TB/HIV Dead Case Revie¸.พัช... · Thai HIV/TB Guideline 2008 CD4 counts (cells/mm3)...
Transcript of TB/HIV Dead Case Revie¸.พัช... · Thai HIV/TB Guideline 2008 CD4 counts (cells/mm3)...
1
TBHIV Dead Case Reviewชวยอะไรไดบางในงานพฒนาคณภาพ
พญพชร ขนตพงษTHE 2ND NATIONAL QI FORUMFOR HIV TB AND STIS1 สค 2559
2
High Burden Country Lists of 30 countries Will be used by WHO 2016-2020
ALL TB CASE by HIV statusin Chiang Rai Province1987 - 2008
TBHIV Research Project (RIT-JATA)
year
1st AIDS in THAI NAPHA CAT team
Extensive closed contact screening
2
TB treatment outcome in all HIV positiveIn Chiang Rai Province2000-2008
(Adjusted transfer cases)
Still high mortality rate for TBHIV co-infection during TB treatment in Chiang Rai province
3TBHIV Research Project (RIT-JATA)
TB treatment outcome in all HIV positive TB in Chiangrai Prachanukroh hospital 2000-2008
142
141
92
72
76
78
64
73
94
483
470
420
440
386
381
227
207
237
73
70
108
77
109
104
133
76
83
280
302
322
355
366
384
500
545
504 33
04
07
07
18
00
10
11
18
0 20 40 60 80 100
2551
2550
2549
2548
2547
2546
2545
2544
2543
Cure Complete Default Died Failure Transfer out
4TBHIV Research Project (RIT-JATA)
Information
Quality Improvement
Health System Technology
TB screening for HIV people and IPTsince 2004
TB screening before providing ARTsince 2004
HIV counseling and testing for all TBsince 2005
ARV for all PLHIV who have CD4 count helliphellipaccording to guideline
7
Implemented Program in Chiangrai Prachanukroh Hospital
However the mortality rate is still high
Cause of death Number
TB 38 27
HIV associated condition 50 35
TB or HIV equally likely 32 23
Non TBHIV associated 22 15
Total 142 100
In HIV tertiary care in Bangkok Thailand
TB itself is not main cause of death among TBHIV co-infection
8
Causes of mortality among tuberculosis and HIV co-infected patients in Chiang Rai Northern Thailand
Pacharee Kantipong1 Kuniko Murakami2 Saiyud Moolphate3 Myo Nyein Aung45 and Norio Yamada2
Cause of death Number
TB 130 393
AIDS related OIs 94 284
Non TBnonAOI systemic diseases ( renal or liver disease)
54 163
Ambiguous causes 53 16
Total 331 100
2005-2008
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (1)
N
Total number 331 100
Male 219 662
Female 112 338
Age
lt45 263 795
ge45 68 205
Median 35
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (2)
N
Ethnicity
Thai 297 897
Non-Thai 34 103
Marital status
Married 146 445
Single 87 265
Widoweddivorce 95 290
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (3)
N
Occupation
Laborer 140 438
Farmer 84 263
Household worker 36 113
Prisoner 16 50
Business owner 13 41
Government employee 6 19
Other 25 78
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (4)
N
Site of TB
Pulm TB 134 405
Extra with Pulm TB 64 193
Extrapulmonary TB 133 402
Extrapulmonary TB
Meningeal 60 305
Lymphatic 41 208
Intestinal 38 193
Disseminated 36 183
Pleural 12 61
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (5)
N
TB Diagnosis reconfirmation
Definitive 102 308
Probable 46 139
Presumptive 165 499
NTM 18 54
MDR TB
Yes 7 21
No 324 979
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (6)
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
CD4
lt200 205 6193
gt200 23 695
Unknown 103 3112
Median CD4 37
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (7)
N
ART
Before TB Dx 73 221
After TB Dx 35 106
Not received 223 674
Time of death after start TB Rx
Within 30 days 121 3656
Later than 30 days 210 6344
Causes of death shown by proportion of deathsin each month of TB treatment
bull 3927 of TBHIV death was caused by TB and 2840 by AIDS-related OIs
bull 674 of TBHIV death didnt receive ART
bull Most case had extra-pulmonary TB 595
bull Dx HIV before TB 662
bull CD4 lt 200 6193 unknown CD4 3112
18
Summary
bull All TBHIV dead within 1 mo after Dx 367
2nd mo 187
bull 669 of death in 1st mo due to TB
bull Death from AOI occurred throughout the timeline of TB Rx peak at 4th mo
bull Systemic diseases deaths in the later mo
19
Summary
HIV Care
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
ART
Not received 223 674
CD4
Unknown 103 3112
Median CD4 37
Thai HIVTB Guideline 2008
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 100Start as soon as possible after patients can
tolerate anti-TB treatment
100 - 200Start ART at 2 months after initiation of TB
treatment
200 ndash 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 3 months
gt 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 6 months
Some Thai HIV experts may commence ART 2 months after the start of TB treatment especially if the patients cannot be tested for CD4 counts at 3 months after initiation of TB treatment
TAS J Med Assoc Thai 2008911925-36
33
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
2
High Burden Country Lists of 30 countries Will be used by WHO 2016-2020
ALL TB CASE by HIV statusin Chiang Rai Province1987 - 2008
TBHIV Research Project (RIT-JATA)
year
1st AIDS in THAI NAPHA CAT team
Extensive closed contact screening
2
TB treatment outcome in all HIV positiveIn Chiang Rai Province2000-2008
(Adjusted transfer cases)
Still high mortality rate for TBHIV co-infection during TB treatment in Chiang Rai province
3TBHIV Research Project (RIT-JATA)
TB treatment outcome in all HIV positive TB in Chiangrai Prachanukroh hospital 2000-2008
142
141
92
72
76
78
64
73
94
483
470
420
440
386
381
227
207
237
73
70
108
77
109
104
133
76
83
280
302
322
355
366
384
500
545
504 33
04
07
07
18
00
10
11
18
0 20 40 60 80 100
2551
2550
2549
2548
2547
2546
2545
2544
2543
Cure Complete Default Died Failure Transfer out
4TBHIV Research Project (RIT-JATA)
Information
Quality Improvement
Health System Technology
TB screening for HIV people and IPTsince 2004
TB screening before providing ARTsince 2004
HIV counseling and testing for all TBsince 2005
ARV for all PLHIV who have CD4 count helliphellipaccording to guideline
7
Implemented Program in Chiangrai Prachanukroh Hospital
However the mortality rate is still high
Cause of death Number
TB 38 27
HIV associated condition 50 35
TB or HIV equally likely 32 23
Non TBHIV associated 22 15
Total 142 100
In HIV tertiary care in Bangkok Thailand
TB itself is not main cause of death among TBHIV co-infection
8
Causes of mortality among tuberculosis and HIV co-infected patients in Chiang Rai Northern Thailand
Pacharee Kantipong1 Kuniko Murakami2 Saiyud Moolphate3 Myo Nyein Aung45 and Norio Yamada2
Cause of death Number
TB 130 393
AIDS related OIs 94 284
Non TBnonAOI systemic diseases ( renal or liver disease)
54 163
Ambiguous causes 53 16
Total 331 100
2005-2008
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (1)
N
Total number 331 100
Male 219 662
Female 112 338
Age
lt45 263 795
ge45 68 205
Median 35
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (2)
N
Ethnicity
Thai 297 897
Non-Thai 34 103
Marital status
Married 146 445
Single 87 265
Widoweddivorce 95 290
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (3)
N
Occupation
Laborer 140 438
Farmer 84 263
Household worker 36 113
Prisoner 16 50
Business owner 13 41
Government employee 6 19
Other 25 78
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (4)
N
Site of TB
Pulm TB 134 405
Extra with Pulm TB 64 193
Extrapulmonary TB 133 402
Extrapulmonary TB
Meningeal 60 305
