Cambodia
CHC's community-based treatment model for TB, begun in 3 district hospitals in 1994 in Svay Rieng Province, has now been expanded countrywide to cover all 15 million Cambodians through the Cambodian National TB program; CHC is directly delivering TB care to three of Cambodia’s provinces, Svay Rieng, Kompot and Kandal.

With continued support from the Jolie-Pitt Foundation, CHC’s Maddox Chivan Children’s Center has served close to 1000 HIV-infected or -affected children with medical, nutritional, educational, social, and vocational programs.  A major achievement of 2010 has been the completion of a counseling manual to help children of different ages to understand their HIV infection and the importance of taking drugs daily.  Its translation into Khmer and Amharic are underway and we anticipate it will be used globally.

With support of the Annenberg Foundation, CHC has expanded access to treatment for multi-drug resistant tuberculosis (MDR-TB) in Cambodia with the goal of universal access to MDR-TB care for all Cambodians, creating a model of community- and home-based care, in partnership with the National TB program.

The CHC-led clinical trial (CAMELIA) supported by the U.S National Institutes of Health (NIH), and the French Agence Nationale Recherches sur le SIDA was concluded and its first results were presented at the International AIDS conference in July. The results show that initiating AIDS therapy 2 weeks after beginning TB drug therapy decreases mortality by 34%.  These results, which will change global practice and save tens of thousands of lives, were recently cited by the NIH as one of the 2010 landmark discoveries for AIDS.

CHC’s Joseph P. Sullivan Outpatient Center of Excellence for TB and AIDS Care of Children at the Khmer-Soviet Friendship Hospital (KSFH), Phnom Penh’s largest public hospital is providing care for more than 400 HIV-positive children, and enhancing services for all children at the hospital, with a particular focus on neonatal care in 2010.

The CHC’s program at the pulmonary ward at the Khmer-Soviet Friendship Hospital in Phnom Penh, which was once a dilapidated ward for destitute adult TB and AIDS patients, has been transformed by CHC into a teaching ward and the Cambodian Center of Excellence for AIDS and TB care and has provided care for over 1200 patients since 2006.

CHC’s community based provincial AIDS programs, the first to treat AIDS at the provincial level and to integrate TB and AIDS care in Cambodia, now provides treatment and follow-up for over 5,000 patients.

CHC is working to prevent the suffering that TB causes to children and their families and is currently implementing one of the largest pediatric TB diagnostic studies in Svay Rieng, the first of its kind in South-East Asia.  The study will help deliver TB care to children under 5 and provide knowledge to find better ways to diagnose TB in children.  CHC is pioneering the new Gene Xpert technology to speed up diagnosis.

Ethiopia
After training in Cambodia, Ethiopian doctors together with Global Health Committee, began the first-ever treatment program for treatment for multi-drug resistant tuberculosis (MDR-TB) in Ethiopia in February 2009.  Supported by the Jolie-Pitt Foundation, by January 2011, the program had initiated 171 patients on therapy.  Most of the patients had been waiting for years for therapy and were extremely ill. Planning for National scale-up of this pioneering program with the Ethiopian Ministry of Health is underway.

The MDR-TB program was expanded to the north of Ethiopia to Gondar in August 2010 in a collaboration between GHC, the Ethiopian Ministry of Health, and Gondar University Hospital.

Based on the successes in Ethiopia, GHC/CHC presented a keynote talk “Working with National TB Programs Across Two Continents: Opportunities and Challenges” at the WHO’s expert Consultation Meeting to Strengthen Engagement of  Civil Society Organizations in the TB Area of Work of the WHO, in Geneva in Sept. 2010.

Berlin (Germany) based Graft Lab architects design the Zahara Center for AIDS- and tuberculosis-affected children in the outskirts of Addis Ababa, modeled after the CHC’s successful Maddox Chivan Children’s Center in Cambodia.

GHC/CHC’s work was featured in the photo exhibition of James Nachtwey at 401 Projects in NY, NY and in his video on MDR-TB, ‘Struggle for Life’; was written up in the international journal Nature, as having developed a pioneering community-based approach to HIV and TB care and research, was featured on the Women’s Conference website, and was the subject of two ABC news reports on Good Morning America and World News Tonight showing the impact of the work.

Cambodia
CHC's community-based treatment model for TB has been expanded countrywide to cover all 15 million Cambodians through the Cambodian National TB program.  The CHC is directly supervising and delivering TB care in the three most populated Cambodian provinces.

With support from the Annenberg Foundation, the CHC expanded access to treatment for multi-drug resistant tuberculosis to 144 patients, from 62 last year.  Using our powerful model of community- and home-based care, we aim to provide universal access to MDR care in partnership with the National TB program.

GHC/CHC opens the Joseph P. Sullivan Outpatient Center of Excellence for TB and AIDS Care of Children at the Khmer-Soviet Friendship (KSF) Hospital, Phnom Penh’s largest public hospital.   Outpatient care is provided for more than 400 HIV-positive children, and an accompanying renovation of the pediatric ward has enhanced services for all children at the hospital.

With continued support of the Jolie-Pitt Foundation, CHC’s Maddox Chivan Children’s Center serves more than 700 HIV-infected or -affected children with medical, nutritional, educational, social and vocational programs at the Maddox itself and at the Sullivan Center.

CHC-led clinical trial (CAMELIA) of combined TB and AIDS treatment enters its final phase.

CHC began a study of tuberculosis in children aimed at interrupting infection, funded by the AERAS TB Global Vaccine Initiative and the Gates Foundation.

CHC researchers at Harvard Medical School and the Immune Disease Institute in Boston and at the Institut Pasteur du Cambodge in Phnom Penh, receiving key support from the Annenberg Foundation, the NIH, and the ANRS, continue their collaboration to develop new treatments for the “paradoxical reaction,” a severe side effect that complicates HIV treatment in one-fifth of TB-infected patients.

Ethiopia
After training in Cambodia, Ethiopian doctors began the first-ever treatment program for MDR-TB in February 2009.  The new program, which is supported by the Jolie-Pitt Foundation,  is working with the Ministry of Health and the GHC.

GHC/CHC obtains free medicines to treat MDR-TB in Ethiopia from Eli Lilly, the Chao Center of Purdue University, and Jacobus Pharmaceuticals.

To date, 74 patients have received life-saving MDR-TB medicines and care under the new program.  Plans for national scale up of the program are underway.

Architects begin work on Zahara Center for AIDS- and tuberculosis-affected children in outskirts of Addis Ababa, modeled after CHC’s successful Maddox Chivan Children’s Center in Cambodia.

Cambodian National TB program scales up CHC’s community-based treatment model to cover the entire country.

The CHC expands its operations outside Cambodia, to Southeast Asia and Africa. To reflect this international expansion, the organization takes on a new name, the Global Health Committee.

GHC/CHC breaks ground on the Joseph P. Sullivan Outpatient Center of Excellence for TB and AIDS Care of Children at the Khmer-Soviet Friendship Hospital, Phnom Penh’s largest public hospital. Renovation and modernization of the existing children’s ward and addition of a new outpatient wing are all supported by a gift from Jeanne Sullivan in memory of her husband, a long-time CHC supporter and tireless advocate for refugees and human rights.

In Phnom Penh, GHC/CHC takes charge of outpatient care for nearly 300 HIV-positive children from the Maryknoll Missionaries and from the departing Médecins Sans Frontières.

GHC/CHC develops a new model for treating multi-drug resistant TB (MDR-TB) in hospitals and in the community. Working with the Cambodian government, the GHC/CHC obtains free medicines from the World Health Organization and UNITAID and sets a goal of universal access to MDR-TB treatment in Cambodia.

GHC/CHC researchers at Harvard Medical School, the Immune Disease Institute in Boston and the Pasteur Institute of Phnom Penh begin an NIH-funded study in Cambodia to investigate the “paradoxical reaction”, a severe immune side effect that complicates HIV treatment in one-fifth of TB-infected patients.

GHC/CHC’s TB and AIDS work featured in major photography exhibits in Paris, New York and Bangkok by award-winning Time Magazine photojournalist James Nachtwey, who is working to raise world awareness of drug-resistant tuberculosis and the link between TB and AIDS.

CHC receives a two-year $500 thousand grant from the Annenberg Foundation for TB and AIDS treatment programs in Cambodia and research at the Immune Disease Institute in Boston. The grant recognizes the power of combining clinical care and discovery in the fight against TB and AIDS.

GHC/CHC doctors train colleagues from Viet Nam and partner with them to initiate treatment of extensively drug resistant (XDR) TB with a donation of medicines from Eli Lilly and Co.

GHC/CHC makes its first site visit to Swaziland, consulting with the national TB program to improve case detection and care for conventional and MDR-TB and TB/HIV coinfection using CHC Community DOTS methods.

GHC/CHC receives $2 million gift from the Jolie-Pitt Foundation for work in Ethiopia. Planning starts for a center for AIDS- and tuberculosis-affected children in Addis Ababa, modeled after CHC’s successful Maddox Chivan Children’s Center in Cambodia.

GHC/CHC conducts training in Ethiopia for physicians and nurses to begin MDR-TB treatment there, and Ethiopian medical workers travel to Cambodia for additional hands-on training from GHC/CHC staff.

Recruitment in CAMELIA trial continues, nearing goal of 660 patients. 

James Nachtwey's photo exhibit at the United Nations, "A World Free of TB," spotlights the efforts of the CHC.

To provide universal access to drugs for MDR TB, CHC develops a countrywide treatment plan at the request of the National TB Program, and receives Green Light Status from the World Health Organization to obtain low-cost drugs for the program.

CHC convenes the first MDR Working Group Conference to develop the Cambodian national guidelines for treatment and prevention of MDR TB.

CHC opens Maddox Chivan Children's Center (MCCC) in Phnom Penh, with the support of Angelina Jolie, providing a new model of integrated medical care, education, and social support to children infected or affected by AIDS. Marie-Pierre Fernandez leads this effort as its director. 

Cambodian National TB Program officially adopts CHC treatment model country-wide.

CHC gets go-ahead from World Health Organization to obtain low-cost medicines to treat multi drug-resistant TB (MDR TB) for patients participating in the CAMELIA trial.

First Cambodian patients begin CAMELIA trial.

The CHC opens an AIDS treatment clinic at Kompong Trach District Hospital in Kompot Province, making it the most rural area to have access to AIDS treatment.  Didier Laureillard leaves MSF France and becomes the first CHC medical coordinator, a position he will hold for two years, helping to launch the CAMELIA trial.

CHC works with Japan International Cooperation Agency to expand TB treatment and Community DOTS to all of Svay Rieng province.

Svay Rieng village bank microloan program, started by CHC in 1994, becomes an independent Cambodian Microfinance Institution dedicated to alleviating poverty.

Sok Thim named a Hero of Global Health by TIME Magazine, which profiles him, Goldfeld and the CHC in its focus issue on global health.

The NIH/CIPRA expands the planning grant to a five year, $2.5 million grant to build a clinical and research network for TB and AIDS and to support the CAMELIA trial.

With support from US NIH and the Japanese embassy, CHC begins to renovate and upgrade the TB care facilities in the pulmonary ward of the largest hospital in Phnom Penh (KSFH, the Khmer-Soviet Friendship Hospital), which serves the poorest and sickest Cambodians dying from both diseases.

With the support of the Sullivan Foundation and the American Foundation for AIDS Research TREAT Asia initiative, the CHC starts a pioneering at-home AIDS treatment program for AIDS patients built upon its TB treatment model. The program is based on the successful CHC TB model, using community health workers, patient supporter, education, treatment contracts, and food.  It allows patients to receive care near their homes so they do not have to seek care in Phnom Penh where cut off from social supports they often end up homeless, sick and dying.

CHC opens an AIDS clinic and inpatient ward at the Svay Rieng Provincial Hospital, the first rural Cambodian managed AIDS project.

As an outcome of the CIPRA planning process, the CHC develops a proposal to carry out the CAMbodian Early vs. Late Introduction of Antiretrovirals (CAMELIA) trial, which will establish the best timing of medication regimens for patients with both TB and AIDS.  The study, the first of its kind, receives funding from the French ANRS and will be done in collaboration with the US NIH funded CIPRA.

To raise global awareness of AIDS and TB, Goldfeld initiates a project with photojournalist James Nachtwey to document the twin epidemics in Cambodia.  His photoessay, TB in Cambodia, is part of a portfolio that garners the Magazine Photographer of the Year award from the National Press Photographers Association.

CHC receives planning grant from the United States National Institutes of Health under the Comprehensive International Program of Research on AIDS (CIPRA) to establish a TB and AIDS clinical and research network throughout Cambodia.  This leads to an extensive planning process engaging the French Agence Nationale Recherches sur le Sida and Cambodian governmental health agencies to achieve this goal.

CHC begins treating hard-to-cure cases of drug-resistant TB in Svay Rieng. The program treats people in their homes using community health workers, patient supporters and individually tailored regimens of drugs (DOTSPlus).

Goldfeld and Sok Thim spread the CHC model by traveling to Pakistan and Afghanistan with the American Refugee Committee to establish AIDS and TB treatment programs in refugee camps there.

Sok Thim and Goldfeld publish Curing Tuberculosis: A Manual for Developing Communities.

Goldfeld and team discover a unique immune reaction in patients that helps the TB bacterium evade host defenses.  It is later found that this mechanism is a general mechanism by which the host immune system is regulated in many infectious diseases.

Goldfeld begins a long-term research project in the Peruvian highlands around Cusco. The study of Quechua people will help to understand the genetic causes for differences in the immune response to TB.

With additional private funding, the CHC expands its TB treatment program to Kompot, another poor and war-affected province in southern Cambodia, that had been a Khmer Rouge stronghold up until a few months before.

The CHC is officially founded in Svay Rieng, Cambodia, by Sok Thim, Goldfeld and Brian Heidel, Cambodian Country Director for the ARC, with a mission to deliver tuberculosis treatment to rural residents. In founding CHC they overcome international skepticism that community based care for TB could be successful in Cambodia or elsewhere.

With a private donations, a TB program is started in the spring of 1994 using some approaches from the successful ARC camp program, but modified to meet the needs of impoverished and isolated residents in one of Cambodia's poorest provinces. Working out of three district hospitals in collaboration with the National TB Program, CHC rapidly expands to include free medicine, food assistance (in partnership with the World Food Program), patient supporters and community health workers and a novel village bank/microloan program.

Beginning with a cadre of health workers trained by ARC in the border camps, CHC focused on the development of community health workers and joined forces early on with Ministry of Health doctors and the Cambodian National TB program providing training and support to them. This alliance ensures that the CHC's work will be sustainable and not just a boutique health delivery program.

In partnership with OxFAM America and later with Catholic Relief Services, CHC initiates the first microfinance program linked to a TB treatment program, based on the Grameen bank model. The CHC Village Bank program goes on to make approximately 20,000 loans, and uses its profits to train village health workers. TB patients whose families participate in the village bank program have close to 100% adherence with TB medicines and similar cure rates. The dozens of village health workers trained with interest from the loans turn out to be key players in spreading information about the new epidemic of AIDS that is gripping Cambodia.

CHC continues to refine its system of training community health workers, enlisting relatives as patient supporters and drafting treatment contracts, which eventually becomes the standard for outpatient TB treatment throughout Cambodia. The technique is also used as the base for other models of TB and AIDS care globally.

Sok Thim travels to Boston to finish the TB treatment manual with Goldfeld, and together they make plans to start a TB program in Cambodia.

Sok Thim takes over management of the ARC TB treatment program from Maat and eventually becomes the head of all camps for the United Nations Border Relief Organization, an international effort to aid Cambodians and others affected by years of warfare along the Thai-Cambodian border. 

Goldfeld, who has completed her training in internal medicine and infectious disease, makes her first visit inside war-ravaged Cambodia, which is still under an international trade and aid embargo. She works briefly as a medical advisor to the Mennonite Central Committee there, then assumes the position of medical coordinator for ARC at Site II where she meets Sok Thim. Goldfeld and Thim begin to compile the case histories of all the TB patients treated in the camps, and pool their expertise to write a manual to treating the disease among refugees in war zones and in developing countries.

Miles and Maat publish their landmark article on DOTS treatment in Nong Samet. Their results show nearly 100 percent adherence to medicine and many cures, despite the difficult conditions in the camps. 

Refugee Sok Thim arrives in Nong Samet with his family. He begins nursing training in the ARC school.

Vietnamese troops occupy war-torn Cambodia, a country that has been in the grips of the genocidal Khmer Rouge regime, which has already killed 1 million Cambodians. When the regime falls, another 1 million starving people flee west to refugee camps on the Thai border.

American Refugee Committee is founded in Minneapolis and Chicago to aid Indochina Refugees, and begins a program of health worker training in Cambodian camps.