin Disease Surveillance System (MBDS). Sub‐national collaborations (e.g. ‘twin‐cities) are active in some border areas, but degree of cross border communication may depend on personal relationships and informal mechanisms rather than agreed protocols and standards. Detention centers No information available
Gaps and challenges 

Lack of formal or informal mechanisms to engage private sector and employers in TB control among migrants. Employers have no incentive to support TB control due to high mobility among migrants. Perhaps due to chronic nature of TB and challenges with diagnosis, there appears to be less regional mechanisms or forums or collaborations on TB than some other key diseases (e.g. HIV, malaria). Limited opportunities for engagement among NGOs, academics, government, and IOs to discuss TB issues 23 Patient care dimension Key question: From the perspective of the clinician, what are the key challenges that are specific to controlling TB among migrants compared to the general Thai population? Case detection and diagnosis Labour Migrants 





Casual cross border migrants
Special settings
Displaced person shelters Detention centers Due to fear of retribution from their employers if they are found 
to be TB infected, migrants are often reluctant to seek health care at all, or until symptoms are far progressed. Health providers perceive that, in general, migrants have a low level of trust towards the health system. While documented migrants may receive check‐ups each year 
through the hospitals holding contract with MOPH when they apply for health insurance, additional active case detection through outreach program is required to seek out TB cases among undocumented migrants and others reluctant to come to government hospitals. Active case detection is expensive but often better in rural 
provinces than urban areas due to lack of support from large employers. While TB diagnostic services (sputum and CXR) are generally available, GeneXpert is only utilized in a few areas. Migrants and other border populations in isolated areas may have to travel long distances at great personal expense to seek care. 
Due to shortage of staff, public hospitals face a challenge to track suspected TB patients to collect sputum samples‐‐
especially for migrants in isolated areas. National protocols and guidelines for providing TB diagnosis and care to migrant populations are not always clear to local clinicians. Specifically need additional guidance on specimen transport for drug sensitivity testing and HIV testing. Primarily rely on passive No information available case detection but camp residents do not present due to fear that diagnosis of TB will be a barrier to resettlement Absence of funding as well as clear guidelines for active case finding for both new comers as well as long term shelter residents Need to improve communication and feedback mechanism between NGOs and referral hospitals for diagnostic results HIV+ cases are routinely tested for TB and vice versa. 24 Treatment 




Referral and follow‐up DOTS compliance is sporadic among migrants and may be similar to Thai patients in some areas; however, difficult to identify DOT provider for those who live far from a health facility. Default rates are high (20‐40% on Thai‐Myanmar border) ‐‐‐
especially in casual cross border and undocumented migrants; dropout rates among MDR patients in these groups may be even higher. Patients previously treated for TB in other countries often lack proper records or documentation of prior drugs used. Supplies of 1st and 2nd line TB drugs are generally sufficient. Since migrants are not part of the Thai Universal Health Care Coverage, supplies of ART are inadequate. 
There is a referral system in place in some twin cities; however, this system could be expanded to more areas and more frequent meetings between health officials on both sides of the border to share patient information.  Patients are difficult to track due to high mobility, language barriers, lost treatment/ID cards, lack of mobile phone numbers.
 Treatment/referral cards are only be in a single language, this is considered as a limitation on information sharing and referral to cross‐border patients 



Widespread use of DOTs following Thai National treatment guidelines, including proper isolation mechanisms 1st line drugs are readily available; but challenges to obtain 2nd line drugs. Sometime shortages of pediatric dose preparations. DST and regular patient monitoring is available for patients in the camps Patients who leave the camps are often lost to follow‐up, especially if they cross the border 25 Key recommendations Monitoring migrant health 1. Improve data collection through recruitment and training of more migrant health volunteers/workers in health facilities, use of unique ID number for migrants (regardless of documentation status), and use of standard multi‐language data collection forms and data collection protocols in all countries. Primary responsibility: BTB, PHOs, hospitals, in collaboration with other NTPs 2. Improve information sharing about TB situation/burden through designation of staff in each hospital and PHO with responsibility to track migrant data and provide quarterly analysis and feedback to BTB, DHO, and other stakeholders. All private hospitals, academics, or NGOs providing health care to migrants should regularly provide standardized data to the relevant PHO. Primary responsibility: BTB, PHOs, hospitals, other health care providers Migrant Sensitive Health System 3. Promote expansion of active case finding for TB cases among all migrant populations. Primary responsibility: BTB, PHOs, IOs, NGOs, donors 4. Scale up the effort in developing appropriate IEC materials on TB targeting migrants in multiple languages, including languages of ethnic minorities, and make the information widely available at TB testing and treatment sites and for use in community outreach programs. Primary responsibility: BTB, NGOs 5. Update TB treatment advice and guidelines for controlling TB among migrants and disseminate widely to all government, NGO, and private health facilities. Provide training to ensure these guidelines and policies are well understood by all health care providers. Primary responsibility: BTB, PHO 6. Develop innovative ways of tracking mobile patients both across borders and within migrant communities. Establish a common cross‐border referral mechanism, including multi‐language referral forms and patient ID cards. Review experience on the Thai‐Laos border for applicable lessons learned which could be scaled up. Primary responsibility: BTB, NTPs, NGOs, IOs 7. Develop a regional clearinghouse for migrant health information and resource for notification of available health care facilities providing TB care in the region. Primary responsibility: BTB along with other NTPs, IOM, WHO 8. Undertake relevant operational research on controlling TB among migrants, including studies on cost benefit analysis of TB program options (e.g. active case finding), and migrants’ health seeking behaviors and treatment adherence. Primary responsibility: BTB, Research Institutes, WHO, IOM, NGOs 9. Intensify TB control in immigration detention centers through further review of the current status of TB care in detention centers, including infection control practices, case finding, treatment and referral mechanisms between detention centers and counter parts across the border. Primary responsibility: BTB, DDC 26 Policy and Legal frameworks 10. Scale up policy to integrate HIV testing and treatment for migrants in all TB programs and link with advocacy to secure sustainable funding for ART in migrant patients. Primary responsibility: BTB, PHOs, IOs, NGOs 11. Develop regional guidelines and principles for TB control among migrants as part of more comprehensive frameworks for migrant health care in the GMS. Primary responsibility: NTPs, WHO, IOM, Partnerships, Networks, Multi‐country frameworks 12. Formalize relationships between TB programs and services across borders with regularly scheduled meetings at PHO and DHO level. Primary responsibility: PHO/DHO with support from BTB links to other NTPs, WHO 13. Expand partnerships with employers in both industry wide organizations as well as individual factories to reach out to migrants and advocate for friendly workplace policy for controlling TB among migrant workers. Primary responsibility: PHO, DHO, NGOs (with the support from BTB) 14. As a short‐medium term measure, Thailand, Myanmar, Cambodia and Lao PDR should develop a multi‐country funding proposal (possibly to the Global Fund to fight AIDS, TB and Malaria) to address gaps in the response to TB control and treatment in the borders between these four countries. Primary responsibility: BTB, PR‐DDC, WHO, NTPs 27 Annex 1 – Epidemiologic data on TB among migrants provided by Provincial Health Offices 1. Tak Provincial Health Office Tak province in Thailand shares a long border with Myanmar. The Provincial Health Office (PHO) in Tak estimates that there are around 27,000 registered and more than 200,000 undocumented migrants from Myanmar working in Tak, these numbers are added to another 605,431 Thais registered in the province. There is a one‐stop TB clinic service available at all public hospitals in Tak province and DOTS is provided with the majority of observers being family members. Sputum culture tests and TB detection using GeneXpert platform are provided at Mae Sot provincial hospital. Presentation from Tak‐PHO demonstrated almost equal number of TB reported cases from Thais and Non Thais. (See Table 1) Interestingly 83.9% (743/885) of TB cases among migrants reported are uninsured migrants. (See Table 2) Among total 8 administrative districts of Tak province, the highest proportion of TB cases reported from Mae Sot district. MDR‐TB seems to be the biggest problem in Mae Sot district as well. In term of treatment outcomes (M+), overall success rates are still < 85% (81% and 75% in 2011 and 20121 respectively) and default rates are > 3% (6.5% and 7.8% in 2011 and 2012 respectively). Figures in 2011 suggested that success rate is a bit higher in migrant group (Thai 79.5% and migrant 82.5%) and success rates of the two population groups have decreased to around 75% in 2012. The occurrence of high dead rate, particular among Thai TB patients (13.9% and 16.8% in 2011 and 2012 respectively) perhaps could explain this phenomenon. Presentation also highlights that default rate is higher in migrant group (2011: Thai 1.6% and migrant 8.9%, 2012: Thai 2.2% and migrant 12.7%). Key challenges mentioned by PHO‐Tak included  High death rate in Thai TB patients  High default rate in Non‐Thai TB patient  Increasing number of MDR cases (particularly among non‐Thais)  DOT watchers are mainly patients’ family member, not health care workers or village health volunteer Table 1. Number of TB cases (Thai and Non Thai) by district in Tak province District 2011 Thai Non‐