Lymphatic 41 208
Intestinal 38 193
Disseminated 36 183
Pleural 12 61
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (5)
N
TB Diagnosis reconfirmation
Definitive 102 308
Probable 46 139
Presumptive 165 499
NTM 18 54
MDR TB
Yes 7 21
No 324 979
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (6)
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
CD4
lt200 205 6193
gt200 23 695
Unknown 103 3112
Median CD4 37
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (7)
N
ART
Before TB Dx 73 221
After TB Dx 35 106
Not received 223 674
Time of death after start TB Rx
Within 30 days 121 3656
Later than 30 days 210 6344
Causes of death shown by proportion of deathsin each month of TB treatment
bull 3927 of TBHIV death was caused by TB and 2840 by AIDS-related OIs
bull 674 of TBHIV death didnt receive ART
bull Most case had extra-pulmonary TB 595
bull Dx HIV before TB 662
bull CD4 lt 200 6193 unknown CD4 3112
18
Summary
bull All TBHIV dead within 1 mo after Dx 367
2nd mo 187
bull 669 of death in 1st mo due to TB
bull Death from AOI occurred throughout the timeline of TB Rx peak at 4th mo
bull Systemic diseases deaths in the later mo
19
Summary
HIV Care
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
ART
Not received 223 674
CD4
Unknown 103 3112
Median CD4 37
Thai HIVTB Guideline 2008
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 100Start as soon as possible after patients can
tolerate anti-TB treatment
100 - 200Start ART at 2 months after initiation of TB
treatment
200 ndash 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 3 months
gt 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 6 months
Some Thai HIV experts may commence ART 2 months after the start of TB treatment especially if the patients cannot be tested for CD4 counts at 3 months after initiation of TB treatment
TAS J Med Assoc Thai 2008911925-36
33
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
ALL TB CASE by HIV statusin Chiang Rai Province1987 - 2008
TBHIV Research Project (RIT-JATA)
year
1st AIDS in THAI NAPHA CAT team
Extensive closed contact screening
2
TB treatment outcome in all HIV positiveIn Chiang Rai Province2000-2008
(Adjusted transfer cases)
Still high mortality rate for TBHIV co-infection during TB treatment in Chiang Rai province
3TBHIV Research Project (RIT-JATA)
TB treatment outcome in all HIV positive TB in Chiangrai Prachanukroh hospital 2000-2008
142
141
92
72
76
78
64
73
94
483
470
420
440
386
381
227
207
237
73
70
108
77
109
104
133
76
83
280
302
322
355
366
384
500
545
504 33
04
07
07
18
00
10
11
18
0 20 40 60 80 100
2551
2550
2549
2548
2547
2546
2545
2544
2543
Cure Complete Default Died Failure Transfer out
4TBHIV Research Project (RIT-JATA)
Information
Quality Improvement
Health System Technology
TB screening for HIV people and IPTsince 2004
TB screening before providing ARTsince 2004
HIV counseling and testing for all TBsince 2005
ARV for all PLHIV who have CD4 count helliphellipaccording to guideline
7
Implemented Program in Chiangrai Prachanukroh Hospital
However the mortality rate is still high
Cause of death Number
TB 38 27
HIV associated condition 50 35
TB or HIV equally likely 32 23
Non TBHIV associated 22 15
Total 142 100
In HIV tertiary care in Bangkok Thailand
TB itself is not main cause of death among TBHIV co-infection
8
Causes of mortality among tuberculosis and HIV co-infected patients in Chiang Rai Northern Thailand
Pacharee Kantipong1 Kuniko Murakami2 Saiyud Moolphate3 Myo Nyein Aung45 and Norio Yamada2
Cause of death Number
TB 130 393
AIDS related OIs 94 284
Non TBnonAOI systemic diseases ( renal or liver disease)
54 163
Ambiguous causes 53 16
Total 331 100
2005-2008
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (1)
N
Total number 331 100
Male 219 662
Female 112 338
Age
lt45 263 795
ge45 68 205
Median 35
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (2)
N
Ethnicity
Thai 297 897
Non-Thai 34 103
Marital status
Married 146 445
Single 87 265
Widoweddivorce 95 290
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (3)
N
Occupation
Laborer 140 438
Farmer 84 263
Household worker 36 113
Prisoner 16 50
Business owner 13 41
Government employee 6 19
Other 25 78
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (4)
N
Site of TB
Pulm TB 134 405
Extra with Pulm TB 64 193
Extrapulmonary TB 133 402
Extrapulmonary TB
Meningeal 60 305
Lymphatic 41 208
Intestinal 38 193
Disseminated 36 183
Pleural 12 61
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (5)
N
TB Diagnosis reconfirmation
Definitive 102 308
Probable 46 139
Presumptive 165 499
NTM 18 54
MDR TB
Yes 7 21
No 324 979
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (6)
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
CD4
lt200 205 6193
gt200 23 695
Unknown 103 3112
Median CD4 37
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (7)
N
ART
Before TB Dx 73 221
After TB Dx 35 106
Not received 223 674
Time of death after start TB Rx
Within 30 days 121 3656
Later than 30 days 210 6344
Causes of death shown by proportion of deathsin each month of TB treatment
bull 3927 of TBHIV death was caused by TB and 2840 by AIDS-related OIs
bull 674 of TBHIV death didnt receive ART
bull Most case had extra-pulmonary TB 595
bull Dx HIV before TB 662
bull CD4 lt 200 6193 unknown CD4 3112
18
Summary
bull All TBHIV dead within 1 mo after Dx 367
2nd mo 187
bull 669 of death in 1st mo due to TB
bull Death from AOI occurred throughout the timeline of TB Rx peak at 4th mo
bull Systemic diseases deaths in the later mo
19
Summary
HIV Care
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
ART
Not received 223 674
CD4
Unknown 103 3112
Median CD4 37
Thai HIVTB Guideline 2008
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 100Start as soon as possible after patients can
tolerate anti-TB treatment
100 - 200Start ART at 2 months after initiation of TB
treatment
200 ndash 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 3 months
gt 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 6 months
Some Thai HIV experts may commence ART 2 months after the start of TB treatment especially if the patients cannot be tested for CD4 counts at 3 months after initiation of TB treatment
TAS J Med Assoc Thai 2008911925-36
33
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
TB treatment outcome in all HIV positiveIn Chiang Rai Province2000-2008
(Adjusted transfer cases)
Still high mortality rate for TBHIV co-infection during TB treatment in Chiang Rai province
3TBHIV Research Project (RIT-JATA)
TB treatment outcome in all HIV positive TB in Chiangrai Prachanukroh hospital 2000-2008
142
141
92
72
76
78
64
73
94
483
470
420
440
386
381
227
207
237
73
70
108
77
109
104
133
76
83
280
302
322
355
366
384
500
545
504 33
04
07
07
18
00
10
11
18
0 20 40 60 80 100
2551
2550
2549
2548
2547
2546
2545
2544
2543
Cure Complete Default Died Failure Transfer out
4TBHIV Research Project (RIT-JATA)
Information
Quality Improvement
Health System Technology
TB screening for HIV people and IPTsince 2004
TB screening before providing ARTsince 2004
HIV counseling and testing for all TBsince 2005
ARV for all PLHIV who have CD4 count helliphellipaccording to guideline
7
Implemented Program in Chiangrai Prachanukroh Hospital
However the mortality rate is still high
