Public private partnership in TB control, in Phnom Penh, Cambodia
Issue: Sihanouk Hospital Center of HOPE (SHCH) is a private NGO Hospital in Phnom Penh. Cambodia is among the 23 countries in the world with a high burden of TB and TB/HIV co-infection. A National TB Program (NTP) with DOTS strategy concentrates on free diagnosis and treatment of smear positive pulmonary TB (PTB+). The cost of an expensive work-up for extrapulmonary (EPTB) and smear negative pulmonary TB (PTB-), more frequent in PLWHA, is left to patients. Many TB/HIV patients are poor, so delays occur in case finding and treatment. At SHCH care is free. To improve adherence and cure rates, we joined NTP in August 2001.
Description: Before joining NTP, from January 1999 to December 2000, of 89 TB/non-HIV and 158 TB/HIV cases, only 48.3% and 41.2% completed treatment, respectively. In TB/HIV patients, 59% had EPTB. In total 45.7% defaulted. After becoming a NTP site the first annual report showed 602 cases with PTB or EPTB and 29.2% were registered for DOTS in SHCH; the rest was referred out to other NTP sites. Of those at SHCH, 37% had PTB+, 2.2% had PTB-, 60.8% had EPTB, 48% were HIV+, 20% were HIV-. Among TB/HIV group, 34.5% PTB+, 4.8% PTB-, and 60.7% EPTB. DOTS outcomes were PTB+ 75% cured; PTB- 50% fully treated; and EPTB 55.9% fully treated. TB deaths were 31.5%, of which 69% were TB/HIV+. Defaulters were only 6.8%.
Lessons learned: Joining NTP improved case detection, finding, and holding. EPTB was a significant finding in TB/HIV group. DOTS strategy improved outcomes in our patients. TB deaths were still high because of advanced stage of TB/HIV. The referral system improved, but we have few feedback on the outcome of referred patients.
Recommendations: Identifying HIV/TB patients is important. Treatment adherence must be linked to good referral system and patient support. Diagnostic strategy for PTB- and the communication in NTP network need to be improved. Efforts should continue to involve the private sector in TB programs.
The XV International AIDS Conference
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Public private partnership in TB control, in Phnom Penh, Cambodia.
The XV International AIDS Conference: