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Prevalence of nontuberculous mycobacteria (NTM) disease is poorly documented in countries with high prevalence of tuberculosis (TB). We describe prevalence, risk factors, and TB program implications for NTM isolates and disease in Cambodia. A prospective cohort of 1,183 patients with presumptive TB underwent epidemiologic, clinical, radiologic, and microbiologic evaluation, including >12-months of follow-up for patients with NTM isolates. Prevalence of NTM isolates was 10.8% and of disease was 0.9%; 217 (18.3%) patients had TB. Of 197 smear-positive patients, 171 (86.8%) had TB confirmed (167 by culture and 4 by Xpert MTB/RIF assay only) and 11 (5.6%) had NTM isolates. HIV infection and past TB were independently associated with having NTM isolates. Improved detection of NTM isolates in Cambodia might require more systematic use of mycobacterial culture and the use of Xpert MTB/RIF to confirm smear-positive TB cases, especially in patients with HIV infection or a history of TB.

Objective To measure trends in the pulmonary tuberculosis burden between 2002 and 2011 and to assess the impact of the DOTS (directly observed treatment, short-course) strategy in Cambodia. Methods Cambodia's first population-based nationwide tuberculosis survey, based on multistage cluster sampling, was conducted in 2002. The second tuberculosis survey, encompassing 62 clusters, followed in 2011. Participants aged 15 years or older were screened for active pulmonary tuberculosis with chest radiography and/or for tuberculosis symptoms. For diagnostic confirmation, sputum smear and culture were conducted on those whose screening results were positive. Findings Of the 40423 eligible subjects, 37417 (92.6%) participated in the survey; 103 smear-positive cases and 211 smear-negative, culture-positive cases were identified. The weighted prevalences of smear-positive tuberculosis and bacteriologically- positive tuberculosis were 271 (95% confidence interval, Cl: 212-348) and 831 (95% Cl: 707-977) per 100000 population, respectively. Tuberculosis prevalence was higher in men than women and increased with age. A 38% decline in smear-positive tuberculosis (P=0.0085) was observed with respect to the 2002 survey, after participants were matched by demographic and geographical characteristics. The prevalence of symptomatic, smear-positive tuberculosis decreased by 56% (P=0.001), whereas the prevalence of asymptomatic, smear-positive tuberculosis decreased by only 7% (P=0.7249). Conclusion The tuberculosis burden in Cambodia has declined significantly, most probably because of the decentralization of DOTS to health centres. To further reduce the tuberculosis burden in Cambodia, tuberculosis control should be strengthened and should focus on identifying cases without symptoms and in the middle-aged and elderly population. Objectif Mesurer les tendances de la prevalence de la tuberculose pulmonaire entre 2002 et 2011 et evaluer l'lmpact de la strategie DOTS (traitement de breve duree sous surveillance directe) au Cambodge. Methodes La premiere etude sur la tuberculose a l'echelle nationale, axee sur la population cambodgienne et basee surun echantillonnage par grappes et a plusleurs degres a ete menee en 2002. La deuxieme etude sur la tuberculose, incluant 62 grappes, a ensulte ete menee en 2011. Les participants, ages de 15 ans ou plus, ont ete testes pour la tuberculose pulmonaire active avec une radiographle pulmonaire et/ ou des symptomestuberculeux. Pour confirmer le diagnostic, des frottis et des cultures d'expectoratlon ont ete effectues pour les participants dont les resultats de deplstage se sont averes positifs. Resultats Sur les 40423 sujets eligibles, 37 417 (92,6%) ont participe a l'etude; 103 cas a frottis positif et 211 cas a culture positive et a frottis negatif ont ete identlfies. Les prevalences ponderees de la tuberculose a frottis positif et de la tuberculose bacteriologiquement positive etaient de 271 (intervalle de confiance de 95%, IC: 212-348) et de 831 (IC de 95%: 707-977) pour 100 000 habitants, respectivement. La prevalence de la tuberculose etait plus elevee chez les hommes que chez les femmes et augmentait avec l'age. Une baisse de 38% de la tuberculose a frottis positif (P=0,0085) a ete observee par rapport a l'etude de 2002, apres que les participants ont ete associes a des caracteristiques demographiques et geographiques. La prevalence de la tuberculose symptomatique a frottis positif a diminue de 56% (P=0,001), alors que la prevalence de la tuberculose asymptomatique a frottis positif a diminue de seulement 7% (P=0,7249). Conclusion Au Cambodge, la prevalence de la tuberculose a fortement diminue, probablement a cause de la decentralisation du DOTS vers les centres de sante.Pourcontinuerareduire la prevalence de la tuberculose au Cambodge, la lutte antituberculoseuse doit etre renforcee et se concentrer sur l'identincation des cas sans symptomes et dans la population d'age moyen et agee. Objetivo Medir las tendencias de la carga de tuberculosis pulmonar entre 2002 y 2011, y evaluar el impacto de la estrategia DOTS (tratamiento directamente observado, curso corto) en Camboya. Metodos En 2002 se realizo la primera encuesta de la tuberculosis demografica a nivel nacional de Camboya, basada en pruebas de grupos multietapas. La segunda encuesta de la tuberculosis, que abarco 62 grupos, se llevo a cabo en 2011. Se realizaron pruebas de deteccion de la tuberculosis pulmonar activa mediante radiografia de torax o de sintomas de la tuberculosis a participantes mayores de 15 anos. Para confirmar el diagnostico, se realizo una baciloscopia y un cultivo del esputo en aquellos participantes cuyos resultados de la evaluacion fueron positivos. Resultados De los 40 423 participantes idoneos, 37 417 (92,6%) participaron en la encuesta. Se identificaron 103 casos baciliferos y 211 casos no baciliferos con cultivo positivo. Las prevalencias ponderadas de tuberculosis bacilifera y tuberculosis bacteriologicamente positiva fueron 271 (intervalo de confianza del 95%, IC: 212-348) y 831 (95% Cl: 707-977) por 100000 poblacion, respectivamente. La prevalencia de la tuberculosis fue mayor en hombres que en mujeres y aumento con la edad. Se observo una disminucion del 38% en la tuberculosis bacilifera (P = 0,0085) con respecto a la encuesta de 2002 tras agrupar a los participantes por caracteristicas demograficas y geograficas. La prevalencia la tuberculosis bacilifera y sintomatica disminuyo en un 56% (P=0,001), mientras que la prevalencia de la tuberculosis bacilifera asintomatica solo se redujo en un 7% (P= 0,7249). Conclusion La carga de tuberculosis en Camboya ha disminuido considerablemente, lo cual probablemente se debe a la descentralizacion de la estrategia DOTS en los centros de salud. Para reducir aun mas la carga de la tuberculosis en Camboya, debe reforzarse el control de la tuberculosis y centrarse en la identificacion de casos sin sintomas y en la poblacion anciana y de mediana edad., Introduction Tuberculosis remains a major global health problem, with 8.6 million estimated incident cases and 1.3 million estimated deaths in 2012. (1) Cambodia ranks second among the 22 countries with [...]

