In FY 08 FHI will continue to support activities in the area of PMTCT implemented in FY07. Namely,

involvement at the national level through technical working groups (TWG) in the development of appropriate

guidelines and policies; strengthening PMTCT services and improving linkages among PMTCT and other

Continum of Care (CoC) and prevention services at the facility and community levels. FHI will support 8

PMTCT sites in Battambang, Kampong Cham and Pailin where the emphasis will be placed on

strengthening quality of services, providing targeted capacity building to providers, assisting in using site

level data for improving the program and strengthening linkages between PMTCT and different CoC and

prevention components. The primary target groups that will be reached through program activities, will

include pregnant women and their partners, health staff and providers, traditional birth attendants and CoC

providers, including home care teams.

The first component of this activity will provide technical support at the national level to the National Center

for HIV/AIDS, Dermatology and STDs (NCHADS), National Maternal and Child Health Center (NMCHC)

and the Ministry of Health (MoH) in the revision of PMTCT guidelines, policies and procedures, and training

curricula. FHI will support quarterly in-country regional counselor networks in Battambang, Pailin and

Kampong Cham, which provide a forum for sharing of experiences, providing updated skills and knowledge,

and discussing approaches for quality assurance and quality improvement (QA/QI). These fora will be used

to provide training on new PMTCT algorithms, positive prevention and discordant couple counseling to

PMTCT counselors as per the national guidance. FHI will support key stakeholders to integrate family

planning and reproductive health education and services into PMTCT initiatives and vice versa.

The second component includes strengthening PMTCT services at the facility and community level,

including strengthening linkages with other prevention and CoC components. Antenatal care (ANC) will be

used as an entry point for pregnant women and their partners to access a range of services. To promote

testing among pregnant women, breastfeeding women and postpartum women, health center staff will be

trained in provider initiated testing and counseling (PITC). Regular monthly supervision using QA/QI tools

will be undertaken by FHI PMTCT officers, as well as periodic joint operational districts (OD), provincial

health departments (PHD), NMCHC and FHI supervision teams. All PMTCT services are integrated within a

CoC framework that links PMTCT with other prevention, care and treatment services such as OI, ART, STI,

palliative care and pediatric AIDS. To promote better follow up of infants born to HIV positive mothers, FHI

will continue to provide technical assistance to 8 PMTCT sites, by promoting close linkages and

collaboration between community workers and PMTCT health staff. Existing fora such as site coordination

meetings and referral mechanisms will be used to discuss feedback and follow up. During PMTCT biweekly

site meetings, representatives from the OI/ART team will join to discuss status and follow up of HIV positive

pregnant women, or vice versa.

Training will also be provided to traditional birth attendants (TBAs) in collaboration with Reproductive and

Child Health Alliance (RACHA), Catholic Relief Services (CRS) and Save the Children Australia (SCA) on

PMTCT and universal precautions. PMTCT teams and home-based family care teams will be trained on

using checklists to follow up on exposed infants and their mothers, as well as promoting polymerase chain

reaction (PCR) testing for exposed infants at six weeks, universal precaution, ANC, appropriate prophylaxis

and promoting informed safe infant feeding and immunization. To enable provision of all these services FHI

works in close collaboration with the NMCHC, NCHADS provincial and operational district departments and

NGOs such as RACHA and Save the Children.

In FY 08, 8 PMTCT services outlets will receive technical assistance for strengthening of PMTCT services;

3600 pregnant women will receive counseling, testing and test results; 30 HIV positive pregnant women will

receive complete course of ARV prophylaxis; and 550 persons 490 of which will be traditional birth

attendants, will receive training on PMTCT services.

In FY 08, FHI will target entertainment workers (FSWs brothel and non brothel based) and their clients.

