Dr Mean Chhi Vun NCHADS Director

Transcription

1 Dr Mean Chhi Vun NCHADS Director First Phnom Penh Symposium on HIV Medicine, September 2006

2 HIV/AIDS situation in Cambodia First HIV detected in 1991 First AIDS case diagnosed in 1993 Main route of HIV transmission: heterosexual 1998: 179,000 people living with HIV and AIDS In 2003: Estimated adult population infection rate: 1.9 % Estimated number of PLHAs among adult population: 123,100 (women 57,500) AIDS patients: ~ 20,000

3 Estimated number of people aged living with HIV/AIDS, , Cambodia 180,000 Number 160, , , ,000 80,000 60,000 40,000 20,000 0 Total Men Women 120,600 85,600 81,100 60,800 45,700 18,700 33,700 39,500 1,150 4,300 24,800 12, , , , , , , , ,100 95, , ,500 99,100 92,700 84,600 75,200 65,600 51,600 56,400 56,400 56,800 57,200 57,500 57,700 57, Year

4 Estimated number of AIDS cases by year, Cambodia Women Men Total

5 HIV/AIDS Treatment and care in Cambodia: before 2003 OI & ART commenced in few centres in Phnom Penh in 1999 (OI), (ART) Then expanded to a few provinces by NGOs Home-based care commenced in Phnom Penh and a few provinces VCCT centers confined in Phnom Penh and provincial towns (fewer than 20 ) No systematic framework for continuum of care

6 The Continuum of Care: after 2003 CoC framework: approved by the MOH in May 2003 Partnerships between medical services, PLHA groups, the public health system & NGOs at OD Strong referral mechanisms between the home, the community & the institutional care levels Effective involvement of PLHA in all aspects of the continuum of care MMM (RIPA) Reinforcement of health care facilities to provide quality care services to PLHA Development of care packages at each level of the health care system

7 Comprehensive CoC in Cambodia Family NGO clinics (VCCT, STD etc.) Public Health Facility Private clinics (VCCT etc) COMMUNITIES / VILLAGES OPD/Health centre (VCCT, ANC, etc.) OTHER CBOs TB/HIV PMTCT TB Services Lab support Maternity PLHAs HBC PLHA SUPPORT GROUPS MMM OI/ART (adults) IPD OI/ART (children) mmm Health service delivery

8 VCCT VCCT: entry point for both Prevention and Care First VCCT established in 1995 at Institute Pasteur of Cambodia Between VCCTs: 4 VCCTs - stand-alone alone 2 VCCTs integrated in the Public Hospitals From 2002 to Dec 2005, 103 new VCCT sites established: 74 VCCT sites - in the public health sector 24 VCCT sites NGOs (RHAC, Center of Hope, K. Angkor Hosp) 5 VCCT sites Sun Health Quality Clinic (PSI) By end of December 2005 : 109 VCCT sites in all provinces Jan- Aug 1, 2006: 24 VCCT sites (As of Aug 2006 = 133 VCCT sites) Plan by 2006: 160 VCCT sites

9 Trend in number of people tested for HIV from 1997 to June 2006 Number of people tested for HIV Average client-load per VCCT from 65 per month in 2003 increase to 130 per month in Jun-06 Years

10 Quality of VCCT: 97% received their test results through post-test test counseling, ,336 Type of service 152, , ,000 40,000 60,000 80, , , , , ,000 Number of people Pre-test Tested Post-test

11 Quality of VCCT: 97.67% received their test results through post-test test counseling, Jan-Jun Jun ,454 Type of service 98,756 99, ,000 40,000 60,000 80, , ,000 Number of people Pre-test Tested Post-test

12 VCCT Sites

13 Health Facility Based Care (HFBC) OI/ART: started in June 21, 2001 at PBSHN Hospital CoC started in August 23, 2003 at Maung Ressey RH (BTB Prov.) 2006 Plan: 40 OI/ART sites; 16,000 on ART As of 30 June 2006: 39 OI/ART sites (11 new sites from Jan to Jun/06) 1. CoC (incl. OI/ART) in 28 ODs/RHs at 17 Provinces 2. OI/ART (not full CoC): 9 sites in Phnom Penh and 2 sites at 2 Provinces 3. 16,379 AIDS Patients (Male: 8383,, Female: ) ) are on ART (including 1493 children [boys: 773,, girls: 720] ] on ART) ~ additional 12,140 PLHA receiving OI treatment and prophylaxis (no ART) 4. Jan-Jun/06: Jun/06: 4024 AIDS Patients on ART 4. 98% on 1 st line treatment PMTCT: started in 2002 As of December 2005: 27 sites in 15 ODs at 10 Provinces: Plan from Jun to Dec/06: 6 new OI/ART sites (STreng( STreng, Kratie,, OMC, Kralanh, Tmor Kol and RMHek)

14 OI and ART Sites, July 2006 On-going services: 9 sites in Phnom Penh 31 sites in operational districts Quarter I/ 2005 Quarter IV/ sites

