Goals and Objectives. The National Center for HIV/AIDS, Dermatology and STDs (NCHADS) leads the HIV response within the Ministry of Health. This implementing mechanism will strengthen care and treatment for people living with HIV and reduce mother-to-child transmission (MTCT) in Cambodia. Objectives are to: improve the quality of HIV clinical services; build clinical and laboratory capacity to monitor HIV treatment; expand MTCT to 85 percent of HIV-infected pregnant women; and strengthen collection and use of strategic information.

Geographic Coverage and Target Populations. This program supports activities at the national level and in four focus provinces in northwest Cambodia, where 14 percent of Cambodias population resides and 18 percent of patients enrolled in HIV care and treatment services receive their care.

Cost Efficiency. Models of service provision which have potential to become more cost-effective over time are introduced through this program in the focus provinces and, when fully developed, scaled-up nationally using other resources, primarily the Global Fund.

Monitoring and Evaluation. Programmatic data and an improved electronic patient information system will be used to monitor impacts and improve care, and lead to better understanding of the HIV epidemic. Joint site visits using standardized tools will be carried out by NCHADS and CDC staff to monitor program performance.

Transition to Government Partner. NCHADS is the Ministry of Health agency responsible for planning, developing and implementing HIV prevention, care, and treatment activities.

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? Principal Recipient3. What activities does this partner undertake to support global fund implementation or governance?(No data provided.)

In FY 2012 the National Center for HIV/AIDS, Dermatology and STDs (NCHADS) Cooperative Agreement will support prevention of mother-to-child-transmission, adult and pediatric care and treatment, TB/HIV, and strategic information at funding levels similar to in FY 2011.

Funding for basic health care will focus on improving continuum of care services to reduce death and loss to follow-up. Health providers will be trained on new guidelines and policies. The Continuous Quality Improvement (CQI) program will be expanded to more care and treatment sites and strengthened through better analysis and use of the information collected at the national and facility level. Monitoring and CQI activities will promote early identification of people living with HIV, and focus on prompt entry into care and provision of the standard package of care services. Integration of programs (for example, dual protection for HIV prevention and family planning and intensive case finding for TB) will lead to better care for people living with HIV and improve access to needed services in health facilities.

Transition: NCHADS receives funding from the Global Fund, and financial and technical assistance from the World Health Organization, UNICEF, Clinton Foundation, and the U.S. government. The Global Fund is by far the largest donor to NCHADS, funding drugs, most testing supplies, and program costs including human resources, infrastructure, and training. In the short term, the U.S. government transition supplies, commodities and training costs from PEPFAR to the Global Fund and use resources for implementing and evaluating innovative activities relevant for the Cambodian context, and strengthening data systems.

Beginning in 2013, U.S. government focus will transition to virtual elimination of new pediatric infections, reducing new infections through rolling out new preventive activities (family planning integration and treatment as prevention in selected populations), with continuing support for monitoring and improving the quality of care and treatment.

In FY 2012, the National Center for HIV/AIDS, Dermatology, and STDs (NCHADS) Cooperative Agreement will support prevention of mother-to-child transmission, pediatric and adult care and treatment, TB/HIV, and strategic information at funding levels similar to FY 2011.

NCHADS will focus TB/HIV activities on intensified case finding and isoniazid preventive therapy. As a result of CDC technical and financial support, clinicians are screening HIV patients for TB symptoms well but more assistance is needed to support the diagnosis and treatment of patients who have TB symptoms. Under the cooperative agreement, NCHADS will collaborate with the National TB program to develop and implement TB diagnostic algorithms and treatment protocols for people living with HIV. The program will promote use of cotrimoxazole prophylaxis and early antiretroviral treatment (ART) for TB/HIV co-infected patients (just after 2 weeks of starting TB treatment). Health provider initiated HIV testing and counseling for TB patients will be increased under the national Linked Response program.

