The NCHADS Social Health Clinic (SHC), or Clinic Sokhapheap Sangkom provides clinical care and treatment to people living with HIV / AIDS (PLHA). It was established through the support of the Cambodian Treatment Access Program (CTAP), a collaboration between the Cambodian Ministry of Health National Center for HIV/AIDS, Dermatology and STDs (NCHADS) Research Unit, and the National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Australia, with funding from Roche.
It was officially opened on November 15th 2004 by H.E. Dr. Mam Bun Heng, Secretary of State, Ministry of Health. The SHC contributes to national ARV scale-up through pilot testing of key program activities, including ARV procurement and data management, training of health care workers and operational clinical research.
A purpose specific building will be constructed in the grounds of the National Institute of Public Health which is due for completion in 2006. In the meantime the SHC is located at a temporary site in Sankat Toul Svay Prey, Kahn Chamkar Morn, Phnom Penh.
The Social Health Clinic staff includes a senior medical officer, a part time pediatrician, 3 doctors, 4 nurses, 2 pharmacists, and a clinic coordinator. A strong counseling and peer support group team consists of a senior counselor, 2 counselors and 3 peer educators. Data management and prospective quantitative data collection is performed by two research assistants, and research coordinated by 2 research team leaders. A qualitative researcher and 2 interviewers conduct qualitative research on topics related to HIV care. Technical support is provided by 2 expatriate infectious disease physicians.
The Social Health Clinic (SHC) provides outpatient care, including antiretroviral therapy (ART), for HIV infected adults and children. The Social Health Clinic is committed to providing family based therapy and priority enrollment is given to HIV infected spouse and children of currently enrolled patients. Outpatient care, investigations and medications are provided free of charge to patients.
Comprehensive patient care is ensured through excellent collaboration with the National Tuberculosis Program (CENAT), the National Institute of Public Health Laboratory (NIPH), national hospitals and community based organisations. Currently all patients are referred to the SHC from an NCHADS HIV testing and counseling site in Phnom Penh. Patients are referred to CENAT and other public hospitals for inpatient management and to the National Center for Dermatology and STIs for assessment and management of dermatology conditions and sexually transmitted infections. They are also regularly referred to home based care teams, non government organizations and other support networks. SHC doctors and nurses provide a 24 hour telephone advice and call back service for patients enrolled in the clinic who are on ART.
Specimen collection and blood centrifugation is performed at SHC and specimens are transported by motorbike courier to the CENAT and NIPH laboratories. Routine tests include CD4, haematology, clinical chemistry and sputum for microscopy for acid fast bacilli. Staff at the NIPH and SHC have collaborated in developing systems for specimen transport, processing and tracking that can provide a model for the provision of quality-managed laboratory services in a resource-poor setting. Patients are transported to CENAT for routine chest x-ray and ultrasound if required. A strong emphasis is placed on counseling including psychosocial and adherence support. All patients see a counselor at each visit, and informal interactions between patients and peer support workers are facilitated in the waiting room area. Patients are invited to attend Peer Support Group meetings to share their experience.
In addition to OI prophylaxis and treatment ART is provided to all enrolled patients who are eligible for ART based on criteria in the Cambodian National Guidelines for the Selection of People Living with HIV/AIDS for Antiretroviral Therapy. ART treatment regimens are according to the Cambodian National Guidelines for the use of Antiretroviral Therapy in Adults and Adolescents, and the Cambodian National Guidelines for the use of Paediatric Antiretroviral Therapy. Currently over 90% of patients are on first line therapy: stavudine (or zidovudine) + lamivudine + nevirapine (or efavirenz), the second line therapy regimen currently available includes didanosine + lamivudine + saquinavir/ritonavir.
When a patient is determined to be eligible for ART on clinical and immunological criteria they are referred to the counselor for at least 3 HIV and ART preparation sessions over 3 weeks, for information and counseling on the effective use of ART. Prescription of ART is provided once there is agreement between the treating doctor, counselor and a senior doctor that the patient is eligible and has achieved a good understanding, and the patient consents to commit to the prescribed regimen and follow up. ART and non ART drugs prescribed by the SHC doctors are provided free of charge from the SHC pharmacy. The average time from enrollment to commencement of ART in eligible patients is currently 6 – 7 weeks. Ongoing adherence counseling is provided by the counselors and peer educators, with input from the doctors and pharmacist.
From November 2004 to February 2006, 861 patients enrolled in the clinic, and 399 commenced anti retroviral therapy (ARV). Enrolment is approximately 50 – 70 patients per month, with about 60% requiring ARV.