TB CARE I - Cambodia Final Report

The program's swift action and health reforms led to a dramatic decline in TB prevalence, with a 38% reduction in smear-positive cases and a 45% reduction in bacteriologically confirmed cases over a nine-year period. The introduction of directly observed therapy-short course (DOTS) in 1994 played a crucial role in this success. The TB CARE I project, funded by the United States Agency for International Development (USAID) from October 2010 to December 2014, aimed to build on this progress. The project, led by the KNCV Tuberculosis Foundation (KNCV), focused on seven key technical areas: universal and early access, laboratories and improved diagnosis, infection control, programmatic management of drug-resistant tuberculosis (PMDT), TB/HIV, health systems strengthening, and monitoring and evaluation, operational research, and surveillance. One of the project's key achievements was increasing case detection for risk groups. In prisons, the prevalence rate decreased from 18 times that of the general population in 2009 to approximately 3,000 per 100,000 in 2011. The project also supported screening for TB in hospital settings, particularly in outpatient departments and diabetes clinics. From January to September 2014, 4,715 clients were screened for TB, and 745 were diagnosed and put on treatment. The project also expanded childhood TB care, training TB physicians in diagnosis and treatment. During the project period, a total of 79,441 children suspected of having TB were referred for further diagnosis, and 14,180 were diagnosed and put on treatment. The project also introduced isoniazid preventive therapy (IPT) at health facilities, with 5,825 children registered for IPT over the life of the project. In addition, the project supported public-private mix (PPM) engagement, engaging with over 1,323 private providers in 26 operational districts. A total of 1,626 patients were diagnosed through PPM activities, exceeding the project's target of 1,243. The project also introduced innovative technologies to strengthen TB diagnosis and management. The GeneXpert MTB/RIF (GeneXpert) technology was introduced to decrease the diagnosis gap for MDR-TB. The project also developed a mobile health initiative to expedite sputum smear results to health center staff, reducing the turnaround time for delivery of test results from 15 days to 4 days. Community mobilization was also a key aspect of the project. CENAT developed standard operating procedures for MDR-TB, and the project supported the transition from an NGO-led pilot to mainstreaming PMDT under CENAT. The number of presumptive MDR-TB patients tested using all forms of testing increased throughout the project period. Overall, the TB CARE I project made significant contributions to TB control in Cambodia, building on the country's progress since 1993. The project's achievements in increasing case detection, expanding childhood TB care, introducing innovative technologies, and community mobilization have set the stage for continued progress in TB control in Cambodia.