Cause of death Number
TB 38 27
HIV associated condition 50 35
TB or HIV equally likely 32 23
Non TBHIV associated 22 15
Total 142 100
In HIV tertiary care in Bangkok Thailand
TB itself is not main cause of death among TBHIV co-infection
8
Causes of mortality among tuberculosis and HIV co-infected patients in Chiang Rai Northern Thailand
Pacharee Kantipong1 Kuniko Murakami2 Saiyud Moolphate3 Myo Nyein Aung45 and Norio Yamada2
Cause of death Number
TB 130 393
AIDS related OIs 94 284
Non TBnonAOI systemic diseases ( renal or liver disease)
54 163
Ambiguous causes 53 16
Total 331 100
2005-2008
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (1)
N
Total number 331 100
Male 219 662
Female 112 338
Age
lt45 263 795
ge45 68 205
Median 35
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (2)
N
Ethnicity
Thai 297 897
Non-Thai 34 103
Marital status
Married 146 445
Single 87 265
Widoweddivorce 95 290
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (3)
N
Occupation
Laborer 140 438
Farmer 84 263
Household worker 36 113
Prisoner 16 50
Business owner 13 41
Government employee 6 19
Other 25 78
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (4)
N
Site of TB
Pulm TB 134 405
Extra with Pulm TB 64 193
Extrapulmonary TB 133 402
Extrapulmonary TB
Meningeal 60 305
Lymphatic 41 208
Intestinal 38 193
Disseminated 36 183
Pleural 12 61
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (5)
N
TB Diagnosis reconfirmation
Definitive 102 308
Probable 46 139
Presumptive 165 499
NTM 18 54
MDR TB
Yes 7 21
No 324 979
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (6)
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
CD4
lt200 205 6193
gt200 23 695
Unknown 103 3112
Median CD4 37
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (7)
N
ART
Before TB Dx 73 221
After TB Dx 35 106
Not received 223 674
Time of death after start TB Rx
Within 30 days 121 3656
Later than 30 days 210 6344
Causes of death shown by proportion of deathsin each month of TB treatment
bull 3927 of TBHIV death was caused by TB and 2840 by AIDS-related OIs
bull 674 of TBHIV death didnt receive ART
bull Most case had extra-pulmonary TB 595
bull Dx HIV before TB 662
bull CD4 lt 200 6193 unknown CD4 3112
18
Summary
bull All TBHIV dead within 1 mo after Dx 367
2nd mo 187
bull 669 of death in 1st mo due to TB
bull Death from AOI occurred throughout the timeline of TB Rx peak at 4th mo
bull Systemic diseases deaths in the later mo
19
Summary
HIV Care
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
ART
Not received 223 674
CD4
Unknown 103 3112
Median CD4 37
Thai HIVTB Guideline 2008
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 100Start as soon as possible after patients can
tolerate anti-TB treatment
100 - 200Start ART at 2 months after initiation of TB
treatment
200 ndash 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 3 months
gt 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 6 months
Some Thai HIV experts may commence ART 2 months after the start of TB treatment especially if the patients cannot be tested for CD4 counts at 3 months after initiation of TB treatment
TAS J Med Assoc Thai 2008911925-36
33
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
TB treatment outcome in all HIV positive TB in Chiangrai Prachanukroh hospital 2000-2008
142
141
92
72
76
78
64
73
94
483
470
420
440
386
381
227
207
237
73
70
108
77
109
104
133
76
83
280
302
322
355
366
384
500
545
504 33
04
07
07
18
00
10
11
18
0 20 40 60 80 100
2551
2550
2549
2548
2547
2546
2545
2544
2543
Cure Complete Default Died Failure Transfer out
4TBHIV Research Project (RIT-JATA)
Information
Quality Improvement
Health System Technology
TB screening for HIV people and IPTsince 2004
TB screening before providing ARTsince 2004
HIV counseling and testing for all TBsince 2005
ARV for all PLHIV who have CD4 count helliphellipaccording to guideline
7
Implemented Program in Chiangrai Prachanukroh Hospital
However the mortality rate is still high
Cause of death Number
TB 38 27
HIV associated condition 50 35
TB or HIV equally likely 32 23
Non TBHIV associated 22 15
Total 142 100
In HIV tertiary care in Bangkok Thailand
TB itself is not main cause of death among TBHIV co-infection
8
Causes of mortality among tuberculosis and HIV co-infected patients in Chiang Rai Northern Thailand
Pacharee Kantipong1 Kuniko Murakami2 Saiyud Moolphate3 Myo Nyein Aung45 and Norio Yamada2
Cause of death Number
TB 130 393
AIDS related OIs 94 284
Non TBnonAOI systemic diseases ( renal or liver disease)
54 163
Ambiguous causes 53 16
Total 331 100
2005-2008
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (1)
N
Total number 331 100
Male 219 662
Female 112 338
Age
lt45 263 795
ge45 68 205
Median 35
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (2)
N
Ethnicity
Thai 297 897
Non-Thai 34 103
Marital status
Married 146 445
Single 87 265
Widoweddivorce 95 290
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (3)
N
Occupation
Laborer 140 438
Farmer 84 263
Household worker 36 113
Prisoner 16 50
Business owner 13 41
Government employee 6 19
Other 25 78
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (4)
N
Site of TB
Pulm TB 134 405
Extra with Pulm TB 64 193
Extrapulmonary TB 133 402
Extrapulmonary TB
Meningeal 60 305
Lymphatic 41 208
Intestinal 38 193
Disseminated 36 183
Pleural 12 61
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (5)
N
TB Diagnosis reconfirmation
Definitive 102 308
Probable 46 139
Presumptive 165 499
NTM 18 54
MDR TB
Yes 7 21
No 324 979
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (6)
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
CD4
lt200 205 6193
gt200 23 695
Unknown 103 3112
Median CD4 37
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (7)
N
ART
Before TB Dx 73 221
After TB Dx 35 106
Not received 223 674
Time of death after start TB Rx
Within 30 days 121 3656
Later than 30 days 210 6344
Causes of death shown by proportion of deathsin each month of TB treatment
bull 3927 of TBHIV death was caused by TB and 2840 by AIDS-related OIs
bull 674 of TBHIV death didnt receive ART
bull Most case had extra-pulmonary TB 595
bull Dx HIV before TB 662
bull CD4 lt 200 6193 unknown CD4 3112
18
Summary
bull All TBHIV dead within 1 mo after Dx 367
2nd mo 187
bull 669 of death in 1st mo due to TB
bull Death from AOI occurred throughout the timeline of TB Rx peak at 4th mo
bull Systemic diseases deaths in the later mo
19
Summary
HIV Care
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
ART
Not received 223 674
CD4
Unknown 103 3112
Median CD4 37
Thai HIVTB Guideline 2008
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 100Start as soon as possible after patients can
tolerate anti-TB treatment
100 - 200Start ART at 2 months after initiation of TB
treatment
200 ndash 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 3 months
gt 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 6 months
Some Thai HIV experts may commence ART 2 months after the start of TB treatment especially if the patients cannot be tested for CD4 counts at 3 months after initiation of TB treatment
TAS J Med Assoc Thai 2008911925-36
33
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
Information
Quality Improvement
Health System Technology
