PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
ACTIVITY UNCHANGED FROM FY 2008
In FY 2009 FHI will continue to support activities in PMTCT (Prevention of Mother To Child Transmission)
implemented in FY 2008. FHI will work to develop appropriate guidelines and policies; strengthen PMTCT
services and improve linkages among PMTCT and other Continuum of Care (CoC) and prevention services
at facility and community levels. FHI will support 8 PMTCT sites in Battambang, Kampong Cham and Pailin
where emphasis will be placed on strengthening the quality of services, providing targeted capacity building
to providers, using site level data for program improvement and strengthening linkages between PMTCT
and other CoC and prevention activities. Primary target groups will include pregnant women and their
partners, health staff and providers, traditional birth attendants and CoC providers, including home care
teams.
FHI will provide technical support at the national level to the National Center for HIV/AIDS, Dermatology and
STDs (NCHADS), the National Maternal and Child Health Center (NMCHC) and the Ministry of Health
(MoH) to revise PMTCT guidelines, policies and procedures, and update training curricula. FHI will support
regional counselor networks in Battambang, Pailin and Kampong Cham, providing a forum for sharing
experiences, updating 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. FHI will support the integration of
family planning and reproductive health education and services into PMTCT initiatives.
FHI will also strengthen PMTCT services at the facility and community level, including strengthening
linkages with other prevention and CoC activities. 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,
breastfeeding, and postpartum women, health center staff will be trained in provider initiated testing and
counseling (PITC). FHI PMTCT officers will provide regular monthly supervision using QA/QI tools and
working with 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 (Opportunistic Infection), ART (Anti-Retroviral
Treatment), STI (Sexually Transmitted Infections), 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 the 8
PMTCT sites, promoting close linkages and collaboration between community workers and PMTCT health
staff. Site coordination meetings and referral mechanisms will promote community feedback and follow up.
FHI will provide training to traditional birth attendants (TBAs) in collaboration with the Reproductive and
Child Health Alliance (RACHA) 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, promoting polymerase chain reaction (PCR) testing for exposed
infants at six weeks, and incorporating universal precaution, ANC and appropriate prophylaxis as part of
PMTCT follow up. FHI will also promote informed safe infant feeding and immunization. To enable
provision of these services, FHI works in close collaboration with the NMCHC, NCHADS provincial and
operational district departments and NGOs such as RACHA and SCA.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Safe Motherhood
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Estimated amount of funding that is planned for Food and Nutrition: Commodities $640
Economic Strengthening
Education
Water
Table 3.3.01:
The same as activity 28836.09 -- funding is split between GHCS (USAID) and GHCS (State)
FHI's comprehensive HIV prevention strategy focuses on entertainment service workers (ESWs), their
clients, men who have sex with men (MSM) and injecting and non-injecting drug users. Interventions
concentrate on behavior change approaches that reduce risk and vulnerability; promote and ensure access
to health information, products and services; create a more enabling environment for HIV prevention and
care; and improve the capacities of implementing agencies to manage, implement and monitor the program.
During FY 2008, FHI implemented the SMARTgirl and MStyle programs which will continue during FY 2009.
In FY 2009, FHI and its partners will continue the SMARTgirl initiative which targets female entertainment
service workers employed in brothels and non-brothel based entertainment establishments. This program
responds to issues identified in the 100% condom use program (such as the movement from brothels to
other entertainment establishments; low health service uptake and negative portrayal of all ESWs as sex
workers, when many of them do not sell sex) and establishes targets for annual reach and service uptake
using a social marketing approach. Outreach workers and peer educators will use invigorated tools and
communications materials to respond to specific objectives, while establishment owners and health
providers will be mobilized as SMARTgirl supporters to deliver messages, products and interventions. FHI
staff and partners will participate in capacity building sessions to improve and standardize program
implementation.
