Use of Information to Address TB/HIV in Cambodia

Published by the PHRplus Project at Abt Associates Inc., this 91-page paper aims to present the findings of a workshop conducted by Partners for Health Reformplus concerning co-morbidity pilot interventions implemented in four provinces.

From the Abstract
Cambodia is one of the countries most severely affected by tuberculosis (TB) and HIV. Adult HIV prevalence is 2.7 percent, 64 percent of the total population is infected by TB, and hundreds of thousand of people with HIV/AIDS are at risk to develop TB. In response, the Cambodian Ministry of Health has made addressing TB and HIV co-morbidity a priority and the National Tuberculosis Program and the National Center for HIV/AIDS, Dermatology and STDs are working to jointly plan, implement, and monitor TB/HIV interventions, starting with pilot activities in four sites.

At the Ministry’s request, the Partners for Health Reformplus (PHRplus) is providing technical support to develop an information component to support the TB/HIV activities. PHRplus is standardizing the information being collected across all sites and facilitating its use by implementing partners in order to increase case detection and strengthen case management of TB/HIV co-morbidity. In January–March 2004, PHRplus conducted workshops with the four sites to review information and data it had collected, to identify current pilot accomplishments, and to recommend how work could be improved. This report presents the workshop findings.

Excerpts from the Executive Summary
From January to March 2004, PHRplus conducted four workshops (one per pilot site) during which it presented to a total of 136 workshop participants the all information materials (forms and registers) and data it had previously collected in that site through site visits, on-site observations, and in-depth interviews with provincial and operational district health authorities and supporting agencies.1 Participants were asked to identify any missing forms or data collection instruments. Detailed maps showing the intersection of both the TB and HIV service delivery systems were presented for participant validation.

Following the plenary presentation session, participants were divided into smaller groups and, using the maps and their knowledge of the implementation experience, asked to identify what currently is working and what is not. An analytical guide listing the main components and essential tasks under each component of TB/HIV co-morbidity care intervention was provided to each of the participants, to help them with the analytical process.

...The following are important additional observations, gleaned by PHRplus during its visits to all four pilot sites:

• Battambang and Sihanoukville have well-organized central units (HIV Consultation clinic and Opportunistic Infection (OI) clinic, respectively) that treat OIs including TB, and manage the client referrals and care.
• In Banteay Meanchey, all TB patients are referred for HIV testing regardless of symptoms.
• HIV counseling training for TB service providers is crucial.
• Phnom Penh conducts a follow-up of TB patients every six months.
• An OI follow-up is conducted in Moung Roussey (every two weeks) and Sihanoukville (every month), which helps track the health status of the client.
• The Mondol Mith Chouy Mith (‘Friend helps a Friend’) meeting held every month in Moung Roussey helps TB/HIV peers to meet with each other as well with local authorities to communicate their grievances. They also benefit from services offered by the OI clinic.