Table 1 Timeline of TB/HIV activities in Cambodia*

1993

I

CENAT

DOTS expansion initiated

Availability of TB treatment increased

Post-conflict environment

1999

P

MoH

TB/HIV subcommittee formed

Dialogue initiated

Irregular meetings; limited action

2002

P

CENAT and NCHADS

Framework for TB/HIV

First formal agreement

Agreement remained general; technical direction still unclear

2003

I

NCHADS

ART initiated under Continuum of Care; OI/ART team included TB physician

Availability of ART increased

Initially low capacity of healthcare system

2003

R

NCHADS, CENAT, WHO, FHI, US CDC, JICA

TB/HIV pilot programs

Pilots initiated and results published; operational challenges highlighted

Commitment to national roll-out not present prior to pilots, and relative roles of CENAT and NCHADS were not yet defined

2006

P

CENAT and NCHADS

SoP on HIV testing of TB patients and TB screening of PLHIV

Relative roles of CENAT and NCHADS defined; OI/ART teams screened PLHIV for TB and CENAT used 3 options to increase screening of TB patients for HIV

Technical questions remained, i.e., research was needed to define best practices for ART initiation and TB symptom screening prior to IPT

2009

R

CENAT, NCHADS, US CDC, Cambodian Health Committee and research partners

CAMELIA and ID-TB/HIV studies completed and results disseminated in Cambodia

Results define when ART should be started in TB patients and what symptom screen to use in PLHIV prior to IPT

Very few challenges; rapid adoption of findings into field practice

2010

P

TWG for TB/HIV, NCHADS with CENAT

3Is SOP completed

Roll-out of 3Is, based on detailed roles and responsibilities

TB screening of existing PLHIV may put burden on TB diagnostic services

2010

P

CENAT, NCHADS

Revised TB/HIV framework

All TB/HIV policy captured in a single document