Characteristics of HIV-infected tuberculosis patients in Thailand.

To improve understanding about the epidemiology and clinical features of HIV-associated tuberculosis (TB) infection we conducted a prospective, multi-center observational study of HIV-infected TB patients in Thailand. We enrolled HIV-infected patients diagnosed with TB at public health facilities from three provinces and the national infectious diseases referral hospital in Thailand. Patients underwent standardized interviews, evaluations, and laboratory testing at the beginning of TB treatment. We analyzed demographic and clinical characteristics of patients and stratified our findings by level of immune-suppression and whether antiretroviral therapy (ART) was used before TB diagnosis. Of 769 patients analyzed, pulmonary TB was diagnosed in 461 (60%). The median CD4+ T-lymphocyte (CD4) count was 63 cells/microl [interquartile range (IQR), 23-163.5] and the median HIV RNA viral load was 308,000 copies/ml (IQR, 51,900-759,000) at the time of TB diagnosis. Methamphetamine use was reported by 304 patients (40%), marijuana by 267 patients (35%), and injection drug use by 199 patients (26%). Three hundred three patients (40%) reported having been previously incarcerated. Among sexually active patients, 142 (42%) reported never using condoms at all. Patients with CD4 counts <200 cells/microl were significantly more likely than patients with CD4 counts > or =200 cells/microl to have extra-pulmonary TB, fever, fatigue, muscle weakness, no hemoptysis, tachycardia, low body mass index, jaundice, or no pleural effusion. Of the 94 patients that received ART before TB diagnosis, the median time from ART initiation to TB diagnosis was 105 days (IQR, 31-468). HIV-infected patients who developed TB after ART initiation were more likely than other HIV-infected TB patients to have extra-pulmonary TB, a normal chest radiograph, low HIV RNA viral load, or a history of previous TB treatment.

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

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

Cost analysis of different types of tuberculosis patient at tuberculosis centers in Thailand.

Tuberculosis (TB) has recently re-emerged as a major public health problem in Thailand. As a consequence of the HIV epidemic in the country, the TB burden has been rising in terms of both morbidity, and mortality which have tremendous socioeconomic impact. However, a study of the cost of various anti-TB drugs in Thailand has never been conducted. A specific aim of this study was to compare the total provider costs of delivering services to different types of TB patient in four zonal TB centers located in the east, northeast, north, and south of Thailand. This aim was accomplished by calculating the unit costs of TB treatment services at these TB centers during the year 1996-1997. All units of the zonal TB centers were classified into 5 cost-center categories: treatment units, laboratory units, radiology units, pharmaceutical units, and administrative/supportive units. The results showed that the average total provider cost of multidrug resistant TB (MDR TB) patients was 89,735.49 baht which was the highest of any type of patient and was 17 times higher than the cost of smear-negative TB cases; this finding was attributed to the high cost of anti-TB drugs for MDR TB cases (65,870 baht), some 95 times higher than the cost for smear-negative cases. Total provider costs were highest in the northeastern region TB centers and lowest in the southern centers for every type of TB patient: smear-negative TB cases (7.727 baht vs 3.916 baht). newly smear positive TB cases (12,539 baht vs 7.020 baht), TB with AIDS cases (15,108 baht vs 8,369 baht). re-treatment TB cases (16,679 baht vs 9,696 baht), and MDR TB cases (102.330 baht vs 82,933 baht). The information from this study may be useful when reviewing the role, function, and cost structure of each TB center in Thailand in order to establish a strategic plan for effective TB control.