Thai 2012
Total (%) Thai Non‐
Thai 2013(Q1+Q2) Total (%) Thai Non‐
Thai Total (%) Mueang 115 10 125
(16.3)
112
2
114
(14.9)
54
2 56
(17.9)
Ban Tak 23 2 25
36
1
37
10
0 10
(3.3)
Sam Ngao 23 0 23
(2.9)
(4.8)
25
0
25
(3.3)
(3.2)
10
0 10
(3.2)
28 Mae Sot 140 250 390
106
215
(50.9)
Mae Ramat 31 Thasong Yang 27 Phob Pra 20 14 33
10
(5.8)
44
45
20
(5.7)
52 4 72
39 32
49
383 43
384 43 (5.6)
9
65
30
81
9
68
77
8 398
365
(100)
763
17
(5.4)
5 35
(11.2)
12
27 39
(12.5)
2
39 41 (13.1)
177
136 313
(10.1)
767
105
(33.5)
(10.6)
(5.7)
Total 55 (8.5)
(9.4)
Umphang 50
(42.2)
45
17 321
(100)
(100)
Table 2. Cumulative number of TB cases among Non‐Thais by district from 2011‐ 2013 (Q1+Q2) District Total Insured migrant n Uninsured migrant % n % Mueang 14 10
71.4
4 28.6
Ban Tak 3 3
100
0 0
Sam Ngao 0 0
0
0 0
520 71
13.7
449 86.3
Mae Ramat 32 2
6.3
51 93.7
Thasong Yang 42 0
0
42 100
Phob Pra 128 53
41.4
75 58.1
Umphang 146 3
2.1
143 97.9
Total 885 142
16.1
743 83.9
Mae Sot 29 Table 3. TB treatment outcomes in Thai TB cases (M+) 2011 Treatment outcomes N 2012 % N % No. of TB patients received treatment 195
‐
190 ‐
Success 155
79.5
143 75.2
Failed 6
3.0
6 3.2
Died 27
13.9
32 16.8
Defaulted 6
1.6
4 2.2
Transferred out 0
0
5 2.6
Note: Treatment outcomes analysis is based on TB cases with complete record only Table 4 TB treatment outcomes in Non‐Thai TB cases (M+) 2011 Treatment outcomes N 2012 % N % No. of TB patients received treatment
256
‐
220 ‐
Success 211
82.5
166 75.5
Failed 12
4.8
10 4.5
Died 5
1.9
13 5.9
23
8.9
28 12.7
5
1.9
3 1.4
Defaulted Transferred out Figure 1. Number of Reported MDR‐TB cases in Mae Sot district, 2007‐2013 (Q1+Q2) 16
14
12
10
Thai
8
Non-Thai
6
4
2
0
2007
2008
2009
2010
2011
2012
2013
30 Figure 2. Outcomes of MDR‐TB treatment in Thai patients 100
90
80
70
60
On treatment
50
Died
40
Defaulted
Cured
30
20
10
0
2007
2008
2009
2010
2011
2012
2013
Figure 3. Outcomes of MDR‐ TB treatment in Non‐Thai patients 100
90
80
70
60
On treatment
50
Died
40
Defaulted
Cured
30
20
10
0
2007
2008
2009
2010
2011
2012
2013
2. Kanchanaburi Province PHO‐ Kanchanaburi province shares a 370km border long with Myanmar and is only 130km from Bangkok. Of a population of around 950,000, 11% (110,296) are migrants. The PHO supervises and monitors all TB control activities and employs both active and passive case finding and screening, particularly in migrant workers in the large factories in the province based on the national guidelines. They provide education for high risk groups through community health volunteers and TB treatment with home visits to support DOT. Constraints identified on TB control programme include:  Staff issue include under staff and high staff turn over 31 

Inadequate budget on programme management Capture highly mobile population as cross‐border patients are highly mobile (moving from one district to another district and across the province) Key concerns are on controlling of MDR TB particularly in the context of AEC which will be effect in 2015 and how to enhance participation of community organization in TB control programme. Table 5. TB case notification in Thai population in 2009‐2013 Total M+ M‐ Extra pulmonary Relapse 2009 729 382
203
124
20 2010 806 406 211 159 30 2011 674 362 165 121 26 2012 697 378 193 110 16 2013(Q1+Q2) 371 200 104 56 11 Table 6. TB case notification in non‐Thai population in 2009‐2013 Total M+ M‐ (all forms) Extra pulmonary Relapse 2009 202 112 66 21 3 2010 226 137
67
21
1 2011 207 125 60 22 0 2012 263 148
95
18
2 2013(Q1+Q2) 71 36 22 12 1 Figure 4. Treatment Outcomes in Thai TB cases in 2009‐2012 32 Figure 5. Treatment Outcomes in non‐Thai TB cases in 2009‐2012 3. Samut Sakhon Province Samut Sakhon province is located in the central part of Thailand and only 30km far from Bangkok. Of a total populations around 722,152 (Thais 508,812, Non Thais 213,340) residing in Samut Sakhon, 30 % are migrants. Most of migrants (97%) are from Myanmar, Lao PDR and Cambodia. (Source: PHO SSK, 28 Feb 2013) Presentation showed that the highest number of migrants enrolled in the MOPH health insurance scheme occurred in 2009, in which 155,599 migrants were enrolled in CMHI, and then the number has slightly declined to 134,860 in 2011 and sharply dropped in 2012 to 19,429 only. The latest TB data from Health Check‐up in 2011 suggested 284 TB cases from 134,860 persons checked (0.21%). The following are the TB programme goals set by PHO‐SSK  Detection rate > 75%  Success rate (New M+) > 90%  Mortality rate < 6%  Default rate < 3% Based on SSK‐PHO Cohort TB Reporting system in 2012, of total 1,347 TB (all forms) reported cases 74.5% (n=1,003) are Thais and 25.5% (n=344) are migrants. The presentation also suggested that all detected M+ cases (both Thais and migrants) were not enrolled in the TB treatment programme. There are only 28.9% (143/495) for Thais and 3.6 % for migrants (7/194) enrolled in TB programme. PHO‐SSK TB programme data shown the success rates (M+) is 79% (113/143 cases) in Thai patients and 71% among migrant patients (5/7 cases). It is also noted that default rate is higher among migrants (28%:2/7 cases) than Thais (11%:16/143 cases). Referral systems both within the country (between private and public hospitals) and between country to country are the key challenges that SSK TB Programme faced. 