IMPACT
Cambodia 1994 - Present
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Introduced community-based TB care in Cambodia in Svay Rieng Province partnering with the National TB Program.
Piloted and then worked with the National TB Program to scale-up Community TB Daily Observed Therapy (cDOTs), throughout Cambodia. Credited by the World Health Organization (WHO) with the significant decrease in TB prevalence in Cambodia between 1990s and 2010.
CHC has treated >100,000 adults and children for TB with high treatment success as of 2024.
In 2024 CHC delivers TB-cDOTS to 13 of Cambodia's 25 provinces.
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- ,CHC launched the drug resistant (DR)-TB program in 2006 in cooperation with the National TB program.
- Leadership of the DR-TB program transferred to the National TB Program in 2012 with CHC continuing as the lead clinical partner in scale-up of program throughout Cambodia.
-Treated over 1700 patients by 2023 reporting equally high treatment success in patients with community-based and hospitalized-based initiation of treatment.
-CHC assisted in initiating the Vietnamese DR-TB program and the Ethiopian DR-TB program, providing hands-on training for core members of those country programs.
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- Began HIV prevention activities in rural areas in 2000.
-Began HIV screening in Svay Rieng TB program in 2003
- Introduced the first AIDS drugs to rural Cambodia in 2004.
- Provided HIV treatment to over 7,000 individuals for HIV/AIDS over the past 20 years.
- Conducted the CAMELIA trial with French ANRS, Institut Pasteur du Cambodge, US NIH and Cambodian National TB and AIDS Programs, which showed that starting AIDS drugs early in patients with TB and HIV led to a 34% increase in survival.
- The CAMELIA Trial rapidly changed practice in Cambodia, and based on its findings the World Health Organization (WHO) issued new guidelines to start AIDS drugs early, which is estimated to have saved ~150,000 lives annually since 2011.
- CHC's HIV treatment program has treated >6000 adults and children over the last 20 years.
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- Opened the Maddox Chivan Children’s Center (MCCC) together with Angelina Jolie in 2006 for children infected with HIV or for children orphaned by AIDS.
At the origin of AIDS drugs for children, CHC provided AIDS drugs for infected children at the MCCC starting in 2006 and comprehensive care, education, and nutritional and counseling support for children infected or affected by HIV/AIDS.
-trained key Cambodian physicians working in the Cambodian national program pediatric HIV/AIDS care.
-pioneered an age-specific medical counseling manual for children at the MCCC to understand their illness and to help with taking life-saving drugs faithfully, which has been widely used nationally.
- CHC established the Joseph P. Sullivan Pediatric HIV Treatment Center in 2009 at the largest public hospital in Cambodia, which hosted >85,000 clinic visits for >600 children over the past 15 years.
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- The local Cambodian Health Committee (CHC) team provided first hands-on practical training of the designated Ethiopian DR-TB team in Cambodia in December 2008.
-First 9 patients initiated on DR-TB treatment at St Peters Hospital in Addis Ababa in February 2009 in the Ethiopian GHC/Ethiopian Federal Ministry of Health (FMOH) DR-TB partnership.
- GHC/FMOH DR-TB program expanded to Gondar University Hospital in 2010 in northern Amhara Province.
-GHC/FMOH program expanded to Yirgalem Hospital in southern Ethiopia in 2012 in partnership with FMOH.
-GHC performs successful pilot of outpatient start of DR-TB treatment (as opposed to hospitalized start), which is scaled up in country.
-as a key member of the Ethiopian Technical Working Group, GHC approaches of side-effect monitoring, social and food support, and outpatients monitoring incorporated into national scale-up.
-GHC-St. Peters Program chosen as an international site of the STREAM Trial in 2011.
-GHC reports highest DR-TB treatment success outcomes so far achieved in Africa in the GHC/FMOH program in a setting with severe resource constraints and patients with advanced disease and 24% HIV co-infection.
-STREAM trial in which GHC participates provides the data for WHO to recommend shortening of the 2 year course of DR-TB treatment and the efficacy of newly discovered DR-TB drugs in shortening treatment to 6 or 9 months, a game-changer for the goal of eradicating DR-TB.
- As of May 2023, 2850 individuals (with 22% HIV co-infected) individuals are directly treated by GHC/FMOH programs with national program scaling care to an additional 4832 individuals.
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-530 children and teens have received treatment for DR-TB in the GHC/FMOH program.
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- In 2023 GHC re-opened the DR-TB program in Afar Province at Dupti Hospital, which was disrupted by spill-over fighting in Afar due to the civil war between neighboring Tigray and Ethiopia.