Risk reduction and risk elimination messages around sex and drug-taking behaviors, peer, outreach and

community-based education approaches will be utilized. FHI will identify new client groups and approaches

that reach commercial sex clients in targeted workplaces and entertainment venues. Tools and strategies to

target clients will emphasize and promote ‘B' messages and partner reduction. At the national level, through

involvement in the 100% Condom Use Program working group, FHI, and its consortium partners (Cambodia

Women for Peace and Development/CWPD and Medecin de l'Espoir du Cambodge/MEC) will advocate for

changes in guidelines and new strategic approaches. FHI, MEC and CWPD will assist National Center for

HIV/AIDS, STD and Dermatology (NCHADS) and local NGOs to implement HIV prevention and care

interventions with sex workers and clients and will support the development and utilization of approaches

which segment direct and indirect sex workers. Innovative approaches will also be piloted to involve

gatekeepers, such as establishment owners, in the delivery of messages, commodities and interventions.

Military and police are another risk group due to their mobility and frequent travel away from home. In FY

08, FHI will use targeted interventions with military and police in schools and recruitment sites, in addition,

greater support will be provided to the Ministry of National Defense (MOND) and Ministry of Interior (MOI)

for greater leveraging of resources.

In FY 08, at the national level, FHI will provide technical input to the National MSM Secretariat to implement

the national MSM strategic framework and operational plan. Insitutional capacity building training through

mentoring and formal workshops will be conducted for the national MSM network- Bandah Chaktomuk.

Peer and outreach activities through six implementing agencies will continue in ‘hot spots' in Phnom Penh,

Kandal and Banteay Meanchey provinces reaching over 2500 MSM. In addition, modern technology based

approaches such as websites, and text messaging (SMS) will be used to address risk behaviors of different

subgroups of MSM. FHI will provide training and be involved in the support of seven provincial MSM-

friendly government clinics- Battambang, Banteay Meanchey (2), Pursat, Siem Reap, Kampong Cham, and

Pailin. Training on drug use education and counseling will also be provided in these selected government

STI sites. In Phnom Penh, Chhouk Sar, an opportunistic infection/anti-retroviral therapy (OI/ART) clinic for

sex workers (SWs) will provide management of OI and ART services to most at risk populations (MARPs),

and counselors in these sites will be trained on working with these groups, especially drug users.

Drug use programming and messages will be integrated into all components targeting MARPs. FHI will also

work closely with the MOI in targeted prisons to implement strategic activities with 3000 prisoners, including

HIV testing and HIV prevention activities. FHI will continue to work closely with the National Authority

Combating Drugs (NACD), WHO, United Nations Office for Drug and Crime (UNODC) to operationalize

minimum standards for military and police drug treatment centers and provide appropriate training to staff.

FHI will also provide technical assistance to FHI implementing agencies working with drug using MARPs as

well as provide training on reducing use of amphetamine type substances (ATS). MEC will provide mobile

voluntary counseling and testing (VCT)/STI services to KORSANG (a local NGO working with drug users)

and Chhouk Sar will provide OI/ART services for drug users who are HIV positive.

In the seven targeted provinces, FHI will work with NCHADS and its local NGO partner, MEC, to strengthen

VCT/STI case management capacity and service delivery for MARPs. FHI and its partners will provide

quality assurance training, monitoring and support among government/NGO STI clinics and health centers

serving MARPs, particularly sex workers and their clients, and MSM.

Positive prevention in care and treatment settings will be emphasized in all programs. Through Cambodian

People Living with HIV/AIDS Network (CPN+) , Village Health Support Groups (VHSG), and home-based

family care teams, prevention messaging will be incorporated into community education and through

support groups.

In FY 08, 52,000 most at-risk individuals will be reached by targeted behavior change interventions that

move beyond an AB focus. Another 1,200 individuals will be trained to promote HIV/AIDS prevention efforts

across the country.

FHI activities under palliative care are comprised of primarily two components-facility and community based,

both of which target PLHA and their families. In FY 08, FHI will build on its strategic approaches of family

focused care, integration, creation of model sites and quality assurance and quality improvement within the

continuum of care framework.

