MSF hands over it's HIV/AIDS activities in Kuchinarai to the local authorities.  After more than six years supporting HIV/AIDS care in Kuchinarai district, Kalasin province, Médecins Sans Frontières (MSF) is today leaving the district.

MSF has been working in Kuchinarai district since February 2002 in collaboration with local partners including Kuchinarai Crown Prince Hospital, Srinagarind hospital in Khon Kaen, HIVNAT organisation in Bangkok and the local People living with HIV/AIDS (PHA) Group, Kuchinarai Friends. MSF's programme has helped to provide quality care and treatment to over 400 PHA and their families in Kuchinarai district. Of which almost 250 patients received Antiretroviral Treatment (ART).  

"MSF came to Kuchinarai in 2001 because of the commitment of the local hospital to provide care and treatment at a time when this was poorly available in Thailand" said Dr David Wilson, former medical co-ordinator for MSF, who established the programme.      

The initial objective of the project was to demonstrate that AIDS treatment was feasible in a poor rural district of Thailand. In 2006, four new objectives were added: optimizing adherence support; improving the management of complicated opportunistic infections; introducing second-line HIV medicines and establishing a new model of community-based peer support.  For treatment of HIV/AIDS, usually a laboratory test called viral load is done to diagnose treatment failure. MSF piloted a different approach: introducing viral load in Kuchinarai as a tool for patients to adherence to their treatment. After 6 years, almost all PHA are still taking first-line ART and only 3% had to switch to second-line treatment.    

For those patients who do fail treatment, more potent, second-line drugs are needed, but these drugs are more expensive and poorly available in Thailand. The implementation of second-line treatment in the project was an entry point for advocating for greater availability of those drugs. Partly thanks to these efforts, the price of two key drugs – Tenofovir and lopinavir/ritonavir – have fallen and availability has increased.  Another major achievement of the project was the establishment of a programme to diagnose and treat Cytomegalovirus (CMV) retinitis, a blinding viral infection from which people with HIV/AIDS with low immunity are at particular risk. Despite high levels of infection in Thailand there is no national strategy to deal with CMV. A training and screening programme was established with the Ophthalmology Department of Srinagarind Hospital and the regional office of Disease Prevention and Control of Ubon Ratchatanee to support diagnosis and treatment of this neglected disease.  

Finally, MSF introduced the concept of community-based PHA support groups. The 'One Tambon One Group' (OTOG) approach at the sub-district level served as a way to provide support to stable patients nearer to where they live, thereby both decongesting hospital services and removing the need for PHA to travel to the hospital to get their medicines. OTOG provides at local level support to PHA through education and adherence support, stigma reduction activities in the community and referral to the health services for patients in need of medical care. The success of this approach has been recognised by the sub-district administration and they agreed to finance the group's activities after the departure of MSF.  

"The treatment success rates in this rural district of Thailand, with only 3% failing first line treatment so far, are as good as anywhere in the world. This success is down to the equal partnership between the hospital, MSF, and the PHA group." said Dr Kace Keiluhu, medical advisor for the MSF project.

After the handover of the HIV/AIDS activities MSF will close it's base Kuchinarai. MSF's activities in Bangkok, Phang Nga, Sangklaburi, Chiang Rai and Pattani will continue.