TB: Can we end it as AIDS in the future? Presentation for discussion RIHES December 9, 2015

Global Burden

Global Policy

End TB Targets and Milestones until 2035, Note: Target of Incidence in year 2050 is 1/ million population

Is TB elimination in Thailand possible? Global vs Local Policy? Strategy? How to reach vulnerable populations/ TB patients, migrants (internal, external)? Technology? Diagnostics of TB infection/ active TB/ DR-TB? Treatment of LTBI/ active TB/ DR-TB? TB vaccines? (pre/post infection) Financing? Others (HSS, CSS, Socio-economic environment)?

TB Burden in Thailand

Thai MoPH’s Policy

Milestones and Targets of Reduction of Incidence/ cases for Thailand According to End TB

Target20% (<85/100K) 50% (<55/100K ) SDG80% (<20/100K ) End TB 90% (10/100K) End TB (1/Mil) Incidence rate 171/100K137/100K, (20% reduction), 85/100K (50%reduc tion) 85/100K (50%redu ction) 55/100K (68% reduction) 34/100K (80%redu ction) 20/100K (88%redu ction) 17/100K (90%redu ction) 10/100K (94%redu ction) Incidence cases 120,00092,800 (20% reduction), 60,000 (50% reduction) 60,000 (50% reduction) 37,000 (68% reduction) 23,000 (80%redu ction) 13,500 (88%redu ction) 12,000 (90%redu ction) 6,770 (94%redu ction) 68 Reduction of TB incidence rate (and cases) compared to 2015 Note: Numbers are roughly estimated

Is TB elimination in Thailand possible? No/ May be? Global vs Local Policy? Need strong policy, target and sustain high case finding for several years Strategy? How to reach vulnerable populations/ TB patients/migrants (internal, external), prison inmates, etc? Use data from NPS (National Prevalence Surveys) and reports, WHO active screening, prioritization of areas Technology? Diagnostics of TB infection/ active TB/ DR-TB? Treatment of LTBI/ active TB/ DR-TB? TB vaccines? (pre/post infection) Expand new screening strategies, diagnostics, implement “real DOTS” Financing? National budget, philanthropists, external for investments (such as GeneXpert) Others?

Brief on Thailand’s TB-NPS 2012 Bangkok and Non-BKK, BKK participation was very low Community-based surveys of age 15 years or more Screening for all: TB symptoms+ CXR: SS and culture: SS+ and Bacteriological confirmed Results: Prevalence 236/100K, incidence 171/100K, Northeast had higher prevalence (58% of B+ cases), more men than women (ratio M:W= 3:1), higher age- specific rates among elderly, symptoms only could detect very few, of all cases only 46% were on treatment and 80% were notified, 20% were not

Conclusion: Is TB Elimination possible, in Thailand? Possible: “Where there’s a will, there is a way” Strong policy and ambitious targets, Use NPS data and program reports to set priority, Use new screening strategies based on NPS, Use new diagnostics, particularly digital CXR plus GeneXpert (Xpert MTB/Rif), Implement “Real DOTS” Active involvement of private sector and CSS Improve mentoring, M&E Sustainable Financing & Logistics

Research possibility Implementation research (how to reach, screen vulnerable populations?) LTBI (Latent TB Infection), diagnosis and preventive therapy Shorter- term TB/ DR-TB treatment Trials of new drugs Trials of TB Vaccines

Thank you