Transcript HCV: Thailand country situation

Karyn Kaplan
Thai AIDS Treatment Action Group (TTAG)
www.ttag.info







Thailand: Population: 62 million
Est. HCV prevalence reports range from .7% 5% in voluntary blood donors (active/inactive
unspecified)
IDU population: 160,000
Est. HCV prevalence 92.5%
IDU HIV/HCV co-infection 88-96%
JAIDS: “…almost universal prevalence of HCV
in HIV-infected IDU…”
“…a diagnosis of HIV in IDU should indicate
probable HIV/HCV co-infection”

Antibody test (200-300 THB*)
Screened if suspected IDU
If HIV+ every 3 - 6 mos. basic liver enzyme testing performed
Many Bangkok IDU get their health care in context of clinical trials

Genotyping (2,500 – 7,000 THB)

Diagnostic tests can be ordered by physician and paid for under universal health care,
rarely practised in reality and genotyping available only in few major city hospitals



a. IDU have little access to health care
b. Negative attitude toward providers toward IDU adherence capaciy further
inhibits access to diagnostics and treatment, including ART
c. Lack of access to treatment precludes urgency of diagnostics (prohibitive cost
most frequently-stated problem)
HCV Viral Load (2,500 THB)
“So many (hepatitis) tests” – confirmatory, ultrasound (800 THB), monitoring side effects
(100 THB)
“HIV gets priority, ie, cd4 will be performed over hepatitis diagnostics with limited hospital
budgets”
*1 USD = 35 THB





International guidelines
Leading hepatologists at major public
hospital still only treating 3-5 cases/year
Both Roche and Schering-Plough tx available,
ribavirin cheap or free; PEG-IFN 7,000/dose x
24 or 48 weeks or $10-15,000 USD/person
“How can we get away from Roche and get
IFN from China?”
IFN v. PEG-IFN efficacy study completed,
equally effective SVR





Side effects include: astemia, anemia,
leucopenia, nausea, anorexia, headache,
insomnia, fever
Provision of anti-depressants or NSIADS
Dose reductions or discontinuation
HIV exclusion criteria; also, alcohol/drug use
Mixed willingness to treat OST clients





WHO IS GOING TO PAY?
Patient education – integrate hepatitis issues into
HIV care and drug treatment? What to ask your
doctor. Earlier access to HIV tx
Provider education – training across disciplines
(HIV, hepatology, drug treatment) and improved
treatment guidelines; med school curriculum
Improve referral system
Improve health care system (health care worker
shortage, rotation of doctors, lack of support for
nurses)




Prison health care capitation 100 THB/person
Universal health care – not cover HAV, HBV
vax or screening
Lack of harm reduction services and less IDU
in care
Organization of
IDU/PLWHA/NGOs/providers/GPO/NHSO/MSF
and need for global campaign
Mit Sampan Harm Reduction Drop-in Ctr, BKK