Male clients of female entertainment service workers will be reached through a combination of mass media
and interpersonal communications approaches. A weekly television program (Cambodia's Man among
Men), which challenges gender stereotypes and promotes male responsibility for self and family health and
well being, may continue into FY 2009. FHI and its implementing agency partners will also continue to
conduct targeted outreach for men in high risk entertainment establishments using tools developed jointly
by PSI (Population Services International) and FHI.
In FY 2009, FHI and its partners will continue to implement the MStyle program for MSM (Men who have
Sex with Men) in Phnom Penh, Kandal and Banteay Meanchey, and in other areas supported by the Global
Fund. MSM will be reached through a variety of channels including outreach and peer education, the
internet, phone messaging and special events. Targets for annual reach and service uptake will be
established and standards applied across implementing sites to ensure quality and foster greater impact.
FHI will continue to provide technical support to partner agencies, the MSM national technical working
group and Bandanh Chaktomuk (the National MSM network) in strategic behavioral communications,
information and MSM programming.
The revised uniformed services program which targets subgroups at greatest risk will continue in FY 2009.
FHI will work with the Ministry of National Defense (MoND) and the Ministry of Interior (MoI) to ensure that
HIV and health issues continue to be integrated into schools and recruitment sites and that both ministries
identify and monitor key strategic priorities from their HIV strategic plans.
In FY 2009, FHI and its partners will continue to implement its positive prevention strategy for PLHA, health
care workers and community volunteers. Positive prevention messaging and interventions will be integrated
in all of FHI's prevention, care, treatment and mitigation programming.
In six targeted sites, FHI will work with NCHADS and its local NGO partner, MEC, to strengthen VCT/STI
(Voluntary Counseling and Testing/Sexually Transmitted Infections) case management capacity and service
delivery for MARPs (Most At Risk Populations). FHI and its partners will provide quality assurance training,
monitoring and support among government/NGO STI clinics and health centers serving MARPs, particularly
PLHA, ESWs and their clients, and MSM.
* Addressing male norms and behaviors
* Reducing violence and coercion
Military Populations
Workplace Programs
Table 3.3.03:
FHI will integrate drug use programming and messages into HIV prevention initiatives targeting persons
engaged in high risk behaviors. Drug use prevention, harm reduction, addiction counseling, drug use
support groups, needle and syringe exchange (using funds from the Global Fund and AusAID), and
referrals to HIV and drug use care and treatment services will continue to be integral parts of the MStyle
and SMARTgirl initiatives. FHI will continue to work closely with the National Authority for Combating Drugs
(NACD), the Ministry of Interior (MoI) and others to implement, manage and monitor minimum standards in
targeted drug rehabilitation centers and prisons. FHI will also continue to provide technical assistance to
FHI implementing agencies and other stakeholders working with drug using MARPs (Most At Risk
Populations) as well as provide training on topics dealing with amphetamine type substances (ATS) drug
use and methadone maintenance treatment. MEC, an FHI local NGO partner, will continue to provide
mobile VCT (Voluntary Counseling and Testing) and STI (Sexually Transmitted Infection) services to
Korsang (a local NGO working with drug users) and Chhouk Sar (a local NGO providing ART, clinical care,
and supportive services to PLHA in most at risk populations (MARPs)) will provide OI/ART services for drug
users who are HIV positive.
Table 3.3.06:
FHI activities focus on facility and community levels within the Continuum of Care (CoC) framework. In FY
2009, FHI will build on its strategic approaches of family focused care, integration, creation of model sites
and quality assurance/quality improvement within the CoC.
At the facility level, FHI will strengthen the quality of OI/ART (Opportunistic Infection/Anti-Retroviral
Treatment) services through training and supervision to improve commodity supply systems, case
management, coordination structures, referral procedures and monitoring systems. Targeted training will be
provided to physicians through a combination of onsite mentoring and formal training. Case discussions,
expert group reviews, quarterly physician network meetings, and CoC coordination meetings will be used as
a forum to discuss findings. In locations where other partners work, such as the Reproductive and Child
Health Alliance (RACHA), Reproductive Health Association of Cambodia (RHAC) and HHS/CDC, FHI will
collaborate closely to ensure complementary services are provided that enhance USG funded interventions.
