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Thailand. Well-developed health care system 200,000 need ARV Target 50,000 on ARV 50\% in Northern Thailand 50\% rest of Thailand, including Bangkok. Thailand. Min of Public Health and BMA responsible for scaling up ARV Major target: district hospital (DH)

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thailand
Thailand
  • Well-developed health care system
  • 200,000 need ARV
  • Target 50,000 on ARV
  • 50% in Northern Thailand
  • 50% rest of Thailand, including Bangkok
slide2
Thailand
  • Min of Public Health and BMA responsible for scaling up ARV
  • Major target: district hospital (DH)
  • 800 DHs, of which 500 deliver ARV now
  • ARV free/cheap
slide3
General remarks
  • M&E info comes from different sources:
    • Continuous monitoring
    • Surveillance
    • Surveys
  • Unified M&E system is possible in Thailand, while the following issues are important to keep in mind:
    • patient referral between hospitals
    • patient migration
    • stigma on ARV (no smartcards)
slide4
Needs, resources,access
  • Available: national level guidelines for doctors, nurses, counselors
  • Needed: training in comprehensive treatment, including OIs and pediatrics
  • Lab infrastructure + QA system
  • Better pediatric formulation
  • Policies to ensure equal access
  • Better access for children
slide6
Program Monitoring (2)
  • Start of treatment
  • Body weight
  • CD4
  • Side-effects
  • Regimen + regimen change + reason
  • Termination + reason
  • Electronic, 1 page, once a month
slide7
Program Monitoring (3)
  • Data can be used at all levels
  • Feedback of results important
  • Drug resistance: now going from research to surveillance (1000 patients)
  • Cost/Cost-effectiveness: important to measure, monitor
research issues
Research Issues
  • Evaluations of the ongoing program
  • Research on program improvement, additions to program
  • Step-by-step-improvement model
  • Adherence very important issue
    • Effects of training?
    • Effects of peer support?
    • Relation quality of program and adherence?
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