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Public private partnership in TB control, in Phnom Penh, Cambodia

S Thai1, L Lynen2, K Kimura3, J G Hines1, S Moung1, N Seng1, W Schrooten2
1Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia; 2Institute of Tropical Medicine, Antwerp, Belgium; 3The Research institute of Tuberculosis, Tokyo, Japan

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
Abstract no. MoPeB3188

Suggested Citation
" S Thai , , et al. Public private partnership in TB control, in Phnom Penh, Cambodia. Poster Exhibition: The XV International AIDS Conference: Abstract no. MoPeB3188"