Integrating & Increasing Voluntary Counseling and Confidential Testing in Cambodia

Cambodia succeeded in reducing HIV prevalence from a high of 3% in 1997 to 0.6% in 2005. Access to VCCT supports adoption of safer behaviors and increases HIV+ persons' access to care, support and treatment. In 2000, the government had only 8 VCCT service outlets throughout Cambodia, most of which focused on sex workers; other population groups had limited access to VCCT. In 2000, RHAC expanded access to the wider Cambodian population by integrating VCCT services into its network of reproductive health clinics. RHAC clinics provide reproductive health/family planning services, and its workplace-based sites serve garment workers, construction workers, and fishermen. Working with Cambodia's National HIV/AIDS/STI program, RHAC trained clinic staff in VCCT and post exposure prophylaxis; redesigned client flow and counseling rooms to ensure confidentiality; developed quality assurance guidelines and practices for ELISA tests (and later, rapid tests); updated clinic recording and reporting; developed referral systems to HIV/AIDS prevention programs; as well as a referral system linking HIV+ clients to Cambodia's existing ART, HIV/AIDS home-based care, and TB program. Integrating VCT with other RHAC services meets RH needs of HIV positive couples, e.g. discussing fertility and birth spacing options and PMTCT or newborn care. VCCT clients at RHAC's 15 clinics increased from less than 100 in 2000 to 53,375 in 2006 (67% were women, 41% were under 25 years old, and 97% received their results and post test counseling). Even though RHAC clinics represented only one-tenth of the total of 140 VCCT sites operating in Cambodia in 2006, RHAC's contribution accounted for 25% of the national total for VCCT clients served in the country. Some key recommendations based on this experience included:

• Integration of VCCT into reproductive health services increases access

• A linkage to HIV/AIDS/STI prevention programs enhances prevention with HIV+ clients

• Ensuring staff safety (e.g. readily available prophylaxis in the case of exposure) is important, as is staff training.