Antiretroviral Therapy

1
Antiretroviral Therapy

• in
• Moung Russey
• Battambang Cambodia

2
Planning implementation process

• Provincial Health Department/Provincial AIDS
  office, Operational District and COC coordination
  committee discussions on the aims, plans to make
  ART available in Moung Russey
• Provide technical assistance to develop draft
  guidelines on ARTeligibility criteria and
  procedures for clinical monitoring,medical
  record,etc.
• Formation of ART committee
• Training including physicians, nurses,
  pharmacist,lab.technicians on ART,HIV disease
  management and adherence counseling

3
Contd

• Trained community home base care, volunteers,self
  help group leaders, health center staff who
  provide HBC, RH staff nurses and midwives on
  management of patients undergoing ART, drug
  counseling and monitoring of adherence to ART
• Establish a drug management system
• (procedures for ordering, storage,monitoring
• of supplies and dispensing of drugs.)

4
Contd

• In June 2004, started ART through the OPD of the
  referral hospital as part of continuous process
  of prophylaxis,treatment and management of OIs
• Strengthened linkages to refer patient in
• need of care and support in other services
• Involvement of PLHA and community throughout the
  process
• NCHADS with support from UNICEF has
• provided ARVs (first line regimen) for 150
  clients in
• Moung Russey

5
Statistics
6
Deaths

• 4 patients (2 male and 2 female) died after 2-14
  days of treatment
• Diagnosis (OI)
• 1-PulmonaryTuberculosis (on TB treatment for 5
  months)
• 1-Post extrapulmonary
• Tuberculosis and CM (completed TB treatment)
• 2-Post Cryptococcal Meningitis ( taking
  secondary prophylaxis)

7
Lessons Learned

• Establishing other components of Continuum of
  Care and strengthening the health care system
  prior to introduction of ART
• Partnership mechanism at all level is essential

8
Challenges

• Motivating underpaid staff

9
VCT August 03 - June 04
10
PMTCT October 20,2003 June 30,2004
11
HIV Care (OPD)August 23,2003 June 30,2004

• Number of patient enrolled
• Total 323 (male 44 and female 56)
• Diagnosis of patients
• 1.PCP
• 2.TB
• 3.Oral Candidiasis
• 4.Chronic Diarrhea
• 5.Others

12
MMM (Friends Help Friends Center)August
23,2003-June 2004
13
TB/IPT Screening(September 2003 May 2004)
14
Partners

• MOH/NCHADS
• National Tuberculosis Program (NTP)
• National MCH
• Provincial Health Department/Operational District
• UNICEF
• ADB
• JICA (INH for IPT)
• Gorgas TB Initiative
• PHR plus (Partnership for Health Reform)
• URC (University Research Company)
• Pasteur Institute,Cambodia
• Calmette Hospital
• RACHA (Reproductive and child health alliance)
• KHANA (Khmer HIV/AIDS NGO Alliance)
• CRC (Cambodian Red Cross)
• Self-Help group (4)
• KRDA (Khmer Rural Development Association)