Cambodia

Background
Cambodia is a country in South East Asia with a population of 14 million.  The prevalence of HIV in Cambodia is currently 0.9%, declined from 3.3% in 1997.  The HIV diagnosis and treatment for adults have been scaled up and VCCT testing sites have quadrupled since 2002.  The infant testing was initiated in 2007 and the access has been rather limited so far.

  GHI in Cambodia
   
   

GHI in Cambodia
GHI aims to redesign existing technologies so that infants can be diagnosed around 6 weeks of age using a test that is accurate, low cost, and easy to administer.  To understand the interest and needs for HIV diagnosis and infant testing in Cambodia, a GHI team conducted extensive Field Research through site visits and interviews with key opinion leaders (government, healthcare providers, international agencies, NGOs, and community based organizations).  The role of each stakeholder for HIV, especially for infant testing, was identified, and the best approaches to engage the key stakeholders were evaluated. 

The GHI team also conducted product concept tests, identified the important product attributes, and evaluated the acceptance and preference of different technologies in Cambodia.  Stakeholders in Cambodia received GHI’s proposals for a point of care infant diagnostic for HIV with high enthusiasm. With 77% total cost savings the device is both cost effective and efficient, delivering faster results to mothers.  

GHI Future Work in Cambodia
GHI will build and maintain relationships with key stakeholders in Cambodia, continue to monitor the status of HIV/AIDS programs, and form partnerships with major organizations to facilitate the test and approval process of the infant testing devices in Cambodia.

Preliminary Findings from Cambodia
In 2008 a group of students and partners found the Cambodian HIV/AIDs landscape to be quite different from those of the African nations GHI has visited in prior years. Cambodia has a significantly lower prevalence rate and since 1997 the rate has declined from 3.3% to 0.9%. However the students found that the majority of this decrease has occurred among female commercial sex workers and the next major transmission route to fight is from mother-to-child. Additionally, only about 10% of HIV + mothers have been identified and the government is trying to increase the Prevention of Mother to Child Transmission (PMTCT) reach, which will give rise to the need for infant testing. Overall, the group assessment showed that while infant testing in Cambodia is just being scaled up with limited reach thus far, the overall infant testing market is small relative to GHI focus countries at approximately 4,500/yr.

Stakeholder Analysis
Students recommended the National Center for HIV/AIDS, Dermatology, and STDs (NCHADS) as the key organization to target in Cambodia . While this organization is almost completely funded by NGOs, they still control the majority of funds in Cambodia and approve/administer primary HIV/AIDS programs, thus making them an ideal organization to help deliver infant testing to rural communities.

Concept Testing
The GHI team’s proposals for a point of care infant diagnostic HIV test were received with high enthusiasm. Specifically, the students found the single sample concept to be the most popular, due to its high quality, affordable price and simplicity. Finally, in terms of benefits to the country’s health system, the students found two main advantages: reductions in both cost and time. By including patient and lab-related costs, they found that GHI’s device has potential for a 77% total cost savings. An additional benefit identified was the test’s delivery of same day results, as opposed to current system’s testing period of up to 3 weeks.