Goal and objectives:The Reproductive Health Association of Cambodia (RHAC) works with the Ministry of Health to strengthen the capacity of health workers to provide or refer clients appropriately to HIV, reproductive health, and other health services. Program objectives are: 1) increasing the uptake of HIV testing and counseling, sexually transmitted infection treatment, and reproductive health services among most-at-risk populations; promoting the adoption of safer sexual behaviors; and increasing access to AIDS treatment, care, and support services for children infected or affected by HIV.

Geographic coverage and target population:RHAC works in Phnom Penh, Battambang, Siem Reap, Kampong Cham, Kampong Speu, Preah Sihanouk, Takeo and Svay Rieng provinces to provide services to 50,450 pregnant women, 5,000 female entertainment workers, and 2,560 men who have sex with men. More than 100,000 patients, including 3,528 tuberculosis patients, will receive HIV testing and counseling from 15 RHAC clinics and 88 public health sites with RHAC support. More than 10,000 individuals will receive sexually transmitted infection services. In Siem Reap province, 570 HIV-infected children will receive antiretroviral treatment and 1,550 children will receive HIV care and support services.

Strategies for maximizing cost efficiency and sustainability:RHAC clinics and government health centers provide integrated HIV and reproductive health services to improve client satisfaction and reduce costs. RHAC will enhance HIV programming in public health centers and will develop strategies to promote cost recovery and sustainability within its own clinics.

Monitoring and evaluation:RHAC regularly collects, monitors, and analyzes program data to strengthen implementation.

Global Fund / Programmatic Engagement Questions

1. Is the Prime Partner of this mechanism also a Global Fund principal or sub-recipient, and/or does this mechanism support Global Fund grant implementation? Yes2. Is this partner also a Global Fund principal or sub-recipient? Sub Recipient3. What activities does this partner undertake to support global fund implementation or governance?(No data provided.)

Target populations:Orphans and vulnerable children and their caregivers.

Interventions:With RHAC support, the Angkor Hospital for Children provides HIV care and treatment services to orphans and vulnerable children. The services and support are designed to improve the quality of life of children infected and affected by HIV/AIDS and their families. RHAC expects to support 1,150 such children in FY 2012.

Activities focus on the integration of orphans and vulnerable children into the community by strengthening the caregiving capacities of families, foster families, and alternative caregivers. RHAC supports monthly orphanage and home-care visits and provides support such as food, school and hygiene supplies, and repairs to homes and wells for families of HIV-affected children. During each visit, a clinical team monitors childrens growth and development and helps ensure the access of orphans and vulnerable children to essential services such as secure shelter, proper nutrition, clothing, and formal and informal education. The Angkor Hospital for Children provides school supplies to enable orphans and vulnerable children to pursue higher education, supports family income-generation activities to ensure food security and improve nutrition, and provides hygiene kits to promote healthy living.

In FY 2012, RHAC will strengthen links between community-based interventions and health facilities to increase access to clinical services among orphans and vulnerable children. Routine checkups will be conducted for children in the orphanages, schools and community. RHAC will refer affected children and caregivers to other organizations for legal aid, psychological, and financial support, as needed.

Target populations:Target populations include tuberculosis patients and their family members.

Interventions:RHAC supports HIV counseling and testing for tuberculosis patients by partnering with community-directly-observed-tuberculosis-therapy activities to identify individuals who would benefit from an HIV test, and by supporting HIV testing among tuberculosis patients in RHAC-supported public health centers.

With RHAC training and support, health center staff provide HIV testing and counseling services to tuberculosis patients. If HIV laboratory services are not available on site, RHAC supports transportation costs for health centers sending patient blood samples for analysis. Patients are referred to appropriate tuberculosis clinics and HIV care and treatment sites, and health center staff is trained to monitor and address challenges related to patient referrals and follow-up.

Target populations:Target populations include HIV-infected children and their caregivers.

Interventions:RHAC provides a comprehensive package of services for HIV-infected children at the Angkor Hospital for Children, including: care and treatment of HIV-related illnesses; nutrition support; social and material assistance; and psychosocial and spiritual support. About 650 HIV-infected children will receive care and support services through RHAC activities in FY 2012.

Assessments of CD4 cell counts are conducted every six months to determine whether HIV-infected children are eligible for antiretroviral treatment. Drug adherence counseling and management skills for minor side effects are provided to both parents and caregivers during their visits to the hospital and during home-care visits made by home-care teams. The hospital provides transportation support for poor families to bring their children for regular follow-up visits.

RHAC actively promotes involvement of people living with HIV in hospital and home care activities, in providing education and counseling to children and parents/caregivers, and in pediatric peer education for children. Peer educators play an important role in providing education and counseling, discussing problems, and identifying potential solutions with their peers. Education and counseling focus on good adherence to treatment, sexual and reproductive health, HIV and sexually transmitted infections, drug abuse, and other issues.

RHAC aims to strengthen links between hospital and community services with outreach to local leaders and community groups, and through established networks of community- and home-based care providers.

Target populations:Target populations include individuals most-at-risk for HIV infection.

