Epidemiology of Tuberculosis in Eight Provinces, the Upper North Region of Thailand during Fiscal Year 2009 - 2013

Abstract

Background: Tuberculosis (TB) is global and domestic public health concerns. In Thailand, the upper north region is a study area of interest for TB epidemiology because the population in this area currently have the lowest of treatment success rate and the highest prevalence of HIV infection among non-high risk group. Therefore, this study aims to study epidemiology of TB in eight provinces in the upper north region of Thailand during fiscal year 2009 - 2013, in terms of incidence, treatment outcomes and key indicators of TB/HIV prevention and control program.
Methods: All TB patients’ records in Tuberculosis clinic management (TBCM) program were used as the data source. The incidence, treatment outcomes and key indicators of TB/HIV prevention and control program were presented via descriptive statistics. The statistical differences in selected important variables were analyzed using Fisher Exact test with significant level of 0.05.
Results: The annual incidences of tuberculosis among Thais continuously decreased from 1 0 5 . 9 3 patients per 100,000 populations in 2009 to 92.43 patients per 100,000 populations in 2013, while the trend of treatment success rates remained stable which had the 5 year median equal to 78.24%. The most important of unsuccessful factor was the death during treatment which had the 5 year median equal to 1 5 . 4 9 % . The rates of annual voluntary HIV testing also remained stable which had the 5 year median equal to 91.59%, while the annual HIV positive rates were continuously dropped from 21.60% in 2009 to 16.19% in 2013. Among types of population (Thai, non-Thai, and prisoners), there were statistical significant differences in terms of successful treatment outcome, receiving voluntary HIV testing, HIV status, anti-retroviral drug access and co-trimoxazole access. In addition, there were statistical significant differences in successful treatment outcome among patients with different HIV status and types of TB registration.
Conclusions: The annual incidences of tuberculosis among Thais and HIV positive rates continuously decreased during this 5 year period. However, the death rate was high that influenced the low treatment success rate in this region. The populations at risk for unsuccessful treatment were HIV-TB co-infection and retreatment patients. The patients are needed to pay special attention during TB treatment for achieving the treatment success. The number of TB cases in national TB reporting system was obviously lower than TB reported patients in TBCM program. Therefore, the discordant TB report in the two systems should be checked and solved in the near future.