Policy Recommendations for Managing Latent Tuberculosis Infection Detection Among Contacts Using the Interferon-γ Release Assay (IGRA) and Treatment in the Lower Northern Region of Thailand

Abstract

The objective of this study was to develop policy proposals through mixed methods research. Phase 1 included document research, policy analysis of strengths and opportunities, global fund budget, Laboratory unit, networks, weaknesses and threats, insufficient policy communication, and budget reduction. Phase 2 included quantitative research. 43,457 cases were exposed to CXR, 40,181 (92.5%) had normal CXR results, 6,056 (15.1%) normal CXRs received IGRA testing, 1,214 (20.0%) had IGRAs positive, and 1,119 (92.2%) had IGRAs positive and received treatment. 83.6% completed treatment, 4.6% stopped medication due to side effects, and 71.0% used the 3HP formula. Logistic regression analysis revealed that (1) those treated at community hospitals (OR = 2.823) had a higher chance of completing treatment than at regional hospitals. 2.8 times and (2) those who received the 3HP formula were 4.1 times more likely to complete the treatment than those who received the 6-9 H formula (OR=4.132). Phase 3, qualitative research, key informants, 6 groups of policy proposals, set as indicators by the Ministry of Public Health and government inspection, Monitoring and evaluation, and continuous development by the Service plan TB Committee. IGRA testing should be included in the National Health Security benefits package. Every province has a Laboratory unit and medication (Point of care). Start treatment 2-4 weeks early. NTIP adds the variable of drug side effects. Budget from the networks, allocate funds for testing Thai and non-Thai disenfranchised people, and have an action plan strategy. The IGRA test is a method that most service providers and service recipients are confident in. It should be continuously supported. Seeking the alternative of other testing methods that are easy, accurate, and treated at nearby sub-district health-promoting hospitals to increase coverage, access to services, and reduce the burden of travel expenses.