11 research outputs found
HIV Viral Load Testing in Laos
The number of people living with HIV/AIDS in the People’s Democratic Republic of Laos (also known as Laos PDR) is estimated at 13,600 and the number of people in need of antiretroviral therapy at 8,000. Today, around 3,200 HIV infected individuals receive treatment in seven centres throughout the country. Until recently, antiretroviral treated patients were followed-up only on the basis of clinical and immunological criteria. In 2009 the Centre d'Infectiologie Christophe MĂ©rieux in Laos PDR (CICML) signed a collaboration agreement with the national Centre of HIV/AIDS/STI (CHAS) for the implementation of HIV viral load testing (VLT) in the country, leading to the technological transfer of the ANRS generic assay (HIV Generic charge virale, Biocentric, Bandol, France). The introduction of HIV VLT has been accompanied through national HIV workshops every 6 months. From June 2009 to December 2011, HIV viral load has been measured in 1,782 antiretoviral-treated patients. Of these, 97% were on reverse-transcriptase inhibitor -based 1st line regimen. HIV viral load was undetectable (<250 copies/ml) for 1,491 out of 1,782 (84%) antiretroviral-treated patients. Four months after adherence strengthening, HIV viral load became undetectable for 179/247 patients (72.5%) while 68/247 patients (27.5%) remained viremic (median viral load: 4.1 Log10). This report demonstrates the feasibility of setting up an affordable HIV viral load generic test at a national level in Laos PDR. Interestingly, only 16% of antiretroviral-treated patients presented with detectable VL at their first viral load measurement. Importantly, almost two thirds of them have controlled their viral load after strengthening their adherence to treatment.La RĂ©publique dĂ©mocratique populaire du Laos compterait 13 600 personnes atteintes du VIH/SIDA dont 8000 auraient besoin d’un traitement antirĂ©troviral. Aujourd’hui, environ 3200 individus infectĂ©s par le VIH reçoivent un traitement dans sept centres rĂ©partis dans tout le pays. Jusqu’à rĂ©cemment, le suivi des patients traitĂ©s par antirĂ©troviraux se faisait uniquement sur la base de critères cliniques et immunologiques. En 2009, le Centre d'Infectiologie Christophe MĂ©rieux du Laos (CICML) a signĂ© un accord de collaboration avec le Programme national SIDA du Laos (CHAS) pour la mise en Ĺ“uvre de tests de dĂ©tection de la charge virale de VIH (VLT) dans le pays, qui permettra le transfert technologique de la technique gĂ©nĂ©rique ANRS (HIV Generic charge virale, Biocentric, Bandol, France). L’introduction du VLT appliquĂ© au VIH s’est faite au travers d’ateliers nationaux sur le VIH tous les 6 mois. De juin 2009 Ă dĂ©cembre 2011, la charge virale de VIH a Ă©tĂ© mesurĂ©e chez 1782 patients traitĂ©s par antirĂ©troviraux. Parmi eux, 97 % prenaient un traitement de première intention Ă base d’inhibiteur de la transcriptase inverse. La charge virale de VIH Ă©tait indĂ©tectable (<250 copies/ml) chez 1491 des 1782 (84 %) patients traitĂ©s par antirĂ©troviraux. Quatre mois après renforcement de l’administration du traitement, la charge virale de VIH est devenue indĂ©tectable chez 179/247 patients (72,5 %) tandis que 68/247 patients (27,5 %) sont demeurĂ©s virĂ©miques (charge virale mĂ©diane : 4,1 Log10). Cet article montre la faisabilitĂ© de la mise en place d’un test de dĂ©tection gĂ©nĂ©rique de la charge virale de VIH abordable au niveau national au Laos. Il est intĂ©ressant de noter que seuls 16 % des patients traitĂ©s par antirĂ©troviraux ont prĂ©sentĂ© une charge virale dĂ©tectable lors de la première mesure. En outre, près des deux-tiers d’entre eux ont pu maĂ®triser leur charge virale par une meilleure administration du traitement.El nĂşmero de personas que padecen VIH/SIDA en la RepĂşblica Democrática Popular de Laos (tambiĂ©n conocida como RDP Lao) se estima en 13.600, y el nĂşmero de personas que necesitan un tratamiento antirretroviral es de 8.000. En la actualidad, cerca de 3.200 personas infectadas por el VIH reciben tratamiento en siete centros repartidos por todo el paĂs. Hasta hace poco, el seguimiento de los pacientes tratados con fármacos antirretrovirales dependĂa exclusivamente de criterios clĂnicos e inmunolĂłgicos. En el 2009, el Centro de InfectologĂa Christophe MĂ©rieux de PDR Lao (CICML) suscribiĂł un acuerdo de colaboraciĂłn con el Centro Nacional de VIH/SIDA/ITS (CHAS) para la implantaciĂłn del estudio de la carga viral del VIH (VLT, por sus siglas en inglĂ©s) en el paĂs, lo que comportarĂa la transferencia de la tecnologĂa del ensayo genĂ©rico ANRS (carga viral genĂ©rica del VIH, Biocentric, Bandol, Francia). La introducciĂłn del