TB Reduction Among Non-Thai Migrants (TB-RAM) Project of WV Foundation of Thailand

TB Reduction Among Non-Thai Migrants (TB-RAM) Project of WV Foundation of Thailand

WHY MIGRANTS? TB prevalence among migrants is estimated to be Higher than among Thai populations Limited or poor access to health care/tb medicine

Goals and Objectives Project Goal: To reduce TB morbidity among non-thai migrants in six border and adjacent provinces Objectives 1) To expend quality TB services to achieve increased case detection and treatment success among non-thai migrants 2) To empower non-thai communities to reduce their TB burden through public awareness 3) Develop a service delivery system that ensures coordinated TB/HIV care for non-thai migrants 4) To increase the capacity of the implementing agencies

Provinces where TB-RAM operated Mae sot Kanchanaburi Chumphon Ranong Phang Nga Phuket

WVFT designated as both PR and SR 3 SRs (Sub- Recipient) - American Refugee Committee - Kawe River Christian Hospital - World Vision Foundation of Thailand 2 Phases - Phase I (Oct 2007 Sep 2009) - Phase II (Oct 2009 Sep 2012) Total Budget - 8.3 million USD

Project Strategy; Advocacy Communication and Social Mobilization

Advocacy Collaborate and advocate for TB. migrant health. Provincial level GO-NGO meeting (Hospital, PPHO, DPHO, NGOs) Community level, owner meeting Organize World TB day

Communication Through MHV and FSN Provides health information and counseling Through IEC/BCC materials Myanmar BCC materials developed

Social Mobilization Volunteers - Empower the volunteers - Capacity buildings (both technical and soft skills) Stakeholders - Mobilized different stakeholders

Community Health Posts

Migrant Health Volunteers

TB patient care: 1) TB diagnosis/treatment 2) DOT (Directly Observe Treatment) 3) Nutrition 4) Transportation 5) Psychosocial support

DOT & Supervisory Visits

5 Years Project achievement Suspects referred 27,037 Case notified (NSP) 1,548 (6%) Case enrollment (NSP) 1,384 (89%) Treatment success rate ( NSP) 86% Case notified (All) 2,496 (9%) Case enrollment (All) 2,324 (93%) Treatment success rate (all TB) 86%

Knowledge Attitude Practices Survey Baseline KAP Follow- up KAP 2007 2008 2009 2010 2011 2012 Objectives To assess the changes in TB related KAP among the targeted migrants comparing to those of the baseline survey To determine the factors contributing to level of KAP Methodology Multi-stage sampling, cross-sectional quantitative survey Sample Size Baseline = 717 Follow up KAP = 1,142

Graph showing Knowledge about TB from Baseline Vs follow up KAP 100 95.73 90 80 % 70 76.07 65.82 82.26 76 76.18 % 60 50 40 49.59 47.32 Baseline Follow up KAP 30 20 10 0 Correct Symptoms Mode of Transmission Mode of Prevention DOT at Health facilities P Value <0.001

% Graph showing Knowledge difference between migrant community who directly benefit from Health Education and those who do not 100 90 80 % 70 60 50 40 30 20 10 0 71 89 Correct Symptoms 78 91.8 Mode of Transmission 72.8 85 Mode of Prevention 76.18 95.73 DOT at Health facilities Not directly benefit from HE Directly Benefit from HE P Value <0.001

Graph showing Respondents Opinions on Most Effective Ways for TB Information Dissemination in Migrant Communities 70 60 61.52 Performance of MHVs Effectiveness of IEC Benefits from using peer channels 50 % 45.33 40 % 30 38.91 31.71 Baseline Follow up KAP 20 16.6 10 0 0.42 NGO Health Workers Printed Materials Friends and families

Operations Research OR 2007 2008 2009 2010 2011 2012 Objectives To determine the key factors that contribute to TB treatment outcomes of migrants and challenges faced by the project Methodology Quantitative and Qualitative methods by using both primary and secondary data

OR KEY RESULTS Treatment success rate stood at 85% 15 key factors affecting the favorable and unfavorable treatment outcomes

15 key factors affecting the favorable and unfavorable treatment outcomes 1) Size of the target population 2) Location of the patient s house 3) Patient s intention or motivation 4) Support of families and friends 5) Type of doctor serving the patients 6) Spiritual and religious beliefs 7) Support of patient selfhelp group 8) TB knowledge and perception 9) Presence and absence of stigma and discrimination 10) TB treatment partner 11) Patient s socio-economic status 12) Patient s mobility 13) Access to health services and information 14) HIV co-infection and other underlying health problems 15) The patient s employer PR- WVFT TB RAM Slide 21

Challenges and Lesson Learned 1) Lack of reliable epidemiological migrant data 2) Migrant mobility 3) Difficulty accessing communities 4) Restrictive hospitals policies 5) TB-HIV co-infected patients 6) Language barriers 7) High staff turnover 8) Difficulty of cross-border referrals 9) Sustainability