Tschirhart Naomi, Thi Sein Sein, Swe Lei Lei, Nosten Francois, Foster Angel M
Faculty of Health Sciences, University of Ottawa, 1 Stewart Street, Ottawa, K1N 6N5, ON, Canada.
Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, PO Box 46, Mae Sot, Tak, 63110, Thailand.
BMC Health Serv Res. 2017 Jan 13;17(1):29. doi: 10.1186/s12913-016-1954-9.
In Thailand's northwestern Tak province, contextual conditions along the border with Myanmar pose difficulties for TB control among migrant populations. Incomplete surveillance data, migrant patient mobility, and loss to follow-up make it difficult to estimate the TB burden and implement effective TB control measures. This multi-methods study examined tuberculosis, tuberculosis and human immunodeficiency virus co-infection, and multidrug-resistant tuberculosis treatment accessibility for migrants and refugees in Tak province, health system response, and public health surveillance.
In this study we conducted 13 interviews with key informants working in public health or TB treatment provision to elicit information on TB treatment availability and TB surveillance practices. In addition we organized 15 focus group discussions with refugee and migrant TB, TB/HIV, and MDR-TB patients and non-patients to discuss treatment access. We analyzed the data using thematic analysis and created treatment availability maps with Google maps.
The study identified surveillance, treatment, and funding gaps. Migrant TB cases are underreported in the provincial statistics due to jurisdictional interpretations and resource barriers. Our results suggest that TB/HIV and MDR-TB treatment options are limited for migrants and a heavy reliance on donor funding may lead to potential funding gaps for migrant TB services. We identified several opportunities that positively contribute to TB control in Tak province: improved diagnostics, comprehensive care, and collaboration through data sharing, planning, and patient referrals. The various organizations providing TB treatment to migrant and refugee populations along the border and the Tak Provincial Public Health Office are highly collaborative which offers a strong foundation for future TB control initiatives.
Our findings suggest the need to enhance the surveillance system to include all migrant TB patients who seek treatment in Tak province and support efforts by stakeholders on both sides of the border to continue to share data and engage in collaborative planning on TB, TB/HIV, and MDR-TB treatment provision for migrant populations.
在泰国西北部的来兴府，与缅甸接壤地区的环境状况给流动人口的结核病控制工作带来了困难。监测数据不完整、流动患者的流动性以及失访情况使得难以估计结核病负担并实施有效的结核病控制措施。这项多方法研究调查了来兴府移民和难民的结核病、结核病与人类免疫缺陷病毒合并感染以及耐多药结核病的治疗可及性、卫生系统应对措施和公共卫生监测情况。
在本研究中，我们对从事公共卫生或结核病治疗工作的关键信息提供者进行了13次访谈，以获取有关结核病治疗可及性和结核病监测实践的信息。此外，我们组织了15次焦点小组讨论，参与讨论的有难民和移民结核病患者、结核病/艾滋病患者、耐多药结核病患者以及非患者，以讨论治疗可及性问题。我们使用主题分析法对数据进行了分析，并通过谷歌地图制作了治疗可及性地图。
该研究发现了监测、治疗和资金方面的差距。由于管辖权解释和资源障碍，省级统计数据中移民结核病病例报告不足。我们的研究结果表明，移民的结核病/艾滋病和耐多药结核病治疗选择有限，对捐助资金的严重依赖可能导致移民结核病服务出现潜在的资金缺口。我们确定了几个对来兴府结核病控制有积极贡献的机会：改进诊断、提供全面护理以及通过数据共享、规划和患者转诊进行协作。为边境沿线的移民和难民群体提供结核病治疗的各组织与来兴府公共卫生办公室之间高度协作，这为未来的结核病控制举措奠定了坚实基础。
我们的研究结果表明，有必要加强监测系统，将在来兴府寻求治疗的所有移民结核病患者纳入其中，并支持边境两侧的利益相关者继续共享数据，并就为移民群体提供结核病、结核病/艾滋病和耐多药结核病治疗开展协作规划。