Diagnosis of TB in people living with HIV will be improved in collaboration with the National TB Program through implementation of GeneXpert and TB liquid culture, initially in the 4 focus districts and Phnom Penh. Diagnostic and treatment algorithms and standard operating procedures will be developed and disseminated using standardized training materials. Supervisory visits and routine reporting systems will be used to monitor progress.

In FY 2012 the National Center for HIV/AIDS, Dermatology and STDs (NCHADS) Cooperative Agreement will support prevention of mother-to-child-transmission, adult and pediatric care and treatment, TB/HIV, and strategic information at funding levels similar to FY 2011.

Funding for pediatric care will focus on improving monitoring and follow-up of HIV-exposed infants, promotion of cotrimoxazole prophylaxis, early initiation of antiretroviral treatment for HIV-exposed infants found to be HIV- infected, and support for training/mentoring of public sector pediatric AIDS care clinicians.

The continuous quality improvement program for adults will be adapted for pediatric care and treatment and expanded to pediatric care and treatment sites in order to more closely monitor quality of pediatric care services. Indicators that will be followed include mortality, loss to follow-up, and cotrimoxazole prophylaxis.

NCHADS receives funding from the Global Fund and financial and technical assistance from the World Health Organization, UNICEF, Clinton Foundation, and the U.S. government for pediatric care.

Beginning in 2013, focus of U.S. government support will be implementing and evaluating virtual elimination of new pediatric infections, reducing new infections through rolling out new preventive activities (Family Planning integration with HIV services and treatment as prevention in selected populations) with continuing support for training and monitoring to improve the quality of care and treatment for children and adults. These activities will be linked to the Government of Cambodias Fast Track Initiative for Maternal and Neonatal Mortality, the foundation for the U.S. governments Global Health Initiative strategy for Cambodia.

In FY 2012 the National Center for HIV/AIDS, Dermatology, and STDs (NCHADS) Cooperative Agreement will support prevention of mother-to-child transmission, pediatric and adult care and treatment, TB/HIV, and strategic information activities at funding levels similar to FY 2011.

Funding for strategic information will be used to enhance NCHADS capacity to collect and use data for program planning and monitoring. The quality of electronic patient record systems will be improved and a national unique identifier system to track individuals in a confidential manner established. An automated system to merge patient records from different services, including counseling and testing clinics, laboratories and antiretroviral treatment clinics will be developed, and implemented. An assessment of whether electronic systems result in better patient outcomes and more effective supervision and monitoring will be designed and carried out.

Under the cooperative agreement, cost efficient activities, like implementing integrated biologic and behavioral surveys and using programmatic data more effectively will be supported.

Because most people infected with HIV in Cambodia are receiving care, greater emphasis is being placed on using routine programmatic data instead of special surveys. Protocols for transitioning antenatal surveillance surveys (implemented every 3-5 years) to using antenatal patient records will be developed and the feasibility assessed.

Transition: In 2013 activities will be transitioned to focus on virtual elimination of new pediatric infections, reducing new infections through rolling out and evaluating new preventive activities (Family Planning integration with HIV services and treatment as prevention in selected populations), strengthening monitoring, and improving quality of care and treatment. As a result, strategic information capacity of NCHADS will need to be enhanced in order to effectively design, evaluate and track these new initiatives.

With technical support from CDC, the National Center for HIV/AIDS, Dermatology and STDs (NCHADS) will promote: expansion of HIV testing of pregnant women; efficient use of staff trained in prevention of maternal-to-child-transmission (MTCT); regular follow-up of HIV-infected pregnant women after they are identified to ensure they receive MTCT services during labor and post-partum; follow up of HIV- exposed infants and entry into treatment if they are found to be HIV- infected; and provision of appropriate care and treatment for people living with HIV, including pregnant women.

