title: Treating the invisible: Gaps and opportunities for enhanced TB control along the Thailand-Myanmar border.
abstract: In Thailand's northwestern Tak province, contextual conditions along the border with Myanmar pose difficulties for TB control among migrant populations. Incomplete surveillance data, migrant patient mobility, and loss to follow-up make it difficult to estimate the TB burden and implement effective TB control measures. This multi-methods study examined tuberculosis, tuberculosis and human immunodeficiency virus co-infection, and multidrug-resistant tuberculosis treatment accessibility for migrants and refugees in Tak province, health system response, and public health surveillance.
  
  
  
  In this study we conducted 13 interviews with key informants working in public health or TB treatment provision to elicit information on TB treatment availability and TB surveillance practices. In addition we organized 15 focus group discussions with refugee and migrant TB, TB/HIV, and MDR-TB patients and non-patients to discuss treatment access. We analyzed the data using thematic analysis and created treatment availability maps with Google maps.
  
  
  
  The study identified surveillance, treatment, and funding gaps. Migrant TB cases are underreported in the provincial statistics due to jurisdictional interpretations and resource barriers. Our results suggest that TB/HIV and MDR-TB treatment options are limited for migrants and a heavy reliance on donor funding may lead to potential funding gaps for migrant TB services. We identified several opportunities that positively contribute to TB control in Tak province: improved diagnostics, comprehensive care, and collaboration through data sharing, planning, and patient referrals. The various organizations providing TB treatment to migrant and refugee populations along the border and the Tak Provincial Public Health Office are highly collaborative which offers a strong foundation for future TB control initiatives.
  
  
  
  Our findings suggest the need to enhance the surveillance system to include all migrant TB patients who seek treatment in Tak province and support efforts by stakeholders on both sides of the border to continue to share data and engage in collaborative planning on TB, TB/HIV, and MDR-TB treatment provision for migrant populations.
authors.affiliation: Faculty of Health Sciences, University of Ottawa, 1 Stewart Street, Ottawa, K1N 6N5, ON, Canada. ntsch059@uottawa.ca.|Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, PO Box 46, Mae Sot, Tak, 63110, Thailand. ntsch059@uottawa.ca.
authors.forename: Naomi
authors.identifier: 0000-0001-8132-1110
authors.initials: N
authors.lastname: Tschirhart
authors.affiliation: Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, PO Box 46, Mae Sot, Tak, 63110, Thailand.
authors.forename: Sein Sein
authors.initials: SS
authors.lastname: Thi
authors.affiliation: Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, PO Box 46, Mae Sot, Tak, 63110, Thailand.
authors.forename: Lei Lei
authors.initials: LL
authors.lastname: Swe
authors.affiliation: Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, PO Box 46, Mae Sot, Tak, 63110, Thailand.|Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, UK.
authors.forename: Francois
authors.initials: F
authors.lastname: Nosten
authors.affiliation: Faculty of Health Sciences, University of Ottawa, 1 Stewart Street, Ottawa, K1N 6N5, ON, Canada.
authors.forename: Angel M
authors.initials: AM
authors.lastname: Foster
mesh_terms: D000328:Adult; D060085:Coinfection / Q000453:epidemiology; D003299:Cooperative Behavior; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D002052:Myanmar / Q000453:epidemiology; D012036:Refugees / Q000706:statistics & numerical data; D013785:Thailand / Q000453:epidemiology; D014171:Transients and Migrants / Q000706:statistics & numerical data; D014376:Tuberculosis / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000517:prevention & control*
keywords: MDR-TB; Migrants; Surveillance; TB/HIV; Treatment; Tuberculosis