TB screening for HIV people and IPTsince 2004
TB screening before providing ARTsince 2004
HIV counseling and testing for all TBsince 2005
ARV for all PLHIV who have CD4 count helliphellipaccording to guideline
7
Implemented Program in Chiangrai Prachanukroh Hospital
However the mortality rate is still high
Cause of death Number
TB 38 27
HIV associated condition 50 35
TB or HIV equally likely 32 23
Non TBHIV associated 22 15
Total 142 100
In HIV tertiary care in Bangkok Thailand
TB itself is not main cause of death among TBHIV co-infection
8
Causes of mortality among tuberculosis and HIV co-infected patients in Chiang Rai Northern Thailand
Pacharee Kantipong1 Kuniko Murakami2 Saiyud Moolphate3 Myo Nyein Aung45 and Norio Yamada2
Cause of death Number
TB 130 393
AIDS related OIs 94 284
Non TBnonAOI systemic diseases ( renal or liver disease)
54 163
Ambiguous causes 53 16
Total 331 100
2005-2008
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (1)
N
Total number 331 100
Male 219 662
Female 112 338
Age
lt45 263 795
ge45 68 205
Median 35
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (2)
N
Ethnicity
Thai 297 897
Non-Thai 34 103
Marital status
Married 146 445
Single 87 265
Widoweddivorce 95 290
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (3)
N
Occupation
Laborer 140 438
Farmer 84 263
Household worker 36 113
Prisoner 16 50
Business owner 13 41
Government employee 6 19
Other 25 78
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (4)
N
Site of TB
Pulm TB 134 405
Extra with Pulm TB 64 193
Extrapulmonary TB 133 402
Extrapulmonary TB
Meningeal 60 305
Lymphatic 41 208
Intestinal 38 193
Disseminated 36 183
Pleural 12 61
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (5)
N
TB Diagnosis reconfirmation
Definitive 102 308
Probable 46 139
Presumptive 165 499
NTM 18 54
MDR TB
Yes 7 21
No 324 979
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (6)
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
CD4
lt200 205 6193
gt200 23 695
Unknown 103 3112
Median CD4 37
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (7)
N
ART
Before TB Dx 73 221
After TB Dx 35 106
Not received 223 674
Time of death after start TB Rx
Within 30 days 121 3656
Later than 30 days 210 6344
Causes of death shown by proportion of deathsin each month of TB treatment
bull 3927 of TBHIV death was caused by TB and 2840 by AIDS-related OIs
bull 674 of TBHIV death didnt receive ART
bull Most case had extra-pulmonary TB 595
bull Dx HIV before TB 662
bull CD4 lt 200 6193 unknown CD4 3112
18
Summary
bull All TBHIV dead within 1 mo after Dx 367
2nd mo 187
bull 669 of death in 1st mo due to TB
bull Death from AOI occurred throughout the timeline of TB Rx peak at 4th mo
bull Systemic diseases deaths in the later mo
19
Summary
HIV Care
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
ART
Not received 223 674
CD4
Unknown 103 3112
Median CD4 37
Thai HIVTB Guideline 2008
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 100Start as soon as possible after patients can
tolerate anti-TB treatment
100 - 200Start ART at 2 months after initiation of TB
treatment
200 ndash 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 3 months
gt 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 6 months
Some Thai HIV experts may commence ART 2 months after the start of TB treatment especially if the patients cannot be tested for CD4 counts at 3 months after initiation of TB treatment
TAS J Med Assoc Thai 2008911925-36
33
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
TB screening for HIV people and IPTsince 2004
TB screening before providing ARTsince 2004
HIV counseling and testing for all TBsince 2005
ARV for all PLHIV who have CD4 count helliphellipaccording to guideline
7
Implemented Program in Chiangrai Prachanukroh Hospital
However the mortality rate is still high
Cause of death Number
TB 38 27
HIV associated condition 50 35
TB or HIV equally likely 32 23
Non TBHIV associated 22 15
Total 142 100
In HIV tertiary care in Bangkok Thailand
TB itself is not main cause of death among TBHIV co-infection
8
Causes of mortality among tuberculosis and HIV co-infected patients in Chiang Rai Northern Thailand
Pacharee Kantipong1 Kuniko Murakami2 Saiyud Moolphate3 Myo Nyein Aung45 and Norio Yamada2
Cause of death Number
TB 130 393
AIDS related OIs 94 284
Non TBnonAOI systemic diseases ( renal or liver disease)
54 163
Ambiguous causes 53 16
Total 331 100
2005-2008
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (1)
N
Total number 331 100
Male 219 662
Female 112 338
Age
lt45 263 795
ge45 68 205
Median 35
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (2)
N
Ethnicity
Thai 297 897
Non-Thai 34 103
Marital status
Married 146 445
Single 87 265
Widoweddivorce 95 290
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (3)
N
Occupation
Laborer 140 438
Farmer 84 263
Household worker 36 113
Prisoner 16 50
Business owner 13 41
Government employee 6 19
Other 25 78
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (4)
N
Site of TB
Pulm TB 134 405
Extra with Pulm TB 64 193
Extrapulmonary TB 133 402
Extrapulmonary TB
Meningeal 60 305
Lymphatic 41 208
Intestinal 38 193
Disseminated 36 183
Pleural 12 61
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (5)
N
TB Diagnosis reconfirmation
Definitive 102 308
Probable 46 139
Presumptive 165 499
NTM 18 54
MDR TB
Yes 7 21
No 324 979
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (6)
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
CD4
lt200 205 6193
gt200 23 695
Unknown 103 3112
Median CD4 37
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (7)
N
ART
Before TB Dx 73 221
After TB Dx 35 106
Not received 223 674
Time of death after start TB Rx
Within 30 days 121 3656
Later than 30 days 210 6344
Causes of death shown by proportion of deathsin each month of TB treatment
bull 3927 of TBHIV death was caused by TB and 2840 by AIDS-related OIs
bull 674 of TBHIV death didnt receive ART
bull Most case had extra-pulmonary TB 595
bull Dx HIV before TB 662
bull CD4 lt 200 6193 unknown CD4 3112
18
Summary
bull All TBHIV dead within 1 mo after Dx 367
2nd mo 187
bull 669 of death in 1st mo due to TB
bull Death from AOI occurred throughout the timeline of TB Rx peak at 4th mo
bull Systemic diseases deaths in the later mo
19
Summary
HIV Care
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
ART
Not received 223 674
CD4
Unknown 103 3112
Median CD4 37
Thai HIVTB Guideline 2008
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 100Start as soon as possible after patients can
tolerate anti-TB treatment
100 - 200Start ART at 2 months after initiation of TB
treatment
200 ndash 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 3 months
gt 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 6 months
Some Thai HIV experts may commence ART 2 months after the start of TB treatment especially if the patients cannot be tested for CD4 counts at 3 months after initiation of TB treatment
TAS J Med Assoc Thai 2008911925-36
33
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
Cause of death Number
TB 38 27
HIV associated condition 50 35
TB or HIV equally likely 32 23
Non TBHIV associated 22 15
Total 142 100
In HIV tertiary care in Bangkok Thailand
TB itself is not main cause of death among TBHIV co-infection
