The 5th Joint International Monitoring Mission to

review NTP Thailand, 2013

14-19 August 2013

ODPC7 and Srisaket Province

Outline

• Objectives

• Sites visited

• Overall impressions

• Key findings, recommendations by topic

OBJECTIVES

Objectives of 5th Joint Monitoring Mission of NTP

• Track progress of recommendations from 2007 and 2009 reviews

• Review implementation within National TB Strategic Plan 2011-2016

• Analyse achievements and challenges

• Identify actions and areas for improvements

Approach• 5 field teams: ODPC 9, 11, 3, 7, 1, plus

epidemiology review team

• Site criteria – Not included in previous JMM’s

And one or more of the following:– Examples of good practice

– High TB burden

– Requiring additional support

– Opportunity to assess a specific technical issue

SITE VISITS

ODPC 7

Sisaket Provincial Hospital

Sisaket Provincial Health Office

Khuk Khan District Hospital

Huay Nuea Primary Care Unit

Sriritana District Hospital

Pingpuay Primary Care Unit

Sisaket Prison

Samrongtagen Primary Care Unit

Overall Impressions• Extraordinarily warm welcome; open

sharing of information

• Impressively dedicated staff at all levels, including volunteers

• Strong technical teams

• Monitoring and accountability are strong and effective

• Innovation is encouraged

Overall Impressions (II)

• Collaboration between institutions and at different levels is excellent

• Multiple examples of best practice, opportunities for others to learn from staff teams here

• Most key TB indicators better than national average; continuing high prevalence

Overall Impressions (III)

• Systemic challenges to efficient program implementation

• A few specific technical recommendations

• Key issue: how to translate local excellence to other areas?

TECHNICAL AREAS

1. Case Finding

• At every level, both testing (AFB) and SS+ case finding was high 2008-10 then decreased

• Active case finding efforts: case contacts, elderly, DM, TB/HIV, migrants, prisoners

• Symptom screening, AFB/CXR

Case Finding• Algorithms not always clear

– Symptom questions, criteria for diagnostic assessment and which tests

• Monitoring information often not enough to evaluate yield, effectiveness of screening

• Yield appears low in most groups other than TB/HIV and DM

– Sensitivity of algorithm?

– Juice worth the squeeze?

Case Finding: Recommendations

• Define approach clearly and track data to evaluate yield

– Asymptomatic primary screening vs. symptomatic care seekers; community vs. facility

– Target population number, number symptom screened, number with diagnostics, SS+/SS-/EP cases

TB screening in DM patients

ODPC7 Case Finding