Interventions:RHAC provides HIV testing and counseling in 15 of its own clinics, and supports HIV testing and counseling in 88 public health centers. In addition to routinely offering HIV testing and counseling to pregnant women, RHAC provides specialized HIV testing and counseling services to address the specific needs of female entertainment workers and men who have sex with men. These services are informed by regular meetings with members of beneficiary populations, and are provided through specially trained peer counselors and midwives. RHAC also supports HIV testing and counseling activities provided at the Angkor Hospital for Children.

Clients requesting HIV testing are referred to counselors for pre-test counseling and testing. RHAC promotes routine HIV testing for clients who receive treatment for sexually transmitted infections in their clinics. Trained providers and counselors provide counseling and testing services. In FY 2012, seven mobile teams will be established to conduct community-based HIV testing for entertainment workers in Phnom Penh, Siem Reap, Preah Sihanouk, and Svay Rieng provinces. With RHAC support, the Angkor Hospital for Children conducts HIV risk assessments among patients, identifies HIV-exposed children, and conducts HIV counseling and testing as needed.

RHAC refers HIV-infected clients to HIV care and treatment sites for needed services, and routinely follows up with these clients to ensure that their needs are met. The Angkor Hospital for Children provides HIV care and treatment services directly to children in need. Rapid HIV tests are used in a manner consistent with national guidelines, and external quality assurance monitoring is regularly performed at RHAC sites by the national HIV program.

Target populations:Target populations include female entertainment workers and men who have sex with men.

Interventions:RHAC provides prevention education and specialized clinical services to populations facing the greatest HIV infection risks, and aims to provide HIV testing or other clinical services to 2,400 female entertainment workers and 11,625 men who have sex with men in FY 2012. Interventions include: treatment for sexually transmitted infections and HIV testing at 15 clinics in eight provinces; behavior change communication on HIV and reproductive health in 43 entertainment establishments in Svay Rieng province; and partnerships with organizations in Phnom Penh, Preah Sihanouk, Battambang, Siem Reap, Kampong Cham, and Kampong Speu provinces to increase use of clinical services among men who have sex with men. In Svay Rieng, RHAC will train 120 peer educators to reach at-risk individuals through one-on-one counseling, group discussions, and quiz shows. RHAC will conduct 378 group discussion sessions reaching approximately 5,600 participants.

RHAC clinics provide client-friendly services for most-at-risk populations through the placement of peer counselors and midwife counselors trained specially to address the needs of entertainment workers and men who have sex with men. RHAC conducts meetings regular meetings with the entertainment worker and men who have sex with men groups to ensure that RHAC services are relevant to client needs.

Target populations:Target populations include pregnant women and infants.

Interventions:RHAC provides HIV testing and counseling for pregnant women through 15 private RHAC clinics in eight provinces and through support to 88 public health centers. RHAC clinics provide integrated reproductive health and HIV services including family planning, antenatal care, postnatal care, sexually transmitted infections diagnosis and treatment, and HIV counseling and testing. RHAC clinic staff provides comprehensive health education messages and offer HIV testing to patients waiting for other services. As part of RHACs antenatal care activities, midwives provide HIV counseling for pregnant women and routinely offer clients HIV testing services. All women receive appropriate family planning counseling and pregnant women who are HIV-infected receive information on safe infant feeding options. RHAC clinics refer HIV-infected women to HIV treatment and prevention of mother-to-child-transmission sites for needed services, and routinely follow-up with these women to ensure that their needs are met.

With RHAC training and support to public health centers, midwife counselors provide HIV counseling as needed to pregnant women receiving antenatal care. Blood samples from pregnant women, and often from their male partners, are send with their consent to laboratories for HIV testing; appropriate post-test counseling is provided at the health center. HIV-seropositive pregnant women are referred to HIV care and treatment sites and RHAC supports the associated transportation costs. RHAC supports staff supervision, quarterly meetings, and the provision of lab supplies to health centers, and works to strengthen referral systems between health centers and HIV care and treatment sites. In FY 2012, 50,500 pregnant women will receive HIV testing with RHAC support.

Target populations:Target populations include HIV-infected children and their caregivers.

Interventions:RHAC provides a comprehensive package of treatment services for HIV-infected children at the Angkor Hospital for Children. For HIV-infected children over 12 months of age, antiretroviral therapy is initiated as soon as possible regardless of CD4 or clinical stage. In FY 2012, 47 HIV-infected children will be newly enrolled on HIV antiretroviral therapy, and 580 HIV-infected children will continue receiving treatment.

RHAC provides ongoing mentoring and coaching for clinical staff at the Angkor Hospital for Children. To promote learning and experience sharing, staff attends regular coordination meetings with the provincial AIDS office and other partners.

With RHAC support, trained nurses, counselors and peer educators at the Angkor Hospital for Children provide three or more pre-antiretroviral treatment counseling sessions to children and parents or caregivers prior to the initiation of antiretroviral treatment. For patients receiving treatment, CD4 cell counts will be assessed ever six months, and viral load will be assessed annually, to monitor treatment effectiveness. Treatment adherence counseling will be provided to parents/caregivers and children during follow-up visits at the hospital and during home-care visits. Clinical staff assesses knowledge of parents, caregivers and children regarding proper administration of medicines, and provide education to aid in the assessment and management of possible side effects. Home-care visits are conducted to enhance partnerships and collaboration among parents, caregivers and staff, and to enhance rates of patient follow-up.