1. 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

2. 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( )
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)

3. 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

4. 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, and years beyond

5. National TB Strategy/Policies
Timeframe:
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: USD million per year
Funding sources :
:GF: ~27%,Govt: 20%,USAID: amount ?
: GF?,Govt: 25%,USAID: amount ?

6. 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)

7. 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

8. 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

9. 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

10. Bold policies and supportive systems
TB care financing and social protection
- big financial gap (govt~ 25-30%)
- social protection is under discussion between NTP and partners including MoH (TB NSP )
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

11. 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