Under the cooperative agreement, NCHADS will improve and expand activities, including:

1. Supporting monitoring and supervision of HIV testing and counseling in the four focus provinces using standardized formats to assess coverage and follow-up of women attending antenatal clinics,2. Coordinating activities with Maternal and Child Health at provincial and district levels and linkages between facilities and community care teams to strengthen referrals and follow-up,3. Supporting the dissemination of updated MTCT policies and recommendations,4. Providing technical assistance to provincial health staff to reduce loss to follow up of identified HIV-infected pregnant women prior to and after delivery,5. Providing technical leadership for the virtual elimination of pediatric HIV in defining target coverage, interventions and measurement of the elimination goal.

NCHADS receives funding from the Global Fund and financial and technical assistance from WHO, UNICEF, Clinton Foundation, and the U.S. government. The Global Fund supports drugs, most testing supplies, and program costs.

Beginning in 2013 U.S. government focus will transition to support virtual elimination of new pediatric infections, reducing new infections through rolling out new preventive activities (family planning integration and treatment as prevention in selected populations), while continuing support for monitoring and improving the quality of care and treatment. This will be linked to the Government of Cambodias Fast Track initiative for Maternal and Neonatal Mortality and the U.S. governments Global Health Initiative strategy for Cambodia.

In FY 2012 the National Center for HIV/AIDS, Dermatology and STDs (NCHADS) Cooperative Agreement will support prevention of mother-to-child-transmission, adult and pediatric care and treatment, TB/HIV, and strategic information at funding levels similar to FY 2011.

NCHADS will implement activities to promote prompt initiation of treatment and improve the quality of HIV treatment activities in public health facilities. The continuous quality improvement program will be expanded to new facilities and data use at facilities improved. Laboratory and clinical protocols for viral load testing will be finalized, training materials developed, and testing implemented for patients with suspected treatment failure. Drug- resistance testing will be implemented and antiretroviral drug regimens for second and third line-therapy modified, based on international guidelines. Integration of services within facilities and strengthening linkages with community- based programs and positive networks will improve adherence and patient outcomes.

Transition: NCHADS receives funds from the Global Fund and financial and technical assistance from the World Health Organization, Clinton Foundation, and the U.S. government. The Global Fund provides all funding for treatment, most laboratory supplies and supports program implementation costs including human resources, infrastructure and training. In 2013, the focus of U.S. government support will transition to implementing and evaluating virtual elimination of new pediatric infections activities, reducing new infections through rolling out new preventive activities (Family Planning integration with HIV services, and treatment as prevention in selected populations) with continuing support for training and monitoring to improve the quality of care and treatment for children and adults.

In FY 2012 the National Center for HIV/AIDS, Dermatology and STDs (NCHADS) Cooperative Agreement will support prevention of mother-to-child-transmission, pediatric and adult care and treatment, TB/HIV, and strategic information at funding levels similar to FY2011.

NCHADS will fund activities to promote prompt initiation of treatment and improve the quality of the care that infants and children receive using the continuous quality improvement system. Links between facilities and community care-givers will provide improved adherence and patient outcomes. Supportive supervision by NCHADS and CDC staff will improve monitoring and follow-up of HIV-exposed infants and lead to earlier initiation of antiretroviral treatment for infants found to be HIV- infected. Viral load protocols for children will be developed and training materials developed. Treatment guidelines will be disseminated and public sector pediatric AIDS care clinicians mentored.

Transition: NCHADS receives funding from the Global Fund, and financial and technical assistance from the World Health Organization, UNICEF, Clinton Foundation, and the U.S. government. The Global Fund provides all funding for treatment, most laboratory supplies and program implementation costs including human resources, infrastructure, and training. In 2013 activities will be transitioned to focus on: virtual elimination of new pediatric infections; reducing new infections through new preventive activities (Family Planning integration with HIV services and treatment as prevention in selected populations); while continuing to strengthen monitoring, and improving quality of care and treatment. Activities will be linked to the Government of Cambodias Fast Track initiative for Maternal and Neonatal Mortality, the foundation for the U.S. governments Global Health Initiative strategy for Cambodia.