At the community level, FHI will develop, implement and model community-based, family-focused programs
and provide holistic prevention, care, support, treatment, and impact mitigation services. FHI will support
government and NGO partners to integrate palliative care and OVC (Orphans and Vulnerable Children)
interventions to respond to the wide range of needs of families living with and affected by HIV/AIDS. Family
care teams composed of NGO and health center staff, community members 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 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. 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. By supporting the implementation of the
Linked Response Standard Operating Procedures at health centers, FHI will further strengthen referral
systems and coordination with CoC activities. Quality of Care and support services will be monitored using
quality assurance guidelines and tools. In FY 2009, FHI will strengthen CoC coordination meetings. These
forums will promote discussion and follow up among facility-based providers and home care teams with
patients who are deceased, missing or require follow-up. The home based care (HBC) component is linked
to all other care and treatment areas and prevention components. Training is cross cutting as it covers a
range of issues such as OI/ART side effects, treatment adherence and literacy, positive prevention and
universal precaution.
Program Budget Code: 09 - HTXS Treatment: Adult Treatment
Total Planned Funding for Program Budget Code: $1,158,896
Total Planned Funding for Program Budget Code: $0
Table 3.3.09:
FHI will support an additional OI/ART site.
FHI ensures that ownership of all processes lies not with FHI but with national and provincial governments,
local organizations, and community members. The overarching approach includes strengthening the linked
response between HIV services and health centers and providing technical assistance to the national
government on integrating different components of care; quality assurance and quality improvement; and
strengthening data management and data use at provincial and facility levels.
In FY 2009, emerging issues include people on second line regimens, treatment failures, adherence fatigue
and greater need for polymerase chain reaction (PCR) and viral load testing. To address these emerging
issues 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 establish
standard operating procedures for a linked response and quality assurance.
FHI will support a new OI/ART site with an active file of 2,200 HIV patients at the Kampong Cham referral
hospital following Medecins Sans Frontieres (MSF) withdrawal. FHI will also support eight operational
district referral hospitals, the military Region 5 hospital and Chhouk Sar clinic (a local NGO providing ART,
clinical care, and supportive services to PLHA in most at risk populations (MARPs)). Regional opportunistic
infection OI/ART networks will 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 through a
combination of onsite mentoring and formal trainings. To promote greater learning and experience sharing,
case discussions, expert group reviews, quarterly physician network meetings and Continuum of Care
(CoC) coordination meetings will also be used for training and capacity building in RH/STI (Reproductive
Health/Sexually Transmitted Infections), drug use and positive prevention. Quality assurance and data use
will be strengthened through 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.
To ensure better coordination, linkages and quality of care, FHI will collaborate closely with organizations
such as the Clinton Foundation, HHS/CDC, WHO, and other USG partners.
At the community level, home-based family care teams, composed of NGO staff, community members,
PLHA, and health center representatives, will continue to promote ART adherence, treatment literacy, and
appropriate follow up for ART patients. In FY 2009, FHI will continue to strengthen linkages between
community level and facility-based activities such as PMTCT, voluntary counseling and testing (VCT),
TB/HIV and OI/ART. Existing health equity fund support will be utilized to increase access to care and
treatment services for those who cannot afford to pay.
Strengthening linkages between OI/ART pediatric, Continuum of Care (CoC) and prevention services is a
priority of the National Center for HIV/AIDS, Dermatology and STDs (NCHADS) and the National Maternal
and Child Health Center (NMCHC). At the national level, FHI will work through technical working groups
(TWGs) to develop appropriate guidelines and policies at the facility and community levels.
