1. 3rd Global WG on TB/HIV, Montreux, 4-6 June, 2003
National HIV Prevalence Survey
Among TB Patients, Jan 2003
As one of supplemental studies of
the National TB Survey 2002
National TB Program, Cambodia,
JICA National TB Control Project
3rd Global WG on TB/HIV, Montreux, 4-6　June, 2003

2. From NTP Statistics

3. Increase in TB detection in the Capital City (from: National TB Statistics)

4. (From Chris Dye)

5. Trend of HIV Sero-prevalence among TB Patients, Cambodia (Crude Prevalence: 92,94 independent studies, 95- National HSS)

6. Why HIV/TB Prevalence Survey?
The HSS by AIDS program provides useful information on geographical and time trends.
However
Representativeness is questionable
Hospital base: DOTS has been expanded
Non population based sample allocation
Diagnosis/Categorization errors
Low frequency of blood collection: Severe cases are more likely to be missed

8. Sampling Design(1): 100% v.s. Cluster
Huge variation between facilities was expected from “death” rate during treatment
Hot spots might be missed in cluster sampling
Facilities linked with AIDS treatment service
Sampling Design(2): All v.s. Pul(+)New
Technical and moral problems in “Partial participation” :False positive cases
Advocacy issues
Conclusion: 100% Sampling for all TB cases
who are registered in January 2003

9. Study Design
Anonymous: No Name, No TB Number, De/Re-coding at National Center
Operational Health District, Age, Sex, Nationality, Type, New or Retreatment, Rather precise information on diagnostic process, Reason of Failing to take blood

10. Provincial Health Department(24)
National TB Center
HIV Test
Sample collection visit & Supervision
Supervision
Provincial Health Department(24)
Overall management in province
50 Centrifuge/Cold Store Center
Supervision
Blood Transportation
150 Referral and Former District Hospitals with TB Lab
in 74 Operational Health Districts
Blood collection for own patients
Smear results
Blood collection visit
Smear slides
500+ Health Centers/No doctor, No X-ray, No Microscope

11. (English translation)
Informed consent (Oral) A sheet in local language was provided to staff
(English translation)
This examination is only for the purpose of examining overall health condition of TB patients in Cambodia including HIV status. You are invited to participate in the survey. If you consent, you will be taken blood with the amount of 5ml, which process does not physically affect your body at all. There will be no side effect with this examination. The result of HIV test will not be informed to you, doctors, health workers, or any people (nobody will know your individual result).
It is very important to make a future plan to help more TB and TB/HIV patients in Cambodia.
Thank you very much for your understanding. You are entitled to receive a small gift for your participation.

12. Incentives Participants Cloth of 1.2$ value Staff
Guidance/Training in Phnom Penh
20-40$ handling charge per TB unit and/or Lab
Allowance for transportation
Dissemination WS

13. HIV Test National Reference TB Lab in National Center for TB Control
Test 1: Serodia HIV1/2, FUJIREBIO, Japan
Test 2: Determine HIV1/2, ABBOTT, Japan

14. Result(1) Eligibility 25 (Blood was actually collected) No
Blood Collection
2289
Registered
and
Contacted 23
(1.0%)
2264 No
Yes
2241
(99.0%)
Yes

15. Preliminary result of National Survey of HIV sero-prevalence among TB Patients Jan. 2003, Cambodia

16. TB patients and HIV infection Age distribution, Jan 2003
National TB/HIV Survey, Jan 2003, Cambodia

17. TB/HIV Burden Geographical Differences
27/900
(14 provinces+Kep)
9/149
17/173
9/36
(2)
17/159
(3+Pailin)
28/139
(1)
Pul+ New Cases, Jun 2003, National HIV/TB Survey, Cambodia

18. TB/HIV in Phnom Penh Jan 2003

19. TB/HIV Hot Spots in Cambodia
BANTY
MEANCHEY
SIHANOUKVILLE
TB/HIV Hot Spots in Cambodia

20. Finance Training for Central staff and Supervisors (30): 3,500$
Training and Guidance for all TB Units (160): 22,000$**
Supervision and Sample collection (Central team): 5,000$
Local handling charge and local transportation: 15,000$
Cloth for participants: 3,000$
HIV test kits, other Lab equipment and consumables, printing etc.: 12,000$
+ Technical Assistance by JICA Project Team
**:Funded by STB/WPRO, Others were by JICA

21. Lessons learned
To carry out quality study, it is essential to make staff of all levels understand meanings and importance of the study
Although HSS provides good information on HIV/TB trend, periodic prevalence surveys are essential to know whole pictures especially in a country where HIV situation is very different by areas/service facilities
Quality of HIV kits locally available is sometimes questionable

22. Major Studies by NTP since 2000 National TB Drug Resistance
Although our primary mission is to assist NTP to expand DOTS, we are proud of completing several quality studies to clarify TB situation in Cambodia. Our achievements are not only the study results but also huge capacity development of NTP staff. We believe that proper policy plans can be developed with scientific evidences by quality studies.
Major Studies by NTP since 2000
National TB Drug Resistance
National TB Prevalence (Tuberculin, X-ray, Smear/Culture)
National HIV/TB
Delay (Behavior Survey)
JICA National TB Control Project Team (Mar ’03)