STANDARD OPERATING PROCEDURES (SOP) EXPANDING THE CONTINUUM OF CARE SATELLITE SITES 1. Intrductin t Cntinuum f Care In 2003, the Ministry f Health f the Ryal Kingdm f Cambdia apprved the Cntinuum f Care (CC) framewrk prpsed by the Natinal Center fr HIV/AIDS, Dermatlgy and STD (NCHADS). The Cntinuum f Care links the fllwing key elements f cmprehensive HIV/AIDS care: Clinical Care: Diagnsis f HIV infectin, Management f Opprtunistic infectins (OI) including TB, Prphylaxis f pprtunistic infectins, symptmatic and palliative care, antiretrviral (ARV) therapy, universal precautins (UP) and pst-expsure prphylaxis (PEP), and preventin f mther t child transmissin (PMTCT). Supprt: Cunseling, psychscial and financial supprt, supprt fr caregivers and children affected by HIV/AIDS (CAA), and reductin f stigma and discriminatin. Health Prmtin and Educatin: Infrmatin and educatin fr peple living with HIV/AIDS (PLHA) and their families abut HIV and HIV care, nutritin, and preventin f further HIV transmissin and family planning. The Cntinuum f Care is characterized by strng referral mechanisms between the hme, the cmmunity and the institutinal care levels. PLHA are invlved in all aspects f care and treatment including a frum t express cncerns and share experiences at MMM (Mndul Mith Chuy Mith), attached t the Referral Hspital.
Private HIV Testing and Care services HC TB MMM PMTCT OTHER CBOs PLHAs HBC OPD VCCT, ANC IPD (TB, Maternity Pediatric ) PLHA SUPPORT GROUPS Supprt services (Lab, X-ray) HIV Testing CD4 COMMUNITIES / VILLAGES Surce: Cntinuum f Care fr Peple Living with HIV/AIDS, 1 st editin, April 2003 REFERRAL HOSPITAL 2. Current Status f Cntinuum f Care At the beginning f 2006, there are a ttal f 20 cmprehensive CC sites and an additinal 12 sites that prvide OI/ART services. There are currently apprximately 11,000 patients n ARV treatment in Cambdia. The number f cmprehensive CC sites and OI/ART clinics is expected t increase t a ttal f 50 sites by 2010, cvering the care and treatment f ver 20,000 patients. There are currently 109 VCCT sites lcated thrughut the cuntry (each prvince is cvered) as well as fur CD 4 labratries, placed in strategic lcatins t cver the needs f all CC and OI/ART Service Sites. By 2010, 200 VCCT sites are prjected t be peratinal. The number f hme based care teams has increased t 261 in 2005, lcated in 17 prvinces and Phnm Penh. 2.1. Human Resurces The CC at each site cnsists f an OI/ART team fr adult f 7 individuals: 1. 2 Clinicians 2. 2 Nurse Cunselrs and keeping medical recrd 3. 1 Lgistics Officer
4. 1 Lab technician 5. 1 X-ray technician By the end f 2005, 100 clinicians, 50 nurse cunselrs, 30 lgistics fficers and 12 CD 4 lab technicians had successfully cmpleted Natinal training curses administered by NCHADS. 2.2. Cmpnents f Cmprehensive Cntinuum f Care The Cmprehensive Cntinuum f Care ffers the patient a package f services that includes: Entry Pint Fr HIV preventin and Care: VCCT Clinical Care: Prphylaxis and treatment f pprtunistic infectins (OI) fr children and adults TB/HIV care and treatment Pst-expsure prphylaxis (PEP) Antiretrviral treatment (ART) fr children and adults PMTCT Labratry and X-ray supprt Cmmunity Invlvement: Hme-based care PLHA peer supprt grups MMM 2.3. Integratin f Pediatric Services int Cntinuum f Care In 2006, the care and treatment f children and adlescents living with HIV/AIDS will be integrated int the Cntinuum f Care. Clinical management fr pediatric patients will be administered by the pediatric ward f the Referral Hspital in clse cllabratin with the OI/ART team. 3. Expanding the Cntinuum f Care: Satellite Sites 3.1. Objectives In rder t strengthen the care and treatment f peple living with HIV/AIDS in Cambdia, NCHADS fresees the establishment f secndary CC sites, r CC Satellites at Referral Hspitals in Operatinal Districts that are deemed t small t require a cmprehensive CC site. The bjectives f the CC Satellites will be: Reduce the wrklad f the OI/ART team at the cmprehensive CC sites Minimize the travel burden fr patients living with HIV/AIDS Build the capacity f clinicians and nurse cunselrs at Referral Hspitals in small Operatinal Districts
