To identify in the existing networks geographic gaps, service area gaps, and vulnerable population coverage gaps and describe possible barriers to the effective collaboration of the existing networks in engaging in the national TB response.

The semi-structured interviews were conducted national and sub national level including: one national institution, one donor agency, one TB patient representative. And 15 TB-active NGOs including eight international NGOs (INGOs) and seven local NGOs (NGOs) and two TB-inactive local NGOs. Findings show there are 15 NGOs (eight INGOs and seven LNGOs) working on TB in Cambodia. There are many NGOs that have no funding to continue their TB programs. The major funding sources for the National TB Program (NTP) managed directly and indirectly by CENAT comprise the government, Global Fund (GF), and USAID. Besides, findings also identified the gaps by geographic at HC an OD of service area gaps, inadequacy of community screenings and active case findings was salient. Moreover, lack of consultation and treatment support at some HCs and RHs was pointed out. Another gap was limited data collection on the number of 0-5 year-old children, who may be at risk in terms of infection from adults.

To engage community responses to TB in Cambodia and build a directory information about NGOs active in TB and not active in TB.

The Tuberculosis NGO informational Directory 2016 has been initiative guided by Mr. Choub Sok Chamreun, Executive Director of KHANA. It was conducted interviewing with CENAT, US-CDC, TB representative, NGO representative at Country Coordination Mechanism (CCM) and NGOs both active and non-active in TB. After the preliminary findings workshop and modified consultation workshop with the participants and CENAT, KHANA shows the findings of directory contains key information about 16 NGOs active in TB and four NGOs non-active in TB. All NGOs were presented profiles, background, programs, geographic coverage, target groups, and major activities. We hope that this directory is a stepping stone to build and strengthen a civil society and community network to better contribute to the national TB responses.

To identify and prioritize KPs in Cambodia and address the needs in understanding the gaps in the national TB response programs among KPs in the country. The qualitative methods in Community Assessment were conducted to address the primary needs and understanding the gaps in the national TB response programs among key populations in the country. Five processes were carried out included: multi-stakeholders meeting, workshop to identify the prioritize key populations, desk review existing document, collection additional information and validation workshop among stakeholders. Findings show the national population size of the KPs in Cambodia in 2016 was estimated 72,607 for people living with HIV, 79,585 for TB household contacts, between 221,070-331,605 for TB close contacts, 1,795,415 for elderly people aged 55 years and older, between 205,502 to 418,90 for people with diabetes, 22,801 for prisoners, 13,000 for PWUD and 1,303 for PWID. There were several data gaps in the reporting systems that should be improved. We found that there were no official estimates of the national population size of TB KPs at the moment, and the precision of the estimates we proposed needs to be periodically verified. Although NTP has conducted two national TB prevalence surveys in the general population, no prevalence and behavioral surveys have been conducted among the KPs.

To assess the gender consideration in the national TB response in Cambodia with the intention to provide recommendations to move towards gender transformative national TB response in Cambodia.

Mixed method approaches followed the processes: Desk Review, KII, FGDs and IDI were conducted to collect the existing necessary data and information from national programs at different levels and key population representative community levels. Findings show TB prevalence rate, disaggregated by sex and age at national and provincial levels between year 2011-2014. Overall, in this report when gender was disaggregated, they were disaggregated into male and female, as the existing system does not record transgender people or third gender. The latest data on TB prevalence rate for all forms of TB were available for the years 2011 to 2014. The data indicate that the prevalence rates decreased quite significantly between 2011 (817 in 100,000 people) and 2014 (668 in 100,000 people). However, Data on the TB prevalence rates for later years were not available. In addition to findings of KII, FGD and IDI show misperception among the general population (and even the KPs themselves) about TB still exists, and reportedly there is some degree of stigma and community discrimination (which is sometimes related to the misperception) as well. Finally, all the key stakeholders, including CENAT, should be applauded for working together and collaborate on many fronts to fight TB.

Cambodia commits to ending the Tuberculosis epidemics, which is counting as a priority among other communicable diseases by 2030. Currently, community-driven approaches have been an inherent component in addressing tuberculosis (there are limitations in community involvement to improve tuberculosis diagnosis, Community TB) epidemic in Cambodia. Community Mobilization Initiatives to End Tuberculosis (COMMIT) seeks to undertake a multi-sectoral approach using locally generated solutions to improve TB case finding, TB prevention, linkage to diagnosis and treatment support, and enhance community engagements in Cambodia. The shortage of data and information in selected project sites under the COMMIT are widely recognized. Therefore, an assessment is imperative in identifying gaps to implement COMMIT effectively. We conducted a baseline assessment to explore the availability and functionality of health facilities and services related to TB, human resources and capacity, and the linkages between different health services.

With funding support from the EC, KHANA has been providing focused prevention and comprehensive care and support for MARP, PLHIV and OVC through community based care team since 2007. Since 2010, KHANA has been implementing the new Home and Community Based Care approach adapted from the SAHACOM model; which provides a more sustainable and improved management and coordination of the services.  The Social Return on Investment study uses an innovative form of cost benefit analysis to monetize the project outcome. Quantitative and qualitative methods were employed. The findings showed that for every $1 invested in the ICP project generated a return on approximately $2 worth of social, health and economic values. The ICP yielded the significant impact notably in the area of food security, wellbeing, improved health and improved productive capacity which enable greater economic return for the households.

With funding support from European Commission, the “Increasing Community Action on HIV/AIDS Prevention, Integrated with Care and Impact Mitigation Efforts in Cambodia” project has been implemented since 2007 in Prey Veng, Kampong Chnnang, and Kampong Speu. The end project evaluation aims to evaluate the efficiency and effectiveness of the program and measure the impact of the program on the beneficiaries and community as a whole. Quantitative and qualitative methods were employed. The findings showed the high level of overall satisfaction with services for both PLHIV and OVC. PLHIV reported undergoing ART nearly 90%. Increased OVC regularly access schooling, social support and health condition. Consistent condom use among entertainment workers with client remains high but still relatively low when with their sweetheart. HIV test among MARP has significantly increased.

Baseline documentation has been conducted to enable measurement and evaluation of program achievements. Quantitative and qualitative methods were employed. Result showed implementing partners adapted the SAHACOM model based on local context particularly in relation to ratio of community support volunteers and peer facilitators. Integration of SRH services undertaken so far has resulted in increased awareness and understanding among MARP, PLHIV and OVC.

The baseline survey was conducted with funding support from the Global Fund Round 7 and the European Commission (EC). Quantitative methods were used to identify and determine the magnitude of prevention indicators. Results showed there is still gaps in condom use among the three target populations, entertainment workers (EW), men who have sex with men (MSM) and drug users (DU). Target groups were found to be at high risk of HIV infection due to shortage of knowledge and information. Discrimination was found to be a barrier preventing MSM and DU from accessing health services and information.

KHANA implemented an integrated care and prevention program since 2007 in Prey Veng, Kampong Chnnang, and Kampong Speu provinces with EC funding support. The mid-term review aims to monitor progress and provide feedback to improve program design and implementation. Quantitative and qualitative methods were used. Study findings included: 70% of PLHIV in the program were women; 83% of PLHIV were on ART; 84% of OVC attend school, however about 60% suspended study at some point to earn extra household income; levels of stigma and discrimination have dramatically declined; 15% of PLHIV had ever sold farmland, rice-fields or houses to cover food, clothing, medical care and debt repayment. PLHIV and OVC reported high satisfaction with the ICP program.