In FY 2009, FHI will improve the follow-up of HIV-exposed children from delivery sites to OI/ART pediatric
services through strengthened referral mechanisms. Greater emphasis will be placed on performing Early
Infant Diagnosis using PCR (Polymerase Chain Reaction) technology in collaboration with NCHADS, the
NIPH (National Institute of Public Health), UNICEF and the Clinton Foundation. Appropriate training of
home based care (HBC) teams, health center staff and OI/ART pediatric health care providers will be
conducted to efficiently implement early infant diagnosis (EID).
At the facility level, FHI will improve cotrimoxazol OI prophylaxis coverage among HIV infected and HIV
exposed children, as well as palliative care in the four OI/ART pediatric sites. FHI will train, supervise and
mentor staff in case management, coordination structures, as well as referral and monitoring systems.
Targeted training through a combination of onsite mentoring and formal training will be provided to
physicians. MMM (Friends Helping Friends) meetings for children will be supported by FHI and used to
provide appropriate information and education on basic care, prophylaxis and nutrition as well as social and
psychological support.
Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment
Total Planned Funding for Program Budget Code: $267,780
Table 3.3.11:
The National Center for AIDS, Dermatology and STDs (NCHADS) currently provides pediatric HIV care and
treatment through 19 OI/ART centers. In FY 2009, FHI will support NCHADS in expanding the number of
pediatric OI/ART sites in Battambang and Kampong Cham. FHI will work with other stakeholders, such as
UNICEF and the Clinton Foundation, at the national, provincial and site levels.
At the national level, FHI will continue to work with NCHADS and other partners to develop and update
curricula, policies, and guidelines for children receiving HIV care and treatment.
At the provincial level FHI will support four OI/ART pediatric sites in Kampong Cham and Battambang. In
addition to onsite mentoring and formal trainings, OI/ART pediatricians will attend Continuum of Care (CoC)
coordination meetings, PMTCT network meetings and quarterly OI/ART clinical network meetings to share
experiences and build their capacity and understanding of treatment of HIV/AIDS in children. Data collection
and use for care and treatment of HIV in children will be actively supported. In order to ensure quality
assurance and data usage, FHI will support weekly case discussions, supportive supervision of OI/ART
pediatric services through in-country supervisors, and ongoing mentoring and coaching from technical
teams at the national and provincial levels. At the community level, greater emphasis will be placed on
optimizing home-based family care team coverage of HIV children in order to improve ART adherence as
well as follow-up tracing of children lost to the system.
FHI's OVC (Orphans and Vulnerable Children) and home based care (HBC) interventions are integrated to
develop a more comprehensive family focused approach. In FY 2009, 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 voluntary counseling and testing (VCT), PMTCT, OI/ART and pediatric
AIDS care. Strong links and partnerships will be established with community development organizations
that can support more comprehensive economic activities and skills to beneficiaries. Regular
comprehensive monitoring will be conducted using regionally adapted OVC QA/QI (Quality
Assurance/Quality Improvement) tools and resources. To enable effective implementation, FHI links with a
variety of partners, including provincial authorities and NGOs. This ensures coordination of HIV/AIDS care,
support and treatment referrals with income generation and vocational training support, school authorities,
legal bodies, local religious entities (temples), and commune and village chiefs.
FHI also supports the National AIDS Authority (NAA), UNICEF and the Ministry of Social Affairs, Veterans
and Youth (MoSAVY) for development of national policy and advocacy. Support from the Global Fund
enabled FHI to expand coverage to additional sites in Kampong Cham.
Estimated amount of funding that is planned for Food and Nutrition: Commodities $30,267
Estimated amount of funding that is planned for Economic Strengthening $29,185
Estimated amount of funding that is planned for Education $2,783
Table 3.3.13:
At least five additional VCT sites will be supported.
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 counseling and testing (VCT) guidelines,
policies and procedures, and training curricula to incorporate new and emerging issues. FHI will also
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 (QA/QI). Trainings will be conducted
with health providers and counselors on topics such as discordant couple counseling, positive prevention,
family planning, data management, and adherence to national guidelines and procedures. There will also be
more aggressive and intensive promotion of VCT services for families of PLHA, especially partners and
children, as well as pregnant women.