33 Table 7. Number of TB cases detected in 2012 Sputum + Population New Extra pulmonary TB Sputum ‐ Relapse Total Thai 465 30 354 154 1,003 Non‐Thai 186 8 111
39
344 Total 651 38 462 193 1,347 Table 8. Outcomes of TB treatment (M+) in 2012 Population No. M+ enrolled Success n % Failed n died % n defaulted % n % Thai 143
113 79.0
2
1.4
0
0
16 11.2
Non‐Thai 7 5 71.4 0 0 0 0 2 28.6 4. Sa Kaeo Provincial Health Office Sa Kaeo province shares a 165km border with Cambodia. The Sa Kaeo PHO employs both active and passive case finding among Thai and non‐Thai populations. They provide TB treatment via home based care teams and village health volunteers. Registered migrants are eligible for treatment in Thailand, for some the employer bears the cost of treatment and for other’s treatment cost if supported through a Global Fund donation. For undocumented migrants, the PHO will provide advice and refer patients back to Cambodia for treatment. Figure 6. Number of TB cases reported in 2011‐2013 (Q1+Q2) 34 Table 9. Outcomes of TB treatment among non –Thais in 2010‐2012 Year TB Type No. No. No. No. Evaluated Cured Compl
eted Failed
(#enrolled) 2010 New M+ No. Defaulted Transferred out 3 4
0
1
2
0 (12) (30%) (40%) (0%) (10%) (20%) (0%) New M‐ 13 0 8 0 1 4 0 (15) (0%) (61.5%) (0%) (7.7%) (30.8%) (0%) Relaps
ed 1 0 0 0 0 1 0 (1) (0%) (0%) (0%) (0%) (100%) (0%) 11 4 5
0
0
2
0 (11) (36.4%)
(45.5%) (0%) (0%) (18.2%) (0%) New M‐ 2 0 1 0 0 1 0 (2) (0%) (50%) (0%) (0%) (50%) (0%) Relaps
ed 0 0 0 0 0 0 0 (0) (0%) (0%) (0%) (0%) (0%) (0%) 20 13 5
0
1
1
0 (25) (65%) (25%) (0%) (5%) (5%) (0%) New M‐ 13 0 8 0 1 4 0 (15) (0%) (61.5%) (0%) (7.7%) (30.8%) (0%) Relaps
ed 1 0 0 0 0 1 0 (1) (0%) (0%) (0%) (0%) (100%) (0%) 2012 New M+ No. 10 2011 New M+ No. Died Challenges in TB controlling among non‐Thais are:  Increasing number of migrants  Limited understanding on their various migration patterns  Unidentified employers  Changing employer and workplace without informing health care worker 35 Key recommendations include  Early detection is a key to control TB among migrants  Systematic TB treatment should be provided to migrants and diagnosis should be in‐line with national TB guidelines  Employers and village health volunteers can be key agents to assist heal official to provide DOT 5. Immigration Detention Center There are approx. 880‐1,000 detained in the Bangkok Suan Plu Immigration Detention Center, with an area of 114‐156 square meters per 50‐11 persons or approx. 3 square meters per person. TB screening through chest radiography is carried out with more than 2 months detainees. If CXR found abnormal and suggestive of TB cases then they are referred to (Royal Thai police or contracted) hospital. Since 2011, 591 (M=309, F=282) detainees were screened with CXR. Majority of them are North Korean (32%) and Myanmar (25.2%). Of total screen cases, 9.8% (58 cases) found with abnormal CXR result and of those abnormal CXR 25.8% was diagnosed as TB cases by medical doctor at the referred hospitals. Royal Thai Policy hospital then provides TB treatment to TB detainees. It is noted that number of detainees screened seem to be relatively small compare to number of detainees recorded in 2012. (See table 10) Of total 591 cases screened, 2.5 % was detected as TB cases during 2011‐2013. Budget constraint and rapid movement of detainees, particularly a case of Cambodian detainees are factors contributing to low screening rate among detainees at IDC‐Suan Plu. Table 10. Number of detainees in 2012 Nationality No. arrested No. released Cambodia 21,167 (53.3%)
20,959
Myanmar 5,728 (15%) 5,686 Laos 4,333 (11.3%) 4,341 Others 7,015 (18.3%) 7,327 Total 38,243 38,313 Note: No. released is more than No. arrested due to some case was detained crossed a year Figure 7. Proportion of detainees screened with CXR (2011‐2013) by nationality nationality
149
188
North Korean
Myanmar
Vietnamese
Srilankan
pakistani
others
32
69
80
73