>16,000 meals and therapeutic foods obtained for all hospitalized DR-TB patients, and provided meals for outpatients seeking care at Mekele General Hospital who had experienced gender-based violence during the recent conflict. Both groups had an average BMI of 15, consistent with severe malnutrition with some patient BMIs in the starvation range (<13).
Ethiopia 2009 - Present
Across borders
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-CHC hosted the Vietnamese DR-TB team leadership in Cambodia for hands-on training in advance of their initiation of the Vietnam country program.
-CHC trained the Ethiopian DR Team in Cambodia and mentored physician, health worker, nursing and pharmacy staff in Ethiopia both in advance of initiating DR-TB treatment in Ethiopia and during early years of the program.
-GHC Ethiopia provided regional training and support for initiation and/or expansion of the DR-TB country programs in South Sudan and in Zambia and hosted the Zambian team to St Peters Hospital .
-combined GHC and CHC DR-TB teams made two exchange visits to share experience with the Myanmar DR-TB program.
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CHC and GHC's studies show:
-Patient supporters, food packages, home visits, and local health workers, microfinance strategies significantly enhance TB and DR-TB cure in Cambodia and Ethiopia providing a global model (see references 1 - 3 below).
-patients with TB and AIDS, who start AIDS drugs early have a 34% increase in survival (with French ANRS/NIH/Pasteur Inst), providing the data for a change in WHO's global recommendation to early start of AIDS drugs for TB/HIV co-infection. Estimated to save ~150,000 lives/year since 2011 (4).
- working as an international site of the STREAM trial (led by the Medical Research Council of the UK and the Union), which provided the data for WHO's recommendations for a new, shorter, and all oral DR-TB treatment regimen (references 5 & 6).
GHC/CHC Bibliography:
1. A Community-Based Tuberculosis Program in Cambodia. Thim S, Sath S, Sina M, Tsai EY, Delgado JC, Shapiro AE, Glaziou P, Goldfeld, AE. JAMA, 2004; 292:566-568.
2.Initiation, scale-up and outcomes of the Cambodian National MDR-TB programme 2006-2016: hospital and community-based treatment through an NGO-NTP partnership. Sam S, Shapiro AE, Sok T, Khann S, So R, Khem S, Chhun S, Noun S, Koy B, Sayouen PC, Im Sin C, Heng Bunsieth, Mao TE, Goldfeld AE. BMJ Open Respir Res. 2018 Jun 4:5(1):e000256. Doi:10.1136/bmjresp-2017-000256.
3.Achieving high treatment success for multidrug-resistant TB in Africa: initiation and scale-up of MDR TB care in Ethiopia--an observational cohort study. Meressa D, Hurtado RM, Andrews JR, Diro E, Abato K, Daniel T, Prasad P, Prasad R, Fekade B, Tedla Y, Yusuf H, Tadesse M, Tefera D, Ashenafi A, Desta G, Aderaye G, Olson K, Thim S, Goldfeld AE. Thorax. 2015 Dec;70(12):1181-8. doi: 10.1136/thoraxjnl-2015-207374. Epub 2015 Oct 27. PMID:6506854. Chosen as ‘Best in Thorax 2015’.
4.Earlier versus Later Start of Antiretroviral Therapy in HIV-Infected Adults with Tuberculosis. F.-X. Blanc, T. Sok, D. Laureillard, L. Borand, C. Rekacewicz, E. Nerrienet, et al. New England Journal of Medicine 2011 Vol. 365 Issue 16 Pages 1471-1481.https://doi.org/10.1056/NEJMoa1013911
5. A Trial of a Shorter Regimen for Rifampin-Resistant Tuberculosis. A. J. Nunn, P. P. J. Phillips, S. K. Meredith, C.-Y. Chiang, F. Conradie, D. Dalai, et al. New England Journal of Medicine 2019 Vol. 380 Issue 13 Pages 1201-1213 Accession Number:30865791 DOI: 10.1056/NEJMoa1811867. https://www.nejm.org/doi/full/10.1056/NEJMoa1811867
6.Evaluation of two short standardised regimens for the treatment of rifampicinresistant tuberculosis (STREAM stage 2): an open-label, multicentre, randomised, noninferiority trial. Goodall, RL, Meredith SK, Nunn AJ, et al. and collaborators. The Lancet,Volume 400, Issue 10366, 1858-1868. doi.org/10.1016/S0140-6736(22)02078-5
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