AIHA is pleased to have played a key role in supporting the People’s Democratic Republic (PDR) of Lao to develop and establish National Guidelines on Index Testing for HIV/AIDS. These guidelines, that were officially approved on October 12, 2020 by the Lao Ministry of Public Health, Vientiane capital, Lao PDR are also currently serving as a model for countries in the Asia region. 

This comprehensive and detailed 69-page Index Testing Guidelines document encompasses: (1) Defining Index Testing; (2) Implementing Safe and Ethical Index Testing; (3) Implementation Requirements; and (4) Quality Improvement to Monitoring and Reporting elements of Index Testing. This milestone document provides a comprehensive, evidence-based, approach to HIV-testing and HIV prevention with a focus on vulnerable and marginalized populations. These Key Populations (KPs) are driving the HIV pandemic both in Laos and in the Asia region more generally. Lessons can also be learned from this and applied to testing in other areas, including in the response to COVID. 

Index Case Testing is a key component in stemming the transmission of HIV/AIDS, particularly among KPs. Without adequate index testing, it will not be possible to achieve the UNAIDS and U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) 95-95-95 goals.  In Asia, it is estimated that 78% of the new HIV infections occur among KPs. 

AIHA helped develop these guidelines as part of the U.S. Centers for Disease Control and Prevention (CDC)-funded AIHA managed Targeted Programmatic Support Across Countries Project under the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria and PEPFAR.

The National Guidelines on Index Testing integrates the World Health Organization’s principles of 5 C’s, LIVES approach, and UNAIDS and PEPFAR 2030 goals of 95-95-95 (95% of people living with HIV know their HIV status, 95% of people who know their status are on treatment, and 95% of people on treatment have suppressed viral loads).

The Center for HIV/AIDS/STI (CHAS), part of the Lao Ministry of Public Health, expressed an urgent need to develop Index Testing Guidelines and related training based on feedback from health care providers and officials at government facilities and non-governmental organizations who provide HIV/AIDS services. AIHA and other experts concluded that despite many Laos hospitals having HIV testing, access to testing for KP remains a particular challenge in HIV delivery, care, and services in Laos.

The National Guidelines for Index Testing for the Lao PDR was developed in an inclusive and consultative process under the direction of CHAS and the MOH and with technical assistance from the CDC and AIHA. The National Guidelines have been formally endorsed by the Lao Ministry of Health through the organization of a Technical Working Group that guided the preparation and development of this document.

Reflecting on this incredible one-year achievement, Dr. Inna Jurkevich, AIHA Program Director, commented “AIHA is proud not only that we were able to assist in developing a very practical and comprehensive guideline document for Laos, but also, that it is already serving as a guide for other countries. And we were able to achieve this in less than six months, and under COVID conditions.” Deeptha Umpathy, a Global Development Expert who AIHA engaged in this activity added, “There was an urgent need for a concise national guideline that is based on the latest evidence-based information. Now PRL has it and will share with additional countries for adaptation.” 

The new guideline document was introduced nationally at an event on September 21 in Vientiane to Lao officials and to global stakeholders. Printed copies in both English and Laotian were distributed to the ART sites. Along with the guidelines, AIHA printed sets of eight posters to be use as information dissemination job aids at the ART clinical sites.

The new guideline was shared at the Asia Regional Learning Summit on September 22-24 and was highly recognized; at least four countries indicated interest in its adaptation. At the national level, there were 49 participants from 15 global stakeholder groups who received the CHAS MOH launch of the guidelines during the Asia Regional Learning Summit. 

Reflecting on the summit, Ketmala Banchongphanith, MD, MPH, Management of HIV/AIDS/STI Unit, CHAS, Ministry of Public Health, Vientiane capital, Lao PDR said, “Congratulations for convoking a successful learning submit. We learned a lot from all those attending the summit…we are so proud that representatives from other countries are interested in adapting Lao Index Testing guidelines and posters”.

Country experts and community-based organizations, including KP-led and KP-friendly, were included in the Technical Working Group and throughout the duration of these activities. Going forward, the largest challenge for CHAS will be to ensure the effective roll out of the guidelines and monitoring once in use. Additionally, it will be important that the new indicators are incorporated into the National Data Systems, and that the necessary data practices and infrastructure are put in place.

Our gratitude and special thanks go to the following Technical Group Members for their continued engagement, support and valuable advice: Dr. Khanthanouvieng Sayabounthavong, Dr. Ketmala Banchongphanith, Dr. Buathong, Dr. Lattanavanh Sadettanh, Dr. Manichanh Souphanthong, Dr. Phengphet and Dr. Khanthi from CHAS at the Ministry of Public Health of the Lao PDR , and experts from the  World Health Organization (WHO), Civil Society Organizations (CSO): Lao Positive Health Alliance (LaoPHA), APL+, Family Health International (FHI360) and donors: PEPFAR through the CDC.