36 Annex 2 – List of meeting participants Government agencies ‐ Thailand No Name Contact information Title E‐mail address Ministry of Public Health, Office of Inspector General 1 Dr Amnuay Gajeena Inspector General, Regional Health Area Network 2 Tel: 02‐5901462 Fax: 02‐5901431 Tel: 02‐5901634, 081‐6582283 Fax: 02‐5901634 [email protected] Tel: 02‐5901717 Fax: 02‐5918520 [email protected] Ministry of Public Health, Bureau of Health Administration Ms Theerada 2 Sutheeravute Public Health Expert Ministry of Public Health, Office of Permanent Secretary 3 Dr Supakit Sirilak Senior Advisor (Preventive Medicine) Ministry of Public Health, Permanent Secretary, Bureau of Policy and Strategy Ms Suparaporn 4 Thammachart Ms Wannee 5 Kunchornratana 6 Ms Niyada Sukka Plan and Policy Analyst, Professional level Tel: 02‐5901390, 081‐2566636 Fax: 02‐9659818 [email protected] EU Project Manager Tel: 02‐5902485, 081‐9148339 Fax: 02‐9659818 [email protected] EU Project Officer Tel: 02‐5902458, 081‐3005264 Fax: 02‐9659818 [email protected] Tel: 025903817 081‐9490239 Fax; 02‐9659160 [email protected] Ministry of Public Health, Department of Disease Control 7 Dr Nakorn Premsri Director of PR‐DDC Ministry of Public Health, Department of Disease Control, Bureau of TB 8 Dr Chawetsan Namwat Dr Sriprapa 9 Nateniyom 10 Mr Suksont Jittimanee Director Senior Medical Officer Public Health Officer (Professional level) Tel: 02‐2122279 081‐8445468 Tel: 02‐2122279 [email protected] 37 Ministry of Public Health, Department of Disease Control, Bureau of TB 11 Mr Jirawat Vorasingha 12 Mr Somsak Rienthong Ms Nattisa 13 Booncharoen Statistician (Professional level) Scientist (Professional level) Public Health Officer Tel: 02‐2122279 [email protected] Tel: 02‐2122279 [email protected] Tel: 02‐2122279 # 229, [email protected]
089‐2887439 om Ministry of Public Health, Department of Disease Control, Bureau of HIV AIDs and TB Dr Surasak 14 Thanaisawanyangkoon Chief of International Collabouration Development Section Tel: 02‐5903218, 086‐7822288 Fax: 02‐5903218 [email protected] Ministry of Public Health, Department of Disease Control, Office of International Cooperation Ms Pamornrat 15 Asavasena Chief of International Cooperation Tel: 02‐5903250 Fax: 02‐5913625 [email protected] Ministry of Public Health, Department of Disease Control, Bureau of General Communicable Disease Mr. Wachirapun 16 Chainontee Technical Health Officer, Professional level Tel: 081‐8106685 [email protected] Ministry of Public Health, Department of Medical Science 17 Ms Noppavan Janejai Ms Suratameth 18 Mahasirimongkol Medical Scientist, Professional level Tel: 02‐
9510000#99259 02‐5910343, 081‐3710960 Fax: 02‐5910343 [email protected]
.th Physician Tel: 081‐5558568 [email protected]
o.th Tel: 038‐260970, 087‐5364510 Fax: 038‐260206 mom‐[email protected] Tel: 032‐310805, 081‐9413960 Fax: 032‐338580 [email protected] Tel: 043‐222818 , 082‐3169194 Fax: 043‐224302 [email protected] Office of Disease Prevention and Control 3 (Chonburi) Ms Ornnipa Iemsam‐
19 ang Registered nurse, Professional level Office of Disease Prevention and Control 4 (Ratchaburi) Dr Pongtorn 20 Chartipituck Deputy Director Office of Disease Prevention and Control 6 (Khon Kaen) 21 Mrs Supattra Simmatan Registered Nurse, Professional level 38 Office of Disease Prevention and Control 9 (Phitsanulok) Dr Sakchai 22 Chaimahapurk Tel: 055‐214615 081‐7276572 Fax: 055‐321241 Director [email protected] Office of Disease Prevention and Control 10 (Chiang Mai) 23 Dr Witaya Liewsaree Tel: 053‐140767, 081‐9808849 Fax: 053‐140773 [email protected] Director Chiang Rai, Chiang Rai Provincial Health Office Dr Chamnarn 24 Hansudewechakul Tel: 053‐910300, 081‐1643838 Fax: 053‐910345 [email protected] Chief Medical Office Kanchanaburi, Kanchanaburi Provincial Health Office 25 Ms Ketruetai Settakorn Public Health Officer, Professional level Tel: 034‐622982 Fax: 034‐514598 Ms Nattita 26 Keecharoensuk TB Information Officer Tel: 034‐622982 Fax: 034‐514598 Kanchanaburi, Sangklaburi District Health Office Ms Pannapa 27 Vuttikasatekit Tel: 034‐595035, 091‐7169385 Fax: 034‐595035 [email protected] Public Health Officer, Professional level Mae Hong Son, Mae Hong Son Provincial Health Office 28 Dr Walairat Chaifoo Tel: 053‐611281, 081‐8318537 Fax:053‐611322 [email protected] Deputy Chief Medical Officer Tel: 053‐611281, 081‐6713257 Fax: 053‐611322 [email protected] Public Health Officer, 29 Mr Woraphan Amrarong Professional level Nong Khai, Nong Khai Provincial Health Office Mr Thapon 30 Tiawsirichaisakul Public Health Officer, Professional level Tel: 042‐
465067#70, 081‐9756115 Fax: 042‐412650 [email protected]
39 Ratchaburi, Ratchaburi Provincial Health Office 31 Ms Nisachon Sriring Public Health Officer, Professional level Ratchaburi, Tham Hin Health Promoting Hospital 32 Mr Apisit Wechasart Director Tel: 032‐
326270#141, 088‐9017345 Fax: 032‐325225 Tel: 081‐9413676 Fax: 032‐395155 [email protected] Tel: 077‐812679, 086‐3009520 Fax: 077‐811584 [email protected]
m Tel: 038‐967415‐
7, 081‐6836159 Fax: 038‐620976 [email protected] [email protected] Ranong, Ranong Provincial Health Office 33 Dr Suriya Guharat Chief Medical Office Rayong, Rayong Provincial Health Office 34 Ms Jongdee Intrasub Rayong, Rayong hospital Public Health Officer, Professional level 35 Dr Bralee Suntiwut Pulmonologist, Professional level Tel: 038‐611104, 081‐8806580 Fax: 038‐
611104#2140 [email protected] 36 Ms Jaruwan Iamsa‐ard Registered Nurse Tel: 086‐6055482 [email protected] Tel: 037‐
425141#104, 081‐9837675 Fax: 037‐425147 Tel: 037‐
425141#104, 084‐3625243 Fax: 037‐425147 Tel: 037‐