Approximately 34% of people with tuberculosis (TB) were undiagnosed in Cambodia in 2017. This study explored barriers in access to TB services and information gaps by genders and key populations in the Cambodian national TB programme. In 2017, we conducted a consensus and validation workshop, desk reviews, 19 in-depth interviews, and 30 focus group discussions with representatives of stakeholder groups, affected populations, and communities. Content analyses were performed for qualitative interviews. We employed the consensus development methods during the workshop to define and prioritise key populations. Key themes that inhibited access to TB services included the lack of knowledge, awareness, time and financial means, and gender-specific vulnerabilities. Systemic barriers included inconsistencies in policy and guideline implementation and lack of resources required for effective TB management. We did not find indications of coercive practices against women and key populations. However, stigma and discrimination did exist in healthcare institutions, the workplace, and the community. There were significant gaps in gender and key population-specific data and reporting systems at all levels. Data availability is vital for understanding gender and key population-specific gaps, and they should be duly utilised. Mechanisms to ensure equality and inclusivity are necessary to end TB in Cambodia. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) estimated that 29% of global tuberculosis (TB) and almost 47% of childhood TB cases were not reported to national TB programs in 2019. In Cambodia, most childhood TB cases were reported from health facilities supported by the Global Fund to Fight AIDS, Tuberculosis, and Malaria in 2019. This study aimed to compare the healthcare providers' knowledge, attitude, and practices (KAP) on childhood TB case detection in operational districts (ODs) with high and low childhood TB case detection in Cambodia.Methods: We conducted a cross-sectional study between November and December 2020 among healthcare providers in 10 purposively selected ODs with high childhood TB case detection and 10 ODs with low childhood TB case detection. A total of 110 healthcare providers from referral hospitals (RHs) and 220 from health centers (HCs) were interviewed. We collected information on socio-demographic characteristics, training, and KAP on childhood TB. Pearson's Chi-square or Fisher's exact and Student's t-tests were performed to explore the differences in KAP of healthcare providers from ODs with low vs. high childhood TB detection.Results: Of the 330 respondents, 193 were from ODs with high childhood TB case detection, and 66.67% were from HCs. A significantly higher proportion (46.11%) of respondents from ODs with high childhood TB case detection received training on childhood TB within the past two years than those from low childhood TB case detection ODs (34.31%) (p = 0.03). Key knowledge on childhood TB was not significantly different among respondents from ODs with high and low childhood TB case detection. A significantly higher proportion of respondents from ODs with high childhood TB case detection had a good attitude (98.96 vs. 97.08%, p = 0.002) and performed good practices (58.55 vs. 45.26%, p = 0.02) on contact investigation in the community than those from low childhood TB case detection ODs.Conclusions: Healthcare providers from ODs with high childhood TB detection had better attitudes and practices towards childhood TB. The attitudes and practices need to be improved among healthcare providers in ODs with low case detection. Further investment in training and experience sharing on childhood TB case detection among healthcare providers is needed to improve childhood TB case detection. [ABSTRACT FROM AUTHOR]

