This activity is linked to HBHC HCMC-PAC (9533), HTXS HCMC-PAC (9409), and HKID HCMC-PAC (9535).

FY07 funds will continue to support the 5-year strategy and expand PMTCT services in Ho Chi Minh City (HCMC) to counsel and test 115,000 pregnant women at ANC sites and provide ART prophylaxis to 552 HIV-positive pregnant women with a target of 90% coverage. HCMC has the largest population and highest number of PLWHA in Vietnam, including pregnant women. In FY06, PEPFAR supported the Ho Chi Minh City Provincial AIDS Committee (HCMC-PAC), a provincial HIV/AIDS coordination body, to coordinate resources from partners including UNICEF, GF, and Action Aid in order to expand PMTCT services throughout the city. Funding was used to improve PMTCT services in the existing sites, 10 districts and 208 commune-level service delivery sites providing the minimum package of PMTCT services with referrals to 6 district level PMTCT outlets and 2 OB/GYN city hospitals, providing a complete package of PMTCT services to women in HCMC and neighboring provinces.

Currently HCMC has PMTCT services in all districts, with 20 out of 24 districts receiving support from international organizations such as PEPFAR, World Bank and UNICEF. In FY07, PEPFAR will expand services to 2 districts that lost funding in 2006 to maintain current coverage levels in the city. PMTCT services will be provided using an opt-out approach, and women testing positive will be systematically referred to care and treatment services in coordination with affiliated outpatient clinics. All pregnant women who seek ANC and delivery at the two OB hospitals and all districts and communes health centers will be provided counseling and offered HIV testing.

In FY 07, PEPFAR will focus on improving the quality of services provided at sites through raising public awareness and decreasing stigma surrounding PMTCT and other HIV services (key legislative issue: stigma). Activities will also focus on strengthening linkages and referral systems between OB/GYN hospitals, the community and pediatric hospitals to reduce loss to follow-up of mother-child pairs. This will be accomplished through referral forms, frequent communication among service providers, case management follow-up at both adult and pediatric OPCs and linkages to community and home-based care.

Community health care workers will continue to serve as educators and adherence supporters during the antenatal period. These staff will play an integral role in linking women, children and their families to other services available in HCMC, as described in the ARV and palliative care program areas, including counseling and testing, care and treatment, community and home-based care and additional OVC services to be supported in 2007 including a new drop-in center that will provide psychosocial support through a trained case manager and support groups (key legislative issue: gender).

Additional support in FY 07 will improve the capacity of community case workers to provide education, referrals, counseling and adherence support as well as the long-term follow-up of mothers and children.

This activity is linked to HVCT HCMC-PAC (9509), HVOP TBD Provincial Outreach Coordinators (9600), HVOP TBD CSW/IDU (9602) and HBHC HCMC-PAC (9533).

The Ho Chi Minh City Provincial AIDS Committee (HCMC-PAC) takes the lead on peer driven outreach in HCMC, coordinating all HIV services and assisting former residents of government centers for rehabilitating drug users (06 centers), reintegrate into home communities. PEPFAR will partner with HCMC-PAC to train 90 peer educators in behavior change communication (BCC) for HIV prevention targeting intravenous drug users (IDU), commercial sex workers (CSW) and their partners. HCMC-PAC peer educators will reach 4,000 IDU, 3,500 CSW, and 2,500 former 06 center residents. These activities support drug use and sex work reduction goals outlined in the Vietnam National HIV/AIDS Strategy and the PEPFAR Vietnam 5-Year Strategy. PEPFAR will work closely with the HCMC-PAC to provide financial and technical assistance for implementation, monitoring, and evaluation.

