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Two birds one stone?-Effectiveness of community engagement and integrated TB/HIV interventions for hard to reach migrant population, Thailand's experiences

      Background: As part of Thailand National TB/HIV response, World Vision Foundation of Thailand (WVFT) has awarded the sub recipient of Global Fund round 13 within 2015-2016. It targeted for migrants population from neighboring countries like Myanmar, Cambodia, Lao and Vietnam. The program was set up in six borders between Thailand- Myanmar and urban areas (Tak, Bangkok, Pathumthani, Kanchanaburi, Phuket and Ranong) which are high TB/HIV burden in Thailand. Target population was set at 100,139 and WVFT launched RRTTR (Reach-Recruit-Test-Treat and Retain) strategy to obtain community engagement to fight against TB/HIV at the same time approach.
      Methods & Materials: WVFT launched to engage the community engagement for systematic community mapping, screening and selection of migrant health volunteers. Those volunteers were received by intensive training of trainer (ToT)integrated TB/HIV training categorized by three modules like roles and responsibilities of migrant health volunteers, TB/HIV counseling & management and public communication skills by native health personnel.
      Results: After two years, WVFT classified 504 migrant community clusters and reached 220 clusters. 650 migrant health volunteers were recruited for intensified TB/HIV case finding and health talks around their clusters. In TB component, 61,320 migrant community people were screened by verbal Intensified TB case finding (ICF)screening and 61% (61320/100139) achieved against the project target. 3, 681 migrants people were notified as presumptive TB cases and 100% tested for TB diagnosis. Among them, 341 and 196 presumptive TB cases were identified as all TB cases and New smear positive TB patients respectively and 100%(196/196) of New Smear positive TB patients and 98%(333/341) of all TB patients were enrolled for TB treatment. In HIV sector, 26,768 migrant people received HIV service package and 6,526 people were tested. HIV incidence rate was about 2% (124/6526) among migrants and 44%(54/124) are accessed to Antiretroviral therapy (ART)
      Conclusion: This evidence showed that integrated same time TB/HIV interventions, role of community engagement and participation of civil society organization (CSO) are crucial part of ending TB /HIV in hard to reach population. It is also cost effective and able to overcome language barriers, legal status and other socio cultural and structural barriers.