Progress report: the national LF and STH programme in Thailand By Sunsanee Rojanapanus, Dr. Thitima Wongsaroj 2014 RPRG Meeting WHO Region

Background Information Geography and Population – Total population 64,785,909 (31Dec2013) – Ecological zones Total area 520,000 km 2 were divided to 6 geographical regions, based on natural features including landforms and drainage, as well as human cultural patterns. Bangkok geographically is part of the central plain as the capital. North, north-east, central, east, west and south region

Background Information Political & Health Administrative Divisions: -First level (States, Regions, Provinces): Region (4); northern, north-east, central and southern/Province (77) Region; 12 Regional Health office 77 provincial health office -Second level (Districts); 927 districts district health office -Third level (Tambol, Villages) Sub-district or Tambol (7,409), Village (74,944) Tambol health promotion hospital

Historical Perspective (1-2 slides) Summary of historical data on LF and STH before inception of the NTD programme, e.g. Geographical distribution Vector (LF) Brief history of interventions (drug distribution, treatment of clinical manifestation, vector control etc)

LF Intervention MDA; DEC+ALB once a year (NELF) DEC alone in Myanmar migrant group Individual treatment; DEC alone Clinical manifestation; home-based care promotion Vector control; - surveillance in migrant group Cx mosquito Vectors W. b Ae. niveus, Ae. annandalei Ae. Desmotes, Ae. Immitator B. m M. bonneae, M. uniformis M. dives, M. indiana, M. annulata, M. annulifera LF Endemic province in Thailand, 2013 Non Endemic area Endemic area (MDA stoped)

STH Intervention 100% stool exam in target area 1 st round Targeted treatment 2 nd round Mass chemotherapy with ALB in area where prevalence>50%

National programme overview IndicatorLFSTH Year of inception of the national programme 1961-control program elimination program 1977-control program Target date for elimination2017 Name of administrative unit for implementation of PC Sub-villageSchool/village Total # administrative units requiring PC at the start of the programme schools/villages Total population requiring PC in the country 124,206 (2002) 166,647 (2006) 73,495 (2012) 131,000

PC Programme Financing Contributors to the 2013 programme costs (and rough estimate of contributions by each if available): ContributorFunding (US$) National governmentLF 150,000 USD STH 15,000 USD Sub-national government- Internal donors (___)- External donors (___)- Others (___)-

PC programme achievements 2013 IndicatorTargetedAchieved M&E Total # sentinel and spot check sites surveyed (LF) 0 Total # sentinel sites surveyed (STH) 0 Total # IUs where stopping-MDA TAS implemented (LF) 0 Total # IUs which passed TAS and stopped MDA (LF) 87 Total # IUs where surveillance TAS implemented (LF) 0 MMDP # IUs where hydrocele surgeries performed 0 # IUs where lymphedema and ADLA management provided 0 Activities TargetedAchieved # administrative units for PC # people # administrative units for PC # people PC MDA2 (DEC + ALB) 0000 T3 (ALB/MBD) for STH 1 st round 119,38422,925 T3 (ALB/MBD) for STH 2 nd round 119,384

Progress Towards LF Elimination Definitions Started MDA≥5 MDA roundsSurveillanceMMDP access*

Progress Towards STH scale up *Coverage = SACPre-SAC

PC coverage, 2013 *65% for LF and 75% for STH **reported coverage was verified by coverage survey or similar independent activity PC type # administrative units receiving PC # administrative units with reported coverage above target* # administrative units where coverage was verified** MDA2 (DEC + ALB) 000 T3 (ALB/MBD) for STH 1 st round 771 schools/villages0 T3 (ALB/MBD) for STH 2 nd round 771 schools/villages0

Impacts of MDA in Sentinel Sites (LF) # SS/SC sites Sentinel Sites <1% mf Sentinel Sites ≥1% mf Spot Check sites <1% mf Spot Check sites ≥1% mf Baseline surveys (2002) Ag 54 IUs Mf 18 IUs Ag 6 IUs Mf 2 IUs -- Surveys (2005)Ag 23 IUs Mf 4 IUs 0Ag 5 IUs Mf 1 IUs Ag 3 IUs Surveys (2006)* (2-6 year) 270 IUs Ag=0/Mf=0 15/87IUs Mf=0 Surveys (2011)** (4-6 years ) 270 IUs Ag=0/Mf=0 87 IUs Ab=0.6% (Mf=0.16%) Latest surveys (post-MDA) ----

Non endemic Area Endemic Area Hospital Post-MDA surveillance 2014 hospitalNo of blood test Ab-Ab+ Narathiwatratc hanakarin Sungaikolok154 0 Reusau261 0 total670 0

PC Monitoring and Evaluation Describe how coverage is monitored - report - survey SAE protocol – Detection by survey – Management; every severe SAE cases had to report to health officer for treatment – Reporting; SAE report

# # administrative units currently eligible for surveys to stop mass treatment0 # administrative units where surveys to stop mass treatment were conducted 357 # administrative units where criteria was passed and mass treatment stopped 357 Justification for stopping MDA without TAS in the above IUs - Integrated assessment of STH considered? - LF Transmission Assessment Survey to stop MDA

LF Transmission Assessment: Forecasting Year Number of IUs to be covered TAS1 TAS2 TAS3 Total number of EUs ICT/LF ST Required* *sum of the total sample size required for each EU assessed;

Integrated Vector Management (LF) Describe any activities targeted to control LF vectors (including those conducted by other programmes) no for LF vectors improve household sanitation for possible vectors Describe monitoring and evaluation of such activities entomological survey; density, infective, infection

LF MMDP – Strategy LF National policy exist?yes Organizational placement within the government (who is responsible?) Tambol health promoting hospital under provincial health office How integrated with the health service? A part of home visit activity by Tambol health promoting hospital Training of service providers conducted (by who? How frequent?) Training for provincial health staff by central office (BVD). And they trained affected persons and theirrelatives to taking care themselves at home to prevent ADL. Patient mobilization and registration (by who? How?) Tambol health promoting hospital through home visit activity. Report by health volunteer

LF MMDP – monitoring and evaluation LF Describe how MMDP services are currently monitored and reported to the national programme Monitored and report by Provincial health office, regional office and to BVD. How is “access” determined?Training Is there any quality assessment of provided services? Survey by BVD

Best Practices Describe interventions and/or M&E activities that worked well -Small IUs in NELF -Antibody test

Challenges and “Issues” For each disease, list the specific challenges/issues that need advice from RPRG - post-MDA surveillance -TAS2,3 -Surveillance in migrant group

Programme Plan Activities 2014 target2015 target # administrative units for PC # people # administrative units for PC # people PC MDA2 (DEC + ALB) 0000 T3 (ALB/MBD) for STH 1 st round 771 schools130, schools130,000 T3 (ALB/MBD) for STH 2 nd round 771 schools130, schools130,000 Activities2014 Target2015 Target M&E # districts/IUs where coverage surveys are planned for any PC diseases 771 schools for STH # IUs where pre-TAS sentinel site and spot checks planned (LF) 00 # IUs where TAS for stopping MDA is planned (LF)00 # IUs where STH survey integrated with LF TAS planned # IUs where MMDP is to be evaluated (LF) 50 sub-district hospitals # IUs where surveillance activities are to be carried out (LF) MMDP # IUs where MMDP services newly initiated (LF)00 IVM # IUs where IVM coordinated to target LF vectors00

PC medicine request for 2015 ALB (LF)ALB (STH)MBDDEC required--- in stock in pipeline requested to WHO requested to MDP (IVM) or ITI (AZI) Procured from other sources (source, # tablets and target age group)