WHO/Enric Catala
A village malaria worker with her child before heading on an outreach visit.
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Tackling malaria, HIV, tuberculosis and neglected tropical diseases

HIV, tuberculosis (TB), malaria and neglected tropical diseases (NTDs) take a heavy toll on chronically disadvantaged populations in Lao PDR. Yet, the fight against these diseases can be won.  

Lao PDR’s climate and environment create positive conditions for malaria, with cases in 1999 numbering in the hundreds of thousands. Impressive progress has seen cases fall from 46 141 in 2012 to 810 in 2023. However, populations in remaining high-risk areas are hard to reach and require intensive efforts to eliminate malaria by 2030.  

HIV prevalence remains low (0.3% in 2019) and is concentrated in key at-risk populations, often difficult to reach through traditional facility-based approaches.  

TB remains prevalent with an estimated 10 000 new cases in 2022. People with TB often face socioeconomic or exclusionary challenges. They may live in cramped conditions with limited sanitation and struggle to access health care despite free treatment.  

Viral hepatitis and some NTDs remain health problems but efforts have seen marked declines. Dengue cases, however, continue to experience surges.  

NTDs are a diverse group of conditions, prevalent in tropical areas and mostly affecting impoverished communities. NTDs are called “neglected” because they generally afflict the world’s poor and historically have not received as much attention as other diseases. 

 

Our support

The National Malaria Programme is supported by WHO’s Country Office and Mekong Malaria Elimination Programme. 

Our focus has been maintaining and improving core interventions: rapid, early diagnosis and effective treatment at all levels of the health system (including community health workers), education, preventative measures such as insecticide treated bed nets, a sensitive surveillance system and monitoring the efficacy of frontline anti-malaria drugs.  

With the potential for malaria parasites to develop resistance to current antimalarial treatment, traditional approaches have been complemented by innovative WHO-led strategies to accelerate elimination:  

  • Targeted drug administration in high-risk locations to kill malaria parasites in the blood, treating symptom-free people, eliminating the reservoir of malaria infection in the community;
  • Targeted preventative treatment for those who sleep overnight in forests or fields, preventing reinfection into the community;
  • Working with the national Malaria Elimination Committee to establish a standardized subnational “malaria-free” certification process; and improving malaria reporting via digital tools 

TB, HIV and hepatitis support aligns with national plans to end the transmission of HIV and limit its impact, find missed TB cases, scaling up of TB preventive treatment (TPT) and increase healthcare worker capacity to diagnose and treat hepatitis. This includes:  

  • Assisting TB/HIV programmes to develop essential guidelines/workplans and improve information systems;
  • Expanding molecular testing activities, including specimen transportation, early drug resistance diagnosis, and HIV viral load testing; and aiding development of a National TB Reference Lab; and
  • Support to develop hepatitis B and C national strategic plans, diagnosis and treatment guidelines, and training.  

WHO also provides technical support to eliminate and control NTDs, including building capacity for dengue outbreaks and disease surveys, medicine donation, and mass drug administration in endemic areas.  

 

   

Results

  • Lao PDR has made impressive progress reducing malaria cases. In 2022, ‘accelerator’ strategies have contributed to an 80% drop in the deadly form of malaria and a 41% drop in all cases, compared to 2021. Sub-national capacity has been significantly improved, allowing fast, effective malaria interventions within communities.  
  • Reporting of TB case notification has improved, while treatment success was 87% in 2021.  
  • HIV testing expanded to district level alongside outreach activities to key populations. The number of HIV tests has increased from 85 703 in 2015 to 110 205 in 2021.  
  • Creation of Lao PDR’s first guidelines on the diagnosis, treatment and prevention of hepatitis B and C.  
  • Support for dengue preparedness and response has seen fatality rates drop in 2022.  
  • Following mass drug administration for de-worming: zero cases of lymphatic filariasis since 2017, the population estimated to have schistosomiasis has fallen to less than 5% in 2021 and soil-transmitted helminthiasis to 17.7% in 2020.  

 

   

The work ahead

By 2024, the country aims to eliminate the most fatal malarial parasite and an end to malarial deaths. The final steps are:  

  • Accessing high risk, very difficult to reach populations. WHO is profiling and mapping these groups to tailor strategies and responses; and 
  • Improving provincial and district capacity to pivot from a “routine” footing to a proactive “elimination” mindset. WHO is providing assistance via staff in the 2 high-risk provinces.  

To end TB and HIV, and improve knowledge on hepatitis B and C, we will support the Ministry of Health to:  

  • Increase case identification, allowing for early diagnosis and quality care; 
  • Coach health staff in reporting via case-based information systems to improve real time surveillance and strategic planning; and
  • Disseminate hepatitis guidelines nationwide.  

While significant gains have been made on some NTDs, re-infection and spread remains a significant risk. Limited resources exist to tackle further gaps. WHO is:  

  • Advocating with partners domestically and internationally for increased support;  
  • Improving water, sanitation and hygiene (WASH) infrastructure in health facilities;  
  • Supporting education on personal hygiene; 
  • Developing primary/secondary school materials. 

   

Our partners

The Government of China through the China International Development Cooperation Agency (CIDCA)  

The Government of the United States of America through USAID

The Bill & Melinda Gates Foundation 

The Global Fund to Fight AIDS, Tuberculosis and Malaria

UNAIDS 

UNOPS, the United Nations Office for Project Services