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August 4, 2004

A Community-Based Tuberculosis Program in Cambodia

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(5):566-568. doi:10.1001/jama.292.5.566-c

To the Editor: Cambodia has one of the highest global burdens of tuberculosis (TB).1 In 1994, the Cambodian Health Committee (CHC), a nongovernmental organization, developed a community-based approach to the treatment of TB using microfinance and food supplementation in Svay Rieng, one of Cambodia's poorest provinces.


The program comprised 2 components: a health center–based component (hospital/health care center [HHC]) and a home-based component (Home Directly Observed Therapy Short Course [Home DOTS]). The mean annual target population was 149 577 for the HHC component and 11 557 for the Home DOTS component. Between 1994 and 2001, 2780 patients with TB were treated in the HHC protocol involving DOTS (with 2 months of forced hospitalization during the period 1994-1999, per the national protocol), followed by 6 months of outpatient therapy with monthly drug pick-up at the HHC. After 1999, daily health center visits were offered as an alternative to hospitalization during the intensive phase. From 1999 to 2001, a separate Home DOTS protocol used mobile health teams to actively detect patients in 2 districts not served by HHC and to provide TB therapy to 219 patients in their homes. Compliance strategies in both components expanded on those pioneered in refugee camps at the Thai-Cambodian border2 and included: pretreatment patient education, patient supporters to supervise treatment, a treatment contract, nutritional supplementation, and surprise home visits. Beginning in 1994, a novel linked microfinance project established a network of village banks.3