Welcome toWelcome to

TB/HIV Research Foundation (THRF),Chiang Rai ThailandChiang Rai, Thailand

Local Wisdom…Global Knowledge

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

Thailand.

AcknowledgementAcknowledgement

• The Research Institute of Tuberculosis, Anti-

Tuberculosis Association (RIT/JATA)( )

•Double barred cross seal donation of Japan

• Japan Foundation for AIDS Prevention (JFAP)• Japan Foundation for AIDS Prevention (JFAP)

• Stop TB Partnership (CFCS grant)

Th Mit bi hi F d ti• The Mitsubishi Foundation

10/11/2011 2

Presentation outline- Knowing THRF

Knowing TB and TB/HIV- Knowing TB and TB/HIV- Knowing Chiang Rai and situations of TB and TB/HIV in

Chiang Raig- Challenges and opportunities for control TB and TB/HIV in Chiang Rai

Empowering community and people with TB and TB/HIV- Empowering community and people with TB and TB/HIV* Patient volunteers": The important human resource for TB/HIV care

* Center for Sharing: Mobilizing women volunteers to support poor patients

- Comments, recommendation and commitments from the ,delegates.

Knowing TB and TB/HIV

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

In the old days TB th di f VIPwas the disease of VIP

Chopin, Pianist, composer

Emperor Akihito

Japan

Nelson Mandela, former-president, former-president, South Africa

22 t i

1. India2 - China

3.Indonesia22 countries with high TB

4 - Nigeria5 - South Africa6 - Bangladesh

7 Ethiopiaburden in the world.

7 - Ethiopia8 - Pakistan9.Philippines

10 - Democratic Republic of Congo(WHO, 2009)

10 - Democratic Republic of Congo11 - Russian Federation

12 - Viet Nam13 - Kenyay14 - Brazil

15 - United Republic of Tanzania16. Uganda

17 - Zimbabwe18.Thailand

19 - Mozambique20 M20.Myanmar

21 - Cambodia22 - Afghanistan

TB is transmitted by the tuberculosis patients who d t i t t t do not receive treatment

(when coughing, sneezing, spitting, speaking)

1 untreated TB case will infect approximately 10 15 people every yearapproximately 10-15 people every year(an untreated (an untreated TB patients who have drugTB patients who have drug--resistant strain willresistant strain will also also

transmit transmit the resistantthe resistant--strain to others)strain to others)transmit transmit the resistantthe resistant strain to others)strain to others)

A TB patient who The best way todoes not receive TB treatment

yprevent TB transmission is to cure TB patients

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

cure TB patients

The Travelling of TB Germs… TB without borderTB without border

TB/HIV Research Project (RIT-JATA)

TB is curable by using 4 drugs f 6 8 thfor 6-8 months

http://www.textbookofbacteriology.net/tuberculosis 3.htmlp gy _

isoniazid, rifampicin, pyrazinamide, ethambutol.p py

Why TB/HIV?y• HIV is the most powerful known risk factor for reactivating latent TB infections into TB diseasesreactivating latent TB infections into TB diseases

• TB is the leading cause of death in PLHIV

Not TB Latent TB Active TBinfected infection (disease)

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

Knowing Chiang Raiand situations of TB and

TB/HIVTB/HIV

• Population ~ 67 million (2010)

• Living with HIV ~ 610,000(2007)

• HIV adult prevalence 1.4%(2007)

• TB cases ~ 55,000 (2007)

TB incidence 142/100 000• TB incidence ~ 142/100,000

• ranked 18th of the 22 high

burden countries (WHO 2010)

10/11/2011

Map of Thailand

14

Chiang Rai ProvinceChiang Rai ProvinceChina Vietnam

Chiang Rai••Migrants from Myanmar and LaosMigrants from Myanmar and Laos

Bangkok

gGoldenGolden--TriangleTriangle

Cambodia

••HillHill--tribe population : tribe population : 1313%%

•• Population ~Population ~11..3 3 millionsmillions•• Areas Areas 1111,,678 678 sq.kms.sq.kms.,, qq

(~(~3030% mountain/forest)% mountain/forest)•• 18 18 DistrictsDistricts

Population ~ 1.3 millionLiving with HIV 9922

TB tifi ti t 144/100 000 l ti

2000

2500

TB notification rate 144/100,000 population

HIV positive in TB patients 46% in 1998

1500

2000

500

1000

46%

0

10/11/2011

HIV positive HIV negative HIV unknown

16TB/HIV Research Project (RITTB/HIV Research Project (RIT--JATA)JATA)

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

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

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

2000-2009

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

Number of reported among children TB cases in 2000 20092000-2009

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

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

Percentage of TB cases with and without HIV-co infection who died during TB treatmentHIV-co infection who died during TB treatment

in 2000-2009

Percentage of TB cases with and without HIV-co infection who dropped out from TB treatment co ect o o d opped out o t eat e t

more than 2 moths in 2000-2009

Children who diedChildren who died during TB treatmentduring TB treatment

i Chi R iin Chiang Rai

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

Children 0-4 years Children 5-14 yearsDied/Total(%) Died/Total(%)

Characteristics 18/194 (9.3%) 44/377 (11.7%)( ) ( )GenderGirl 8/94 (8.5%) 22/199 (11.1%)B 10/100 (10%) 22/178 (12 4%)Boy 10/100 (10%) 22/178 (12.4%)RaceThai 7/98 (7.1%) 30/198 (15.2%)Hilltribe 3/60 (5%) 10/102 (9.8%)NonThai 8/36 (22.2%) 4/77 (5.2%)HIV co infectionHIV-co infectionWithout HIV-co infection 6/92 (6.5%) 6/156 (3.8%)With HIV-co infection 9/24 (37.5%) 32/98 (32.7%)HIV unknown 3/78 (3.8%) 6/123 (4.9%)

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

Children 0-4 years Children 5-14 yearsDied/Total(%) Died/Total(%)

Characteristics 18/194 (9.3%) 44/377 (11.7%)( ) ( )Without HIV-co infectionThai 0/40 (0%) 1/62 (1.6%)Hilltribe 1/32 (3 1%) 3/48 (6 3%)Hilltribe 1/32 (3.1%) 3/48 (6.3%)NonThai 5/20 (25%) 2/46 (4.3%)With HIV-co infectionThai 7/17 (41.2%) 27/80 (33.8%)Hilltribe 1/2 (50%) 4/7 (57.1%)NonThai 1/5 (20%) 1/11 (9.1%)( ) ( )HIV unknownThai 0/41 (0%) 2/56 (3.6%)Hilltribe 1/26 (3 8%) 3/47 (6 4%)Hilltribe 1/26 (3.8%) 3/47 (6.4%)NonThai 2/11 (18.2%) 1/20 (5%)