estudio de la carga viral del VIH se ha visto respaldada por la realizaciĂłn de varios talleres nacionales sobre el VIH cada 6 meses. Desde junio de 2009 a diciembre de 2011 se ha medido la carga vĂrica del VIH de 1.782 pacientes tratados con antirretrovirales. El 97 % de ellos seguĂa un rĂ©gimen antirretroviral de primera lĂnea basado en inhibidores de la transcriptasa inversa. No se detectĂł carga viral del VIH (<250 copias/ml) en 1.491 de 1.782 (84 %) de los pacientes tratados con antirretrovirales. Cuatro meses despuĂ©s del fortalecimiento de la adherencia, no se detectĂł carga viral del VIH en 179 de 247 pacientes (72,5 %) mientras que 68 de 247 pacientes (27,5 %) seguĂan siendo virĂ©micos (carga viral media: 4,1 Log10). Este informe demuestra la viabilidad de elaborar un estudio genĂ©rico de la carga viral del VIH econĂłmico a nivel nacional en la RDP Lao). Cabe destacar que solamente el 16 % de los pacientes tratados con antirretrovirales presentaron una carga viral detectable en su primera mediciĂłn de la carga viral. Es significativo que casi dos terceras partes de ellos hayan conseguido controlar su carga viral despuĂ©s de fortalecer su adherencia al tratamiento
Women experience a better long-term immune recovery and a better survival on HAART in Lao People's Democratic Republic.
<p>Abstract</p> <p>Background</p> <p>In April 2003, Médecins Sans Frontières launched an HIV/AIDS programme to provide free HAART to HIV-infected patients in Laos. Although HIV prevalence is estimated as low in this country, it has been increasing in the last years. This work reports the first results of an observational cohort study and it aims to identify the principal determinants of the CD4 cells evolution and to assess mortality among patients on HAART.</p> <p>Methods</p> <p>We performed a retrospective database analysis on patients initiated on HAART between 2003 and 2009 (CD4<200cells/μL or WHO stage 4). We excluded from the analysis patients who were less than 16 years old and pregnant women. To explore the determinants of the CD4 reconstitution, a linear mixed model was adjusted. To identify typical trajectories of the CD4 cells, a latent trajectory analysis was carried out. Finally, a Cox proportional-hazards model was used to reveal predictors of mortality on HAART including appointment delay greater than 1 day.</p> <p>Results</p> <p>A total of 1365 patients entered the programme and 913 (66.9%) received an HAART with a median CD4 of 49 cells/μL [IQR 15–148]. High baseline CD4 cell count and female gender were associated with a higher CD4 level over time. In addition, this gender difference increased over time. Two typical latent CD4 trajectories were revealed showing that 31% of women against 22% of men followed a high CD4 trajectory. In the long-term, women were more likely to attend appointments without delay. Mortality reached 6.2% (95% CI 4.8-8.0%) at 4 months and 9.1% (95% CI 7.3-11.3%) at 1 year. Female gender (HR=0.17, 95% CI 0.07-0.44) and high CD4 trajectory (HR=0.19, 95% CI 0.08-0.47) were independently associated with a lower death rate.</p> <p>Conclusions</p> <p>Patients who initiated HAART were severely immunocompromised yielding to a high early mortality. In the long-term on HAART, women achieved a better CD4 cells reconstitution than men and were less likely to die. This study highlights important differences between men and women regarding response to HAART and medical care, and questions men’s compliance to treatment.</p
Care seeking behaviour and barriers to accessing services for sexually transmitted infections among female sex workers in Laos: a cross-sectional study
<p>Abstract</p> <p>Background</p> <p>Prompt, correct diagnosis and treatment with health information are essential components of reproductive tract infection (RTI) and sexually transmitted infection (STI) services. This study aims to describe care seeking behaviour and barriers to accessing RTI/STI services among female sex workers (FSWs) in Laos.</p> <p>Methods</p> <p>A cross-sectional survey using closed and open-ended questions was performed in six districts along Road 9, traversing Savannakhet province from Thailand to Vietnam. In total, 407 FSWs were interviewed. The data were analyzed and presented descriptively. Multiple logistic regression analysis was applied to assess associations between respondents' background characteristics and care seeking behaviour.</p> <p>Results</p> <p>About half of the respondents (49%) were less than or equal to 19 years of age, and 50% had started or completed secondary school. Fifty-eight percent had been engaged in sex work for less than 1 year. Eighty-six percent of the respondents reported RTI/STI signs or symptoms currently or in the last 3 months but only two-thirds of those with symptoms sought treatment. Source of treatment for the last RTI/STI episode was the drop-in centre (53%) followed by a public hospital (23%), private clinic (12%), private pharmacy (9%), and herbalist (2%). The main barriers to service use were long waiting time, inconvenient location of the clinic, not knowing where to get the services needed, and negative attitudes among healthcare providers. Care seeking behaviour was associated with longer duration of sex work (OR = 2.6, 95%CI 1.52-5.36). Forty-four percent received health information from peer educators, 34% from fellow friends, 26% from a pimp, and 26% had received information from a healthcare provider during the visit.</p> <p>Conclusion</p> <p>There were several barriers to accessing RTI/STI services and they were related to both structural and individual factors. Innovative STI service strategies to inform FSWs about the importance of early diagnosis and treatment should be established. Continuous training for STI service providers focusing on counseling skills and awareness of the sexual health care needs for FSWs is recommended in order to minimize the barriers experienced by FSWs in this particular setting.</p
Impact of economic and institutional reforms on the health sector in Laos Implications for health system management
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Building capacity and community resilience to HIV: a project designed, implemented, and evaluated by young Lao people
A partnership was formed between a mass youth organization, a national HIV coordinating committee, and an international agency, to implement an HIV capacity building project in the youth sector of Lao PDR. Involving the local community in situation analysis, planning and skills-building was a key focus of the project. District project working teams were trained in situation analysis, strategic planning, proposal development, and the implementation of HIV prevention activities. Young village volunteers were trained in participatory research, analysis, and behaviour change communication to promote HIV prevention. After 6 years, the partnership used qualitative methods to evaluate the local outcomes of the project. We found that district project working teams and young volunteers had improved skills in the areas in which they had been trained. Communities and local government workers had developed greater understanding of the HIV situation in their districts, and expressed a strong sense of ownership over their activity plans. Young people more readily acknowledged personal risk of HIV infection and were more comfortable talking about sexually transmitted infections. Although there were challenges to sustaining project activities in some areas, we found that our approach helped to engage youth and build their resilience to HIV in this country of low prevalence
HIV Viral Load Testing in Laos
The number of people living with HIV/AIDS in the People’s Democratic Republic of Laos (also known as Laos PDR) is estimated at 13,600 and the number of people in need of antiretroviral therapy at 8,000. Today, around 3,200 HIV infected individuals receive treatment in seven centres throughout the country. Until recently, antiretroviral treated patients were followed-up only on the basis of clinical and immunological criteria. In 2009 the Centre d'Infectiologie Christophe Mérieux in Laos PDR (CICML) signed a collaboration agreement with the national Centre of HIV/AIDS/STI (CHAS) for the implementation of HIV viral load testing (VLT) in the country, leading to the technological transfer of the ANRS generic assay (HIV Generic charge virale, Biocentric, Bandol, France). The introduction of HIV VLT has been accompanied through national HIV workshops every 6 months. From June 2009 to December 2011, HIV viral load has been measured in 1,782 antiretoviral-treated patients. Of these, 97% were on reverse-transcriptase inhibitor -based 1st line regimen. HIV viral load was undetectable (<250 copies/ml) for 1,491 out of 1,782 (84%) antiretroviral-treated patients. Four months after adherence strengthening, HIV viral load became undetectable for 179/247 patients (72.5%) while 68/247 patients (27.5%) remained viremic (median viral load: 4.1 Log10). This report demonstrates the feasibility of setting up an affordable HIV viral load generic test at a national level in Laos PDR. Interestingly, only 16% of antiretroviral-treated patients presented with detectable VL at their first viral load measurement. Importantly, almost two thirds of them have controlled their viral load after strengthening their adherence to treatment