Background: The National HIV Program in Cambodia has been successful in reducing HIV prevalence in the general adult population from 1.7% in 1998 to 0.6% in 2016 with strong prevention programs, expansion of HIV testing, and optimization of the continuum of care with ART coverage reaching more than 80% PLHIV. In 2016 AEM modeling, 70,498 individuals were estimated to be HIV infected; 58,338 (83%) knew their status; and, 56,754 (97%) of these on ART1 but 12,000 PLHIV do not yet know their HIV status and new approaches are needed to find them. Cambodia''s HIV program, having achieved UNAIDS 90-90-90 targets, is focused on elimination of HIV transmission by 2025 and B-IACM is central to that plan.
1 Spectrum/AEM modelling 2016
Description: The BIACM strategy, implemented at the Operational District (OD) level, involves an HIV Case Management Coordinator (CMC) assisted by a Case Management Assistant (CMA) work daily with HIV Case Management Service Providers (CMPs) who coordinate, communicate, and share information concerning HIV cases. Their efforts ensure timely enrollment in care and initiation of ART and support adherence and achievement of viral load suppression. Pregnant women, HIV-exposed infants, and PLHIV partners are targeted for testing, enrollment in HIV care and treatment if HIV+. Coordination meetings between CMC and CMPs and broader stakeholders review site performance and identify solutions to improve care and retention. Direct data reporting to the National Center for HIV/AIDS, Dermatology and Sexually Transmitted Infections (NCHADS) is used to generate a dashboard that allows offsite monitoring and intervention as necessary.
Lessons learned: B-IACM has doubled previous yield, increasing new HIV case detection from 444 (pre-B-IACM from February 2014 - September 2015) to 753 (B-IACM from October 2015 to May 2017) in Battambang and Siem Reap. The B-IACM strategy has: improved targeting for HIV testing and the achievement of the first 90%[2]; improved ART initiation rates to 96% (1,577/1,647), the second 90; and, increased adherence achieving viral load suppression to undetectable levels in 97% of cases, the third 90.
[2] http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2017/july/20170720_PR_Global_AIDS_Update_2017
Conclusions/Next steps: NCHADS will scale up B-IACM implementation to all provinces in Cambodia as it moves toward achieving 95-95-95 by 2025.