Accelerating the fight against pandemics in Southeast Asia
For over a decade, the Initiative has been fighting HIV/AIDS, tuberculosis and malaria in the Greater Mekong. This region of nearly 250 million people includes Cambodia, Laos, Myanmar, Thailand and Vietnam, countries with diverse histories and modern realities that face major public health challenges.
The Initiative, in partnership with the Global Fund, is committed to the Greater Mekong Subregion to combat the HIV/AIDS, tuberculosis and malaria pandemics. With an investment of more than €50 million over ten years, 37 projects have been funded, covering not only these three diseases, but also the strengthening of health systems. These projects, implemented by national programs, civil society organizations, universities and research organizations, have enabled significant progress to be made. The Initiative’s commitment has led to a reduction in incidence and mortality rates, increased access to therapies and the strengthening of existing infrastructure and human resources, notably through the training of community health workers. Despite this progress, challenges persist, including the fight against resistant malaria strains and stigma. In an interview,
Dr. Patrice Piola, an epidemiologist, details the health challenges in the Greater Mekong, a region now facing a “double burden” of public health that combines the pathologies of developed and developing countries.
The need for regional collaboration to effectively combat diseases
Antimalarial drug resistance is a major obstacle to malaria eradication in the Greater Mekong. Established in 2014 and supported by L’Initiative,
the Regional Artemisinin Resistance Initiative (RAI) works closely with governments and local communities to develop integrated strategies to rapidly detect and treat malaria cases, reduce transmission rates, and prevent the spread of resistant strains. However, challenges remain, such as difficult access to remote populations, coordination between different national systems, and the need for sustainable financing.
In this interview, Professor François Nosten, Director of the Shoklo Malaria Research Unit (SMRU) in Thailand, discusses the epidemiological situation in the Greater Mekong region and the latest advances in the fight against antimalarial drug resistance.
REGENERATE Project: Promoting Equality and Health in Asia-Pacific
Launched on June 12 and supported by Expertise France via L’Initiative, the REGENERATE project aims to develop inclusive policies to combat the three pandemics in Asia-Pacific. Led by the APCASO network and deployed by several civil society organizations, this project targets the needs of women, girls and people of all sexualities to promote gender equality and sexual and reproductive health rights (SRHR). Spanning 36 months and funded to the tune of €1.8 million, REGENERATE is being deployed in Cambodia, Thailand and Vietnam, in partnership with the Cambodian NGO KHANA, the Thai foundation SWING and the Vietnamese NGO SCDI.
The APCASO network, active for 30 years, brings together organizations from 12 countries working for social justice and gender equality, and strengthening community systems. RD Marte, Executive Director of APCASO, discusses in an interview the objectives of strengthening community systems and the support of L’Initiative.
Innovative projects to target, detect and treat
The Initiative continues to innovate to address health challenges in Southeast Asia, supporting operational research projects and developing new strategies to combat HIV and tuberculosis. These initiatives aim to improve the prevention and detection of these diseases by particularly targeting marginalized and discriminated populations, such as drug users and sex workers, who are often forgotten by health systems. Gonzague Jourdain, epidemiologist, explains in this interview
how the NAPNEUNG-2 project in Thailand enabled the distribution of pre-exposure prophylaxis (PrEP) and the use of information technologies to facilitate access to HIV testing, thus improving the care of key populations.
New strategies to detect and treat latent tuberculosis
Latent tuberculosis (LTBI) is an asymptomatic infection that affects up to one third of the world’s population, representing a major public health challenge. The Initiative supports innovative projects to detect and treat LTBI, including the Capthai project in Thailand, targeting contacts of TB patients, and the Opticam project in Cambodia, improving LTBI management in people living with HIV.
The Initiative supports operational research to innovate against tuberculosis and HIV
Supported by L’Initiative, SCDI improves the well-being of vulnerable communities in Vietnam, particularly people who use drugs affected by HIV and tuberculosis. Following the success of a similar project on HIV, the Drive-TB project, launched in 2023, uses a community-based approach and innovative research strategies to widely screen and treat tuberculosis among people who inject drugs in Haiphong.
