AEGiS-14IAC: Dual tuberculosis and HIV epidemic in Chiang Rai, Northern Thailand: The integrated approach.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Dual tuberculosis and HIV epidemic in Chiang Rai, Northern Thailand: The integrated approach.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. WeOrF1285)

Supawitkul S, Yanai H, Yoshiyama T, Nedsuwan S
Chiang Rai Provincial Health Office, Chiang Rai, Thailand

ISSUES: Dual TB/HIV epidemic increases the problem-complexity and the care-burden. It is essential to develop the appropriate public health strategy to contain the epidemic.

DESCRIPTION: Chiang Rai, the northernmost province of Thailand, confronted the explosive HIV spread since the early 1990s. At the end of year 2001, among its 1.2 million population, the official cumulative reported AIDS cases, AIDS related deaths, and AIDS affected children mount to 20,600, 5,287, and 3,287 cases respectively. The relative previously well-controlled tuberculosis (TB) endemic rose 3.5 times after the 12-year of HIV epidemic. Tuberculosis was the major opportunistic infection in AIDS patients (14.3 E29.8%). HIV/TB co-infections among new TB cases increased substantially (5.33% in 1990 to 42.85% in 1999). The re-emerging of HIV/AIDS stigma and discrimination occurred due to missed interpretation of TB cases as AIDS and fear of care givers to acquire TB. The integrated TB/HIV services and personnel was adopted e.g. incorporating TB/HIV counseling services, peer support activities to increase drug adherence, implementing DOTS for TB cases and ARV-treated AIDS patients, home and community based care for holistic and continual care; incorporating active case finding and household contact case screening for TB in HIV cases; providing isoniazid preventive therapy (IPT) for HIV infected people. PWA groups and day care center services played vital roles in TB/HIV prevention and care. The treatment default rate of TB-patients decreased from 24.2% in 1995 to 5.2% in 1999. The IPT non-compliance rate decreased from 57% in 1995 to 17% in 1999. The TB-MDR rate gradually decreased from 6.5% to 2.8% during 1996-2000.

LESSON LEARNED: The dual TB/HIV epidemic substantially follows the mature HIV epidemic. Strengthening of existing TB and HIV services is crucial. Integrating and incorporating TB and HIV services is a new effective public health approach in resources-limit countries.

Keywords: AEGIS, Tuberculosis, HIV Infections, Disease Outbreaks, HIV Seropositivity, Acquired Immunodeficiency Syndrome, Thailand, Public Health, Counseling, Greece, Child, Human

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