New Case-Study- Asia-Pacific: Bangkok · 2020. 10. 5. · Bangkok governor announced Order of Temporary Closure of Premises –March 17 Lockdown –April 4 Curfew imposed - March

September 9-10, 2020

Case-Study-Asia-Pacific: BangkokThitisant Palakawong Na Ayuthaya, MD.

BMA Health Department

Virtual Fast-Track Cities 2020 • September 9-10, 2020

VIRTUAL FAST-TRACK CITIES 2020

Content

• COVID-19 Status In Thailand

• Bangkok TB/HIV/STI Situation and Policy

• Disruption in TB/HIV/STI Services

• BMA Responses

• Lessons Learned

2

September 9 - 10, 2020

COVID-19 Status In Thailand



First case1/12

State of emergency and lockdown during 3/26-5/3

Thailand COVID-19 Status – Case Counts (Sep 2, 2020)

4



Bangkok COVID-19 Timeline

0

20

40

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100

120

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160

180

200

12

-Jan

-20

19

-Jan

-20

26

-Jan

-20

2-F

eb-2

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9-F

eb-2

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16

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23

-Fe

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1-M

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8-M

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15

-Mar

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22

-Mar

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29

-Mar

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5-A

pr-

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12

-Ap

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26

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3-M

ay-2

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10

-May

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17

-May

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-May

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31

-May

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7-J

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ul-

20

Thailand BKK

1st case of Boxing stadium outbreak –March 11

1st case of Nightclub outbreak – March 6

Bangkok governor announced Order of Temporary Closure of Premises – March 17 Lockdown – April 4

Curfew imposed - March 26

Gradual easing of the lockdown restrictions – From May 2 onwards

5


VIRTUAL FAST-TRACK CITIES 2020 6






Bangkok TB/HIV/STI Situation and Policy





2017

2030

2018

86% 56% 76%

92% 78% 76%

92% 78% 76%

96% 62% 82%2019

2020As of 2nd quarter

90% 90% 90%

Targ

ets

Re

sult

95% 95% 95%

Fast Track Target

PLHIV Diagnosed

PLHIV on ART

PLHIV Virally Suppressed

Progress Towards The 90–90–90 Targets In Bangkok, 2020

2020 Estimated PLHIV 78,505

PLHIV Diagnosed

75,374 PLHIV on ART

47,041

PLHIV Virally Suppressed

38,811



Strategic Plan to Ending AIDS In Bangkok, 2021 - 2030

Expedite search & service system for all people with HIV to be diagnosed quicklyStrategy 1

Increase access to HIV prevention through effective strategies.Strategy 2

Expedite people living with HIV / AIDS Receive early treatment after diagnosis and improve viral load suppression efficiency.

Strategy 3

Promote and protect human rights And gender equalityStrategy 4

Develop a strategic information system that can be used in planning improvement operations. And mobilize resources from both the public and private sectors

Strategy 5

13



Goal to Ending AIDS

Tested & Knew Status

95%

KP being prevented

95%

PLHIV had VL-suppressed

90%

Stigma & Discrimination

<10%Data-driven

quality improvement

14



TB Situation in Bangkok

WHO : End TB Strategy 2016-2035

126 : 100,000 (2013) 10 : 100,000 (2035)

15



TB Situation in Bangkok To achieve the target in 2035 …

16



TB Situation in Bangkok

TB Cases Reported in Bangkok, 2019

17


Disruption in TB/HIV/STI Services




• Reduction in outreach services and active case findings such as

TB/HIV/STI testing among key populations during COVID-19

outbreak

• Diversion of health systems capacity

19



Active TB Case Finding

20



• Reduction in number of patients seeking TB/HIV/STI treatment

• Slightly decrease in number of PrEP clients (Maybe due to changed in

social/sexual behaviors)

• More time with patients, faster services in some cases


21




• Increased risk for non-continuous TB/HIV/STI treatment or

LTFU due to Restriction of Movement Order (curfew, border

closure, air travel restriction)

22



Number of New PEP/PrEP Client Visits at BMA Public Health Centers (Aug 2020)