Mobile Link: Promoting access to health for sex workers in Cambodia
In Cambodia, there are over 40,000 female sex workers, including 24,000 in Phnom Penh. In 2009, a study showed that approximately 9% of this population was infected with HIV, and that nearly 82% of these women had already taken an HIV test. To address these challenges, the NGO KHANA launched the Mobile Link project (2017-2020). This project aims to share educational information on HIV with Cambodian sex workers and redirect them to health centers through regular SMS or voice message exchanges. Beyond HIV, Mobile Link addresses other health issues, such as cervical cancer prevention, drug use and forced alcohol consumption. Initially targeting a sample of 600 sex workers, the project reached an often marginalized population, providing vital resources and pathways to health care, while respecting their confidentiality and dignity.
Communities on the front lines against malaria and HIV
Community-based approaches are essential to combating diseases in Southeast Asia. In Cambodia, despite a significant reduction in malaria morbidity and mortality, its elimination remains difficult due to mosquitoes in forested areas.
The Pasteur Institute of Cambodia and its partners are working to eliminate the parasite reservoir with community-based interventions. In Laos, the NGO CHIAs is working to eliminate malaria by strengthening local communities and training community health workers to diagnose and treat cases quickly. These projects demonstrate the effectiveness of community engagement and health worker training to improve public health in remote areas, targeting vulnerable populations and integrating prevention, treatment and social support.
In Cambodia, delivering antiretroviral therapy through communities
With the support of L’Initiative, the NGO KHANA successfully piloted a community-based distribution system for antiretroviral (ARV) treatment. This project, which ran from 2020 to 2023, aimed to develop and evaluate a community-based ARV dispensing model in 10 HIV treatment centers. The results show a reduction in the workload of clinic staff and greater efficiency of services. People living with HIV (PLHIV) expressed high satisfaction, improved treatment adherence, and savings in time and money. In addition, the number of PLHIV lost to follow-up decreased. Currently, 70 municipalities finance this model in their annual budget, ensuring the continuity of the initiative after the end of the project. In this interview,
Chamreun Choub Sok, Executive Director of KHANA, highlights the lessons of this community-based approach, demonstrating the effectiveness of local mobilization in the fight against HIV-AIDS.
Human resources, the keystone of health and community systems
Strengthening human resources for health is essential for resilient and sustainable health systems. The Greater Mekong Region is particularly vulnerable to endemic diseases such as malaria and tuberculosis. Improving the skills and increasing the number of health professionals is crucial to ensure equitable access to quality care and an effective response to health crises. Among these health professionals, community health workers play a key role in filling gaps in rural areas, where they provide disease prevention, diagnosis and treatment.
Strengthening the role of community health workers in the Greater Mekong
The fight against malaria and emerging diseases in the Greater Mekong relies on community health workers. RAI, a regional initiative supported by L’Initiative, relies on a network of thousands of workers active in communities. These professionals fill the shortage of medical personnel, particularly in rural areas. However, disparities between countries complicate regional coordination. A report recommends better integration, training and professional recognition to optimize their effectiveness.
Mae Sot, a human issue on the border between Thailand and Burma
Every year, millions of migrants, mainly from Myanmar, arrive in Thailand without documentation or access to health services. Women, in particular, lack essential services, including reproductive health. Since 2020, SMRU, supported by L’Initiative, has been running a project to improve their access to care by strengthening the capacities of community health workers. In partnership with Dreamlopments and its M-FUND insurance, this initiative aims to reduce maternal and child mortality among marginalized populations.
Improving human resource management in the fight against HIV/AIDS in Vietnam
From 2019 to 2023, the Hanoi University of Public Health (HUPH) collaborated with the Vietnamese government to pilot human resource management tools in health facilities in seven provinces. Supported by The Initiative, this project developed tools based on the WHO WISN tool to assess the workload of direct and administrative health staff. Although challenges remain, these tools are now being used in various health services. The Initiative is supporting a second phase to expand human resource management and planning in public and community health systems, advocating for national and international scale-up. The Vietnamese Ministry of Health plans to expand these tools to ten additional provinces for 2024–2026.
