Located in south-east Asia with a population of 6.5 million, Laos is a country with an underdeveloped infrastructure, particularly in rural areas. According to the United Nations, the country continues to struggle to combat poverty with 40% of the country’s rural population and 10% of the urban population living below the poverty line on less than US$1.90 per day.
With a GDP per capita of $2,542USD (2018), Laos’ economy is heavily dependent on capital-intensive natural resource exports but has also benefited from high-profile foreign direct investment in hydropower dams along the Mekong River, copper and gold mining, logging, and construction.
Laos faces many challenges in the health sector, including a shortage of adequately trained personnel, a weak infrastructure, and an overstretched health care workforce. In 2019, an estimated 12,000 Laotians were living with HIV, with an estimated 1,400 new HIV infections in that year. According to UNAIDS, challenges to controlling the HIV epidemic include: limited access to affordable condoms, insufficient HIV testing, and stigma surrounding men having sex with men (MSM) and PLHIV. Even though more than half of new HIV registered cases are from heterosexual transmission, prevention and testing programs targeting the general population are still scarce.
Targeted Programmatic Support Across Countries (CDC1950)
(2020 – Present)
In September 2019, the U.S. Centers for Disease Control and Prevention (CDC) awarded AIHA a five-year grant, providing a vehicle by which AIHA can assist the CDC at the global and country level, in support of the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. So far, this project has operated in 10 countries including the Philippines, Thailand, Kenya, Tanzania, Nigeria, Zambia, the Dominican Republic, Haiti and Guatemala, as well as Laos.
HIV testing service (HTS) is a key entry point for those who are HIV positive to link to ARV initiation and care and to prevent further transmission; it also serves as a touch point for at-risk populations who are HIV negative to receive prevention packages such as PrEP. Successful HTS to test and identify new people living with HIV (PLHIV), link them to care, and/or provide at-risk populations with prevention packages requires increasing testing sites and finding effective testing modalities to reach them.
Targeted mobile outreach testing and community-based testing for KPs are recognized as effective methods to improve access to testing among KPs, but current evidence suggests relatively low HIV positive yields at a relative high cost.
Partner and couple testing are encouraged among pregnant women. Data show that the testing rate is high, especially among steady partners. With great improvement for HTS globally, finding especially hard to reach people or KPs remains a challenge. WHO strongly recommends voluntary assisted HIV partner notification and testing services (APS) to be offered as part of a comprehensive package of testing and care to enhance testing efficiency and increase the treatment coverage. Improving APS has become the initial focus of AIHA’s activities in Laos.
In February 2020, the AIHA and CDC team made an initial visit to the Setthathirat Hospital ART Facility, the Champasak Provincial Hospital ART facility, and a Drop-in Center in Champasak Province. The Center for HIV/AIDS and STIs at the Ministry of Public Health of Laos (CHAS) team then worked closely with the AIHA team to plan and organize a stakeholder meeting in Vientiane to bring together all the implementation and policy level stakeholders and to discuss the future of Index testing in Laos. The AIHA team presented recommendations and findings from the facility visit and facilitated a session to understand what the current needs and expectations of implementation organization were when thinking about harmonizing index testing at the national level.
The one-day stakeholder meeting was attended by 37 representatives from over 16 organizations. The main recommendation from this meeting was the need to develop a national guideline for index testing and a toolkit for all implementation organizations to be developed by CHAS and AIHA.
- A National Guideline on Index Testing and a toolkit were developed and translated in Lao, approved by the Ministry of Public Health, printed for distribution, and officially launched on September 21, 2020 in Vientiane. 300 copies of the guideline in Lao and 100 copies in English as well as a set of 8 posters or job aids were made available for distribution on a national level;
- Quality Improvement and Capacity Building Plans have been developed;
- AIHA procured approximately 30,000 rapid HIV Test kits and delivered them to CHAS;
- A team from Laos participated in the Regional Summit on Index Testing conducted on September 22-24, when these guidelines and a toolkit were revealed to other countries in the region;
- These guidelines were officially approved on October 12, 2020 by the Lao Ministry of Public Health, Vientiane capital, Lao PDR. These guidelines are also currently serving as a model for adaptation for other countries in the Asia region.