157

96 10575

93 9264

8793 81 70 60 5174

91

52

250

177 175

135 144166 155

139

0

50

100

150

200

250

300

Jan Feb Mar Apr May Jun Jul Aug

PrEP Clients PEP Clients Total


23



9 21 4173 95 112 125 137 153

3162

95

138

173

223257

300

335

1

2

3

9

14

16

19

22

23

0

100

200

300

400

500

600

BMA ARV InitiationState of emergency and

lockdown during 3/26-5/3

1960

94 111140 157 176 195 209

17

59

111

147

202

290

333

375

418

2

3

11

13

17

20

26

33

35

0

100

200

300

400

500

600

700

Gen(M/F) MSM TGThai (n = 662) Non-Thai (n=511)

State of emergency and lockdown

during 3/26-5/3

24



93.98%101.4% 97.5%

106.3%93.9% 91.9% 94.8%

0

10000

20000

30000

40000

50000

FY Q1 FY Q2 FY Q3 FY Q4 FY Q1 FY Q2 FY Q3

2019 2020

Axi

s Ti

tle

Nu

mb

er o

f C

ases

TX_CURR Retention Proxy

BMA HIV Treatment Retention Proxy (2019-2020)


25



BMA TB Treatment Success Rate

79.92% 79.50%

77.54%

88.40% 88.79%

76.15%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

2015 2016 2017 2018 2019 2020

Success Rate

26


BMA Responses



BMA Responses for TB patients

• Decongesting healthcare facilities

• Extended appointment. (from 1 week to 1-2 months)

• To align with Thai government policy: Social distancing

and stay home order

• Promote using communication through existing communication

platforms ex. Line, Facebook etc.

28

Fast-Track Cities Virtual Conference • September 9-10, 2020


• Move to VOT

• Increase home-visits and anti-

TB medication delivered by

HCWs

BMA Responses for TB patients

29



BMA Responses for PLHIV

• Decongesting healthcare facilities

• Differentiated Services Delivery in the

context of COVID-19 pandemic

30



Zoom Session on HIV-COVID19 Management with HCWs

31



• Balancing ARV stock levels with move to MMD

• Shortage of first-line single-tablet ARV - Teevir (TDF/FTC/EFV) due to

India ARVs export restrictions -> Switched to multi-tablet regimen

• Intensified MMD (up to 6 months)

BMA Responses for PLHIV

32







• Ensuring home delivery of

PrEP, condoms, and STI

medications via courier &

NGOs

• Provide TB/HIV/STI/PrEP

service in extended-hours

clinics

BMA Responses for HIV Control

35



BMA Responses for HIV Control

• Utilizing ICT innovations and online platforms for health promotion

36



138

88 9366

86 8556

80

19

8 12

97 7

8

7

0

20

40

60

80

100

120

140

160

180

Jan Feb Mar Apr May Jun Jul Aug

9 hospitals, DMS (N=77)

16 health centers, DOH (N=692)

Clients

Delivery 15 cases

Delivery 19 cases

Delivery 21 cases

Delivery 17 cases

Number of New PrEP Clients in BMA Public Health Centers And Hospitals, in 2020

37



BMA Responses

• Remote consultation (telemedicine)

• Existing social media and chat platforms.

• LTFU case management: Telephone call to F/U missed

appointment at day 0, 3, 7, 30

38



BMA Responses

• Strengthened out outreach

intervention through

combining COVID-19 mobile

swab units with HIV/STD

testing services for target

groups such as sex workers

39



BMA Responses

• In August, BMA launched a new 12-month HIV self-test program

in the Bangkok area, targeting MSM and TG population

40


Lessons Learned



Lessons Learned

• COVID-19 impacted to TB/HIV/STI healthcare services

• Flexible, uncomplicated and comprehensive services can be a solution

• Expansion of healthcare services through ICT services

42



Acknowledgment

• Division of Global HIV and TB Program (DGHT) PEPFAR US. CDC

• UNAIDS, Thailand

43

Documents

New Case-Study- Asia-Pacific: Bangkok · 2020. 10. 5. · Bangkok governor announced Order of Temporary Closure of Premises –March 17 Lockdown –April 4 Curfew imposed - March