The Malaria Testing and Treatment Landscape in the Southern Lao People\u27s Democratic Republic (PDR).

BACKGROUND: In the context of national and regional goals to eliminate malaria by 2030, the Center for Malaria Parasitology and Entomology in the Lao PDR is implementing strategies to ensure all malaria cases are detected and appropriately treated with first-line artemisinin combination therapy, artemether-lumefantrine (AL). Timely and relevant evidence to inform policies and strategies is needed to ensure the most effective and efficient use of resources, and to accelerate progress towards elimination goals. A 2015 outlet survey conducted in five provinces of the southern Lao PDR was the first of its kind to study the total market for malaria treatments and diagnostics. The sub-national outlet survey was designed to describe the market and to assess public and private sector readiness and performance for malaria case management. Additionally, key indicators were estimated among private outlets within districts with and without a Public Private Mix (PPM) programme. RESULTS: Over half of anti-malarial stockists were public sector (65.1%). In the private sector, pharmacies most commonly stocked anti-malarials, although anti-malarials were also found in private health facilities, drug stores, general retailers, and itinerant drug vendors. Nearly all anti-malarial stocking public health facilities had AL (99.5%) and 90.8% had confirmatory testing. Fewer than half of anti-malarial stocking private outlets stocked AL (40.8%) and malaria testing (43.5%). Chloroquine has not been a first-line treatment for Plasmodium falciparum malaria since 2005 and Plasmodium vivax since 2011 yet private sector availability was 77.6% and chloroquine accounted for 62.2% of the total anti-malarial market share. AL and confirmatory testing availability were higher in private outlets in PPM (68.1, 72.6%) versus non-PPM districts (2.5, 12.1%). Chloroquine was available in 63.6% of PPM and 96.7% of non-PPM-district outlets, and was the most commonly distributed anti-malarial among private outlets in both PPM (61.7%) and non-PPM districts (99.1%). CONCLUSIONS: Public sector outlets in the southern Lao PDR are typically equipped to test and appropriately treat malaria. There is need to address widespread private sector availability and distribution of chloroquine. The PPM programme has improved private provider readiness to manage malaria according to national guidelines. However, supporting interventions to address provider and consumer behaviours are needed to further drive uptake

Private sector opportunities and threats to achieving malaria elimination in the Greater Mekong Subregion: results from malaria outlet surveys in Cambodia, the Lao PDR, Myanmar, and Thailand.

BACKGROUND: The aim of this paper is to review multi-country evidence of private sector adherence to national regulations, guidelines, and quality-assurance standards for malaria case management and to document current coverage of private sector engagement and support through ACTwatch outlet surveys implemented in 2015 and 2016. RESULTS: Over 76,168 outlets were screened, and approximately 6500 interviews were conducted (Cambodia, N = 1303; the Lao People\u27s Democratic Republic (PDR), N = 724; Myanmar, N = 4395; and Thailand, N = 74). There was diversity in the types of private sector outlets providing malaria treatment across countries, and the extent to which they were authorized to test and treat for malaria differed. Among outlets stocking at least one anti-malarial, public sector availability of the first-line treatment for uncomplicated Plasmodium falciparum or Plasmodium vivax malaria was \u3e75%. In the anti-malarial stocking private sector, first-line treatment availability was variable (Cambodia, 70.9%; the Lao PDR, 40.8%; Myanmar P. falciparum = 42.7%, P. vivax = 19.6%; Thailand P. falciparum = 19.6%, P. vivax = 73.3%), as was availability of second-line treatment (the Lao PDR, 74.9%; Thailand, 39.1%; Myanmar, 19.8%; and Cambodia, 0.7%). Treatment not in the National Treatment Guidelines (NTGs) was most common in Myanmar (35.8%) and Cambodia (34.0%), and was typically stocked by the informal sector. The majority of anti-malarials distributed in Cambodia and Myanmar were first-line P. falciparum or P. vivax treatments (90.3% and 77.1%, respectively), however, 8.8% of the market share in Cambodia was treatment not in the NTGs (namely chloroquine) and 17.6% in Myanmar (namely oral artemisinin monotherapy). In the Lao PDR, approximately 9 in 10 anti-malarials distributed in the private sector were second-line treatments-typically locally manufactured chloroquine. In Cambodia, 90% of anti-malarials were distributed through outlets that had confirmatory testing available. Over half of all anti-malarial distribution was by outlets that did not have confirmatory testing available in the Lao PDR (54%) and Myanmar (59%). Availability of quality-assured rapid diagnostic tests (RDT) amongst the RDT-stocking public sector ranged from 99.3% in the Lao PDR to 80.1% in Cambodia. In Cambodia, the Lao PDR, and Myanmar, less than 50% of the private sector reportedly received engagement (access to subsidized commodities, supervision, training or caseload reporting), which was most common among private health facilities and pharmacies. CONCLUSIONS: Findings from this multi-country study suggest that Cambodia, the Lao PDR, Myanmar, and Thailand are generally in alignment with national regulations, treatment guidelines, and quality-assurance standards. However, important gaps persist in the private sector which pose a threat to national malaria control and elimination goals. Several options are discussed to help align the private sector anti-malarial market with national elimination strategies