In FY 2009, five new VCT sites will be supported in Battambang province. At the facility level, emphasis will
be placed on quality assurance and improvement, universal precautions, setting up integrated STI/VCT/RH
sites and implementing NCHADS Linked Response strategy to integrate services provided through the HIV
program and health centers. Through counselor network meetings and other training opportunities for
counselors, targeted training will be provided on family planning options among HIV-positive clients, positive
prevention, 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.
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 the options mentioned in national
TB/HIV SOPs. Health center (HC) staff will be trained in PITC to implement the option 2 requirement
sending the blood of TB patients to the nearest VCT site for HIV testing.
At the community level, mobile integrated VCT/STI services will be promoted in military and police schools,
including drug rehabilitation centers in Battambang and Banteay Meanchey, border battalions and Korsang
(a local NGO working with drug users). Outreach and home based care services will promote counseling
and testing services so vulnerable groups and their families have multiple options for HIV testing and can be
linked with community-based prevention, treatment, care, and support services. Regular monthly
supervision using QA/QI tools will be undertaken at VCT sites by FHI staff, as well as by periodic joint
operational district (OD), provincial health department (PHD), NCHADS, and FHI supervision teams.
* TB
Program Budget Code: 15 - HTXD ARV Drugs
Program Budget Code: 16 - HLAB Laboratory Infrastructure
Total Planned Funding for Program Budget Code: $948,246
Program Area Narrative:
In support of Cambodia's National Strategic Plan for a Comprehensive and Multisectoral Response to HIV/AIDS, 2006-2010 (NSP
-II), the USG provides support to the National Institute of Public Health (NIPH) and to the National Center for HIV/AIDS,
Dermatology and Sexually Transmitted Diseases (NCHADS) to establish HIV testing sites, further develop the national Reference
Laboratory for HIV, provide laboratory support for HIV and STD surveillance, monitor care and treatment, and improve the quality
of diagnostic laboratories.
The National Institute of Public Health Laboratory (NIPHL) is designated as the national HIV Reference Laboratory and is
responsible for: (1) assessing training needs and developing the necessary training to respond to those needs; (2) carrying out
regular laboratory supervision; (3) setting standards for equipment; (4) testing protocols and lab design; (5) serving as a reference
laboratory for national hospitals; and (6) providing quality assurance programs for laboratories throughout the country.
NIPH, with technical assistance from HHS/CDC, will continue its work in establishing a national public health laboratory network.
The objective of the laboratory network is to increase availability of a minimum package of laboratory tests across Cambodia,
decrease dependence on the NIPHL in Phnom Penh for such tests, and reduce the proportion of samples that need to be sent to
NIPHL for testing.
The capacity of Cambodia's HIV laboratory services remains weak and has not expanded with the same speed as expansion of
ARV treatment sites and available services are unbalanced. In three provincial facilities, the laboratory provides CD4 testing, but
has difficulty, or is unable to reliably conduct more rudimentary tests such as blood counts, electrolytes, liver function tests, gram
stains, or routine bacterial cultures. In addition, expired reagents and supplies provided through the Ministry of Health's (MoH)
Central Medical Stores remains a major obstacle to quality laboratory services.
Because of limited capacity to perform needed diagnostic tests and lack of reliable test results, clinical staff rely little on
laboratories to inform diagnoses and treatment. Laboratory capacity is further limited by segregation of services in line with
national vertical programs. TB may share laboratory facilities with voluntary counseling and testing (VCT), antiretroviral (ARV)
monitoring, blood bank, and other programs, or each program may maintain distinct laboratories with separate personnel. In either
situation, the staff, supplies, and other support is program-specific, resulting in multiple programs duplicating effort, services, and
resources.
In 2007 NCHADS initiated a movement to integrate the laboratory activities in some referral and former district hospitals. While
political obstacles remain, USG advocates strongly for laboratory integration in national technical working groups and will support
the integrated laboratories with technical assistance and, to a limited extent, essential equipment and reagents. This has already
been initiated at a referral hospital in Battambang.
