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This report presents the achievements and challenges faced in the TB/HIV program in Cambodia, including the burden of disease, prevalence rates, and progress made since 2001. It also outlines areas for collaboration and highlights the challenges in early case detection, staff capacity, and resources.
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3rd Global TB/HIV Working Group Meeting 04-06 June, 2003 Montreux, Switzerland TB/HIV Achivement in Cambodia Prepared by: Dr Seng Sut Wantha & Dr Khun Kim Eam TB/HIV Technical Working Group, Cambodia
Heavy Burden of Disease • Infant Mortality Rate : 95/1,000 live births • U5 Mortality Rate : 124/1,000 live births • Maternal Mortality Ratio : 437/100,000 live births • Main Adult and Children Health Problems : • AIDS : HIV Sero-prevalence rate 15-49 years 2.6% (Y 2002) • TB : 573 cases/100,000 • Malaria : incidence 7/1000 = > 5,000 deaths per year • DHF : Case fatality ratio = 2.9% • Diarrhea, ARI, Malnutrition
How much TB in Cambodia? estimatenumber rate/100,000 incidence (all) 75,000 573 incidence HIV+ 9,200 70 incidence (ss+) 34,000 256 prevalence (all) 178,000 1,356 prevalence (ss+) 72,000 548 (425) deaths 16,000 121
Prevalence of Pulmonary TB Preliminary Result of National TB Survey 2002
Prevalence of HIV among Sentinel groups in Cambodia, 2002
HIV Prevalence among TB Patients Preliminary Result of National TB/HIV Survey 2002
Progress since 2001 • June-July 01: TB/HIV and HIV/TB symposiums • Nov 01-: TB Screening Clinic for PLWHA in Phnom Penh • June 02: TB/HIV National Framework • Aug 02: Workshop for Pilot Project in 4 Hot Spot provinces • Jan 03: HIV prevalence survey among TB patients • Mar 03: Referral from VCT to TB center • Mar 03: VCT at National TB center • June 03: IPT for HIV(+)
Pilot Project: Multi-donor Collaboration • Action Plan: - TB patients to VCT for HIV testing - VCT clients to TB unit for TB screening - IPT , CPT - Networking with existing care activities
Target clients TB program Areas for collaboration HIV/AIDS Program 1 HIV negative Active TB - DOTS - IEC 2 HIV negative, but at risk Active TB - DOTS - IEC -Risk reduction -STI screening and treatment 3 HIV positive Active TB - DOTS - IEC - Joint case holding -HIV/AIDS care -Risk reduction -PCP prophylaxis -STI screening and treatment 4 HIV positive TB infection - IEC - IEC - Monitoring for active TB -HIV/AIDS care -Risk reduction -STI screening and treatment -IPT 5 HIV positive No TB infection - IEC - Assess BCG status for children who are HIV positive and asymptomatic - IEC - Prevention of TB transmission to HIV positive persons - Monitoring for active TB -HIV/AIDS care - Risk reduction STI screening and treatment IPT Responsibility and Collaboration by Epidemilogic Classification
CENAT Afternoon Clinic Interview Chest X-ray Physical examination TB screening for PLWH at CENAT Health Education Regular follow up Health Education Regular follow up & & Phnom Penh Home Care Network Group Non-TB Further Examination Sputum smear/culture, Tuberculin skin test, others Refer to other facilities for further examination TB Transfer to other TB units Ambulatory DOTS Home Care DOTS TB Treatment under CENAT Hospitalization
Follow Up of PLWH at CENAT Enrollment: 919 (Nov’01 - Apr’02) (May’02~Oct’02) 1st TB screening 6thmonth 12thmonth Follow Up = 744 (100%) @TB diagnosed before 6-month regular screening = 17 (2.3%) - Died = 67 (9.0%) - Moved out = 75 (10.1%) @ TB diagnosed at 6-month regular screening = 17 (2.3%) Total TB diagnosed in 6 months = 34 (4.6%) • On TB treatment = 8 • Diagnosed as TB • = 167 (18.2%)
Challenges • High Prevalence of TB • Long Delay, Detection Rate <60% • HIV/AIDS • Staff capacity and motivation • Resources implication: human, $, material • Early case detection • Involvement of community, private sector • Ensuring free -of- charge services