MOESM1 of The malaria testing and treatment landscape in the southern Lao People’s Democratic Republic (PDR)

Additional file 1. The Lao PDR ACTwatch Survey Questionnaire (English)

The malaria testing and treatment landscape in the southern Lao People’s Democratic Republic (PDR)

Abstract Background In the context of national and regional goals to eliminate malaria by 2030, the Center for Malaria Parasitology and Entomology in the Lao PDR is implementing strategies to ensure all malaria cases are detected and appropriately treated with first-line artemisinin combination therapy, artemether–lumefantrine (AL). Timely and relevant evidence to inform policies and strategies is needed to ensure the most effective and efficient use of resources, and to accelerate progress towards elimination goals. A 2015 outlet survey conducted in five provinces of the southern Lao PDR was the first of its kind to study the total market for malaria treatments and diagnostics. The sub-national outlet survey was designed to describe the market and to assess public and private sector readiness and performance for malaria case management. Additionally, key indicators were estimated among private outlets within districts with and without a Public Private Mix (PPM) programme. Results Over half of anti-malarial stockists were public sector (65.1%). In the private sector, pharmacies most commonly stocked anti-malarials, although anti-malarials were also found in private health facilities, drug stores, general retailers, and itinerant drug vendors. Nearly all anti-malarial stocking public health facilities had AL (99.5%) and 90.8% had confirmatory testing. Fewer than half of anti-malarial stocking private outlets stocked AL (40.8%) and malaria testing (43.5%). Chloroquine has not been a first-line treatment for Plasmodium falciparum malaria since 2005 and Plasmodium vivax since 2011 yet private sector availability was 77.6% and chloroquine accounted for 62.2% of the total anti-malarial market share. AL and confirmatory testing availability were higher in private outlets in PPM (68.1, 72.6%) versus non-PPM districts (2.5, 12.1%). Chloroquine was available in 63.6% of PPM and 96.7% of non-PPM-district outlets, and was the most commonly distributed anti-malarial among private outlets in both PPM (61.7%) and non-PPM districts (99.1%). Conclusions Public sector outlets in the southern Lao PDR are typically equipped to test and appropriately treat malaria. There is need to address widespread private sector availability and distribution of chloroquine. The PPM programme has improved private provider readiness to manage malaria according to national guidelines. However, supporting interventions to address provider and consumer behaviours are needed to further drive uptake

