Challenges

The Greater Mekong subregion, one of the world?s fasting-growing areas, has been especially vulnerable to and affected by HIV. As a land bridge between South and East Asia, it is well positioned for trade with its neighbours, yet this same advantage and connectivity expose it to the rapid spread of HIV. The subregion was an original epicentre of the HIV epidemic in Asia, and in the previous decade, it was estimated that more than 1.6 million people in the subregion were living with HIV/AIDS. Nearly a quarter of those affected were women, and the proportion was rising.

(www.adb.org/sites/default/files/publication/29244/hiv-aids-greater-mekong-subregion.pdf)

Toward a Solution

In 2008, the Lao People?s Democratic Republic came together with Australia and Thailand, in partnership with the Thai Red Cross AIDS Research Centre and the Albion Centre, to create the Lao-Thai Collaboration in HIV Nutrition project, known as Lao-TACHIN. The project built on the successful experience of the similarly named Thai-Australian Collaboration in HIV Nutrition (TACHIN) project. The aim was to ensure better, universal access to comprehensive HIV treatment, care and support in the Greater Mekong subregion through a strong focus on nutrition.

The Lao-TACHIN project offers a vast global network of services for capacity-building and the sharing of knowledge and experience that has helped countries to provide adequate HIV treatment. The good practices of integrating HIV-nutrition service into HIV treatment in the southern Lao People?s Democratic Republic demonstrated the benefits of supporting and improving quality of treatment. As a result, other regions and countries have taken up the practice. The Thai Red Cross AIDS Research Centre and the Albion Centre played the key role in advocating and supporting the Lao People?s Democratic Republic to network with other organizations and countries in order to expand the HIV- nutrition project through South-South cooperation.

The project takes a multidimensional approach to treating HIV and its impacts, focusing on providing people living with HIV the right nutrition to ensure survival and a better quality of life. The approach includes strong capacity-development and system-strengthening components, with a focus on local partnerships. The Thai Red Cross AIDS Research Centre used the South-South approach for capacity development and system strengthening of HIV-nutrition services in the Lao People?s Democratic Republic, providing technical support to health-care providers and peers of people living with HIV while supporting the provincial hospital to work with the provincial health office and the peer support group for people living with HIV to integrate HIV-nutrition services into HIV prevention, treatment, care and support.

During its five-year run, the Lao-TACHIN project showed significant progress both in HIV treatment and nutrition in 11 participating provinces, and it has now expanded to others. The project trained peer educators and provided nutrition education in 12 provinces, where it also offered HIV counselling and testing and the prevention of parent-to-child transmission, which are now ongoing. In short, the initiative has demonstrated the importance of a nutrition approach to HIV treatment.

In 2012, the project shared its lesson at the regional HIV-nutrition workshop in Bangkok that was attended by a number of policymakers and health-care providers from Asia-Pacific countries. Cambodian policymakers and providers of HIV health care in turn asked for an onsite visit. The project has since been used as a best practice in Cambodia and Myanmar, following the Lao- TACHIN innovation of a multidisciplinary approach to HIV treatment with a strong focus on nutrition.

The strong capacity-building and system-strengthening components of this Lao-TACHIN project guarantee its long-term sustainability and assimilation in countries. Since the end of the project, nutrition assessments and counselling have been included HIV in antiretroviral clinics in the Lao People’s Democratic Republic national guidelines on HIV treatment. In addition, the project established and provided HIV-nutrition services for people living with , including printed materials in the Lao language that were disseminated to other clinics across the country. As part of the training-of-trainers component, the Lao-TACHIN project trained health- care providers, and peer supporters in turn trained the health-care providers and members of the support group for people living with HIV in other provinces of the country.

Replicating the Lao-TACHIN model depends on political will and adequate funding for capacity development and training. Similar models have been developed in countries such as the Dominican Republic, Honduras, Mozambique, the Plurinational State of Bolivia, Zambia and Zimbabwe. The following conditions are required to replicate the Lao-TACHIN project: inclusion of trained health-care providers in nutrition assessments and counselling, minimal equipment for nutrition assessments and information-education counselling, endorsement or support from the directive department, and partnerships and ownership among all stakeholders.

The main partners included the people-living-with- HIV peer support groups, the provincial health office, provincial hospitals, Lao-TACHIN, AusAID, the Albion Centre, the Thai Red Cross AIDS Research Centre, the Centre for HIV/AIDS and Sexually Transmitted Infections (CHAS, Lao People?s Democratic Republic), WHO and WFP. The support group for people living with HIV and provincial hospitals received technical support and capacity-building in HIV-nutrition services from Lao- TACHIN and provided HIV-nutrition services to people living with HIV who were members of the peer support group and to people who sought HIV treatment at the hospital. Lao-TACHIN, the Thai Red Cross AIDS Research Centre and the Albion Centre acted as implementing partners whose key roles included providing technical support on HIV-nutrition services, project management, monitoring and evaluation, and reporting to donors. The provincial health office and the Centre for HIV/AIDS and Sexually Transmitted Infections provided support in administration and monitoring project implementation, and advocacy for integrating HIV-nutrition services in HIV treatment, care and support at the national level. AusAID provided financial support and reviewed the project work plan to ensure that its goals were achievable as planned. WHO and WFP provided guidance to the Lao-TACHIN project and implementing partners on advocating HIV nutrition at the national and regional levels.