8
Causes of mortality among tuberculosis and HIV co-infected patients in Chiang Rai Northern Thailand
Pacharee Kantipong1 Kuniko Murakami2 Saiyud Moolphate3 Myo Nyein Aung45 and Norio Yamada2
Cause of death Number
TB 130 393
AIDS related OIs 94 284
Non TBnonAOI systemic diseases ( renal or liver disease)
54 163
Ambiguous causes 53 16
Total 331 100
2005-2008
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (1)
N
Total number 331 100
Male 219 662
Female 112 338
Age
lt45 263 795
ge45 68 205
Median 35
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (2)
N
Ethnicity
Thai 297 897
Non-Thai 34 103
Marital status
Married 146 445
Single 87 265
Widoweddivorce 95 290
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (3)
N
Occupation
Laborer 140 438
Farmer 84 263
Household worker 36 113
Prisoner 16 50
Business owner 13 41
Government employee 6 19
Other 25 78
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (4)
N
Site of TB
Pulm TB 134 405
Extra with Pulm TB 64 193
Extrapulmonary TB 133 402
Extrapulmonary TB
Meningeal 60 305
Lymphatic 41 208
Intestinal 38 193
Disseminated 36 183
Pleural 12 61
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (5)
N
TB Diagnosis reconfirmation
Definitive 102 308
Probable 46 139
Presumptive 165 499
NTM 18 54
MDR TB
Yes 7 21
No 324 979
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (6)
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
CD4
lt200 205 6193
gt200 23 695
Unknown 103 3112
Median CD4 37
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (7)
N
ART
Before TB Dx 73 221
After TB Dx 35 106
Not received 223 674
Time of death after start TB Rx
Within 30 days 121 3656
Later than 30 days 210 6344
Causes of death shown by proportion of deathsin each month of TB treatment
bull 3927 of TBHIV death was caused by TB and 2840 by AIDS-related OIs
bull 674 of TBHIV death didnt receive ART
bull Most case had extra-pulmonary TB 595
bull Dx HIV before TB 662
bull CD4 lt 200 6193 unknown CD4 3112
18
Summary
bull All TBHIV dead within 1 mo after Dx 367
2nd mo 187
bull 669 of death in 1st mo due to TB
bull Death from AOI occurred throughout the timeline of TB Rx peak at 4th mo
bull Systemic diseases deaths in the later mo
19
Summary
HIV Care
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
ART
Not received 223 674
CD4
Unknown 103 3112
Median CD4 37
Thai HIVTB Guideline 2008
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 100Start as soon as possible after patients can
tolerate anti-TB treatment
100 - 200Start ART at 2 months after initiation of TB
treatment
200 ndash 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 3 months
gt 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 6 months
Some Thai HIV experts may commence ART 2 months after the start of TB treatment especially if the patients cannot be tested for CD4 counts at 3 months after initiation of TB treatment
TAS J Med Assoc Thai 2008911925-36
33
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
Causes of mortality among tuberculosis and HIV co-infected patients in Chiang Rai Northern Thailand
Pacharee Kantipong1 Kuniko Murakami2 Saiyud Moolphate3 Myo Nyein Aung45 and Norio Yamada2
Cause of death Number
TB 130 393
AIDS related OIs 94 284
Non TBnonAOI systemic diseases ( renal or liver disease)
54 163
Ambiguous causes 53 16
Total 331 100
2005-2008
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (1)
N
Total number 331 100
Male 219 662
Female 112 338
Age
lt45 263 795
ge45 68 205
Median 35
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (2)
N
Ethnicity
Thai 297 897
Non-Thai 34 103
Marital status
Married 146 445
Single 87 265
Widoweddivorce 95 290
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (3)
N
Occupation
Laborer 140 438
Farmer 84 263
Household worker 36 113
Prisoner 16 50
Business owner 13 41
Government employee 6 19
Other 25 78
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (4)
N
Site of TB
Pulm TB 134 405
Extra with Pulm TB 64 193
Extrapulmonary TB 133 402
Extrapulmonary TB
Meningeal 60 305
Lymphatic 41 208
Intestinal 38 193
Disseminated 36 183
Pleural 12 61
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (5)
N
TB Diagnosis reconfirmation
Definitive 102 308
Probable 46 139
Presumptive 165 499
NTM 18 54
MDR TB
Yes 7 21
No 324 979
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (6)
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
CD4
lt200 205 6193
gt200 23 695
Unknown 103 3112
Median CD4 37
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (7)
N
ART
Before TB Dx 73 221
After TB Dx 35 106
Not received 223 674
Time of death after start TB Rx
Within 30 days 121 3656
Later than 30 days 210 6344
Causes of death shown by proportion of deathsin each month of TB treatment
bull 3927 of TBHIV death was caused by TB and 2840 by AIDS-related OIs
bull 674 of TBHIV death didnt receive ART
bull Most case had extra-pulmonary TB 595
bull Dx HIV before TB 662
bull CD4 lt 200 6193 unknown CD4 3112
18
Summary
bull All TBHIV dead within 1 mo after Dx 367
2nd mo 187
bull 669 of death in 1st mo due to TB
bull Death from AOI occurred throughout the timeline of TB Rx peak at 4th mo
bull Systemic diseases deaths in the later mo
19
Summary
HIV Care
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
ART
Not received 223 674
CD4
Unknown 103 3112
Median CD4 37
Thai HIVTB Guideline 2008
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 100Start as soon as possible after patients can
tolerate anti-TB treatment
100 - 200Start ART at 2 months after initiation of TB
treatment
200 ndash 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 3 months
gt 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 6 months
Some Thai HIV experts may commence ART 2 months after the start of TB treatment especially if the patients cannot be tested for CD4 counts at 3 months after initiation of TB treatment
TAS J Med Assoc Thai 2008911925-36
33
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (1)
N
Total number 331 100
Male 219 662
Female 112 338
Age
lt45 263 795
ge45 68 205
Median 35
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (2)
N
Ethnicity
Thai 297 897
Non-Thai 34 103
Marital status
Married 146 445
Single 87 265
Widoweddivorce 95 290
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (3)
N
Occupation
Laborer 140 438
Farmer 84 263
Household worker 36 113
Prisoner 16 50
Business owner 13 41
Government employee 6 19
Other 25 78
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (4)
N
Site of TB
Pulm TB 134 405
Extra with Pulm TB 64 193
Extrapulmonary TB 133 402
Extrapulmonary TB
Meningeal 60 305
Lymphatic 41 208
Intestinal 38 193
Disseminated 36 183
Pleural 12 61
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (5)
N
TB Diagnosis reconfirmation
Definitive 102 308
Probable 46 139
Presumptive 165 499
NTM 18 54
MDR TB
Yes 7 21
No 324 979
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (6)
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
CD4
lt200 205 6193
gt200 23 695
Unknown 103 3112
Median CD4 37
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (7)
N
ART
Before TB Dx 73 221
After TB Dx 35 106
Not received 223 674
Time of death after start TB Rx
Within 30 days 121 3656
Later than 30 days 210 6344
Causes of death shown by proportion of deathsin each month of TB treatment
bull 3927 of TBHIV death was caused by TB and 2840 by AIDS-related OIs
bull 674 of TBHIV death didnt receive ART
bull Most case had extra-pulmonary TB 595
bull Dx HIV before TB 662
bull CD4 lt 200 6193 unknown CD4 3112
18
Summary
bull All TBHIV dead within 1 mo after Dx 367
2nd mo 187
bull 669 of death in 1st mo due to TB
bull Death from AOI occurred throughout the timeline of TB Rx peak at 4th mo
bull Systemic diseases deaths in the later mo
19
Summary
HIV Care
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
ART
Not received 223 674
CD4
Unknown 103 3112
Median CD4 37
Thai HIVTB Guideline 2008
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 100Start as soon as possible after patients can
tolerate anti-TB treatment
100 - 200Start ART at 2 months after initiation of TB
treatment
200 ndash 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 3 months
gt 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 6 months
Some Thai HIV experts may commence ART 2 months after the start of TB treatment especially if the patients cannot be tested for CD4 counts at 3 months after initiation of TB treatment
TAS J Med Assoc Thai 2008911925-36
33
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (2)
N
Ethnicity
Thai 297 897
Non-Thai 34 103
Marital status
Married 146 445
Single 87 265
Widoweddivorce 95 290
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (3)
N
Occupation
Laborer 140 438
Farmer 84 263
Household worker 36 113
Prisoner 16 50
Business owner 13 41
Government employee 6 19
Other 25 78
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (4)
N
Site of TB
Pulm TB 134 405
Extra with Pulm TB 64 193
Extrapulmonary TB 133 402
Extrapulmonary TB
Meningeal 60 305
Lymphatic 41 208
Intestinal 38 193
Disseminated 36 183
Pleural 12 61
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (5)
N
TB Diagnosis reconfirmation
Definitive 102 308
Probable 46 139
Presumptive 165 499
NTM 18 54
MDR TB
Yes 7 21
No 324 979
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (6)
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
CD4
lt200 205 6193
gt200 23 695
Unknown 103 3112
Median CD4 37
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (7)
N
ART
Before TB Dx 73 221
After TB Dx 35 106
Not received 223 674
Time of death after start TB Rx
Within 30 days 121 3656
Later than 30 days 210 6344
Causes of death shown by proportion of deathsin each month of TB treatment
bull 3927 of TBHIV death was caused by TB and 2840 by AIDS-related OIs
bull 674 of TBHIV death didnt receive ART
bull Most case had extra-pulmonary TB 595
bull Dx HIV before TB 662
bull CD4 lt 200 6193 unknown CD4 3112
18
Summary
bull All TBHIV dead within 1 mo after Dx 367
2nd mo 187
bull 669 of death in 1st mo due to TB
bull Death from AOI occurred throughout the timeline of TB Rx peak at 4th mo
bull Systemic diseases deaths in the later mo
19
Summary
HIV Care
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
ART
Not received 223 674
CD4
Unknown 103 3112
Median CD4 37
Thai HIVTB Guideline 2008
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 100Start as soon as possible after patients can
tolerate anti-TB treatment
100 - 200Start ART at 2 months after initiation of TB
treatment
200 ndash 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 3 months
gt 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 6 months
Some Thai HIV experts may commence ART 2 months after the start of TB treatment especially if the patients cannot be tested for CD4 counts at 3 months after initiation of TB treatment
TAS J Med Assoc Thai 2008911925-36
33
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (3)
N
Occupation
Laborer 140 438
Farmer 84 263
Household worker 36 113
Prisoner 16 50
Business owner 13 41
Government employee 6 19
Other 25 78
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (4)
N
Site of TB
Pulm TB 134 405
Extra with Pulm TB 64 193
Extrapulmonary TB 133 402
Extrapulmonary TB
Meningeal 60 305
Lymphatic 41 208
Intestinal 38 193
Disseminated 36 183
Pleural 12 61
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (5)
N
TB Diagnosis reconfirmation
Definitive 102 308
Probable 46 139
Presumptive 165 499
NTM 18 54
MDR TB
Yes 7 21
No 324 979
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (6)
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
CD4
lt200 205 6193
gt200 23 695
Unknown 103 3112
Median CD4 37
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (7)
N
ART
Before TB Dx 73 221
After TB Dx 35 106
Not received 223 674
Time of death after start TB Rx
Within 30 days 121 3656
Later than 30 days 210 6344
Causes of death shown by proportion of deathsin each month of TB treatment
bull 3927 of TBHIV death was caused by TB and 2840 by AIDS-related OIs
bull 674 of TBHIV death didnt receive ART
bull Most case had extra-pulmonary TB 595
bull Dx HIV before TB 662
bull CD4 lt 200 6193 unknown CD4 3112
18
Summary
bull All TBHIV dead within 1 mo after Dx 367
2nd mo 187
bull 669 of death in 1st mo due to TB
bull Death from AOI occurred throughout the timeline of TB Rx peak at 4th mo
bull Systemic diseases deaths in the later mo
19
Summary
HIV Care
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
ART
Not received 223 674
CD4
Unknown 103 3112
Median CD4 37
Thai HIVTB Guideline 2008
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 100Start as soon as possible after patients can
tolerate anti-TB treatment
100 - 200Start ART at 2 months after initiation of TB
treatment
200 ndash 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 3 months
gt 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 6 months
Some Thai HIV experts may commence ART 2 months after the start of TB treatment especially if the patients cannot be tested for CD4 counts at 3 months after initiation of TB treatment
TAS J Med Assoc Thai 2008911925-36
33
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (4)
N
Site of TB
Pulm TB 134 405
Extra with Pulm TB 64 193
Extrapulmonary TB 133 402
Extrapulmonary TB
Meningeal 60 305
Lymphatic 41 208
Intestinal 38 193
Disseminated 36 183
Pleural 12 61
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (5)
N
TB Diagnosis reconfirmation
Definitive 102 308
Probable 46 139
Presumptive 165 499
NTM 18 54
MDR TB
Yes 7 21
No 324 979
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (6)
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
CD4
lt200 205 6193
gt200 23 695
Unknown 103 3112
Median CD4 37
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (7)
N
ART
Before TB Dx 73 221
After TB Dx 35 106
Not received 223 674
Time of death after start TB Rx
Within 30 days 121 3656
Later than 30 days 210 6344
Causes of death shown by proportion of deathsin each month of TB treatment
bull 3927 of TBHIV death was caused by TB and 2840 by AIDS-related OIs
bull 674 of TBHIV death didnt receive ART
bull Most case had extra-pulmonary TB 595
bull Dx HIV before TB 662
bull CD4 lt 200 6193 unknown CD4 3112
18
Summary
bull All TBHIV dead within 1 mo after Dx 367
2nd mo 187
bull 669 of death in 1st mo due to TB
bull Death from AOI occurred throughout the timeline of TB Rx peak at 4th mo
bull Systemic diseases deaths in the later mo
19
Summary
HIV Care
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
ART
