Key Findings


Average self reported baseline CD4 was 179.6 cells/mm3

The overwhelming majority of respondents reported that their reasons given for going for a HIV test was due to illness or death of spouse or child (76.4%).

66.2% of respondents received a viral load test 

The average duration between HIV diagnosis and first CD4 test was 14.4 months (median: 3.6 months, range: 0-120 months)

10.5% of those taking ART had experienced some delay in treatment initiation.

12.3% respondents reported having been sick in the 6 months prior to the interview and 70.8% of them required hospitalisation. Average cost of treatment was 1,035,223 LAK (128.5 USD)

88.7% of participants reported being able to get condoms whenever they needed.

3.8% of participants reported having had their HIV status disclosed by a health care professional without their consent. 

Among 118 International Migrant Workers interviewed, 49.2% had no steady partner but 22.4% of those without a steady partner were sexually active and only 62.5% always used condoms.  

Among steady partners of International Migrant Workers, only 55% were known to be HIV positive. 83.9% always used condoms.

13.6% of respondents or their spouse were pregnant since their HIV diagnosis and 32.7% of these were unintended.

76.6% were advised not to have children.2.1% reported being coerced to terminate pregnancy due to HIV status of mother

16.7% of respondents were still on a stavudine

 

Study Outline


Since 2001, the Asia and the pacific region, has seen a 20% drop in the new HIV infections. In that same time the number of people living with HIV/AIDS who have access to ART has tripled. Despite this progress, access to ART, remains very low, with over 60% of PLHIV not having access to treatment. Overall, the East, South and South East, Asian region has some of the lowest levels of access in the world. For many years PLHIV groups were raising voice against a lack of rigorous research and information on the barriers and enablers to access to treatment, care and support. Historically studies in the region have been ad-hoc, and not representative of the needs and experiences of those affected by the disease.

Study Objectives 


 The overall objective is to monitor and document the issues related to PLHIV’s access to HIV treatment, care and support services in Asia and the Pacific region. The specific objectives of this study is to assess the HIV treatment-related issues such as access to pre-ART care, ART, ART adherence, treatment literacy, high risk behaviours, mental health status, health seeking behaviours, etc. and, to monitor changes in key issues in community access to treatment, care and support services.

Country Context 


The estimated prevalence of HIV in Lao PDR is 0.2% among adults aged 15-49. The main mode of transmission is unsafe sexual activity. In the National Strategic and Action Plan for HIV/AIDS/STI Control and Prevention (NSAP) for 2011-2015, the epidemic scenario is stated as a “potential for a concentrated epidemic”. Sex Workers, Men who have Sex with Men, People who Use Drugs/People who Inject Drugs (PUD/ PWID) and clients of Sex Workers have been identified as key populations at higher risk. By December 2011, there was a reported total of 4,942 people living with HIV (PLHIV) with the male: female ratio at 1:0.8. The actual PLHIV was around 3,650, after accounting for those who had died of AIDS related illnesses. For the same period, there was a reported total of 1,290 people who died of AIDS related causes and the number of PLHIV whose HIV infection developed to AIDS is still increasing. April 2013 data from CHAS Routine Report states that there have been 1,404 cases of death from AIDS related diseases and 5,559 are living with HIV and AIDS and this number will reach 16,000 in 2030 according to the prediction from Estimation and Projection workshop, 2012.

 

Methods  


Screen Shot 2014-07-18 at 3.51.55 PMSample size was determined using proportionate sampling method with error allowance of 0.005 and a target of 530 people living with HIV was set for Lao PDR. The sample size was then distributed based on geographical caseload reported by National AIDS Program. Risk-group and gender specific seeds (initial respondents) were recruited, using convenience sampling. Thereafter, a snow-ball sampling technique was used to enrol study participants with seeds recommending their peers to the study.

Respondents were recruited from 5 provinces of Lao PDR, Bokeo, Luang Prabang, Vientiene Capital, Savannakhet and Champasack. A structured questionnaire was used to collect data. There were 14 sections and an interview in an average took 69 minutes to complete. A total of 11 data collectors were used. Ethical clearance was obtained from Center for HIV/AIDS and STI (CHAS). All participants were provided standard information on the study and a written consent was obtained. Data collection was carried out between 4 January- 7 March 2013.

 

Soco-Demographics


Screen Shot 2014-07-18 at 11.45.31 AM

 The mean age of respondents was 36.5 years.

46.4% of participants were male and 53.6% female. There were no transgender respondents.

37.5% lived in a rural area, 34.2% live in a small town and 27.5% in a large town or city. 

53.9% of participants had a partner or spouse and were living with that person, 45.8% were single, divorced or widowed.

59.2% of all participants reported being members of NGO or CBO and 10.4% did work in a HIV program. 

71.1% of respondents earned some form of income, on average LAK926,225 (114.8 USD)  per month. 

Most of the respondents had a primary level of education (36.6%) and  30.5% had higher secondary or college level. 

The average household size for all respondents was 5 people.

The most common self-identified risk group was “others” (60.9%) and international migrant workers constituted 22.3% of respondents. 

HIV Diagnosis and Pre-ART Care


Screen Shot 2014-07-18 at 12.18.35 PMThe most common reasons given for going for a HIV test was due to being referred by a doctor due to suspected HIV related symptoms or being sick (27.7%), followed by husband/wife/child tested positive (27.2%).

