Country Progress Report Cambodia 9 th Technical Advisory Group and National TB Programme Managers meeting for TB control in the Western Pacific Region Manila, Philippines 9 -12 December 2014

TB Epidemiology Population: 15 million Highest prevalence(764/100,000),incidence ( 411/100,000) and death(63/100,000) among 22 HBC TB (2012) Prevalence (all forms) declined at an average of 5 % per year (from 2000 to 2012) incidence( all forms ) declined at an average of 3 % per year (from 2000 to 2012) Death rate declined at an average of 4.6 % per year(2000-2012) Prevalence far higher in population over 55 (about 3 times) HIV prevalence among TB patients: 6.3 in 2006 HIV prevalence among aldult pop: 0.7 % in 2013 MDR-TB: 1.4% in new and 10.5% in retreatment cases (2006)

Major successes Good DOTS coverage:100% at HC level 1314 health facilities are providing TB services( including 1090 HCs) Identifying more than 2/3 of incident cases Big decline in prevalence,incidence and death Achieving MDG Two prevalence surveys conducted Clear policy, plan and guidelines

Major challenges Still high prevalence, incidence and death Resources to maintain huge services(1314 health DOTS facilities),and expanding specific services and new tools( childhood TB, PPM-DOTS, TB-IC, Xpert…) Big reliance on external aid ( >75 % on donors) More ambitious targets, 2016-2020 and years beyond

National TB Strategy/Policies Timeframe: 2014-2020 Targets: annual average reduction of 6.5 % prevalence, 5.5% death and 4% incidence Alignment with WHO End TB strategy? Alignment with National Health Sector Plan Budgeted: 25-30 USD million per year Funding sources : - 2015-2017 :GF: ~27%,Govt: 20%,USAID: amount ? - 2018-2020: GF?,Govt: 25%,USAID: amount ?

Laboratory strengthening LED:Total Microscopy centers in 2014 = 215 (LED Microscope= 29 and Conventional Microscope = 186) Xpert: 20 in routine services and 8 inn ACF Quality assurance: SOP for EQA exists - Participation rate = 97% , Agreement rate = 98.6% (2013) - False positive rate = 2.8% , False negative rate = 1.2%( 2013) - Acceptable performance = 89% in 2013 Laboratory information management system: Paper based report and quarterly basis TA partners-,GLI , RIT, US-CDC (Atlanta, USA), WHO, MSF (Antwerp, Belgium)

Reach the unreached Intensive case finding: among elderly, diabetics, prison inmates TB screening policy and practice: revising policy, ACF and childhood TB Contact investigation: improve diagnosis and coverage TB-HIV: improve referral and diagnosis procedures( more Xpert MTB/RIF,…) Child-TB: improve diagnosis and coverage current situation: 27/82 districts, cases increase: 4600 in 2010 to 6400 in 2013

Surveillance Quality of surveillance system: sufficient & acceptable( JPR 2012) New case definition roll out: introduced nation wide since early 2014 e-R&R: planned to start in 2016/2017 Analysis and usage of data at national and sub-national levels - national level: good - suib-national level: limited

PMDT Current situation: Plan vs universal coverage 11 treatment sites with 57 isolated rooms 20 Xpert machines MDR-TB cases increased from 31 in 2010 to 121 in 2013 Plan vs universal coverage Treatment sites:11/18 ( 18 by 2020) Xpet: 20/82 (82 by 2018) Target cases: increase around 10% per year from 2014 to 2020 Barriers: missing suspects during diagnosis process for DS TB and referral system of samples of MDR-TB suspects Priority actions: improve diagnostic procedures and referral system

Bold policies and supportive systems TB care financing and social protection - big financial gap 2015-2020 (govt~ 25-30%) - social protection is under discussion between NTP and partners including MoH (TB NSP2014-2020) Strengthening notification mechanism: - improve paper-based and planned for e-reporting Drug regulations - re-enforcing circular on banning on sale and import of anti-TB drugs and sero-logical test for TB

Patient centred care: involvement of patients and civil society Community mobilization activities community DOTS: 577 HCs out of total 1090 HCs CBO involvement and their role : In C-DOTS, ACF, TB/HIV Involvement of patient groups in TB control So far not much, mainly in country consultation and little in C- DOTS Forms of social support to TB patients - transportation costs for DS and DR TB and food enablers for all MDR -TB