Programmatic Management of Multidrug Resistant TB (PMDT) 5 th Joint International Monitoring Mission of NTP, Thailand 23 August, 2013

Situation 2006 Drug Resistance Survey: 1.7% new & 34.5% previously treated MDR-TB (2,190 cases in 2012); 2012 survey results awaited MDR-TB management implemented by NTP in 2008/09; PMDT plan & updated TB Guidelines drafted MDR-TB risk groups defined (Re – On – Pre) Culture & drug susceptibility testing (C/DST) for first line TB drugs available at Regional level and in Bangkok, and rapid molecular testing in various sites 2012: 492 confirmed MDR-TB cases reported to WHO, number on treatment unclear, outcomes on first cohort not available yet 100 MDR-TB treatment centres registered with NHSO No reported stock outs of second line TB drugs (SLD), drugs for adverse drug reactions available and covered under NHSO

Issues MDR-TB plan and updated TB Guidelines not yet available Diagnostic algorithms unclear (with doctors discretion), multiple (re-) confirmation of test results Delay and/or under-reporting of cases, no MDR-TB module in TBCM, reporting to NTP only from late 2011 Inconsistent treatment practices: Regimens not as per guidelines, low SLD dosages, daily DOT not always done Limited experience in managing MDR-TB cases, no M/XDR treatment committee at Regional level Multiple sourcing (GPO & GDF) & funding of SLDs (NHSO, GF & Hospital funds), different ordering cycles (GPO & GDF) Unclear reimbursement / funding under NHSO, SSS and GF for C/DST, follow up cultures, treatment of migrants

Recommendations Finalise and publish 2012 DRS results Finalise MDR-TB Plan and updated TB Guidelines, disseminate and monitor implementation Establish an integrated comprehensive web-based case based information system (Summary recommendation 2) Support clinical practice via clinical case meetings coordinated by ODPC, and link with National MDR-TB Expert group As part of supportive patient-centered care approach, ensure availability of DOT observer for all cases throughout treatment Ensure timely provision of support packages to patients and DOT observer Reimbursement of full PMDT package, including all diagnostic and follow up tests, under the respective insurance schemes Develop mechanism to ensure migrants with MDR-TB diagnosed early and treated based on experiences from GF SSF project

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