At the facility levels in FY 08, FHI will strengthen the quality of Opportunistic Infection (OI)/ART services.

This includes training and supervision; strengthening the drugs and commodity supply systems;

strengthening case management and coordination structures; strengthening referral systems; improving

patient management and monitoring systems; and using data to improve activities. Targeted training

through a combination of onsite mentoring and formal training will be provided to physicians. To promote

greater learning and experience sharing, case discussions, expert group reviews, quarterly physician

network meetings, and Continuum of Care (CoC) coordination meetings will be used as a forum to discuss

findings. In locations where other partners work, such as URC, KHANA, RACHA and CDC, FHI will

collaborate closely to ensure complementary services are provided that enhance the value add of USG

funded interventions.

At the community level, FHI will support its partners to develop, implement and model community-based,

family-focused programs that reduce orphans and provide holistic prevention, care, support, treatment, and

impact mitigation services. Recognizing that HIV/AIDS affects entire families, FHI will support government

and NGO partners to integrate palliative care and OVC interventions to respond to wide range of needs of

families living with and affected by HIV/AIDS. Family care teams--composed of NGO, health center staff,

community and PLHA representatives--will make regular visits to PLHA households, providing material,

psychosocial, nutritional, clinical and legal support. Linkages to vocational training and income generation

will also be promoted as part of family-centered care. FHI will support the development and utilization of

tools such as "family folders" that link the patient records of children and parents living with HIV/AIDS, to

ensure that the socio-economic-medical needs of families are followed up appropriately. To guarantee the

high-quality of services, FHI will provide extensive capacity building to family care teams on topics such as

counseling and palliative care; succession planning; child participation; parenting skills training for

caregivers; community mobilization for care and support; establishing linkages for medical, psychosocial

and economic support; and addressing issues including gender empowerment, greater involvement of

PLHA and stigma and discrimination reduction. FHI will further support its partners to strengthen referral

systems and coordination with organizations and CoC components. Quality of care and support services will

be monitored using quality assurance guidelines and tools.

In FY 08, to better promote linkages between facility and community levels, assistance will be provided in

strengthening the CoC coordination meetings. These forums will be used to promote discussion and follow

up among facility based providers and home care teams on patients who are deceased, missing or require

follow-up. The home based care (HBC) component is linked to all other care and treatment areas as well as

all prevention components.

Training is a cross cutting theme, with providers and home care teams given training on a range of issues

such as OI, ART side effects, treatment adherence and literacy, positive prevention, universal precaution

etc. In FY 08, FHI will reach 8500 people with HIV-related palliative care and train 500 individuals to provide

these services through 22 service outlets.

FHI's primary beneficiaries under this component are OVC/PLHA infected and affected persons and their

families. FHI's OVC and HBC interventions are integrated to develop a more comprehensive family focused

approach. In FY 08, focus will be placed on targeting families directly infected and affected by HIV/AIDS

and technical assistance at the national level, targeted capacity building training, development of tools,

monitoring and supervision, and quality assurance.

In FY 08, FHI will provide extensive capacity building to home care teams on topics such as counseling and

palliative care; succession planning; child participation; life skills; parenting skills for caregivers; providing or

establishing linkages for medical, psychosocial, and economic support; and stigma and discrimination

reduction. Efforts will be made to strengthen the links between OVC community-based interventions and

those in health facilities in order to increase access to services such as VCT, PMTCT, OI treatment, ARVs

and pediatric AIDS care. In addition, strong links and partnerships will be established with community

development organizations that can support more comprehensive economic activities and skills to

beneficaries. Regular comprehensive monitoring will be conducted using the regionally adapted OVC

QA/QI tools and resources. Horizontal cross sharing among different sub partners will be encouraged.

