HIV/AIDS TB
Combating TB and HIV in Rural Cambodia
An Integrated Community Based Strategy
History: AOC has financially supported the MOH Community DOTS program since 2003 in Lvea Em district. During this period the TB compliance rate in this area has risen from initial estimate of 60% to 95% in 2009. However, to reach National goals case detection and community wide awareness need to significantly improve. At the request of the MoH (2002) AOC has been providing HIV testing, medical care, treatment, counseling and support to PLWHA’s and their families. In conjunction with this in 2006 a very effective school and community education program began. This has gone a long way to reduce the level of discrimination; stigma and community care for PLWHA is very slowly improving. While the district Health Centers can provide free OI (opportunistic infection) treatment for PLWHA, ARV treatment is available only in the city and few access care there because of discrimination, lack of confidentiality and transport difficulties..
Purpose: HIV/AIDS-TB:
HIV/AIDS and Tuberculosis case detection, treatment, management and social support is implemented as an integrated community based service in Lvea Em district, Kandal province.
Objectives
*To collaborate with the Cambodian Ministry of Health, and facilitate a process whereby Tuberculosis and HIV/AIDS case detection, treatment, management and social support is implemented as an integrated community based service in Lvea Em district, Kandal province by March 2012.
*To increase the awareness, prevent the spread of HIV/AIDS and foster a sense of personal responsibility within the community through education and training.
The Need
Tuberculosis (TB) is still a major public health problem in Cambodia. According to the World Health Organization (WHO) Global TB Report 2006, Cambodia has the 22nd highest TB burden worldwide. Approximately two-thirds of all Cambodians carry the tuberculosis bacterium, and around 13,000 Cambodians die annually from the disease. TB is described as an opportunistic infection (OI); there is a high prevalence rate of TB amongst HIV/AIDS patients due to their already compromised immune system. The burden of TB in Cambodia is extremely high with an estimate of 703/100,000 in 2005 (WHO report 2007). Tuberculosis and HIV/AIDS are inextricably linked, a national serologic survey in 2005 among TB patients found that 9.9% were co-infected with HIV.
The National Health Strategic Plan for Tuberculosis control in Cambodia (2006-2010) objective is to have 80% Health Centers implementing Community DOTS program and for TB/HIV activities to have at least 80% of all TB patients referred for HIV testing with more than 90% of eligible TB/HIV patients on anti-retroviral therapy (ARV) by December 2010. Despite considerable progress made during the last five years in combating TB and HIV a number of challenges still remain to be overcome. These include high disease prevalence and incidence, quality assurance issues, lack of/limited resources to develop and expand innovative interventions such as C-DOTS, TB-HIV continuum of care and other areas such as MoH staff capacity, motivation and the issue of ensuring free of charge services.
1.65% of the population of Lvea Em is affected by HIV/AIDS. Misconceptions and discriminations are widespread, and many people don’t understand or care to take responsibility for their actions.
Strategy
AOC has been successfully providing medical care, counseling and family support for people living with HIV/AIDS in Lvea Em for a number of years. This along with a community and school HIV/AIDS education and training program has reduced the discrimination and is improving the health seeking behaviors of many adults and youth. AOC will begin working towards implementing the following strategy from January 2010.
In collaboration with the Cambodian Ministry of Health, Asian Outreach Cambodia proposes to facilitate a process whereby Tuberculosis and HIV/AIDS case detection, treatment, management and social support is implemented as an integrated community based service in Lvea Em district, Kandal province.
Impact: this will
* ensure equity and access to quality TB and HIV services at provincial hospitals, local Health Centers and in the community
* increase case detection TB and HIV
* ensure national protocols and guidelines for TB and HIV are implemented and adhered to
* ensure best use of available material and human resource
* quality and sustained continuing care and family support for PLWHA
* create awareness, prevent the spread of HIV/AIDS-TB and foster a sense of personal responsibility within the community through education and training.
Key Activities
1. Stakeholder involveme
2. TB/HIV case detection
a. cross testing of all existing TB and HIV/AIDS patients
b. new case detection - household by household (will be carried out according to detection and testing protocols)
3. Case Management:
local Health Centre staff, community care givers, ARV/TB and OI providers will collaborate to provide best possible treatment and social support for PLWHA and TB. AOC will help facilitate the process and provide technical, educational and social support.
4. Social Support
this will be coordinated by a Social Worker who will work with local volunteers to ensure practical (food security, housing, education etc), emotional/spiritual and social support networks are available when needed for PLWHA-TB.
5.Education and Training
1. Quality training with practical application, ongoing support and monitoring of standards will be given to MoH officials, staff and community volunteers in TB and HIV. This will include case detection protocols and guidelines, case management, patient and family counseling and education, caring for carers, monitoring and evaluation, record keeping and report writing.
2. Community HIV/AIDS Education: Train 50 local Community HIV/AIDS-TB Trainers, 2 for each village (I male, I female).
6. Monitoring and Evaluation
Monitoring and Evaluation is an integral part of each project activity and will be carried out internally and externally through monthly feedback and report meetings with Health Centre staff, community care givers, and AOC. Evaluation will occur every 6 months through feedback surveys, evaluation of use of national protocols and guidelines.
Impact:
The sustainability of this project will rest on successfully integrating the management of HIV/AIDS & TB into a non discriminatory service administered through the local health service with the help and support of local individuals and community groups.
The Cambodia Ministry of Health partners with major NGO’s to provide free anti-retroviral (ARV) drugs and treatment for opportunistic infections (OI) at regional hospitals. The National Aids Authority has developed a set of laws to protect PLWHA against discrimination in the workplace, hospitals etc, as well as promoting education on the spread and prevention of HIV/AIDS however this is taking sometime to be realized.
In 1994 the National TB Control Program (NTP) began the Tuberculosis Directly Observed Treatment Short-course (DOTS) program. Through this program the NTP provides free TB medication to all Referral Hospitals, Health Centers and Health Posts.
Stories
It is a problem that Neang Sophat is only too familiar with. As a participant in the AOC run HIV/AIDS Awareness Resources and Training (HART) Program, the 52 year-old has seen the devastation that discrimination and ignorance wreaks on the lives of HIV/AIDS sufferers in her village. To illustrate her point, she tells the poignant story of a young woman who became HIV positive after her husband had contracted the disease after sleeping with a prostitute. Despite displaying all the symptoms of HIV/AIDS, the woman refused to acknowledge she was HIV positive. more...
