1. KSF Hospital HIV/AIDS patients challenges after June 2010 Emmanuel Lavieuville – MSF-F Cambodia

2. KSF Hospital (KSFH) MSF-F Project (1997-2010) MSF-F at KSFH  Before June 2010 1997-2001: treatment OI 2001: first patient under ART 2003: decentralization to Kg Cham PRH 2005: initial focus & activities to keep under ttt HIV patients of cohort jailed in PP prisons 2006: development of an ambulatory strategy for co-infected DR-TB cases management 2007: ARV treatment supplied by NCHADS (almost 100%) 2008: start the HIV cohort integration process into the public health system. MoU signed between MSF & MoH. 2009: continued progressive integration of the KSFH cohort treatment and follow up within KSF Hospital. Working plan & regular TWG for the formal handover to KSFH and to NCHADS. Initial informal request of NCHADS to extend its support until March-June 2010. MSF-F agree for technical support up to March and OI essential drugs stock up to June 2010. 2010: formal request of the MoH to MSF-F to extend its support up to June. MSF-F overall financial support kept up to June 2010. June 2010 formal end of the handover.  After June 2010: Financial support to AUA Specific support to Phnom Penh Prison HIV/AIDS prisoners kept (MoU with MoH) Ensure the continuation of the care & treatment for the patients of KSFH cohort

3. Main challenges for KSFH HIV/AIDS post June 2010 (1) Cost recovery scheme introduction by KSFH for all HIV/AIDS patients  From 1st July: OPD HIV/AIDS patients must pay 8000 Riel/consultation (+ cost of other tests) IPD HIV/AIDS patients must pay 10 000 Riel/hospitalisation per day and have to pay 7 days in advance to be admitted (+ medical equipment, OI essential drugs & relevant investigations needed)  No budget & no partner? MSF-F identified partners & solutions for specific groups of patients  2008: Paediatric cohort h/o to CHC.  2009: DR-TB co-infected patients h/o to CHC, h/o to Magna of all cohort pregnant mothers.  2009-2010: access to HEF for poor patients of the cohort with URC, FHD & AUA help. NCHADS & KSFH  Global Fund Round 8 transferred to Round 9 includes the KSFH cohort  Aids Healthcare Foundation (AHF) is the Sub-Recipient of NCHADS for KSFH and other cohorts  Global Fund R9 fund for Year 1 of the grant not before January 2011 at best! NCHADS asked AHF to advance fund for KSFH from July 2010 to fill the gap but nothing yet! Urgent Issues!  No funds to support the functioning of the cohort & therefore establishment of a cost recovery by the KSFH against national policy principle!  Increase the access for patients to HEF: agreement of URC to support a post-ID system at KSFH IDD.  No information at all on GF R9 budget lines & estimated timeline  No formal information to all partners on AHF funds to fill the gap  Other options? MSF-F provided formal information on current situation to main stake holders and KSFH is initiating a regular meeting with all PLHA organisation involved at KSFH to help define solutions

4. Main challenges for KSFH HIV/AIDS post June 2010 (2) Phnom Penh HIV/AIDS prisoners still supported by MSF-F within KSFH project  Since 2005 MSF-F identify specific issue for continuation of treatment for patients of the cohort jailed in PP Prisons 2005-2007: agreement with PP jails to extract HIV/AIDS prisoners on regular basis for consultation and to receive treatment at KSFH From 2007: because of progressive increase of the number of prisoners under ART MSF-F set up a regular mobile clinic to CC1 & CC2. Still running until today. Since end 2008 MSF-F support access to VCCT for Phnom Penh Prisoners Since February 2010 MSF-F implements a systematic screening for HIV & TB in PP prisons. Today: 73 on ART and 36 on OImore than 100 patients under ART in PP prisons followed by MSF-F  MoU Prisoners project is part of MSF-F MoU with the MoH (2008-2010) Additional MoUs with MoI, Cenat & PPMHD  Challenges since handover of KSFH project: MSF-F cannot receive the ART from the KSF Hospital as in the past. MSF-F faces difficulties to register in a Phnom Penh cohort the newly screened HIV/AIDS patients imprisoned.  Is KSFH still the CoC centre for the Phnom Penh prisons? Still the closest CoC!  Both NCHADS & KSFH silent. No clear policy. Number of prisoners under treatment is not so high but CC1 & CC2 with many judicial extraction on weekly basis does not have the capacity to extract such a no. of patients! The Global Round 10 proposal does not include the HIV/AIDS prisoners! What is going to be the policy in the future?

5. Main challenges for KSFH HIV/AIDS post June 2010 (3) Threat to Phnom Penh PLHA access to care & treatment?  In 2010 because of planned withdrawal or cut in funding different major actors involved in HIV care & treatment in Phnom Penh are reducing or h/o their HIV/AIDS activities: KSFH – MSF-F (3395 patients on ART; 290 on OI) : largest cohort & with 60 beds one of the main national referral ward for complicated cases! 30 beds for HIV+ patients only since July 2010. Sihanouk Hospital – Hope worldwide (2401 patients on ART; 379 on OI): GF R9 funding reduction lead to reduce activities to 3 new admission per day since Jan 2010 and the closure of 10 beds in Aug 2010. Preah Ketomelea – IPD supported by Douleur Sans Frontières (855 patients on ART; 172 on OI): will reduce activities due to contraints of funding from GF. 30 beds to 15 beds in March 2010. Kossamak – SEAD (2550 patients on ART; 470 on OI) with 18 IPD beds: h/o to AHF with GF Round 9 money planned in Aug. 2010. Maryknoll activities h/o in Dec 2010.  Main consequences: Whether stopped or h/o over the services provided are not free of charge anymore & HEF not accessible in most cases to HIV/AIDS patients. Immediate & direct limitation to the access of care & treatment for the poorest HIV/AIDS patients of Phnom Penh affected cohorts. Significant drop in the capacity of inclusion for new HIV/AIDS patients in Phnom Penh area Significant decrease in the Hospitalisation capacity and access for Phnom Penh HIV/AIDS patients Some HIV related specific complications (CMV, etc…) may not be treated anymore in Phnom Penh Significant decrease of the supported laboratory investigations to help clinicians in the f/u of the patients