To enable effective implementation, FHI links with a variety of partners, including provincial authorities and

NGOs. This ensures the coordination of activities and HIV/AIDS care, support and treatment referrals,

NGOs for income generation and vocational training support; school authorities; legal bodies; local wats and

pagodas, commune and village chiefs; the National AIDS Authority (NAA), UNICEF and MoSVY for

development of national policy and advocacy; and Global Fund for additional funding resources and

implementation in selected sites in Kampong Cham

In FY08, FHI will support its partners to provide direct support to 2500 children living with and affected by

HIV/AIDS. Another 2000 caregivers and health care providers will be trained to provide care and protection

for OVC.

In FY 08, at the national level, FHI will continue providing technical assistance to the National Center for

HIV/AIDS Dermatology and STDs (NCHADS) in the revision of voluntary and confidential counseling and

testing (VCT) guidelines, policies and procedures, and training curricula to incorporate new and emerging

issues. FHI will support quarterly in-country regional counselor networks in Battambang and Kampong

Cham provinces, which will provide a forum for sharing of experiences, providing updated skills and

knowledge, and discussing approaches for quality assurance and quality improvement. These forums will

also be used to provide training on important issues such as discordant couples counseling, positive

prevention and family planning options counseling for HIV positive clients during post test counseling. There

will also be more aggressive and intensive promotion of VCT services for families of PLHA, especially

partners through counseling and other approaches.

At the facility level, in FY08, emphasis will be placed on quality assurance and improvement, setting up

integrated STI/VCT/RH systems and sites. Through counselor network meetings and other specific training

opportunities for counselors, targeted training will be provided on family planning options counseling during

post test counseling among HIV-positive clients, PMTCT and STIs. Due to the lack of systematic links

between STI, reproductive health (RH) and VCT, two additional health centers will be piloted as sites for

‘one stop shop' RH, STI, VCT services. The process will be documented. STI providers in these sites will be

trained on ‘Provider Initiated Testing and Counseling' (PITC). Efforts will be made to strengthen linkages

between TB and HIV through piloting of options mentioned in national SOPs.

At the community level, in selected sites, such as military and police schools including drug rehabilitation

centers in Battambang and Banteay Meanchey, border battalions and Korsang, mobile integrated VCT/STI

services will be promoted. Outreach and home based care services will promote counseling and testing

services so vulnerable groups and their families have multiple options for HIV testing where they can be

directly linked with community-based prevention, treatment, care, and support services. Regular monthly

supervision using QA/QI tools will be undertaken by FHI VCT officers, as well as by periodic joint

operational district (OD), provincial health department (PHD), NCHADS, and FHI supervision teams. Blood

samples will be sent to the National Institute of Public Health (NIPH)/ Pasteur Institute periodically for quality

control checks.

Training is a cross cutting component, with health providers and counselors being trained on topics such as

discordant couple counseling, positive prevention, data management, and adherence to national guideline

and procedures. 56 counselors and providers are expected to be trained on VCT issues.

FHI will provide direct technical assistance to 28 VCT sites, but also promote VCT services in general in all

prevention, care, support and treatment programming. At least 35,000 individuals are expected to use and

collect results from these sites by the end of the year.

FHI works to ensure that ownership of all processes lies not with FHI but with the national and provincial

governments, local organizations, and community members. The overarching approach includes

strengthening the linked response and providing technical assistance to the national government on

integrating different components; quality assurance and quality improvement, and strengthening data

management and data use at facility and provincial levels. In FY 08, emerging issues that will need to be

dealt with include people on second line regimens, treatment failures, adherence fatigue, increasing number

of children on treatment, and greater need for polymerase chain reaction (PCR) and viral load testing.

To address these emerging issues, FHI will work with stakeholders at both the national/ provincial and site

levels. At the national level, FHI will continue to work with National Center for HIV/AIDS, Dermatology and

STDs (NCHADS) and other partners to develop and update curricula, policies, and guidelines and to

establish standard operating procedures for a linked response and for quality assurance. In FY 08, FHI will

support seven operational district referral hospitals and Chhouk Sar (a center providing care and treatment

to most at risk populations (MARPs)) to provide ART, clinical care, and supportive services to PLHA.