425141#104, 084‐8663204 Fax: 037‐425147 Sa Kaeo, Sa Kaeo Provincial Health Office 37 Ms Dararat Howong Public Health Officer, Senior Professional Level Public Health Officer, 38 Ms Wanwimon Surinsak Professional Level 39 Ms Sukanya Songsang Public Health Officer Samutsakhon, Samutsakhon Provincial Health Office 40 Ms Sudarat Seehabona Public Health Officer [email protected] [email protected] [email protected]
om Tel: 081‐2798013 Fax: 034‐842513 [email protected]
om 40 Samut Sakhon, Samutsakhon Provincial Health Office 41 Mr Kitti Ruangwiliporn Registered Nurse Tel: 081‐3750361 Fax: 034‐842513 aaron‐[email protected] Tel: 034‐837784, 081‐9440981 Fax: 034‐837784 [email protected] Samut Sakhon, Samutsakhon Hospital 42 Ms Nahathai Chulkarat Registered Nurse Tak, Tak Provincial Health Office 43 Mr Suporn Kavinum Public Health Technical Officer, Expert level 44 Ms Somsee Khamphira Public Health Technical Officer, Professional level Tel: 055‐518139, 081‐9735012 Fax: 055‐518109 Tel: 055‐
518120#121, 085‐7294072 Fax: 055‐518109 45 Dr Kittiphat Iemrod Public Health Technical Officer Tel: 055‐518121, 081‐6881954 Fax: 055‐518109 kit‐[email protected] Dr Witaya 46 Swaddiwudhipong Head, Department of Community&Social Medicine Tel: 055‐533627 Fax: 055‐533046 [email protected] Mr Pongpot 47 Peanumlom Public Health Technical Officer, Professional Level Tel: 055‐533627, 089‐7074431 Fax: 055‐533627 [email protected]
m Public Health Technical Officer Tel: 039‐
511011#321, Fax: 039‐530347 [email protected] Public Health Technical Officer, Operational level Tel: 039‐
511011#321, 086‐1422459 Fax: 039‐530347 [email protected], [email protected] Tel: 02‐2458514 089‐1477509 Fax: 02‐2458514 [email protected] Tak, Mae Sot Hospital [email protected] [email protected] Trat, Trat Provincial Health Office Ms Saowalak 48 Chubangbo Ms Cheunhathai 49 Khamphet Other Government agencies Bangkok Metropolitan Administration, Department of Health 50 Dr Kovit Yongvanitjit Deputy Director 41 Central Chest Institute of Thailand Dr Charoen 51 Chuchottaworn Immigration Bureau Senior Medical Advisor Ms Pattamakorn 52 Preehajinda Police Senior Sergeant Major Ms Monthida 53 Veeraphan Police Captain Tel: 02‐5883115 081‐8091909 Fax: 02‐5919252 Tel: 02‐
2873101#2281 081‐9891324 Fax: 02‐
2873101#2287 Tel: 02‐2873101 #2281 082‐0832299 Fax: 02‐
2873101#2287 fang‐[email protected] [email protected] National Health Security Office (NHSO) 54 Dr Sorakij Bhakeecheep Director Tel: 02‐1414195 084‐7512289 Fax: 02‐1439730 55 Ms Jittiya Laddaglom Chief of AIDs and TB planning unit Tel: 02‐1414195 083‐8138333 Fax: 02‐1439730 [email protected] Head of Department of Medicine Tel: 02‐3548059 090‐9791179 Fax: 02‐3548179 [email protected]
m Lecturer, Department of Pediatrics Tel: 02‐2011774 081‐0925281 Fax: 02‐2011679 [email protected] Rajavithi Hospital 56 Dr Pairaj Kateruttanakul Ramathibodi Hospital Mr Nopporn 57 Apiwattanakul Social Security Office, Bureau of Medical Service System Management Ms Pattara Peeraphun 58 Hinmuangkow Labour Specialist, Professional level Tel: 02‐9562500 084‐6584427 Fax: 02‐5252496 [email protected] [email protected]
m 42 Government agencies ‐ Cambodia
Ministry of Health, Banteay Mean Chey Province 59 Dr Kimsorth Heng Chief of Tuberculosis Programme in Banteay Mean Chey Province Ministry of Health, Oddor Meanchey Province 60 Dr Kham Samphos +855 17 351111 [email protected] Chief of Ternical Bureau and RRT Manager +855 12 499192 Ministry of Health, Preah Vihear Province [email protected] +855 12 955693 [email protected] National TB Center National TB Center 64 Dr Cho Cho San Assistant Director (TB), National TB Control Programme Department of Health, Naypyitaw 65 Dr Win Naing State TB Control Officer TB Control Programme, Mon State, Mawlamyaing [email protected] 66 Dr Lwin Lwin Mon Team Leader TB Control Programme, Taninthayi Region, Myeik [email protected] 61 Dr Saomony Chhay Deputy Director, Preah Vihear Provincial Health Department Government agencies – Lao PDR Ministry of Health 62 Dr Phouvang Vangvichit Department Director 63 Dr Soth Bounmala Project Coordinator [email protected] [email protected] Government agencies – Myanmar Ministry of Health 43 NGOs and INGOs No Name Kanchanaburi,Kwai River Christian Hospital 1 Mrs Lalida Murray Ms Laongdao 2 Sankawiram 4 Dr Aye Aye Moe E‐mail address Public Health Nurse, Assistant to Business Manager Tel: 034‐688001 082‐2930109 Fax: 034‐688003 [email protected] Health Promotion Officer Tel: 034‐688001 087‐1586285 Fax: 034‐688003 [email protected] Country Director Tel: 02‐2525186 081‐8463548 Fax: 02‐2532899 [email protected] Medical Coordinator Tel: 034‐595580 080‐2165548 Fax: 034‐595177 [email protected] [email protected] American Refugee Committee International (ARC) 3 Dr Gary Dahl Contact information Title Committee for Coordination of Service to Displaced Persons in Thailand (CCSDPT) Health Information System Coordinator Tel: 02‐2557025 081‐9351722 Fax: 02‐2557022 [email protected] 6 Ms Priya Waeohongsa Programme Officer Tel: 02‐3052752 Fax: 02‐2559113 [email protected]
a.eu 7 Ms Khobkhul Inieam Operations Assistant Tel: 02‐3052746 Fax: 02‐2559113 [email protected]
.eu 5 Dr Thet Win European Union (EU) European Commission DG for Humanitarian Aid and Civil Protection (ECHO) 8 Ms Piriyada Vessuwon FHI 360 9 Dr Anh L. Innes Dr Yuthichai 10 Kasetcharoen Regional Programme Assistant Tel: 081‐8411527 [email protected]