Historically, few donors have provided technical and financial assistance to NIPHL. Recognizing the pivotal role the national
laboratory system has specifically for HIV/AIDS treatment and care, and the health system in general, the USG has supported
essential equipment and supplies and provided extensive technical assistance to NIPHL and the National Blood Transfusion
Center at the national level to support increased capacity of laboratories and blood banks throughout the country.
In COP 09, the priorities of USG-supported laboratory services are to improve and expand HIV testing, and ensuring quality
laboratory services at the NIPHL and regional laboratories. Additionally, USG supports the improvement of TB culture for PLHA
in Cambodia. USG provides policy input at the technical working group (TWG) level including the TWG for blood safety and
laboratory services and the TWG for TB Laboratories. Both of these TWGs are intended to provide a forum for discussion of
necessary policy changes at the MoH level.
USG directly supports the following seven laboratories:
(a) Reference Laboratory Level: the National Institute of Public Health Laboratory;
(b) Referral Level: Five referral hospital laboratories in three provinces: Pursat, Battambang, and Banteay Meanchey and one
referral hospital laboratory in Pailin municipality; and
(c) Health Center Level: One, the Poipet Health Center and one laboratory in Banteay Meanchey Province.
There is a tiered public health laboratory services structure in Cambodia. There is only one national reference laboratory in NIPH.
FASCount machines, supported by the Clinton Foundation, are used for CD4 testing in three provincial laboratories and NIPHL.
The number of FASCount machines in the provinces will increase soon to six. NIPHL will perform approximately 40,000 CD4
counts and over 3,800 HIV screening tests in 2008. USG has equipped NIPH with two voluntary counseling and testing (VCT)
rooms. Each of the 24 provinces has one provincial referral hospital with a full service laboratory. Within each province are
operational districts, each with a referral hospital with a laboratory providing only basic hematology. Additionally, there are more
than 950 health centers in Cambodia. Laboratory services, with the exception of sputum smear preparation, are not provided at
the health center level.
The National HIV Reference Laboratory at NIPH has developed the capacity to perform DNA PCR for infant diagnosis of HIV. This
testing was initially available for five provinces with dried blood spot (DBS) and laboratory supplies provided by the Clinton
Foundation. NIPHL staff in collaboration with NCHADS has trained health care workers from an additional seven provinces for
the expansion of DBS collection sites. Within the national laboratory network, viral load testing is available at the national level
with samples collected in the capital and in two provinces. USG will continue to partner with other donors such as the Clinton
Foundation to provide technical assistance to the NIPHL to improve quality and expand the capacity for viral load and CD4 testing
and for DNA PCR for infant diagnosis. Financial support for viral load testing is provided by the Global Fund and WHO.
The National TB Reference Laboratory (NRL) is housed at the National Center for Tuberculosis and Leprosy and is a part of the
National TB Program; it is not a part of NIPHL. There are three national laboratories which are capable of performing cultures for
TB, although these are underutilized. Drug susceptibility testing is only available at the NRL. Sputum smears prepared at the
health centers nationwide are transported (usually weekly) to a microscopy unit in a district or provincial hospital laboratory. USG
will work closely with the National TB Program, USAID's TB Capacity Assistance Project (TBCAP), and WHO on TB laboratory
issues at the national and provincial levels. Additionally, the National TB Program has a National TB Laboratory Strategic Plan
2007-2010. Among the activities planned is the expansion of TB culture capabilities. USG supports this activity and will introduce
liquid culture in the Battambang Referral Hospital laboratory. In FY 2009, USG will develop a Cooperative Agreement with the
National TB Program to further strengthen the laboratory diagnosis of TB in PLHA.
Adequately trained laboratory staff is the biggest unmet need in the national laboratory network. USG will address this by working
with partners to fund a Pre Service Curriculum Development program to the Cambodian Technical School for Medical Care.