LAOS (2009): MALARIA PARASITE PREVALENCE AND TRAC SURVEY AMONG MALARIAL VILLAGES IN SOUTHEASTERN LAO PDR ROUND 2

After one year of program activity, PSI conducted a follow up survey to establish the extent to which interventions in the 28 sample villages have resulted in a reduction of malaria prevalence and an increase in the use of LLINs. To monitor disease prevalence and correlate disease prevalence reduction with program impact, all TRaC respondents were tested for the presence of malaria parasites. The follow-up malaria TRaC survey and the malaria parasite prevalence study among high-risk rural villagers provided: 1. an endline estimate of malaria parasite prevalence rate; 2. an endline estimate of the proportion of people in intervention villages that are using Long Lasting Insecticide Treated Nets (LLINs), as well as net ownership rates

LAOS (2008): MALARIA PARASITE PREVALENCE AND TRAC SURVEY AMONG MALARIAL VILLAGES IN SOUTHEASTERN LAO PDR ROUND 1

The malaria TRaC survey and the malaria parasite prevalence study among high-risk rural villagers provided: 1. a baseline estimate of malaria parasite prevalence rate; 2. a baseline estimate of the proportion of people in intervention villages that are using Long Lasting Insecticide Treated Nets (LLINs); 3. an understanding of the key determinants of net use, i.e., the opportunity, ability and motivation (OAM) of respondents to use nets; as well as the population characteristics that determine use. Study findings then guide the implementation and monitoring of PSI Laos' malaria reduction program PSI Laos conducted the baseline malaria TRaC/parasite prevalence survey in September-December 2008

Laos (2013): Survey measuring public health facility preparedness regarding the provision of IUD ad PAC services. Round I.

The goal of the survey was to assess the current status and readiness of the public facility regarding the provision of IUD and PAC services in public sector facilities in Laos. The survey produced information that will be used to make decisions regarding interventions to public facility activity, and specifically to the Women's Health Program. The survey was carried out in the public health facility in Vientiane Provinces and Champasack, where the public health facility program will be targeted in 2013. Individuals in charge of facilities were interviewed to obtain information regarding IUDs, equipment, and IUD provision services in the facility

LAO PDR (2009): MAP STUDY EVALUATING THE MARKET PENETRATION OF NUMBER 1 CONDOMS IN 7 PROVINCES AND 1-STOP STI TREATMENT KIT IN 3 PROVINCES. ROUND ONE

THe main objective of this study is to assess the market penetration, quality standards and access to PSI's branded Number 1 condoms (Number 1 Deluxe, Number 1 Deluxe Plus, Number 1 Rose, Number 1 Strawberry, and Number 1 Dot Com) in traditional and non-traditional outlets, in urban and semi urban villages of the selected 7 provinces (Luangnamtha, Xayabouly, Bokeo, Vientiane Capital, Khammoane, Savannakhet and Champassak

Laos (2010): First Round HIV/STI Surveillance and Third Round Behavioral Tracking Survey Among Male-to-Female Transgenders in Vientiane Capital, Savannakhet and Luang Prabang, Lao PDR

The research objectives are to identify and describe the segments of the target population in terms of: a. TG consistent condom and water based lubricant use for anal sex with their regular partners (i.e. boyfriend) b. TG cconsistent condom and water based lubricant use for anal sex with their commercial partners (i.e. TG pays partner

LAOS (2008): HIV/AIDS TRaC Study Evaluating Condom Use among Female Sex Workers in Champasak, Luang Prabang, Savannakhet, and Vientiane. First Round.

This endline survey was conducted in April 2008. The survey monitored changes in key indicators between baseline (2005) and endline (2008), segmented respondents into consistent versus inconsistent condom users to determine the main determinants of the target behaviors, and measured program impact by evaluating the relationship between exposure to the program and measured changes in behaviors and determinants of behaviors. A modified version of the 2005 questionnaire was used during this second round of data collection (see appendix). Data was analyzed in SPSS using multivariate techniques. The risk group was defined as Female Sex Workers, ages 18-28 years old, who sell sex for money