KSF Hospital HIV/AIDS patients

challenges after June 2010

Emmanuel Lavieuville – MSF-F Cambodia

KSF Hospital (KSFH) MSF-F Project (1997-2010)

MSF-F at KSFH Before June 2010

1997-2001: treatment OI 2001: first patient under ART 2003: decentralization to Kg Cham PRH 2005: initial focus & activities to keep under ttt HIV patients of cohort jailed in PP

prisons 2006: development of an ambulatory strategy for co-infected DR-TB cases

management 2007: ARV treatment supplied by NCHADS (almost 100%) 2008: start the HIV cohort integration process into the public health system. MoU

signed between MSF & MoH. 2009: continued progressive integration of the KSFH cohort treatment and follow up

within KSF Hospital. Working plan & regular TWG for the formal handover to KSFH and to NCHADS. Initial informal request of NCHADS to extend its support until March-June 2010. MSF-F agree for technical support up to March and OI essential drugs stock up to June 2010.

2010: formal request of the MoH to MSF-F to extend its support up to June. MSF-F overall financial support kept up to June 2010. June 2010 formal end of the handover.

After June 2010: Financial support to AUA Specific support to Phnom Penh Prison HIV/AIDS prisoners kept (MoU with MoH) Ensure the continuation of the care & treatment for the patients of KSFH cohort

Main challenges for KSFH HIV/AIDS post June 2010 (1)

Cost recovery scheme introduction by KSFH for all HIV/AIDS patients From 1st July:

OPD HIV/AIDS patients must pay 8000 Riel/consultation (+ cost of other tests) IPD HIV/AIDS patients must pay 10 000 Riel/hospitalisation per day and have to pay 7 days

in advance to be admitted (+ medical equipment, OI essential drugs & relevant investigations needed)

No budget & no partner? MSF-F identified partners & solutions for specific groups of patients

2008: Paediatric cohort h/o to CHC. 2009: DR-TB co-infected patients h/o to CHC, h/o to Magna of all cohort pregnant mothers. 2009-2010: access to HEF for poor patients of the cohort with URC, FHD & AUA help.

NCHADS & KSFH Global Fund Round 8 transferred to Round 9 includes the KSFH cohort Aids Healthcare Foundation (AHF) is the Sub-Recipient of NCHADS for KSFH and other

cohorts Global Fund R9 fund for Year 1 of the grant not before January 2011 at best! NCHADS asked

AHF to advance fund for KSFH from July 2010 to fill the gap but nothing yet! Urgent Issues!

No funds to support the functioning of the cohort & therefore establishment of a cost recovery by the KSFH against national policy principle!

Increase the access for patients to HEF: agreement of URC to support a post-ID system at KSFH IDD.

No information at all on GF R9 budget lines & estimated timeline No formal information to all partners on AHF funds to fill the gap Other options? MSF-F provided formal information on current situation to main stake holders and KSFH

is initiating a regular meeting with all PLHA organisation involved at KSFH to help define solutions

Main challenges for KSFH HIV/AIDS post June 2010 (2)

Phnom Penh HIV/AIDS prisoners still supported by MSF-F within KSFH project

Since 2005 MSF-F identify specific issue for continuation of treatment for patients of the cohort jailed in PP Prisons

2005-2007: agreement with PP jails to extract HIV/AIDS prisoners on regular basis for consultation and to receive treatment at KSFH

From 2007: because of progressive increase of the number of prisoners under ART MSF-F set up a regular mobile clinic to CC1 & CC2. Still running until today.

Since end 2008 MSF-F support access to VCCT for Phnom Penh Prisoners Since February 2010 MSF-F implements a systematic screening for HIV & TB in PP prisons. Today: 73 on ART and 36 on OImore than 100 patients under ART in PP prisons followed by

MSF-F MoU

Prisoners project is part of MSF-F MoU with the MoH (2008-2010) Additional MoUs with MoI, Cenat & PPMHD

Challenges since handover of KSFH project: MSF-F cannot receive the ART from the KSF Hospital as in the past. MSF-F faces difficulties to register in a Phnom Penh cohort the newly screened HIV/AIDS

patients imprisoned. Is KSFH still the CoC centre for the Phnom Penh prisons? Still the closest CoC! Both NCHADS & KSFH silent. No clear policy.

Number of prisoners under treatment is not so high but CC1 & CC2 with many judicial extraction on weekly basis does not have the capacity to extract such a no. of patients!

The Global Round 10 proposal does not include the HIV/AIDS prisoners! What is going to be the policy in the future?

Main challenges for KSFH HIV/AIDS post June 2010 (3)

Threat to Phnom Penh PLHA access to care & treatment? In 2010 because of planned withdrawal or cut in funding different major actors

involved in HIV care & treatment in Phnom Penh are reducing or h/o their HIV/AIDS activities:

KSFH – MSF-F (3395 patients on ART; 290 on OI) : largest cohort & with 60 beds one of the main national referral ward for complicated cases! 30 beds for HIV+ patients only since July 2010.

Sihanouk Hospital – Hope worldwide (2401 patients on ART; 379 on OI): GF R9 funding reduction lead to reduce activities to 3 new admission per day since Jan 2010 and the closure of 10 beds in Aug 2010.

Preah Ketomelea – IPD supported by Douleur Sans Frontières (855 patients on ART; 172 on OI): will reduce activities due to contraints of funding from GF. 30 beds to 15 beds in March 2010.

Kossamak – SEAD (2550 patients on ART; 470 on OI) with 18 IPD beds: h/o to AHF with GF Round 9 money planned in Aug. 2010.

Maryknoll activities h/o in Dec 2010. Main consequences:

Whether stopped or h/o over the services provided are not free of charge anymore & HEF not accessible in most cases to HIV/AIDS patients. Immediate & direct limitation to the access of care & treatment for the poorest HIV/AIDS patients of Phnom Penh affected cohorts.

Significant drop in the capacity of inclusion for new HIV/AIDS patients in Phnom Penh area Significant decrease in the Hospitalisation capacity and access for Phnom Penh HIV/AIDS

patients Some HIV related specific complications (CMV, etc…) may not be treated anymore in Phnom

Penh Significant decrease of the supported laboratory investigations to help clinicians in the f/u of the

patients