With PEPFAR support, 64 trained peer educators will teach at-risk populations skills to adopt safer behaviors and how to access network services such as counseling and testing, care and treatment, an array of drug and alcohol abuse treatment options, and STI services. High-risk individuals will receive condoms as part of a comprehensive ABC approach to reduce risk from drug injection and commercial sex. Outreach workers will refer clients to peer support groups, drop-in centers, vocational skills training, and job placement. PEPFAR will fund continued outreach in HCMC Districts 1, 2, 4, and 10; however, the 2006 outreach assessment will inform innovative interpersonal strategies to improve equitable access to HIV/AIDS services for drug-using CSW, establishment-based CSW, and cell phone-based or scooter-based CSW. Though many donors sponsor outreach in HCMC, peer interventions will be planned in cooperation with the HCMC provincial outreach coordinator to avoid redundancy in districts where other partners (FHI, TBD-PSI follow-on, Save US, MdM France, and non-USG funded) work.

FY07 funds will also support a HCMC-PAC HIV/AIDS Prevention and Education Center. This center will offer space for group meetings, refresher training, and for clients to learn risk reduction skills. The HCMC provincial outreach coordinator will host coordination meetings and training sessions in the Prevention and Education Center, facilitating networking among different outreach groups and other service providers.

PEPFAR will build on the foundation of an FY06 pilot for comprehensive release planning and aftercare for residents of the Nhi Xuan 06 center. To strengthen traditional outreach in target districts an additional 26 non-drug using peer educators will target former Nhi Xuan 06 center residents as they return to home communities and to the Nhi Xuan industrial zone. Both center-based and community-based non-using peers will counsel former residents to prevent relapse and refer them to counseling and testing, HIV care and treatment, case managers, and employment services.

This activity is linked to HTXS HCMC-PAC (9409), HKID HCMC PAC (9535), HKID VCHAP (9551), and HBHC Pact (9566).

Ho Chi Minh City/Provincial AIDS Committee (HCMC-PAC) is the principle PEPFAR partner providing clinical care and support for PLWHA in Ho Chi Minh City (HCMC), where the largest number of PLWHA reside. In FY06, PEPFAR will support HCMC-PAC to provide HIV-related palliative care to 19,000 individuals in 11 services outlets via training 100 individuals to provide care (in conjunction with the Vietnam CDC-Harvard Medical School HIV/AIDS Partnership).

Ho Chi Minh City (HCMC) is one of the ten highest-prevalence provinces in Vietnam, and has largest number of PLWHA. It is estimated that the number of HIV cases in HCMC will increase from 72,400 in 2006 to 89,900 in 2010, including 1,750 HIV-infected children in 2006 and 3850 in 2010 (HPI/FHI Analysis and Advocacy Project Report, June 2006). In line with the PEPFAR Vietnam 5-Year Strategy to increase care and support services to 110,000 PLWHA through FY08, PEPFAR will continue its partnership with HCMC-PAC to boost local capacity to care for HIV-infected individuals in clinical settings, with strong linkages to community- and home-based care. In FY07, PEPFAR will support HCMC-PAC to provide palliative care services in 11 urban sites. Based on the National Palliative Care Guidelines and O/GAC guidance, services will include: prevention counseling and commodities; regular clinical evaluation and monitoring; symptom management and pain relief; OI prophylaxis and treatment; STI treatment; screening for TB; related laboratory services; and treatment adherence.

In collaboration with the central drug procurement agency, HCMC-PAC will procure and distribute OI drugs, methadone, lab supplies and other commodities to outpatient clinics (OPCs) in a timely fashion. Family Health International (FHI) and a number of C/FBOs supported by PEPFAR will support home- and- community based care and support for PLWHA receiving care at HCMC-PAC sites. PEPFAR will support HCMC-PAC to provide initial and refresher training on stigma reduction in the health care setting, clinic operational procedures, counseling and lab for healthcare providers; training on ART readiness and adherence for patients and caregivers; and training on methadone therapy for healthcare providers once national guidelines are available in early 2007. PEPFAR will also ensure that patients in HCMC-PAC OPCs are provided quality counseling via case managers and referrals to PMTCT, TB/HIV care, drug addiction treatment, and psychosocial and social support services in their communities (to PLWHA support groups, the SMARTWork employment program, and AIDS Service Organizations where applicable).