d.eu Chief of Party, FHI Tel: 02‐
2632300#180 081‐9318621 [email protected]@org Advisor to FHI Tel: 089‐6591878 [email protected] 44 Global Fund Fund Portfolio Manager Tel: +41 79 2217830 [email protected]
nd.org 12 Dr Jaime Calderon Regional Migration Health Adviser Tel: 02‐3439448 081‐8326900 Fax: 02‐3439499 [email protected] 13 Dr Montira Inkochasan Senior Regional Migration Health Assistant Tel: 02‐3439416 080‐5364242 Fax: 02‐3439499 [email protected] Senior Regional Health Assessment Programme 14 Ms Jacqueline Weekers Coordinator Tel: 02‐3439462 081‐9183482 [email protected] 15 Mr Iain Mclellan [email protected] Cambodia Country Office Tel: +855 12 222132 Fax: +855 23 216423 Tel: +95 1 254008#5005 +95 94 3170624 Fax: +95 1 252560#5010 11 Dr Philippe Creac'h International Organization of Migration (IOM) Regional office, Bangkok 16 Dr Brett Dickson Myanmar Country Office 17 Mr Greg Irving Thailand Country Office Project Coordinator, TB REACH funded project Programme Manager ‐
Migration Health [email protected] [email protected] 18 Dr Olga Gorbacheva Chief Medical Officer Tel: 02‐
3439300#9367 081‐3762058 Fax: 02‐3439399 19 Ms Valentina Parr Lab Manager/MHP Coordination Tel: 02‐3439362 081‐3766171 [email protected] Tel: 032‐
364448#103 084‐2738724 Fax: 032‐364357 [email protected] [email protected] International Rescue Committee 20 Dr Aung Than Lin Clinical Medical Officer, Tham Hin Ratchaburi 45 International Rescue Committee 21 Dr Nyi Wynn Soe Malteser International 22 Dr Susanne Rastin Health Coordinator, Mae Hong Son programme Tel: 053‐611626 081‐9606160 Fax: 053‐611404 nyiwy[email protected], [email protected] Medical Coordinator Tel: 053‐621559 086‐1858603 Fax: 053‐681575 [email protected]‐
international.org Premier Urgence‐Aide Medicale Internationale (PU‐AMI) 23 Dr Kyaw Zaw Myat Deputy Programme Coordinator [email protected]‐
ami.org 24 Dr Htun Myint TB Manager [email protected]‐ami.org 25 Dr Carole Deglise Health Advisor‐Asia Tel: 090‐4520994 [email protected]‐ami.org Executive Director Tel: 02‐2656888 081‐8107089 Fax: 02‐2714467 [email protected] Project Manager Tel: 02‐2656888 089‐7123597 Fax: 02‐2714467 [email protected] Programme Assistant‐TB Tel: 02‐
2656888#29 081‐8406116 Fax: 02‐2714467 [email protected] [email protected] Tel: 055‐545020 085‐6030563 [email protected]‐unit.com Tel: 081‐5579626 [email protected]
mail.com Tel: 02‐6438080 081‐8201951 Fax: 02‐6438089 [email protected] Rak Thai Foundation Mr Promboon 26 Panitchpakdi 27 Ms Wanna Buthasane Ms Ruangtong 28 Chantichai Shoklo Malaria Research Unit (SMRU) 29 Dr Sein Sein Thi TB Doctor Thailand Business Coalition on AIDS (TBCA) Dr Anthony 30 Pramualratana Executive Director 31 Dr Brohmsek Yen‐ura Operations Director 46 Thailand Business Coalition on AIDS (TBCA) Dr Peeraporn 32 Weruwanaruk Operations Team Leader Thailand MOPH US‐CDC Collabouration (TUC) 33 Dr Christina Phares Tel: 02‐
6438080081‐
8201951 Fax: 02‐6438089 [email protected] [email protected] 34 Dr Luis Ortega Programme Director Dr Nuttapong 35 Wongjindanon Epidemiologist Tel: 02‐5800669 084‐8742166 Fax: 02‐5912909 Tel: 02‐
5800669#571 085‐4870227 Fax: 02‐5912909 36 Dr Sara Whitehead Tel: 02‐5800669 Fax: 02‐5912909 [email protected] World Vision 37 Dr Sarmphong Nang M&E Coordinator and Technical Support Tel: 02‐3818863 084‐6782176 Fax: 02‐3814923 Rapporteur [email protected] [email protected] [email protected] [email protected]
om [email protected]
om 38 Ms Virginia MacDonald Tel: 089‐0551774 Simultaneous Translation Professional Officer [email protected] 39 Mr Kanok Suwannasit Mr Suraphan 40 Virojanadul Conference organizer World Health Organization WCO Cambodia 1 Dr Miwako Kobayashi 47 WCO Myanmar Technical Officer Tel: +951 241932 +951 241933 Fax: +951 241836 [email protected] 3 Dr Yonas Tegegn WR Representative Tel: 02‐5918198 Fax: 02‐5918199 4 Dr Monirul Islam Tel: 02‐5918198 Fax: 02‐5918199 [email protected] 5 Dr Brenton Burkholder Border and Migrant Health Programme Coordinator Tel: 02‐5918198 089‐8908061 Fax: 02‐5918199 [email protected] Ms Aree 6 Moungsookjareoun Border and Migrant Health Officer Tel: 02‐5918198 081‐8106816 Fax: 02‐5918199 [email protected] Programme Assistant Tel: 02‐5918198 081‐8087145 Fax: 02‐5918199 [email protected] Programme Assistant Tel: 02‐5918198 084‐6630673 Fax: 02‐5918199 [email protected] 2 Dr Eva Nathanson WCO Thailand 7 Ms Benja Sae‐Seai 8 Ms Wilawan Tanyavutti 48 Annex 3 – Agenda Time Session Day 1 (4 June 2013) 8:30‐9:30 Session 1—Plenary 8:30‐8:45 Welcome remarks Opening remarks 8:45‐9:00 Introduction 9:00‐9:15 Policy on international collaboration in disease control 9:15‐9:30 Migration in the GMS Objective Set the scene
Present global/GMS context, forum objectives Provide context by presenting epidemiology of diseases for in GMS—focus on diseases prone for cross border transmission Provide brief overview of regional migration patterns and migrant demographics Person(s) responsible Specific comments MC: Ms Pomornrat Asavasena
Dr Yonas Tegegn
WHO Representative to Thailand Dr Amnuay Gajeena Inspector General, Regional Health Area Network 2 Dr Brenton Burkholder, WHO Thailand Dr Somsak Akksilp Deputy Director‐General, Department of Disease Control, MoPH Thailand Dr Jaime Calderon, Regional Health Advisor, IOM
