TB CARE I - Cambodia Quarterly Report Year 4 January – March 2014

The program is supported by various partners, including FHI360, KNCV, MSH, and WHO. The program's workplan timeframe is from October 2013 to September 2014, with the reporting period covering January to March 2014. One of the significant achievements of the program is the recognition of the Ministry of Health of Cambodia by USAID for its extraordinary progress in TB diagnosis, treatment, and care. The Ministry was honored for reaching its Millennium Development Goal target of cutting in half TB mortality and prevalence prior to 2015. The Public-Private Mix (PPM) project in Cambodia was assessed by a team from CENAT, USAID, FHI360, JATA, WHO, and RHAC in March 2014. The assessment revealed that between 3.6% to 4.1% of TB cases notified in PPM implementing sites from 2007 to 2013 were through referrals made by private practitioners engaged in the PPM project. However, a significant proportion of clients referred by private practitioners do not arrive at the public health facilities they are referred to, with 55% in 2008 reduced to 39% in 2013. The PPM initiative, together with the Government ban on sales of anti-TB drugs, greatly reduced (almost eliminated) TB treatment from the private sector. Private providers are engaged in various ways by TB, malaria, and EPI programs, but these are vertically implemented, and there are missed opportunities for collaboration. The childhood TB program in Cambodia continued to be monitored and supervised by CENAT and the TB CARE I team in the 27 operational districts (ODs) supported by the program. Highlights for this reporting quarter include the referral of 5,243 children in contact with TB cases from health centers to referral hospitals for further diagnosis, with 1,186 (22.6%) children diagnosed with TB and registered for treatment. The proportion of pulmonary TB among these childhood TB cases is 21%. The TB CARE I program also supported HIV testing of TB patients, with about 2,000 TB patients tested for HIV in Q1 2014. As per annual NTP reports, in 2013, 82.7% of the TB patients notified to the NTP were tested for HIV, compared to 80.4% in 2012. Technical and administrative challenges faced by the program include the restriction of visitors to the prisons by the Ministry of the Interior, which has made it challenging to conduct regular supervisory visits to the 10 prisons supported by TB CARE I. The program is in discussions with the relevant department of the MoI to seek exemption and resume joint supervisory visits by FHI360, MoI, and MoH staff. The program's technical outcomes and activity progress are as follows: - Universal Access: The number of facilities where quality of services is measured increased from 38 to 43, and private providers collaborating with the NTP increased from 39% to 45%. - Laboratories: The number of days from the time sputum smears are sent by health centers to receipt of lab results decreased from <5 days to 4 days. - Infection Control: The program implemented a bi-directional screening and referral mechanism in hospitals with diabetes clinics, and provided local operational and coordination support to carry out a case study for the TB screening manual. - PMDT: The program strengthened management of childhood TB, including diagnosis, treatment, contact investigation, and provision of IPT. - TB/HIV: The program provided TB and HIV services in 10 prisons, and supported HIV testing of TB patients. - HSS: The program provided local operational and coordination support to carry out a case study for the TB screening manual. - M&E, OR, and Surveillance: The program implemented a bi-directional screening and referral mechanism in hospitals with diabetes clinics, and provided local operational and coordination support to carry out a case study for the TB screening manual. The program's financial overview is as follows: - The program received funding from USAID, and the financial overview for the reporting period is not provided in the document.