Monitoring HIV Drug Resistance: Early Warning Indicators to Assess Performance of Thailand's Antiretroviral Treatment Program.

OBJECTIVE: To describe trends in Thailand's antiretroviral treatment (ART) program performance assessed by HIV drug resistance early warning indicators (EWIs), as recommended by WHO, between 2009 and 2013. MATERIAL AND METHOD: Seven EWIs were monitored, viral load (VL) testing coverage, VL suppression, retention in ART, lost to follow-up (LTFU), antiretrovirals (ARVs) dispensing practices, on-time pill pick-up, and pharmacy stock-outs. Data from ART adult patients in National Health Security Office Scheme were analyzed except for pharmacy stock-outs, which were reported from hospitals. Aggregated averages were calculated for each EWI. Chi-square for trend was applied to measure significant changes. RESULTS: By September 2013, 174,284 adults were receiving ART at 929 hospitals. Over time, improvement in VL testing coverage (53.8% in 2009 to 79.8% in 2013) was observed. VL suppression and on-time pill pick up rates were well above 90%. Rates of retention in ART declined from 84.0 to 82.9%, whereas LTFU rates increased from 8.3 to 9.2% (p<0.001). Prescriptions with inappropriate ARVs decreased from 0.32 to 0.10% (p<0.001). Of reporting hospitals, 96.1%, 96.3%, and 96.2% observed no ARVs stock-out between 2011 and 2013. CONCLUSION: EWI is a useful tool to monitor ART program performance and to identify area where improvement is needed.

Birth rates and pregnancy complications in adolescent pregnant women giving birth in the hospitals of Thailand.

OBJECTIVE: To determine the rates of births in adolescent pregnant women in diferent regions of Thailand and assess the rates of complications occurring at pregnancy, childbirth, and postpartum in women admitted in the hospitals ofThailand. MATERIAL AND METHOD: The secondary analysis of data from pregnant women aged 10 to 49 years, who were admitted to hospitals and recorded in the National Health Security Office database between October 2010 and September 2011 was carried out. Adolescent birth rate by the regions and rate of complications ofpregnancy, delivery, and postpartum by age groups were analyzed. RESULTS: Highest birth rate was found among women aged 19 years (58.3 per 1, 000 population). The distribution of adolescent births varied across regions of Thailand, which was high in central region. Rate of preterm delivery was highest (10%) in adolescent aged 10 to 14 years. Rate of diabetes mellitus (6%), preeclampsia (4%), and postpartum hemorrhage (3%) among women aged 35 to 49 years were substantially higher than those among women aged 34 years or less. CONCLUSION: Adolescent birth rate varied across regions of Thailand. Complications occurred differently by ages of women. Holistic policy and planning strategies for proper prevention and management among pregnant women in different age groups are needed

A national registry to determine the distribution and prevalence of Parkinson's disease in Thailand: implications of urbanization and pesticides as risk factors for Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) occurs worldwide but prior to this review of data from the Thailand Parkinson's Disease Registry there had been no nationwide PD registry reported globally. OBJECTIVE: To determine the distribution and prevalence of PD in Thailand and related risk factors in order to more adequately develop and allocate prevention and treatment resources where they are most needed and to ascertain risk factors that are specific to the Thai population. DESIGN: The Thailand Parkinson's Disease Registry is a new resource, and data collection began in March 2008. Data is collected by the Registry from physicians, and a mechanism is also provided for patients to self-report. This data was further analyzed by the capture-recapture methodology (CRM) to assess reporting biases. METHODS: The three main sources of data input to the Registry, i.e. (1) public hospitals, (2) private hospitals and (3) self-registration, require checking for duplicates and also allow estimation of completeness of recording (the degree of underreporting) in this disease registry. There is underreporting because of poor record keeping and administrative procedures in some facilities, and there is an unknown number of persons with PD who are not properly diagnosed because of inadequate facilities and staffing in some areas. Since our data sources should be overlapping in some way, and assuming that the likelihood of being detected in one system is independent of the others, we estimated these data sources' actual coverage and the expected total number of patients utilizing the 'capture-recapture' statistical technique. RESULTS: As of March 2011, the Thailand PD Registry had identified 40,049 PD patients. Employing log-linear modeling, the CRM analysis based on the three data sets estimated underreporting of 20,516 cases. The revised estimated total is thus 60,565 cases, resulting in a crude and age-adjusted prevalence of 95.34 and 424.57 PD cases/100,000 population, respectively. The prevalence of PD was 126.83/100,000 in urban areas and 90.82/100,000 in rural areas (p < 0.001). Preliminary regional comparisons revealed a higher prevalence of PD in residents of the central plain valley of Thailand, an area with a large amount of pesticide use. CONCLUSIONS: The combination of a passive registry and the CRM technique allowed us to derive population prevalence estimates for PD in Thailand. Thai PD prevalence estimates were similar to previous ones published for Asian countries; in addition, they suggested that urbanization and exposure to pesticides may both be risk factors for PD in the Thai population.