title: 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.
abstract: OBJECTIVE
  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 sexually transmitted infection/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 2 demonstration projects, covering 5 operational districts. Routine data were collected and analyzed before (2007), during (2008), and after (2009) the implementation of the LR.
  
  
  RESULTS
  Overall in the 5 operational districts, the proportion of pregnant women, tested for HIV increased from 6% (1261 of 21,376) in 2007 to 86% (18394 of 21,478) 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 1 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 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 postpartum follow-up period.
  
  
  CONCLUSIONS
  Sexually transmitted infection/HIV indicators and follow-up dramatically improved after the LR was implemented. Efforts should be pursued to further improve quality of health care services.
authors.affiliation: Institute of Tropical Medicine, Department of Microbiology, Antwerp, Belgium. tdelvaux@itg.be
authors.forename: Thérèse
authors.initials: T
authors.lastname: Delvaux
authors.forename: Sovannarith
authors.initials: S
authors.lastname: Samreth
authors.forename: Magdalena
authors.initials: M
authors.lastname: Barr-DiChiara
authors.forename: Nicole
authors.initials: N
authors.lastname: Seguy
authors.forename: Katherine
authors.initials: K
authors.lastname: Guerra
authors.forename: Bora
authors.initials: B
authors.lastname: Ngauv
authors.forename: Vichea
authors.initials: V
authors.lastname: Ouk
authors.forename: Marie
authors.initials: M
authors.lastname: Laga
authors.forename: Chhivun
authors.initials: C
authors.lastname: Mean
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000627:therapeutic use; D002160:Cambodia / Q000453:epidemiology; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008430:Maternal-Child Health Centers; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D011295:Prenatal Care / Q000379:methods; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy*; D013587:Syphilis / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D019380:Anti-HIV Agents