9:30‐10:15 Group photo and coffee break
10:15‐12:30 Session 2‐ Plenary: General background on TB Gain understanding of TB program and situation Chair: Dr Charoen Chuchotttaworn Senior Medical Advisor, Central Chest Institute of Thailand Co‐chair: Dr Sara Whitehead Director, Tuberculosis Program, Thailand MOPH‐U.S. CDC Collabouration 10:15‐10:40 TB in Thailand Provide update on prevalence of TB in Thailand, status of program, update on health care system 10:40‐11:00 TB in Cambodia 11:00‐11:20 TB in Myanmar Provide update on prevalence of TB and program status in townships bordering Thailand Provide update on prevalence of TB and program status in townships Thai National TB Program Dr Chawetsan Namwat, Director, Bureau of Tuberculosis, Department of Disease Control MOPH Thailand Representative from MOH Cambodia
Representative from MOH Myanmar
49 Time Session 11:20‐11:40 TB in Lao PDR 11:40‐12:30 Comments and discussion
Objective
bordering Thailand
Provide update on prevalence of TB and program status in townships bordering Thailand Provide academic and program perspective Person(s) responsible Specific comments
Representative from MOH Lao PDR
Chair/co‐chair
Provide comments on the 4 national programs 12:30n‐13:30 Lunch 13:30‐17:00 (coffee break from 15:45‐
16:15) Session 3‐ Panels: Target populations Provide experience on current operational challenges/ identification, diagnosis, treatment for TB control among various target populations and provide examples of creative program strategies Chair: Dr Supakit Sirilak,
Senior Advisor (Preventive Medicine), Permanent Secretary Office, MOPH Thailand Co‐chair: Dr Eva Nathanson, Technical Officer, WHO Myanmar 13:30‐14:30 Labour migrants (documented + irregular migrants)— in Thailand for >6months Update on TB among longer stay migrants in both urban and border areas 14:30‐15:45 Causal Cross‐border migrants –
in Thailand for <6 months Update on TB among short term migrants, those crossing the border to seek health care, and outreach across the border 1.“TB reduction among non‐Thai migrants: a NGO perspective”—
World Vision 2.”Controlling TB in a border province:”— Tak PHO 3. “Controlling TB in an urban area:”— Samut Sakhorn PHO 1. “Initial progress of the Tak TB Initiative (TTBI)”—SMRU
2. “Controlling TB in a border province:”— Sa Kaeo PHO 3. “Providing DOTS to migrant populations”—Kwai River Christian Hospital 4. “Controlling TB in a border province:”— Kanchanaburi PHO 15:45‐16:15 16:15‐17:00 Coffee break Special settings: Displaced persons (including those seeking re‐settlement) and Detention Centers 17:00‐17:30 Chair and Co‐chair provide comments and open for panel discussion Update on TB among those in temporary shelters, those seeking re‐settlement, and those in detention centers 1.”Controlling TB in displace person temporary shelters”
‐PU‐AMI 2. “TB screening among displaced persons seeking resettlement”—IOM/Thailand 3. “TB screening among migrants in detention centers”—Mr Wachiarapun Chaimoontee, Bureau of General Communicable Disease, DDC, MOPH Thailand 50 Day 2 (5 June 2013) 8:30‐12.00 (coffee Session 4: Working Groups break 10:‐10:30) (6) Two work groups for each of the three target populations A. Health system impact and requirements B. Health of the migrant 8:30 9:00‐10.00 10:00‐10:30 10:30 12.00‐13:30 13:30‐16:30 (coffee break 15:‐
15:30 16:30‐17:00 To further share experiences and provide opportunity to develop concrete suggestions to strengthen implementation. For all group A: Provide a programmatic overview relevant to the target population by assessing status and gaps for each of the 4 priority action areas* For all group B: Provide an assessment of key challenges and possible suggestions by technical area (diagnosis, treatment, follow‐up/referral) Provide summary of Day 1 and Introduction to Group Work Working Groups: round 1
Coffee break Work Groups: round 2 Lunch Session 5: Report from each work group Closing Facilitators/rapporteurs: Labour A: TBD Labour B: TBD Casual A: TBD Casual B: TBD Special setting A: TBD Special setting B: TBD Divide into 6 working groups (w/ max of 15 persons + designated facilitator). 2 rounds—participants can switch groups after first round if they choose Ms Virginia Macdonald, Rapporteur Dr Brenton Burkholder, WHO Thailand All
All
Share findings and recommendations Reports (10 min) from each working group followed by group discussion Dr Chawetsan Namwat,
Bureau of Tuberculosis, DDC, Thailand MoPH Dr Brent Burkholder WHO Thailand 51 Day 3 (6 June 2013 –half day) 9:00‐12:00 Round tables on cross‐
(coffee break border TB programs 10:‐10:30) A. Thai‐MMR B. Thai‐CAM C. Thai‐Lao PDR 9:00‐9:15 9:15‐12:00 12:00 Plenary—introduction to round tables Round tables Lunch followed by close of forum
To provide an informal discussion among specific cross‐
border issues with opportunity to review recommendations from working groups and to develop possible procedures for future collaboration Program implementers on the Thai‐Myanmar, Thai‐
Cambodia, and Thai‐Lao PDR borders with facilitation by WHO WHO All 52 

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