Thailand: MSF activities in the Surin provincial hospital

MSF has worked in the Surin province since the end of 1996. Our work started with the development of home care for HIV-positive persons or those who had developed full-blown AIDS. Since 1997, MSF has worked in Surin hospital, specifically on prevention of mother-to-child transmission and in- out-patient services for persons with HIV or AIDS (since 1998). The team also provides support for groups of HIV/AIDS patients.

Triple-therapy was first introduced in December 2000.

Some AIDS statistics in Thailand

- The fist visit is organised for a group of 5 or 6 patients. General information is provided on HIV/AIDS, CD4 lymphocytes, anti-retrovirals (how they work, the notion of treatment for life, the benefits and side-effects of treatment), the importance of compliance to treatment.

- The second visit takes place a week later. Each patient is examined by a doctor. The patient then meets with an educator on a one-to-one basis, which helps to validate the information collected from the first meeting. A blood test is carried out to measure the CD4 count.

- The treatment is prescribed by a doctor during the third visit, a week after the second meeting. After the consultation, an educator explains to the patient how to take his treatment (names of drugs in Thai, timetable for taking the medication, dietary precautions to be respected - on an empty stomach or not - what the patient must do in case of side-effects or if they miss their medication, etc.)

- Follow-up visits are carried out (every two weeks at first, then every two to three months, depending on the patient's condition). Alongside the medical evaluation during these visits, particular attention is given to the question of compliance. Theses visits also provide the patient with the opportunity to bring up any other problems: family or financial problems, psychological state, etc.

- 15 to 20 patients are included in the programme each month.

Mid-November 2001: 20 patients have begun triple-therapy and are being monitored at home, and 100 patients (of which 18 are children) are being treated in Surin hospital. Most patients have shown significant improvement both clinically and in their immunological status.

  • HIV prevalence in pregnant women: 1.4% (UNAIDS, 1999)
  • Only 0.5% of the 755,000 HIV patients in Thailand receive anti-retroviral treatment, most thanks to clinical trials.

    Introduction of triple-therapy in Surin

  • Since 1997, Surin hospital has offered bi-therapy (AZT/DDI) to a hundred HIV-positive patients.
  • MSF progressively introduced triple-therapy: at first for patients monitored at home (the first patient was treated in December 2000), and then for those cared for in hospital (April 2001).
  • Patients undergoing triple-therapy must be symptomatic and have a CD4 lymphocyte count below 250/ml. Doctors select as priority patients who are at an advanced stage of the disease.
  • 50 to 200 HIV consultations take place each week.
  • Before treatment, a number of visits are organised: