Laos is a developing country. It borders Vietnam, China, Burma, Cambodia, and Thailand, where high HIV rates have been observed. To prevent expansion of the epidemic, the National Committee for the Control of AIDS has given priority, in the 20112015 national strategy, to keeping HIV prevalence in the general population and most-at-risk populations below 1% and 5% respectively, and to improve quality of life of people living with HIV (PLHA).

WHO takes the lead on helping Laos implement the national strategy. GAP/ARO, alongside Laos Ministry of Public Health (MoH), will work closely with WHO through the global CDC-WHO cooperative agreement to strengthen the existing health system for the effective and sustainable country-owned responses. The proposed technical areas for the 2013 Cooperative Agreement include HIV counseling and testing, HIV prevention among men having sex with men, care and treatment for PLHA, prevention of mother to child HIV transmission, laboratory strengthening, leadership and governance capacity building and strategic information.

GAP/ARO strategy includes provision of technical assistance to develop standard intervention guidelines, increase number of human resources by training and supervision for quality services, set up laboratory quality assurance, strengthen management information system, and strengthen leadership capacity, focusing on capability to use strategic information on result-based strategy and prioritization. Technical knowledge and best practices from the successful Thailand programs will be tailored to the Lao context. The interagency collaboration alongside with Laos MoH consists of the Center of HIV/AIDS/STI, Center of Laboratory and Epidemiology, USAID and its partners (FHI and PSI), and UN agencies (WHO, UNAIDS, UNICEF).

Program Objectives:

USG (CDC) works primarily through National Center of Laboratory and Epidemiology (NCLE) to strengthen laboratory capacity and to improve the quality of HIV related diagnostic services especially to support HIV testing and treatment services at 5 anti-retroviral treatment sites.

Key issues and challenges:

Although National Center of Laboratory and Epidemiology (NCLE), Lao MoH is developing a national laboratory quality program to improve the quality of laboratory services and biosafety program, however, the national strategic laboratory plan is not available. In addition, laboratory practices across various programs are not well standardized. This lack of coordination between program, service facilities and national level has created challenges in strengthening and improving the quality of laboratory services.

2011-2013 accomplishments and current state of the activities:

a. National laboratory testing guidelines was developed.

b. Trained 20 laboratory technicians on laboratory testing and quality programs for HIV related testing

c. Provided technical assistance in preparation of national laboratory quality systems and provide training workshops and in-services training program to increase knowledge and skills of laboratory technicians from NCLE and five ART sites on quality programs for HIV diagnostic, opportunistic infection (OI) direct examination, and CD4 testing.

2014 Action Plan:

In FY 2014, GAP/ARO will promote the establishment and implementation of laboratory assurance programs to monitor and ensure reliable laboratory testing. USG (CDC) will continue supporting implementation EQA programs for HIV and CD4 testing through Ministry of Public Health and Siriraj hospital, Thailand, and assist NCLE to establish and evaluate national HIV serology Internal Quality Control (IQC) and EQA programs to support the National Strategic Plan 2011-2015 in scaling up coverage and quality of HIV services. GAP/ARO will work with NCLE and laboratory teams from 5 ART sites to develop and standardize HIV and CD4 testing SOPs and laboratory quality assurance guideline to support quality HIV/AIDS care and treatment services. GAP/ARO will work with CHAS on laboratory inventory and recording systems at HIV testing sites, and with NCLE for HIV, CD4 test kits and supplies forecasting to improve laboratory supply chain and logistics using information from multiple sources. GAP/ARO will work with NCLE to develop training curriculum for trainers on HIV testing and quality systems, and also explore possibilities for HIV viral load program expansion.

Program objectives:

To obtain reliable and key strategic information that can be used to define the current HIV epidemics and responses, as well as be translated for program improvement and policy message

Key issues and challenges:

a. Limited technical capacity and number of human resources in surveillance, monitoring and evaluation and health management information system, both at provincial and national levels

b. Critically need the harmonized monitoring system to improve metrics for monitoring of HIV, TB, PMTCT-MCH services

c. Critically need a comprehensive system to monitor HIV prevention intervention and the integrated to care and treatment services among KAPs

2011-2013 accomplishments and current state of the activities:

a. Surveillance:

Provided TA on implementation of personal digital assisted self-interviewing for integrated behavioral and biomarker surveillance (IBBS) among MSM and FSW IBBS.

Surveillance data management and interpretation capacity building

b. Monitoring and Evaluation:

The harmonized matrix of HIV program monitoring for HIV counseling and testing, HIV care and treatment and TB/HIV management has been designed, developed and being piloted.

c. Human resources:

Increased number of human resources on triangulation and utilization of strategic information to describe HIV epidemic and program priority setting. Thirteen MoH resource persons (4 program managers) were trained on projection/estimation modeling to describe trend of HIV epidemic. Forty-nine provincial resource persons were trained on HIV program management for program managers-Introduction.

2014 action Plan:

a. Develop SOP for the implementation of surveillance and M&E framework and action-plan

b. Improve metrics for monitoring through developing M&E SOP, design and implement health information system and software tools

HIVCAM- HIV care and treatment program monitoring with the metrics for monitoring of HCT, HIV, TB and PMTCT services across all ART facility settings

Integrated HIV prevention and referral to care services Pilot in the selected provinces (See #2)

c. Increase number of human resources on utilization and interpretation of strategic information for evidence-based strategic planning for program improvement and policy advocacy, focusing for the pilot provinces

Program Objectives:

To facilitate the increased coverage of quality HIV counseling and testing and results notification among populations at risk to HIV infection through building capacity of national program managers on using evidence-based national strategy for program scaling up and building capacity of health care providers on quality services.

Key issues and challenges:

The 2011-2015 national strategic and action plan of LPDR goals include the quality assured HCT services at 94 priority districts and 80% of most-at-risk (MARP) population having received an HIV test and knows results in the last 12 months. The major challenges include limited available resources on test kit supplies for program scaling up and number of human resources for quality services, especially among most at risk population and patients with tuberculosis.

2011-2013 accomplishments and current state of the activities:

a. Development of guideline and SOP for HIV counseling and testing at service deliveries (health center, drop-in center, and hospital)

b. The HIV testing algorithm which is used in SOP following the LPDR national guidelines by working with the CLE (Center of Laboratory and Epidemiology)

c. Human resource capacity building:

Training curriculum on Basic counseling and HIV counseling and testing was developed. 24 TOT and 20 health care provides of LPDR staffs were trained.

Training curriculum on HIV counseling and testing for MARP was developed.

2014 Action Plan:

a. Develop and revise the national strategy and action plan for scaling up of HCT program in Laos

Review key priorities population and/or geographic location and the available funding and resources

Brainstorming discussion among policy makers and key stakeholders

Design strategic map for scaling up HCT, according to the priorities, considering prioritized population at risk (could be TB, STI, MSM, FSW, depending on the designed priorities by time) and/or province(s) with high risk evidence

b. Piloting and scaling up the revised strategy and action plan

Design the appropriate model to ensure the accessibility of population at risk and the quality of HCT services

Develop tools needed for program implementation and scaling up

Building human resources, national and local levels

c. Strengthen HCT monitoring system using the harmonized with the matrix of HIV program monitoring for HIV counseling and testing, HIV care and treatment and TB/HIV management.

Program Objectives:

Strengthen the implementation of MSM prevention activities in aligning with GFATM activities and the current national strategy by piloting the comprehensive integrated prevention and continuum of care services for MSM in 2 provinces and increasing number of human resources on implementation of behavioral change communication package for MSM

Key issues and challenges:

GFATM-support minimum package of services that include peer-led behavior change communication, free condoms and lubricants, free STI services and referral to VCT services has been providing to MSM. The major challenges included the increasing access of MSM to public health services; increasing quality and effectiveness of prevention and care interventions with ensuring the technical and organizational capacities for service providers while human resources are limited; decentralization with increasing multisectoral responses at provincial level; and using of strategic information for evidence-based strategic planning by service providers, program managers and policy makers.

2011-2013 accomplishments and current state of the activities:

a. GAP ARO provided TA to develop a standard peer outreach protocol and the standard operation al procedure on the integrated behavioral change with HIV/STI management for MSM. They are being piloted in 2 provinces.

b. Increasing number of trained local resource persons on the above pilot implementation (25 governmental staff and 70 peer educators for program implementation and 6 physicians for STI management)

2014 Action Plan:

a. Review the current responses, program barriers and available resources to define areas for program improvement.

b. Strengthen the integration of prevention, STI management and continuum of care and treatment services for MSM to ensure Earlier initiation of ART and improved retention

c. Using lessons learned from the MSM pilot to develop strategic plan for the prioritized integrated intervention packaging and scale up the comprehensive interventions packages in selected pilot provinces with expansion for the prioritized population (i.e., female sex workers and migrant workers).

Program Objectives:

To increase local human resource capacity on quality of PMTCT services at 8 ART sites through provision of technical assistance on the integration of PMTCT services with routine maternal and child health services at health care services, and increasing number of trained health care providers on quality service management.