Quality assurance needs to be improved throughout the network and this includes the need for improved laboratory management,
equipment maintenance, uninterrupted supply of quality control (QC) reagents, communication with clinicians and improved turn
around time for specimen processing. For example, positive sputum smear examination results may take seven to ten days to
reach the ordering clinician. Laboratory equipment is often donor provided, however, ongoing equipment maintenance and
supplies of reagents, including QC reagents, are not provided by either the donor or Ministry of Health on a regular basis.
Hematology and biochemistry testing, essential for monitoring ARV toxicity, is generally not supported by the vertical programs
such as the National TB Program or NCHADS. Outside of the laboratories supported by USG implementing partners, quality
assurance of laboratory services is weak.
In COP 09, USG will continue to develop quality management systems in the laboratories it supports. This will include training for
laboratory directors, training in infection control and biosafety equipment, and the addition of another laboratory analyst to provide
technical support in the focus provinces. USG will also work to implement a Laboratory Training Unit within the NIPH.
One USG NGO partner supports 20 laboratories in clinics providing HIV testing on site. The partner will continue to provide
quality control of its laboratory services and ongoing training of laboratory technicians.
Table 3.3.16:
FHI and its partners will collect data to provide information on indicators at the impact, outcome, and
process/output level for USG programming in Cambodia; strengthen the capacity of the HIV
surveillance/monitoring system and its personnel, provide information to explain changes in HIV prevalence,
including the impact of USG-funded prevention programming, provide information for advocacy and policy,
assess the effectiveness of programs that provide care and treatment to ART patients, assess costs of
programs, recurrent costs and implications of costs in the context of scale up, and 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, FHI will continue to provide targeted support, with emphasis placed more on technical
assistance rather than operational costs, especially in relation to the Integrated Behavioral Surveillance
Survey (IBSS). FHI will collaborate closely with the National Center for AIDS, Dermatology and STDs
(NCHADS), WHO and HHS/CDC to see how linkages can be established with the Behavioral Sentinel
Surveillance (BSS)/IBBS and information can be better utilized at all levels for program improvement. In FHI
-supported survival and viral load analyses using the existing routine data from health facilities, technical
support on HIV Sentinel Surveillance (HSS) and modeling data to estimate the HIV prevalence are key
research activities. Ongoing capacity building of the surveillance unit staff will be intensified with seconded
FHI surveillance unit staff within NCHADS. Training on triangulation of biological and behavioral data of
NCHADS surveillance staff will be conducted. 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 other organizations, such as HHS/CDC, to
ensure good use of quality data for program improvement. Close collaboration with 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. Follow-up support will be provided for the FHI Cambodia Management
Information System (FHI CAMIS) database, to improve data analysis and graph generation. Monthly and
quarterly coordination meetings and regular program activities will also be implemented. 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 other organizations to ensure
development of comprehensive health facility surveys and periodically measure progress against set
targets. In Continuum of Care (CoC) sites, strong emphasis will be placed on monitoring treatment failure
and resistance. Refresher training will be conducted for staff and partner agencies on data management,
analysis, quality, and use. Training will be conducted at provincial levels on basic epidemiology and
interpretation and use of data. FHI will collaborate closely with HHS/CDC, WHO, NCHADS, the Global
Fund, 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.
Table 3.3.17:
In FY 2009, FHI will continue to play a key role in the development of the National Center of HIV/AIDS
Dermatology and STDs (NCHADS), National Maternal and Child Health Center (NMCHC) and provincial
annual operational workplans. FHI will also strengthen existing national networks such as the National
MSM (Men having Sex with Men) Network and the Women's Health Network that advocate for reduction of
stigma and discrimination among these marginalized groups. FHI will strengthen institutional capacity in all
partners, implementing agencies and networks in specific areas. Documentation of programs and
processes will enhance sharing of best practices and evidence based programming. FHI will continue to
show leadership in new approaches and share these experiences with partners and stakeholders to
improve HIV/AIDS response.
Table 3.3.18:
