Community pilot in Cambodia: a study calls for rethinking antiretroviral treatment dispensing
In Cambodia, the NGO KHANA tested, between 2021 and 2023, a community-based model of antiretroviral dispensing with the support of L’Initiative — Expertise France. The quasi-experimental study conducted across 20 clinics shows that community dispensing maintains strong retention and high viral suppression while improving adherence, physical quality of life and reducing depressive symptoms. The results support integrating this model into the national HIV care system, provided it is accompanied by targeted stigma-reduction actions.
KHANA has long been a pioneer among civil-society organisations in developing community responses for the HIV response. In response to L’Initiative’s 2018 calls for proposals, the organisation submitted a proposal to pilot a community model for dispensing antiretroviral treatment to people living with HIV.
Cambodia reached the UNAIDS 90-90-90 targets in 2017; however, KHANA had observed that overcrowding at care sites, together with stigma and inequalities in mental health, seemed to threaten the sustainability of HIV care.
A community model for dispensing antiretroviral treatment
The quasi-experimental study evaluated a community-based antiretroviral dispensing model compared with multi-month dispensing among people living with HIV in 20 clinics (N = 4,089) between 2021 and 2023. Baseline and end-of-study surveys, together with clinical data, were used to assess treatment adherence, viral suppression, retention in care, experienced stigma, depressive symptoms and quality of life.
Both approaches achieved high levels of retention in care (>97%) and viral suppression (>99%). The community model showed a significant improvement in adherence, a reduction in depressive symptoms and better physical health–related quality of life. Modest reductions in experienced stigma were observed, but effects on internalized and anticipated stigma remained inconclusive. These results indicate that community antiretroviral dispensing effectively sustains adherence and improves health outcomes, and they support its integration into Cambodia’s HIV care system, alongside interventions specifically aimed at reducing stigma.