Key issues and challenges:

It was estimated from projection and estimation that about 100 HIV infected infants born to HIV positive pregnant women each year. The limited maternal and child health services with low access of antenatal services and low uptake of HIV counseling and testing is the major challenge of PMTCT. In addition, limited number of health care providers with knowledge and skills to provide quality PMTCT services for pregnant women access to health facilities remains challenging.

2011-2013 accomplishments and current state of the activities:

a. The national Lao PDR HIV treatment and care guidelines 2011 which included HIV counseling for pregnant women and PMTCT interventions was developed. The PMTCT training curriculum and the training packages for trainers and health care providers are prepared.

b. PMTCT training for Lao trainers has been being conducted. It is expected that the 15-20 local trainers will subsequently provide training to 60-80 health care providers in 3 geographic regions.

2014 Action Plan:

a. Review and revise the national strategy on PMTCT using exiting evidence based, including the ongoing implementing responses, health care infrastructure, available resources, barriers and country program prioritization to set up the national program goals and targets, as well as strategic direction of program implementation and scaling up framework.

b. Build capacity for local resource persons on quality PMTCT services

Review and revise PMTCT guideline and SOP to ensure the integration of PMTCT services into MCH system with consideration of the national strategic direction of the PMTCT implementation

Conduct PMTCT trainings for health care providers to ensure the quality services on the integration of PMTCT services with the existing maternal and child health services

c. Strengthen PMTCT M&E system by integrating with the matrix of HIV program monitoring for HIV counseling and testing, HIV care and treatment and TB/HIV management.

Program Objectives:

To increase local human resource capacity on quality of adult treatment at 8 ART sites through provision of technical assistance on development of training curriculum and training of the trainers and provide TA to facilitate the integration of the services with routine health care services at hospital facilities.

Key issues and challenges:

In the 2011-2015 national strategic and action plan, one among four main action plans is to increase coverage and quality of HIV treatment, care and support services for people infected with and affected by HIV, as well as positive health services. The major challenges include limited number of human resources for program scaling up and quality service deliveries.

2011-1013 accomplishments and current state of the activities:

a. Development of guideline and SOP

ART treatment and Opportunistic Infections (OI) management guidelines for adult and adolescent was developed. The guidelines were published in FY 2012. Local resource persons of Lao PDR MoH and key resource persons at hospital facilities has participated in development process.

b. Human resource capacity building

Training curriculum on The HIV care, treatment and support was developed.

2014 Action Plan:

a. Human resource capacity building

Conduct HIV care training (e.g. OIs) to provincial health care providers

Conduct HIV treatment and care training and refreshing training for staff of ARV sites

On site supervision to ARV sites

Support LPDR staff to participate International meeting/conference and sharing lesson learned

b. Initiate quality improvement program of HIV treatment and care

Facilitate the using evidence-based information from the existing HIV program monitoring (HIVCAM-PLUS) for the improvement of coverage, linkages and retention to quality HIV counseling and testing, HIV care and treatment and TB/HIV management.

Introduce HIVQUAL special survey for measurement of standard of care for PLHA

Program Objectives:

To increase local human resource capacity on quality of pediatric treatment at 8 ART sites through provision of technical assistance on development of training curriculum and training of the trainers and provide TA to facilitate the integration of the services with routine health care services at hospital facilities.

Key issues and challenges:

In the 2011-2015 national strategic and action plan, one among four main action plans is to increase coverage and quality of HIV treatment, care and support services for people infected with and affected by HIV, as well as positive health services. The major challenges include limited number of human resources for program scaling up and quality service deliveries.

2011-1013 accomplishments and current state of the activities:

(It is integrated with the activities for adults and adolescent HIV care and treatment. Please see details in HTXS)

a. Development of guideline and SOP

ART treatment and Opportunistic Infections (OI) management guidelines for pediatric was developed.

b. Human resource capacity building

2014 Action Plan:

(It is integrated with the activities for adults and adolescent HIV care and treatment. Please see details in HTXS)

a. Human resource capacity building

Conduct HIV care training (e.g. OIs) to provincial health care providers

Conduct HIV treatment and care training and refreshing training for staff of ARV sites

On site supervision to ARV sites

Support LPDR staff to participate International meeting/conference and sharing lesson learned

b. Initiate quality improvement program of HIV treatment and care

Facilitate the using evidence-based information from the existing HIV program monitoring (HIVCAM-PLUS) for the improvement of coverage, linkages and retention to quality HIV counseling and testing, HIV care and treatment and TB/HIV management.

Introduce HIVQUAL special survey for measurement of standard of care for PLHA