With support from the PEPFAR Strategic Information and Care and Treatment teams, HCMC-PAC will improve patient care monitoring, referral networks, program monitoring and quality assurance tools with regard to patient care and program implementation, in support for the national M&E system.

HCMC PAC will support implementation of methadone clinics linked to HIV service delivery in existing outpatient clinics. Methadone will be procured in collaboration with other internatinoal partners and MOH.

This activity is linked to HVCT HCMC-PAC (9509), HBHC HCMC-PAC (9533), and HTXS HCMC-PAC (9409).

At 1 provincial TB hospital, PEPFAR will support expansion of RCT in TB settings to 8,000 persons in all districts in HCMC, provide ART for 200 TB/HIV patients, care for 600 TB/HIV patients, support treatment for TB disease for 3,000 PLWHA and train 50 persons to provide clinical prophylaxis and/or TB treatment for PLWHA.

RCT for TB patients and TB screening for HIV patients in HCMC: In FY06, PEPFAR supported HCMC Provincial AIDS Committee (HCMC-PAC), a provincial coordination body, to begin RCT in 50% of all districts. For FY07, PEPFAR will support the HCMC-PAC to scale-up this model to include all districts with an additional focus on supporting drug rehabilitation centers, as requested by HCMC-PAC and approved by OGAC, to improve diagnosis and outcomes and to assure adequate screening to facilitate the transition of clients from the centers to the community. The program monitoring system will also be strengthened through refinement of paper-based data collection instruments, and routine data analysis and feedback to sites, to improve timeliness, completeness and quality of reporting about TB/HIV collaborative activities in HCMC.

HIV Care and ART at Provincial TB Hospitals: An outpatient clinic (OPC) for TB/HIV patients has been established at Pham Ngoc Thach TB Center in HCMC through a joint effort by the Global Fund (GF), HHS/CDC and the HCMC-PAC. As agreed upon with GF, PEPFAR will take over the management of this clinic in FY07. Funding through PEPFAR palliative basic and ARV services will be used to continue support for cotrimoxazole, routine laboratory testing, care and when appropriate ART in this clinic (no TB/HIV PEPFAR funds are requested for this activity). Diagnostic services will continue to be supported through infectious disease regional funds provided through USAID (non-PEPFAR funds) as part of a targeted evaluation to establish clinical algorithms to diagnose TB in HIV-infected patients.

This activity is linked to MTCT HCMC-PAC (9383), HBHC HCMC-PAC (9533), HTXS HCMC-PAC (9409), and HKID TBD (9552). Note this activity has the same components as HKID MOH (9531).

In FY07 PEPFAR will support HCMC-PAC to strengthen the provision of care and support services for OVC and their caregivers. This activity will focus on HIV+ children served by Pediatric Outpatient Clinics (OPCs) at Pediatric Hospital #1 and Pediatric # 2 in HCMC, which serve children from a number of neighboring provinces. Although these OPCs have been operational since February 2006, they have focused on clinical care and treatment. Through this activity, PEPFAR will support the provision of a wider range of services, designed to better meet the developmental needs of each child. OVC services will be provided at both pediatric hospitals, as well as at nearby drop-in centers. Through this activity, 370 OVC will receive services, and 29 caregivers will be trained to provide services to OVC and their families. This group of caregivers consists of 2 case managers who divide their time between a pediatric hospital and drop-in center for OVC and their caregivers, as well as for 2 full-time trained lay caregivers at each drop-in center (with strong preference for PLWHA women with children). In addition, at least 25 family caregivers will be formally trained to care for OVC at home.

The pediatric HIV/AIDS OPCs will provide a core set of OVC services including needs assessment with OVC and caregivers; counseling and psychosocial support, food/nutrition support (in accordance with PEPFAR guidelines), provision of formula for PMTCT, support for transportation, and referral to other services including PMTCT, clinical care for PLWHA caregivers, and social support services for OVC and caregivers.

