TB CARE I - Cambodia Quarterly Report Year 4 April - June 2014

The project is led by JATA, with coalition partners FHI360, KNCV, MSH, and WHO, and other partners CHC. The workplan timeframe is October 2013 to September 2014, and the reporting period is April to June 2014. TB CARE I's quarterly overview highlights several significant achievements. In the TB infection control project, all 36 health centers in the project sites were monitored and scored on their TB infection control practices using a standard checklist. All health centers achieved over 80% of the acceptable score, with 83% scoring 100% and the remaining 6% scoring 85%. Additionally, a simplified checklist for TB infection control at the community level is being used by DOTS watchers to assess TB patients' awareness on minimizing TB transmission. The project also led a series of focus group discussions with technical stakeholders and key affected populations to obtain their perspective on the interventions that should be prioritized for future funding applications. These discussions culminated in a national country dialogue, which brought together 100+ international, national, and subnational stakeholders, including key affected populations, to discuss and prioritize activities for the Global Fund concept note. TB CARE I also assisted in a joint assessment of the national strategy with an external consultant to meet the requirements of the Global Fund. In the area of childhood TB, 6,931 children in contact with TB cases were screened at health centers for TB symptoms and referred to referral hospitals for further evaluation, including chest x-ray and tuberculin skin test. This is an increase compared to the previous quarter. A total of 27.7% of the referred children were diagnosed with TB and registered for treatment, with 20% of these cases being pulmonary TB. TB CARE I is also supporting five provincial referral hospitals with TB and diabetes clinics to implement a bi-directional screening and referral mechanism. Monthly coordination meetings were held in all five hospitals to review implementation of activities, achievements, and challenges. During the quarter, 1,734 of the total 10,465 clients presenting to the outpatient departments and diabetes clinics were referred to the TB units of the hospitals, with 90% of those referred reporting at the TB unit and 17% eventually diagnosed with TB. The project has also made progress in implementing quality improvement (QI) approaches and tools to improve the quality of TB services in health facilities. Twenty-seven health centers conducted QI learning sessions during May and June 2014, attended by 811 participants, including health center staff, C-DOTS volunteers, private providers, religious leaders, and commune council members. HC staff and C-DOTS volunteers from high-performance sites continued to share their experiences with others during QI learning sessions. TB CARE I is also providing local operational and coordination support to carry out a case study for the TB screening manual, which is linked to a core project led by WHO. The activity is complete, and the project is now looking at ways to address suggestions made by HC staff and C-DOTS volunteers for improvement. In terms of technical and administrative challenges, the project is facing difficulties in finding a replacement for the research officer in Cambodia, who recently resigned, due to the short remaining period of the project.