The most common place for getting a HIV test done was in a NGO run VCT centre (60.7%).

91.8% of respondents reported having had a CD4 test done.

Less than one percent of respondents (0.5%) reported having had a viral load test done.

The average self reported baseline CD4 count was 280.2 cells/mm3

Majority (87%) of the study respondents sought NGO clinic for HIV consultation while 8.2% went to  private hospital/clinic

The average duration of time that CD4 test was done after HIV diagnosis was 8.4 months (median: 3.6 months, range: 0-14 years)

Health Seeking behaviour and associated costs


84.3% reported visiting their doctors, nurses or health workers at least once a month while 8.4% visited only when they are sick.

25.5% respondents reported of being sick within 6 months prior to the interview and 42.5% of them required hospitalisation

Average cost of treatment was 12,335BDT (158.8 USD).

22.2% of those who were sick and hospitalised mentioned that they received some sort of subsidy and 55.6% reported that they paid out of their pocket for their treatment. 

2% had received home-based care services

Stigma and Discrimination


Only 14.7% of respondents had disclosed their HIV status to someone other than their spouse, close family member or health care worker. 

32.9% of respondents who disclosed their status had been forced to change their residence or were unable to rent accommodation because of their HIV status.

Less than one percent of respondents reported having been denied health services due to their HIV status. 

3.8% of respondents reported having had their HIV status disclosed by a health care professional without their consent. 

50.3% of respondents were confident that their medical records were being kept completely confidentially.

Relationship with Health Care Provider


5.8% of respondents on ART agreed or strongly agreed that they were sometimes insulted when talking to their HCP. 87.8% of respondents on ART agreed or strongly agreed that their HCP made them feel comfortable when discussing any issues. 93.8% of respondents on ART agreed or strongly agreed that their HCP had told them of the possible side effects of their ARVs. 87.4% of respondents on ART agreed or strongly agreed that their HCP had told them of the changes to expect in their health when taking ARVs.

HIV Risk Behaviours


28 respondents reported to be current injecting drug users.

89.3% of PWID reported that they were able to get access to clean syringes whenever they needed them.

54.9% of respondents with a spouse or partner reported that the HIV status of their partner was negative or unknown.

59.2% of respondents reported being able to get condoms whenever they needed them. 7.3% were never able to get condoms.

Reproductive Health


83% of respondents have children, of whom 10.6% are known to be HIV positive. 

33.8% of  respondents with a spouse/steady partner had received counselling on child baring since being diagnosed with HIV. 

Only 3 respondents who had a desire to have children reported being coerced into being sterilised. 

22.4% of respondents in a relationship, or their spouses, had become pregnant since being diagnosed.

The majority of those pregnancies were intended (75%)

Treatment of Co-Infections (TB and HCV)


18.8% were diagnosed with TB after being diagnosed with HIV. 

100% of those received treatment and 85% of those had completed treatment. 

10.2% of respondents were provided with information on Hep C. 

Only 2.7% of respondents were offered a HCV test.  

Only 1 respondent was found positive for Hep C and did not receive treatment. 

Treatment Literacy


Screen Shot 2014-07-18 at 4.06.29 PMHIV Treatment literacy was measured by respondents answers to 25 questions. The higher score represents a higher knowledge of HIV prevention and treatment. The mean score for HIV treatment literacy was 17.1. 10.2% of respondents scored between 1 and 10. Only 2.3% had used the internet to search for HIV related information.

ART Initiation


97.4% of participants were on ART and the rest were not eligible for ART at the time of the interview. The most common regimen was Ziudovudine + Lamuvudin + Nevirapine (46.5%)Screen Shot 2014-07-18 at 4.08.41 PM

Among the current ARV users,99.6% reported taking 95-100% of their ARV drugs while 0.4% reported taking less than 95% of their drugs.

None respondents were still on a Stauvoidine.

All respondents were aware of what ART is. Of the 516 study participants who were taking ART,55.9% were taking ART for three years and above.

10.5% percent of those taking ART delayed their initiation of ART treatment despite their eligibility.

ART Regimen and Self-reported Adherence


83.7% of participants on ART reported to have never missed a dose of their ARVs. Only 9.1% of respondents reported to have missed an appointment with their HCP within 3 months prior to interview. 66% of those who missed an appointment cited being busy as the reason. 

The average time on ART was 4.3 years.

46.9% of participants on ART had changed regimen at least once since starting treatment.

The mean self-reported proportion of ARVs taken in the last month was 93.4%. 

83.7% of participants on ART reported to have never missed a dose of their ARVs. 

Long Term Side Effects (self reported)


84.5 % of participants on ART experienced at least one of the listed long-term side effects.

57.9% were told by a clinician that their body fat has changed due to side-effects of ARV

49.8 % reported to have felt numbness in the limbs

66.1% reported to have had problems with the liver

Lao National Network of People Living with HIV/AIDS (LNP+)

Goals


  1.  Promoting GIPA (greater and more meaningful involvement of PLHIV in all aspects of the HIV response);
  2. Ensuring PLHIV have equal rights
  3. Building partnerships with other HIV focused organisations
  4. Improving access to treatment, support and care
  5. Strengthening the capacities of all PLHIV.
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