Braden the scpe f assistance t PLHA by intrducing MMM and ther supprt activities t secndary sites 3.2. CC Satellite Package At CC Satellites, individuals shall have access t the fllwing services: Entry Pint Fr HIV preventin and Care: VCCT Clinical Care: OI Prphylaxis and treatment fr adults PMTCT ART fr adults after successfully cmpleting 3-6 mnth trial perid Access t labratry and X-ray supprt Cmmunity Invlvement: Hme-based care PLHA peer supprt grups MMM Patients that are identified t be at a stage where they require ARV therapy shall be referred t the nearest cmprehensive CC site where they will have access t prper adherence cunseling in preparatin fr ARV medicines. Patients that have successfully undergne a minimum perid f three t six mnths f ARV therapy and have prven t cmply with 100% adherence may be referred back t the CC Satellite, where they can cntinue t regularly receive mnitring and ARV medicines. The satellite sites shall refer bld samples t the clsest reginal CD 4 labratry fr patient mnitring and shall als have access t the labratry and X-ray equipment f the nearest cmprehensive CC site shuld they lack these installatins. 3.3. Human Resurces The CC Satellite team will be slightly smaller than the OI/ART team at the cmprehensive CC level: 1. 1 Clinician Team Leader 2. 1 Clinician 3. 1 Nurse Cunselr 4. 1 Lgistics Officer 3.4. Training Clinicians, cunselrs and lgistics fficers f new Satellite Sites shall receive training in Phnm Penh administered by NCHADS.
3.5. Referral System Stand-alne VCCT centers that are nt part f a cmprehensive CC site shall refer PLHA t the clsest CC Satellite. VCCT centers lcated within cmprehensive CC sites shall cntinue t refer PLHA t the OI/ART team within the cmprehensive CC. Referrals f PLHA between cmprehensive CC sites and CC Satellites will be administered by the OI/ART team leaders under clse supervisin f the Prvincial AIDS Office (PAO). VCCT at CC Satellite VCCT at Cmprehensive CC Stand-alne VCCT centers Referral CC Satellite Referral Cmprehensive CC HIV diagnstics Cunseling OI prphylaxis/ treatment PEP MMM Access t CD 4 ART Cunseling Adult ART* PMTCT HBC Referral: *Patients back t CC Satellite after receiving ARV fr 3-6 mnths OI prphylaxis/ treatment PEP ART Cunseling Adult ART Pediatric ART PMTCT MMM CD 4 Labratry X-Ray HBC TB/HIV 3.6. Pediatric HIV at Satellite Sites It is freseeable that in the lng term, pediatric OI/ART clinical services will be made available at CC Satellites. Hwever, in the shrt term, pediatric HIV cases shall be referred directly t the nearest cmprehensive CC site, where children & adlescents living with HIV/AIDS shall receive necessary treatment at the Referral Hspital s pediatric ward in clse cllabratin with the OI/ART team.
3.7. Lcatin f prjected CC Satellite Sites in 2006 Prvince Operatinal Treatment Site District Battambang Battambang Tmar Kaul RH Pailin Pailin Pailin RH Siem Reap Kralanh Kralanh RH Kh Kng Srê Ambel Srê Ambel RH Svay Rieng Rmeas Hek Rmeas Hek RH Seen and Apprved January, 2006 Dr. Tep Lun Directr General fr Health Ministry f Health Dr. Mean Chhi Vun Directr f NCHADS Ministry f Health