Regional opportunistic infection OI/ART networks for adult and pediatric patients will be supported quarterly

to provide a forum for ART service providers to share experiences, build their capacity, and gain a better

understanding of treatment intolerances and adverse clinical events. Greater emphasis will be placed on

monitoring drug resistance, treatment failure and adherence issues. Targeted training through a

combination of onsite mentoring and formal trainings will be provided. To promote greater learning and

experience sharing, case discussions, expert group reviews, quarterly physician network meetings and

Continuum of Care (CoC) coordination meetings will be used as fora. Training and capacity building will

increasingly look at aspects of RH/STI, drug use, etc. in addition to ART clinical issues. Quality assurance

and data use through fora including weekly case discussions, supportive supervision of services through in-

country supervisors, and ongoing mentoring and coaching from technical teams at the national and

provincial levels will be undertaken. To ensure better coordination, linkages and high quality, FHI will

collaborate closely with organizations such as the Clinton Foundation, CDC, WHO, and other USG partners.

At the community level, home-based family care teams, composed of NGO, community, PLHA, and health

center representatives, will continue to promote ART adherence, treatment literacy, and appropriate follow

up for ART patients. In FY 08, FHI will continue to strengthen the roles of Cambodian People Living with

HIV/AIDS network (CPN+) and Village Health Support Group (VHSG) to expand current treatment literacy

programs and health education. Community level activities are closely linked to facility-based activities;

within the health facility, all components such as PMTCT, voluntary counseling and care (VCT), OI and ART

are inter-linked. The equity fund will be tapped into as a resource in order to increase access to care and

treatment services for those who cannot afford to pay.

In FY 08, 1,300 individuals will initiate ART during the reporting period, and 3,800 people will be receiving

ART. Nine service outlets across the country will be providing ART. Approximately 56 health workers will

be trained to deliver ART services, according to national and/or international standards.

In FY 08, FHI will collaborate with the USG, Clinton Foundation, National Center for HIV/AIDS Dermatology

and STD (NCHADS) and the National Institute of Public Health (NIPH) for laboratory strengthening,

including training, supervision, quality assurance and quality control in FHI supported sites. FHI will seek

support from NIPH on laboratory quality control and training to laboratory staff in referral hospitals on CD4

testing and other laboratory tests important in monitoring HIV disease progression. NCHADS will also

provide supportive supervision to laboratory staff, as well as provide training on blood testing to VCT

counselors, health center staff and PMTCT counselors. To ensure quality testing and application of skills by

laboratory technicians after receiving training and monitoring, samples will be sent to the NIPH laboratory

or Pasteur Institute for retesting. Monitoring of retesting reports will be used to provide feedback to the

program and improving quality of laboratory services. Laboratory support will be provided to referral

hospitals supported by FHI and STI clinics where laboratory activities are implemented.

In support of PMTCT programs, PCR testing for exposed infants will be encouraged; laboratory support will

be provided by the NIPH laboratory. This will enable early diagnosis and hence timely treatment for HIV

positive infants.

In FY 08, 30 persons will be trained in the provision of lab-related activities in collaboration with the USG,

NIPH and NCHADS.

In the area of strategic information (SI), Family Health International (FHI) and its partners: (1) collect data to

provide information on indicators at the impact, outcome, and process/output level for USG programming in

Cambodia; (2) strengthen the capacity of the HIV surveillance/monitoring system and its personnel; (3)

provide information to explain changes in HIV prevalence, including the impact of USG-funded prevention

programming; (4) provide information for advocacy and policy; (5) assess effectiveness of programs that

provide care and treatment to ART patients; (6) assess costs of programs, recurrent costs and implications

of costs in the context of scale up; and (7) through these assessments and special studies develop a clear

understanding of the HIV/AIDS epidemic in the country so that that effective national policies and

appropriately targeted programs can be developed.

