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Cambodia Perspectives Towards Elimination of New HIV Infections and ART as Prevention

Cambodia Perspectives Towards Elimination of New HIV Infections and ART as Prevention. Mean Chhi Vun, MD, MPH National Center for HIV, Dermatology and STI Control (NCHADS), MoH of Cambodia Email: mchhivun@nchads.org www.nchads.org. Outline. Evolution of the health sector response to HIV

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Cambodia Perspectives Towards Elimination of New HIV Infections and ART as Prevention

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  1. Cambodia PerspectivesTowards Elimination of New HIV Infections and ART as Prevention Mean Chhi Vun, MD, MPH National Center for HIV, Dermatology and STI Control (NCHADS), MoH of Cambodia Email: mchhivun@nchads.org www.nchads.org

  2. Outline • Evolution of the health sector response to HIV • Emergency response • Comprehensive response • Towards the elimination of new HIV infections • Challenges and Conclusions

  3. Evolution of Health sector response to HIV:From 1991 to 2020 Phase 2: 2001-2011 Phase 1: 1991-2000 Phase 3: 2012-2020 • Cambodia 2.0 • % HIV declined to 0.8 in 2010 • Universal access to ART • PMTCT and TB/HIV (5Is) • MARPs prevention and link to health services • Continuous Quality Improvement • Cambodia 3.0 • Elimination of new HIV infections • ART as prevention • eMTCT • MARPs • Health/Community System Strengthening • Monitoring and evaluation of impact • Cambodia 1.0 • % HIV peaked at 1.7 in 1998 • 100% condom use in sex work settings • VCT • Home-based care

  4. Cambodia 1.0 – HIV Prevention 100% CUP IEC/BCC STI case management HC Local Authority Police Health Workers RH/NGO Advocacy Monitoring brothel owners Sex workers STD Clinic Media (TV, radio, News paper) Special campaigns (Posters, leaflets, bill boards…)

  5. Cambodia 2.0: Continuum of Care Framework Facilitated Expansion of ART (District Level)

  6. Linked Response Approach (2008- ):Guided expansion of PMTCT and TB/HIV        + +    Referral and Follow-up HC  HC Satellite HC HCBC Team/NGO VCCT Referral and Follow-up Referral and Follow-up Referral and Follow-up Health worker/NGO HCBC Team/NGO HCBC Team/NGO + RH (Hub) Referral and Follow-up HCBC Team/NGO VCCT Community

  7. Continuum of Prevention to Care and Treatment (2009-) MARPs prevention and access to health services Health service delivery at district level Peer Network Peer Educator NGO Sex Workers and MSM HBC Team PHC network CBO NGO Health Workers Community/Peer Initiated Counseling & Testing (CPITC), VCT, Pre-ART/ART STI, ANC, SRH, Safe Abortion, Safe Delivery, EPI, Nutrition (children) TB, Malaria Laboratory

  8. Expansion of ART • ART coverage: Over 85% (CD4≤ 350 cc/mm³) • Survival rate: 86% @ 12M, 84%@24M and 78% @ 60M • Median of CD4 at ART initiation is more than 200

  9. Cambodia 3.0: Virtual elimination of new HIV infections by 2020 e-MTCT (Boosted LR) Pregnant Women and Sex Partners MARP Prevention and Links to Health Service (Boosted COPCT) MARP and Sex Partners STI case management VCCT, PITC (TB, ANC) Community Peer Initiated TC PLHIV and Sex partners on Pre-ART Immediate ART (CD4≤500) ART as Prevention

  10. Challenges Partner notification/involvement Monitoring of impact / Verification of elimination Overload of health workers receiving very low salary Limited leadership and management capacity at sub-national level Fragmented health and community systems (PHC, TB, Malaria, HIV, etc) Financial sustainability

  11. Conclusion • Know your epidemic and response remains key • Focused vertical response has controlled HIV during the early phases of the epidemic • Common service delivery framework for linkage and integration has maximized resources • Now we enter the last phase of active case finding and early ART whilst enhancing prevention efforts

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