This multi-perspective qualitative study at the SMRU tuberculosis sanatorium in Mae Ramat, Tak Province, examined why migrants choose long residential treatment. It included 37 unique patients—33 who chose the sanatorium and four who chose community DOTS—plus five health workers. Three themes organized the findings: desire for cure, barriers to diagnosis and treatment, and community and organizational support.
Key findings
- For participants, being ‘cured’ meant symptom relief, avoiding transmission to family or community, and returning to work to restore economic stability.
- Barriers before and during treatment included direct costs, lost income, transport, limited tuberculosis knowledge, and fear of police or immigration authorities among undocumented migrants.
- Trust in SMRU and Mae Tao Clinic, together with arranged transport, food, accommodation, free care, and psychosocial support, made residential treatment practicable for many participants.
- Participants reported that a treatment-completion certificate could signal recovery and support community or work reintegration, although the study did not measure subsequent employment outcomes.
Why this matters globally
The findings frame migrant tuberculosis care as more than medication adherence: cost, legal vulnerability, income, trust, and basic support interact. Bundling free care with transport, accommodation, food, and psychosocial support is therefore a policy model worth testing in other border settings. This study, however, did not compare cure rates or cost-effectiveness between sanatorium care and community DOTS.
Thai researcher contribution
SMRU/MORU in Tak Province anchored the research question, participant access, data collection, and analysis. Nine authors list SMRU/MORU directly, and Francois Nosten holds joint SMRU/MORU and University of Oxford affiliations. Publisher-listed roles span conceptualization, methodology, investigation, data curation, analysis, project administration, supervision, validation, resources, and funding, showing that the Thailand-based unit was a research core rather than merely a recruitment site.
Limitations to consider
Participants had already selected sanatorium care or community DOTS, excluding people who declined care or were lost after diagnosis and creating possible self-selection bias. Only four participants chose community DOTS, so health-worker accounts supplied part of the perspective on non-use. Social-desirability bias remains possible even though facilitators were not involved in direct care. The exploratory qualitative design cannot establish causality, effectiveness, or cost-effectiveness, and Version 1 remained awaiting peer review on 30 August 2026.