Introduction

Cambodia is one of the few countries in the world which has been successful in reversing its HIV epidemic and achieved near universal access to HIV/AIDS treatment. Such success is only possible with contributions and joint efforts from different stakeholders. In 2010, the Cambodia government has received a United Nations Millennium Development Goal award as a recognition of the success.

By the end of 2018 in Cambodia, 83% of PLHIV knew their status, 97% of those diagnosed were on ART, and 81% of those were virally suppressed. Even then, in Cambodia, HIV prevalence is high with an estimated 73 000 people living with HIV. Nearly 50% of people on treatment have access to multimonth dispensing of HIV treatment. Before the pandemic, that number stood at 34%. 

HIV testing rates remain low among key populations (KPs) in the country and uptake of HIV testing low. In 2019, the national program reported that 33% of MSM and FSWs had never been tested, and more than 50% of trans women had not been tested in the past six months. In this scenario, self-testing for HIV to KPs could potentially overcome the under-diagnosis of HIV and significantly increase testing rates and receipt of the results, and thus could decrease transmission.

Multimonth dispensation system

The multimonth dispensing of HIV treatment programme in Cambodia began in 2019, under which, NCHADS could give medicine to people for up to six months. During the COVID-19 pandemic however, the programme became a of supremely significant one, especially after the biggest and oldest HIV treatment site in the capital was repurposed to serve as a COVID-19 centre and outreach activities had to cease with public venues closed to the public. It is then that UNAIDS and partners pushed to introduce the home delivery of treatment and the rollout of multimonth dispensing of HIV medicine at the national level.

Source: unaids.org

Prep 

1-Roll out of Prep at country level

Unlike other countries in the region where PrEP implementation has been preceded by a comprehensive demonstration project, Cambodia proceeded straight to a phased implementation of PrEP starting with an official launch in Phnom Penh in July 2019. The phased implementation involved the engagement of key stakeholders and significant advocacy work to generate buy-in from the Ministry of Health, which led to the endorsement of the PrEP concept note in May 2019 and an official launch two months later in Phnom Penh. 

The Ministry of Health, Cambodia shared the following PrEP plan in 2019:

Health planners and policy makers worked closely with civil society organizations (CSOs) and community- based organizations (CBOs) focusing on HIV prevention programmes to develop demand generation activities through physical and online outreach.

The number of sites providing PrEP expanded from the initial two in 2019 (one in Phnom Penh and one in Siem Reap), to 14 sites across 5 provinces (Phnom Penh, Battambang, Banteay Meanchey, Siem Reap and Kandal) by late November 2020. As of November 2020, 522 clients were receiving PrEP and uptake has been increasing quarterly.

2-Phased Implementation Plan of PrEP in Cambodia

A PrEP expansion plan has been developed for 2021-2023 with a target of reaching all 15 high-burden provinces of HIV infection and engaging 5,000 clients on PrEP.

The report of a meet hosted in December 2020 by UNAIDS, Unitaid and WHO in association with the Institute of HIV Research and Innovation, mentions the following plan for PrEP roll out in Cambodia:

3-Availability, accessibility and costing

In terms of service delivery, Chhouk Sar clinics provides free PrEP to Cambodian nationals. 

Following are the four stages of PrEP delivery from the Chhouk Sar clinics:

●  Stage 1: Customers receive a leaflet about PrEP. They learn in detail about PrEP. If they are interested in it, they register to receive it. 

●  Stage 2: Customers are transferred to the consulting department where they have a discussion with a consultant to further understand PrEP and its benefits, as well as its dosage schedule. The consultant also conducts a risk assessment of the patient’s likelihood HIV and STIs contraction. 

●  Stage 3: Customers have their blood tested for HIV.

●  If the results are negative, they woule be eligible to receive the PrEP service.

●  If the results are positive, instead of reveiving PrEP, they will meet a consultant and receive life-prolonging medication at Chhouk Sar.

●  Stage 4: Customers is screened during a full body health checkup. If the customer is healthy, they receive PrEP medicine from Chhouk Sar clinic along with information and updates throughout.

PrEP is also available through public facilities, through private providers and online in the country

Are you or your network/organisation working to scale up PrEP availability and access?    

4-Any other Comment / Additional information?

5-Status of PrEP in national guidelines

As per a recent update on unaids.org, with respect to WHO recommendation on oral PrEP adopted in country's national guidelines, these have not yet been developed in Cambodia though there are plans to adopt them in the future. Reasons for PrEP guidelines not having been developed are that there is no policy and it is not a funding priority.

6-Comment / Additional information