15 PLHA on ART: 2001-JUN Number of active patients on ART x 5 target Jun-06 Years

16 TB/HIV Care and Treatment TB/HIV TWG set-up in 2002 TB/HIV care and treatment framework approved by MoH in 2002 Pilot for TB/HIV care and treatment in 4 provinces Strengthened collaboration between NCHADS and CNAT for HIV/TB care and treatment through: Joint statement between NCHADS and CNAT for HIV/TB care and treatment; Joint strategic activities for prompt HIV testing among TB patients and early TB screening among PLHAs; Joint work plan: selection of 150 health centers for prompt HIV testing among TB patients in 2006 Jan-Jun Jun 2006: (SVR = 36 HCs,, PVG = 38 HCs,, TKO = 23 HCs,, SHV = 10 HCs,, KDL = 3 HCs + 37 HCs (Q3), KPT = 3 HCs) 1030 TB patients received HIV testing (30%) ~20% HIV+ (208)

17 Pediatric AIDS CARE Pediatric AIDS Care integrated into CoC package, implemented by pediatric services at RH introduced Pediatric AIDS Care: As of 06/2006 = 15 sites 2003: 2 sites (NPH, Maryknol Clinic) 2004: 2 sites (Komar( AngKor,, AKSH) 2005: 4 sites (Takeo( Takeo, KgCham, SRieng, SHNVille) 06/2006: 7 sites (C.Neas( C.Neas, NLoeung, BBang, KKong,, Kg Speu, SSPhon,, Kg Chhnang) As of June 2006: 1493 HIV inf. children on ART Plan from Jul to Dec/06: 3 new sites (PSat( PSat, KgThom and Kampot)

18 Laboratory Support for OI/ART Before July 2005: cost for CD 4 testing was $14/test main barrier for accessing ART Through leasing agreement of CD 4 FACSCount machines: CD 4 testing is free (subsidized by partners) 12,000 tests per 6 months Upgrading general laboratory: PCR (viral load): 4 machines (NIPH, IPC, UHS) Provide 11 Spectrophotometers, 2 Ultrasound, 4 X-X Ray machines and accessories, 20 microscopes, 11 Hemato-Analyzers, reagents and consumables etc.

19 Capacity Building Set up OI/ART team in RH: 8 members (2 clinicians, 2 nurse ART counselors, 1 logistic officer, 1 X-Ray, X 1 lab. Technician, 1 team leader) Training programmes: Training curriculum already developed: OI/ART for clinicians is 5-month course, ART Counseling is 3-week 3 course, logistics management is 3-3 week course; OI/ART for pediatricians is 5-5 month course. Training activities: (1) OI/ART for clinicians: 125 clinicians trained (5 th Batch); (2) ART counseling: 82 counselors trained (4 th Batch), (3) Logistic Management: 30 logistic officers trained (3 rd Batch); (4) OI/ART for pediatricians started in Aug 1, 2006 with 23 participants. Secondment for clinical practice at National Hospitals for two weeks before commencing OI/ART services

20 Home & Community Based Care (HCBC) HCBC established in 1998 with 8 HBC teams, organized by NCHADS/ WHO From : 4 HCBC teams performed in 4 Provinces: KCN,BTB, SHV and SRP. As of July 2006: 283 HCBC teams in 17 provinces and Phnom Penh now NGOs managing

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22 PLHA Peer Support Groups CPN+ established in July 2001 As of July 2006: 569 peer support group networks in 12 provinces with 17,880 members. Involving in policy, strategy, guideline formulation, and MMM activities. Meetings between HCBC network and PSG network conducted once every quarter. PPN+ network at provincial level and DPN+ network will set up at district level in 2006.

23 Mondul Mith Chuoy Mith (MMM) - RIPA Reduce stigmatization and discrimination of PLHA by care givers Bringing all stakeholders (local authorities, PH officers, Clinicians, Counselors, Religious, NGOs, CBOs,, HBC, PLHA) to work together to support PLHA Linkage between the community responsibility and the clinical care and support to PLHA Started : 23 August 2003 in Maung Russey OD On average : 200 PLHA participate monthly in MMM monthly activities (meditation, exercise, dialogue sharing experiences, income generating, side effects,, health education, reproductive health, relevant care services, medical care and treatment). As of June 2006: 29 MMMs

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25 How was this achieved? Ownership by the Cambodian National Programme (Political commitment, clear vision, common strategies for all stakeholders, effective institutional base, regular monitoring) Support from the International Community partnership and participation to support decentralisation to provinces, ODs and NGO partners Sector-Wide Management (SWiM) comprehensive programme managed by NCHADS transparent & accountable Integration of CoC into the Health Care System Community participation: PLHAs, NGOs, bodies., NGOs, Religious

26 Conclusion The programme is committed to Universal Access: : with ownership, targets, political commitment, capacity building and appropriate technical decision-making making. with wide-ranging partnerships to utilize the contribution of all stakeholders and committed to effective, transparent, accountable management and high quality services.

27 Additional benefits.. CoC contributes to: Strengthening Health Care System (referral system, upgrading lab, capacity building, increasing staff motivation, re-vitalised service delivery ) Change from Clinical Management to Public Health approach (MMM, HCBC..) Stimulate linkage between health facilities and the community client-driven approach

28 Thank you