Why is TB preventive therapy (TPT) important in your community?
The prevalence of latent TB infection (LTBI) is estimated to be 60 percent in Cambodia. However, the coverage of TB preventive treatment (TPT) among people living with HIV (PLHIV) and children under five who were household contacts of people with smear-positive TB are still low (20 and 36 percent, respectively). The National TB Program has been implementing the LTBI guidelines by including the introduction of newer prevention regimens (3HP and 3RH) in 86 Operational Health Districts under the Global Fund and USAID grants. However, the LTBI guideline is mainly focused on health services providers at health facilities while the demand creation being implemented by the community and civil society organizations (CSOs) are excluded.
Can you describe the major goals of your IMPAACT4TB advocacy project? How will your work advance access to TB preventative therapy in your country?
The major goal of the IMPAACT4TB Advocacy Project in Cambodia is to increase feasibility and sustainability access to short-course TPT for PLHIV and children in Cambodia. In order to accomplish the designed goal, KHANA and CATA have come up with key objectives and strategies, including expanding and scaling up the advocacy-led initiatives for accelerating TPT implementation within the national TB response, strengthening critical roles of community and CSO including supervisions, monitoring and participation for TPT/LTBI implementation, and building partnership with national and regional coalitions and platforms to greater advocate for TPT implementation.
What gaps do you think are important to address?
Based on the Joint Program Reviews Report in 2019, there are a number of specific challenges in TPT/LTBI implementation including: LBTI treatment outcomes are not reported despite being captured in the HIV/AIDS database; HIV testing for TB people living with TB is not integrated in TB services while the diagnosis work-up, and treatment of active TB among PLHIV is not offered at ART services.
In addition, based on the TB program reports, there is a lack of comprehensive TPT/LTBI diagnosis and treatment understanding from the perspective of policymakers, health care providers, implementation partners, donors, and end-users (community, key populations, populations eligible for TPT). LTBI diagnosis and TPT delivery is a cost-effective model of care, but it’s the most complicated step. How do we bring TPT to the population in need (PLHIV and children of index cases for now) in the most effective and sustainable manner?
What does it mean for you to be an IMPAACT4TB grantee?
The project will influence the National TB Program to put TPT/LTBI as a priority radar into national tuberculosis prevention programs, particularly for the Global Fund and USAID funding for a long term-run together. Then, TPT implementation will be sustained for a certain period of time for TB response in Cambodia.