Background: Over the last decade, the availability and use of mobile phones have grown exponentially globally and in Cambodia. In the Sihanouk Hospital Centre of Hope(SHCH) in Cambodia about half of all tuberculosis patients referred out to peripheral health facilities for TB treatment initiation or continuation were lost to contact after referral ranging from 19 to 69% between 2008 and 2013. To address this, we implemented a mobile phone-based patient tracking intervention. Here, we report the number and proportion of referred TB patients who could be contacted through a mobile phone and retained in care after the introduction of mobile phone tracking.Methods: A descriptive study involving follow-up of TB patients referred out from SHCH to peripheral health facilities during May-October 2014. Standard operating procedures were used to contact individual patients and/or health facilities using a mobile phone.Results: Among 109 TB patients referred to peripheral health facilities, 107(98%) had access to a mobile phone of whom, 103(97%) could be contacted directly while 5(2%) were contacted through their health care providers. A total of 108(99%) of 109 referred TB patients in intervention period were thus placed on TB treatment.Conclusions: This study provides preliminary, but promising evidence that using mobile phones was accompanied with improved retention of referred TB patients compared to historical cohorts. Given the limitations associated with historical controls, we need better designed studies with larger sample size to strengthen the evidence before national scale-up. [ABSTRACT FROM AUTHOR]

Prevalence of nontuberculous mycobacteria (NTM) disease is poorly documented in countries with high prevalence of tuberculosis (TB). We describe prevalence, risk factors, and TB program implications for NTM isolates and disease in Cambodia. A prospective cohort of 1,183 patients with presumptive TB underwent epidemiologic, clinical, radiologic, and microbiologic evaluation, including >12-months of follow-up for patients with NTM isolates. Prevalence of NTM isolates was 10.8% and of disease was 0.9%; 217 (18.3%) patients had TB. Of 197 smear-positive patients, 171 (86.8%) had TB confirmed (167 by culture and 4 by Xpert MTB/RIF assay only) and 11 (5.6%) had NTM isolates. HIV infection and past TB were independently associated with having NTM isolates. Improved detection of NTM isolates in Cambodia might require more systematic use of mycobacterial culture and the use of Xpert MTB/RIF to confirm smear-positive TB cases, especially in patients with HIV infection or a history of TB. [ABSTRACT FROM AUTHOR]

Tuberculosis and HIV/AIDS have synergistic health impacts in terms of disease development and progression. Therefore, collaborative TB and HIV/AIDS activities are a logical health systems response. However, the establishment of these activities presents a challenge for countries that have strong vertical disease programs that differ in their implementation philosophies. Here, we review the process by which TB/HIV collaboration was established in Cambodia. A cycle of overlapping and mutually reinforcing initiatives--local research; piloted implementation with multiple options; and several rounds of policy formulation guided by a cross-functional Technical Working Group--was used to drive nationwide introduction of a full set of TB/HIV collaborative activities. Senior Ministry of Health officials and partner organizations brought early attention to TB/HIV. Both national programs implemented initial screening and testing interventions, even in the absence of a detailed, overarching framework. The use of multiple options for HIV testing identified which programmatic options worked best, and early implementation and pilots determined what unanswered questions required further research. Local conduct of this research--on co-treatment timing and TB symptom screening--speeded adoption of the results into policy guidance, and clarified the relative roles of the two programs. Roll-out is continuing, and results for a variety of key indicators, including screening PLHIV for TB, and testing TB patients for HIV, are at 70-80% and climbing. This experience in Cambodia illustrates the influence of health research on policy, and demonstrates that clear policy guidance, the pursuit of incremental advances, and the use of different approaches to generate evidence can overcome structural barriers to change and bring direct benefits to patients. [ABSTRACT FROM AUTHOR]