Use of drug-susceptibility testing for management of drug-resistant tuberculosis, Thailand, 2004-2008.

In 2004, routine use of culture and drug-susceptibility testing (DST) was implemented for persons in 5 Thailand provinces with a diagnosis of tuberculosis (TB). To determine if DST results were being used to guide treatment, we conducted a retrospective chart review for patients with rifampin-resistant or multidrug-resistant (MDR) TB during 2004-2008. A total of 208 patients were identified. Median time from clinical sample collection to physician review of DST results was 114 days. Only 5.8% of patients with MDR TB were empirically prescribed an appropriate regimen; an additional 31.3% received an appropriate regimen after DST results were reviewed. Most patients with rifampin -resistant or MDR TB had successful treatment outcomes. Patients with HIV co-infection and patients who were unmarried or had received category II treatment before DST results were reviewed had less successful outcomes. Overall, review of available DST results was delayed, and results were rarely used to improve treatment.

Improvements in physical and mental health among HIV-infected patients treated for TB in Thailand.

We conducted a prospective, observational study of human immunodeficiency virus (HIV) infected patients diagnosed with tuberculosis (TB) at public health facilities in Thailand to evaluate the impact of TB and HIV treatment on overall physical and mental health. Standardized data were collected from patients at the time of TB diagnosis, two months into TB treatment, and at completion of TB treatment. We calculated composite physical and mental health scores for patients that completed treatment, compared scores during treatment, and analyzed factors associated with improvements in these scores. Of 493 patients analyzed, 488 (99%) reported at least one physical health complaint and 210 (43%) had at least one mental health complaint at baseline. Improvement in physical health occurred in 377 (76%) and improvement in mental health occurred in 182 (37%). In a multivariable analysis, factors strongly associated with improvement in physical health were receiving TB treatment in Bangkok, age greater than 50 years, and improved mental health. Improvement in mental health was strongly associated with alleviation of physical symptoms, including bloody urine, foot pain, headache, muscle weakness, difficulty sleeping, chest pain, and dizziness.

Implementing an isoniazid preventive therapy program for people living with HIV in Thailand.

Treatment of people living with HIV (PLHIV) with latent tuberculosis (TB) infection using isoniazid preventive therapy (IPT) can reduce the risk of TB disease, however, the scale-up of IPT among PLHIV in Thailand and worldwide has been slow. To hasten the implementation of IPT in Thailand, we developed IPT implementation training curricula and tools for health care providers and implemented IPT services in seven large government hospitals. Of the 659 PLHIV enrolled, 272 (41.3%) reported symptoms of TB and 39 (14.3% of those with TB symptoms) were diagnosed with TB. A total of 346 (52.4%) participants were eligible for IPT; 318 (91.9%) of these participants opted to have a tuberculin skin test (TST) and 52 (16.3% of those who had a TST) had a positive TST result. Among the 52 participants with a positive TST, 46 (88.5%) initiated and 39 (75.0%) completed 9 months of IPT: physicians instructed three participants to stop IPT, two participants were lost to follow-up, one chose to stop therapy, and one developed TB. IPT can be implemented among PLHIV in Thailand and could reduce the burden of TB in the country.