Not received 223 674
CD4
Unknown 103 3112
Median CD4 37
Thai HIVTB Guideline 2008
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 100Start as soon as possible after patients can
tolerate anti-TB treatment
100 - 200Start ART at 2 months after initiation of TB
treatment
200 ndash 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 3 months
gt 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 6 months
Some Thai HIV experts may commence ART 2 months after the start of TB treatment especially if the patients cannot be tested for CD4 counts at 3 months after initiation of TB treatment
TAS J Med Assoc Thai 2008911925-36
33
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (5)
N
TB Diagnosis reconfirmation
Definitive 102 308
Probable 46 139
Presumptive 165 499
NTM 18 54
MDR TB
Yes 7 21
No 324 979
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (6)
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
CD4
lt200 205 6193
gt200 23 695
Unknown 103 3112
Median CD4 37
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (7)
N
ART
Before TB Dx 73 221
After TB Dx 35 106
Not received 223 674
Time of death after start TB Rx
Within 30 days 121 3656
Later than 30 days 210 6344
Causes of death shown by proportion of deathsin each month of TB treatment
bull 3927 of TBHIV death was caused by TB and 2840 by AIDS-related OIs
bull 674 of TBHIV death didnt receive ART
bull Most case had extra-pulmonary TB 595
bull Dx HIV before TB 662
bull CD4 lt 200 6193 unknown CD4 3112
18
Summary
bull All TBHIV dead within 1 mo after Dx 367
2nd mo 187
bull 669 of death in 1st mo due to TB
bull Death from AOI occurred throughout the timeline of TB Rx peak at 4th mo
bull Systemic diseases deaths in the later mo
19
Summary
HIV Care
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
ART
Not received 223 674
CD4
Unknown 103 3112
Median CD4 37
Thai HIVTB Guideline 2008
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 100Start as soon as possible after patients can
tolerate anti-TB treatment
100 - 200Start ART at 2 months after initiation of TB
treatment
200 ndash 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 3 months
gt 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 6 months
Some Thai HIV experts may commence ART 2 months after the start of TB treatment especially if the patients cannot be tested for CD4 counts at 3 months after initiation of TB treatment
TAS J Med Assoc Thai 2008911925-36
33
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (6)
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
CD4
lt200 205 6193
gt200 23 695
Unknown 103 3112
Median CD4 37
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (7)
N
ART
Before TB Dx 73 221
After TB Dx 35 106
Not received 223 674
Time of death after start TB Rx
Within 30 days 121 3656
Later than 30 days 210 6344
Causes of death shown by proportion of deathsin each month of TB treatment
bull 3927 of TBHIV death was caused by TB and 2840 by AIDS-related OIs
bull 674 of TBHIV death didnt receive ART
bull Most case had extra-pulmonary TB 595
bull Dx HIV before TB 662
bull CD4 lt 200 6193 unknown CD4 3112
18
Summary
bull All TBHIV dead within 1 mo after Dx 367
2nd mo 187
bull 669 of death in 1st mo due to TB
bull Death from AOI occurred throughout the timeline of TB Rx peak at 4th mo
bull Systemic diseases deaths in the later mo
19
Summary
HIV Care
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
ART
Not received 223 674
CD4
Unknown 103 3112
Median CD4 37
Thai HIVTB Guideline 2008
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 100Start as soon as possible after patients can
tolerate anti-TB treatment
100 - 200Start ART at 2 months after initiation of TB
treatment
200 ndash 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 3 months
gt 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 6 months
Some Thai HIV experts may commence ART 2 months after the start of TB treatment especially if the patients cannot be tested for CD4 counts at 3 months after initiation of TB treatment
TAS J Med Assoc Thai 2008911925-36
33
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
Characteristic of TBHIV death in Chiangrai Prachanukroh hospital during
2005-2008 (7)
N
ART
Before TB Dx 73 221
After TB Dx 35 106
Not received 223 674
Time of death after start TB Rx
Within 30 days 121 3656
Later than 30 days 210 6344
Causes of death shown by proportion of deathsin each month of TB treatment
bull 3927 of TBHIV death was caused by TB and 2840 by AIDS-related OIs
bull 674 of TBHIV death didnt receive ART
bull Most case had extra-pulmonary TB 595
bull Dx HIV before TB 662
bull CD4 lt 200 6193 unknown CD4 3112
18
Summary
bull All TBHIV dead within 1 mo after Dx 367
2nd mo 187
bull 669 of death in 1st mo due to TB
bull Death from AOI occurred throughout the timeline of TB Rx peak at 4th mo
bull Systemic diseases deaths in the later mo
19
Summary
HIV Care
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
ART
Not received 223 674
CD4
Unknown 103 3112
Median CD4 37
Thai HIVTB Guideline 2008
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 100Start as soon as possible after patients can
tolerate anti-TB treatment
100 - 200Start ART at 2 months after initiation of TB
treatment
200 ndash 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 3 months
gt 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 6 months
Some Thai HIV experts may commence ART 2 months after the start of TB treatment especially if the patients cannot be tested for CD4 counts at 3 months after initiation of TB treatment
TAS J Med Assoc Thai 2008911925-36
33
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
Causes of death shown by proportion of deathsin each month of TB treatment
bull 3927 of TBHIV death was caused by TB and 2840 by AIDS-related OIs
bull 674 of TBHIV death didnt receive ART
bull Most case had extra-pulmonary TB 595
bull Dx HIV before TB 662
bull CD4 lt 200 6193 unknown CD4 3112
18
Summary
bull All TBHIV dead within 1 mo after Dx 367
2nd mo 187
bull 669 of death in 1st mo due to TB
bull Death from AOI occurred throughout the timeline of TB Rx peak at 4th mo
bull Systemic diseases deaths in the later mo
19
Summary
HIV Care
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
ART
Not received 223 674
CD4
Unknown 103 3112
Median CD4 37
Thai HIVTB Guideline 2008
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 100Start as soon as possible after patients can
tolerate anti-TB treatment
100 - 200Start ART at 2 months after initiation of TB
treatment
200 ndash 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 3 months
gt 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 6 months
Some Thai HIV experts may commence ART 2 months after the start of TB treatment especially if the patients cannot be tested for CD4 counts at 3 months after initiation of TB treatment
TAS J Med Assoc Thai 2008911925-36
33
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
bull 3927 of TBHIV death was caused by TB and 2840 by AIDS-related OIs
bull 674 of TBHIV death didnt receive ART
bull Most case had extra-pulmonary TB 595
bull Dx HIV before TB 662
bull CD4 lt 200 6193 unknown CD4 3112
18
Summary
bull All TBHIV dead within 1 mo after Dx 367
2nd mo 187
bull 669 of death in 1st mo due to TB
