3Is in Continuum of Care
Country of Operation
- Cambodian GovernmentGovernment
Target income level
- Bottom 20%
- Lower-middle income (20-40%)
- Middle-income (40-60%)
- Higher middle-income (60-80%)
- High-income (80-100%)
Summary3Is is an integrated strategy to reduce TB-related morbidity, mortality and transmission, especially for those have co-infections of tuberculosis (TB) and HIV/AIDS, through increased early detection and proper treatment.
Despite remarkable success in reducing HIV/AIDS prevalence among general population from a peak of 3.2% in 1998 to 0.8% in 2010, Cambodia still has one of the higher prevalence rates in Asia. Cambodia is also one of the 22 high-burden countries for TB in the world. It is not unusual to see TB and HIV/AIDS co-infections on many patients in the country because HIV/AIDS infection suppresses immune system which increases the risk of getting active TB. The co-infections generally cause more morbidity and mortality, and increase risk for TB transmission compared to a single infection.
Key program components
3Is refers to Intensified TB case finding (ICF) among people living with HIV (PLHIV) and their household contacts, Isoniazid Preventive Therapy (IPT) for PLHIV unlikely to have active TB, and Improved TB infection control (IC) measures at Continuum of Care (CoC) and home-based Care (HBC) settings.
The screening for TB is usually performed in two phases: (1) a verbal TB symptom screening and (2) a diagnostic workup. The first phase is generally carried out by doctors, nurses and counselors at HIV/AIDS clinic and voluntary confidentiality counseling testing (VCCT) centers, with primary focus on 3 main symptoms, including fever, cough, and drenching night sweats. If none of the above symptoms are identified, no further examinations are applied. If the HIV-infected persons present one or more symptoms, they are required to go through the second phase which is normally performed by TB physicians at TB clinics. The children living with HIV need to be screened by pediatricians when they seek health care at pediatric wards or hospital.
The identified active-TB patients are entitled to immediately receive a single TB treatment or a combination of TB services, opportunity infection (OI) and anti-retrovirus therapy (ART) services free of charge, as well as some social supports according to their infection status.
HIV-infected persons who are unlikely to come into contact with active TB are eligible for Isoniazid Preventive Therapy service. Despite its limited availability, the Tuberculin Skin Test (TST) is a quicker method for TB screening in certain settings. The patients with a positive of TST are required to undergo TB drug therapy.
All patients under TB treatments or prophylaxis are required to conform to the treatment follow up which is generally scheduled for every 4 weeks. Both TB and OI/ART physicians are responsible for checking their respective patient’s adherence, side effects of drugs and evolution of treatment outcomes.
3Is was initiated and implemented by government through a joint work between two national institutions known as National Center for HIV/AIDS Dermatology and Sexually Transmitted Diseases (NCHADS) and National Center for Tuberculosis and Leprosy Control (NCTLC) since 2010.