In Rayong, Thailand, CAP-TB has a unique chance to take “health systems strengthening” to the next level. Unlike some high TB burden countries, Thailand has the capacity to diagnose and treat TB and MDR-TB, largely using the country’s own resources. So here in Thailand, we ask: How can these resources become even more effective? A monthly series of MDR-TB Conferences, started last week by the CAP-TB team in Rayong, is designed to answer that question.
This conference series aims to improve MDR-TB control by building the expertise of multi-disciplinary teams that care for MDR-TB patients in Rayong. When nurses, doctors, pharmacists, TB coordinators, and hospital staff all draw on a unified base of technical knowledge about TB and MDR-TB, we can increase the system’s effectiveness and decrease the risks of nonstandard care. One central tool in this monthly conference series will be an ongoing cohort review of the 33 MDR-TB patients who are managed by this Rayong team.
As doctors know, case-based learning can be a very effective way to teach both the basic concepts of clinical care as well as higher level synthesis and analysis of clinical questions. For example, how does the surprisingly high proportion of HIV among these MDR-TB patients in Rayong influence our strategy? Have skills in conventional TB laboratory methods adequately aligned with the scale-up for molecular testing (such as GeneXpert)? And when technical and clinical questions arise, how can we ensure that this multi-disciplinary MDR-TB team can access current guidelines and, when needed, consult Thailand’s MDR-TB experts? Through connecting and coordinating this MDR-TB team in Rayong, Thailand can lead the way for other countries with similar challenges, demonstrating how clinical capacity building and innovative teaching methods can build skills in data synthesis and critical analysis. For a country such as Thailand, which largely uses its own resources to fight MDR-TB, this can play a crucial role within the TB system, strengthening the health system’s foundation and ultimately saving lives.