bull Death from AOI occurred throughout the timeline of TB Rx peak at 4th mo
bull Systemic diseases deaths in the later mo
19
Summary
HIV Care
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
ART
Not received 223 674
CD4
Unknown 103 3112
Median CD4 37
Thai HIVTB Guideline 2008
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 100Start as soon as possible after patients can
tolerate anti-TB treatment
100 - 200Start ART at 2 months after initiation of TB
treatment
200 ndash 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 3 months
gt 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 6 months
Some Thai HIV experts may commence ART 2 months after the start of TB treatment especially if the patients cannot be tested for CD4 counts at 3 months after initiation of TB treatment
TAS J Med Assoc Thai 2008911925-36
33
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
bull All TBHIV dead within 1 mo after Dx 367
2nd mo 187
bull 669 of death in 1st mo due to TB
bull Death from AOI occurred throughout the timeline of TB Rx peak at 4th mo
bull Systemic diseases deaths in the later mo
19
Summary
HIV Care
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
ART
Not received 223 674
CD4
Unknown 103 3112
Median CD4 37
Thai HIVTB Guideline 2008
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 100Start as soon as possible after patients can
tolerate anti-TB treatment
100 - 200Start ART at 2 months after initiation of TB
treatment
200 ndash 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 3 months
gt 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 6 months
Some Thai HIV experts may commence ART 2 months after the start of TB treatment especially if the patients cannot be tested for CD4 counts at 3 months after initiation of TB treatment
TAS J Med Assoc Thai 2008911925-36
33
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
HIV Care
N
HIV testing
Known before TB Rx 219 662
Not known before TB Rx 112 338
ART
Not received 223 674
CD4
Unknown 103 3112
Median CD4 37
Thai HIVTB Guideline 2008
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 100Start as soon as possible after patients can
tolerate anti-TB treatment
100 - 200Start ART at 2 months after initiation of TB
treatment
200 ndash 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 3 months
gt 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 6 months
Some Thai HIV experts may commence ART 2 months after the start of TB treatment especially if the patients cannot be tested for CD4 counts at 3 months after initiation of TB treatment
TAS J Med Assoc Thai 2008911925-36
33
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
Thai HIVTB Guideline 2008
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 100Start as soon as possible after patients can
tolerate anti-TB treatment
100 - 200Start ART at 2 months after initiation of TB
treatment
200 ndash 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 3 months
gt 350Defer ART and follow-up clinical status AND
monitor CD4 cell count every 6 months
Some Thai HIV experts may commence ART 2 months after the start of TB treatment especially if the patients cannot be tested for CD4 counts at 3 months after initiation of TB treatment
TAS J Med Assoc Thai 2008911925-36
33
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
Thai HIVTB Guideline 2016 (draft)
CD4 counts (cellsmm3)
Recommendation according to the
Thai AIDS Society Guideline 2008
lt 50 เรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
50-350
-ถาอาการวณโรครนแรงเรมภายใน 2 สปดาห อยางชาไมเกน 4 สปดาห
-ถาอาการวณโรคไมรนแรง เรมระหวาง 2 สปดาห อยางชาไมเกน 8 สปดาห
gt350 เรมระหวาง 2 สปดาห ndash 6 เดอน
อาการวณโรครนแรง ไดแก วณโรคแพรกระจาย น าหนกตวนอย อลบมนในเลอดต า ซด
33
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
TB Care
bull Dx of TB is difficult in HIV-infected patients
bull Definitive Dx is only 13
bull Routine microscopic and culture are not sensitive enough to detect active TB in PLWH
bull 595 had extrapulm TB
bull 305 of extrapulm Tb is TB meningitis
bull The importance of earlier detection of TB and improvement of immune status
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
TB Care
QI Projects
bull Increase coverage HIV testing in TB patients
bull Early Dx and Rx TBHIV
bull Collaboration Tb and HIV care
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
409 397 367 373 358 338 312 297 270 251 253 225 195 177 180 150
375 376394 382 415
525 602 627 658 706 697697
663 676747
768
216 227 239 245 228
13786 76 72 43 50 78
142 14773 83
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Positive Negative Unknown
Database update 30 Sep 2015
Total (N) 1946 1994 1893 2050 2162 2250 1923 1923 1822 1828 1881 1829 1562 1597 1629 1575
Year
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
226
246
188
120
143
165
120
0
50
100
150
200
250
300
2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
577552
469 468 464
414
319 317295
281267 264
215
244230
170
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Database update 30 Sep 2015
Data sources fiscal year 2000-2011 RITJATA and THRF2012-2015 CR-PHO
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
707
688
728
707
690
687
651
660
639
607
596
568
548
514
506
72
70
59
75
95
106
115
113
113
140
119
122
134
126
119
153
165
149
161
156
163
171
170
172
191
221
236
252
285
303
07
07
17
18
18
16
20
13
20
20
21
31
17
17
24
61
70
48
38
41
29
43
44
55
42
43
43
49
59
48
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(1906)
(1940)
(1864)
(1987)
(2103)
(2164)
(1852)
(1866)
(1729)
(1728)
(1712)
(1641)
(1447)
(1490)
(1521)
Year (N)
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
747
709
762
718
701
694
662
689
674
638
624
600
568
564
510
51
54
47
55
95
89
93
95
93
153
121
117
143
114
120
149
178
146
157
135
154
169
145
151
151
175
203
219
247
292
07
09
18
31
32
27
33
20
34
26
32
39
24
30
30
46
50
28
39
37
36
42
50
48
32
48
41
47
45
47
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
(866)
(764)
(807)
(822)
(846)
(809)
(755)
(733)
(687)
(671)
(652)
(649)
(685)
(664)
(570)
Year (N)
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
606
587
646
652
671
616
647
631
577
541
506
461
374
334
328
99
91
67
53
76
92
82
80
89
89
73
84
101
79
74
241
248
214
242
218
253
236
258
274
322
369
398
466
516
533
04
00
11
14
07
18
13
05
14
15
09
20
10
13
22
51
75
63
39
28
21
22
25
45
33
42
37
48
58
42
0 10 20 30 40 50 60 70 80 90 100
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
Success Loss follow up Death Failure Transfer out
Database update 30 Sep 2015
Year (N)
(780)
(773)
(684)
(739)
(753)
(730)
(572)
(550)
(462)
(435)
(422)
(359)
(285)
(254)
(274)
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
520
484
512
561
544
612
530
30
71
70
79
76
54
60
160
284
310
246
298
237
258
18
12
18
290
161
109
96
70
80
152
0 10 20 30 40 50 60 70 80 90 100
2015
2014
2013
2012
2011
2010
2009
Success DEFA DIED FAIL TOUT
Database update 30 Sep 2015copyCopy right (THRF_RIT-JATA)
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
Acknowledgements
33
-Dr Hutsaya Tantipong-Staffs members of RIT THRF-Staff members of TB clinic-Staff members of HIV clinic-Laboratory of Chiangrai PrachnukrohHospital
34
Thank you for your kind attention
34
Thank you for your kind attention