At the national level, in FY 08, FHI will provide targeted support, with emphasis placed more on technical

assistance rather than operational costs, especially in relation to the Integrated Behavioral Surveillance

Survey (IBSS). In FY 08, FHI will collaborate closely with organizations that conduct annual tracking

surveys to see how linkages can be established with the BSS/IBBS and information can be better utilized at

all levels for program improvement. FHI will also collaborate and plan for conducting size estimations of

selected most-at-risk populations (MARPs), such as men who have sex with men (MSM) in collaboration

with NCHADS and using wrap around funds from GFATM. In FHI-supported special surveys, surveillance,

research activities, FHI will ensure that it contributes to the priorities set forth in the ‘National Research

Agenda', the National M&E framework and the Country Impact Task Force data gaps analysis. FHI will

continue participation in technical working groups and other networks that review country progress against

national HIV/AIDS targets; and strengthen the implementation of one integrated national M&E system.

At the provincial and site level, emphasis will be placed on strengthening data quality and data use. At

specific sites such as referral hospitals, FHI will partner with organizations such as HHS/CDC and the

University Research Co. (URC) to ensure good use of quality data for program improvement. Close

collaboration with organizations such as WHO and HHS/CDC will be done to roll out any data management,

analysis, and usage models. At the site level, data management and use will be strengthened in the

supported sites and a standardized filing system based on technical areas will be used in all FHI supported

sites. Follow-up support will be provided for the FHI Cambodia Management Information System (FHI

CAMIS) database, which has the provision for data analysis and graph generation. Data use will be

strengthened through monthly and quarterly coordination meetings and regular program activities. Quality

assurance/quality improvement (QA/QI) tools will be used during regular site visits. In addition, in facilities

such as referral hospitals and health centers, FHI will collaborate with organizations such as URC to ensure

development of comprehensive health facility surveys and periodically measure progress against set

targets. In CoC sites, strong emphasis will be placed on monitoring treatment failure and resistance.

Refresher training will be conducted for staff and implementing agencies (IAs) on data management,

analysis, quality, and use. Training will be conducted at provincial levels in basic interpretation and use.

Ongoing capacity building of the surveillance unit staff will be intensified with seconded FHI surveillance unit

staff within the National Center for HIV/AIDS, Dermatology, and STDs (NCHADS). FHI will collaborate and

link closely with HHS/CDC, WHO, NCHADS, GFATM, the National Institute of Public Health (NIPH) and

other key stakeholders to plan and implement high quality strategic information activities and ensure good

use of results. In FY 2008, 37 organizations will be provided with technical assistance on strategic

information activities and 400 individuals will be trained in SI.

In FY 08, FHI will continue to play a key role in the development of the National Center of HIV/AIDs

Dermatology and STDs (NCHADS), National Maternal Child Health Center (NMCHC) and provincial annual

operational workplans. FHI will also strengthen existing national networks such as the National MSM

Network, Cambodian People Living with HIV/AIDS Network and the Women's Health Network that advocate

for reduction of stigma and discrimination among these marginalized groups. FHI will support institutional

capacity to all partners, implementing agencies and networks in specific areas. Documentation of programs

and processes will enhance sharing of best practices and evidence based programming. In FY 08, FHI will

continue to show leadership in new approaches and to share these experiences with partners and

stakeholders to improve the HIV/AIDS response.

Approximately 700 people will be trained in HIV-related community mobilization for prevention, care and/or

treatment in FY 08. 700 individuals will be trained in HIV-related institutional capacity building, and 30

trained in HIV-related policy. 700 people will be trained in HIV-related stigma and discrimination reduction.

Forty seven sites will be provided technical assistance for HIV-related institutional capacity building; FHI will

provide technical assistance to nine organizations--particularly governmental bodies, for HIV-related policy

development.