Linked response for prevention, care and treatment of HIV/AIDS, STIs and reproductive health issues: results after 18 months of implementation in five operational districts in Cambodia

OBJECTIVES: To describe the implementation and results of the Linked Response (LR) in Cambodia after 18 months of follow-up. METHODS:: The main objectives of the LR are to increase access to STI/HIV prevention, testing, care and treatment and to strengthen existing reproductive health services, through increased linkages within and between public health facilities and community-based services. The LR was piloted in Cambodia in 2008, in two demonstration projects, covering five operational districts (ODs). Routine data were collected and analyzed before (2007), during (2008) and after (2009) the implementation of the LR. RESULTS:: Overall in the five ODs, the proportion of pregnant women, tested for HIV, increased from 6% (1261/21376) in 2007 to 86% (18394/21478) in 2009. Syphilis testing, introduced early 2009, reached similar (85%) coverage as HIV by the end of 2009. Between 2007 and 2009, reproductive indicators also increased: antenatal care coverage (at least one visit) from 80% to 100%, public health facility delivery rates from 26% to 46% and contraceptive prevalence from 24% to 28%. Antiretroviral uptake was high among HIV positive mothers and exposed infants, 84% and 95% respectively, and 3 out of 36 (8%) infants tested so far for HIV were diagnosed positive. However, 6 maternal (HIV-positive women) and 7 child deaths (1 tested positive) occurred during the pregnancy or the 30 week-post-partum follow-up period. CONCLUSIONS:: STI/HIV indicators and follow-up improved after the LR was implemented. Efforts should be pursued to further improve quality of health care services.