PEPFAR will also support the provision OVC services at a nearby drop-in center. OVC and their caregivers will be referred to the center from pediatric hospitals as well as through other health care and community-based support services. The drop-in center will provide the same assessment, referral and psychosocial support services offered through the Pediatric OPCs, including referral to AIDS Service Organizations. In addition, the drop-in center will offer more comprehensive services for OVC and their caregivers, including caregiver support groups, educational activities and advocacy/support for enrollment of OVC in community schools, therapeutic play groups for OVC, training of family caregivers in basic care and support for children, age appropriate life-skills education for OVC including primary prevention of HIV/AIDS and primary prevention of drug use, and on-going support to families at risk of institutionalizing children.

PEPFAR will provide intensive and ongoing capacity-building and technical assistance to ensure consistent and quality programming, including training courses, mentoring, coaching, and support to bring OVC partners together to problem-solve, and share experiences and resources. (See HKID TBD 9552).

This activity is linked to HLAB HCMC-PAC (9503), HVTB HCMC-PAC (9569), and HVCT TBD-PSI Follow-on (9513).

PEPFAR will support HCMC-PAC to implement counseling and testing (CT) services at 9 CT clinics in FY07, train 60 healthcare workers in CT, provide HIV test results to 13,000 individuals, and strengthen the social marketing program.

In FY06, through a cooperative agreement with HCMC-PAC, PEPFAR, as part of a comprehensive reintegration program, is supporting 7 CT clinics; 5 clinics in Districts 1, 2, 4, 10, and Dermato-Venerology Hospital (DVH) and 2 clinics in Nhi Xuan drug rehabilitation center and Nhi Xuan Industrial Park (NXIZ), a site providing favorable employment to former IDUs. In the first quarter of FY06, CT services were provided to 1,140 individuals and 32 healthcare workers were trained in HIV CT. In FY07, PEPFAR will continue to support service delivery in these 7 established sites and the 1 existing mobile CT clinic will expand its services to District 7, Thu Duc and Tan Binh to facilitate access to CT and STI services for hard-to-reach populations.

PEPFAR will fund HCMC-PAC to enhance service provision and improve the quality of service delivery by providing training and innovative quality assurance and quality control (QA/QC) measures including introduction of client exit interviews; provision of training to healthcare workers on advanced counseling skills and couples counseling protocol based on the HHS/CDC and OGAC TWG curricula; and enhancement of existing referral systems between HIV prevention and care services by hiring provincial referral coordinators and holding monthly referral coordination meetings for partners working within the HIV prevention and care network. PEPFAR funds will also be used to provide technical assistance to World Bank and GF CT programs through training and QA/QC measures as well as provision of enzyme immunoassay (EIA) confirmatory test kits to 17 World Bank-supported CT clinics in 17 drug rehabilitation centers.

In collaboration with a PEPFAR partner (TBD-PSI follow on), HCMC-PAC will strengthen the CT social marketing program in HCMC to maximize service utilization and link HIV-positive individuals to care and treatment. HCMC-PAC will pilot outreach communication through CT counselors who, in collaboration with outreach programs, PLWHA groups, and Women's and Youth Unions will provide CT education to target populations. This CT education activity, in conjunction with the social marketing activity, will encourage CT-seeking behavior, help eliminate stigma and discrimination, and facilitate recruitment of families and couples into the HIV prevention and care network. This collaboration will also support HCMC-PAC CT program in encouraging test result disclosure and notification, especially for discordant couples, and in ensuring that HIV negative partners do not seroconvert.

PEPFAR CT programs target most at-risk populations (MARPs), including injecting drug users (IDU) and their partners, male and female commercial sex workers (CSW) and their clients, men having sex with men MSM), and sex partners of HIV infected persons. To reach this population, in FY07, PEPFAR will continue to support HCMC-PAC in service delivery of optional anonymous/confidential CT in two established sites in Nhi Xuan rehabilitation center and NXIZ. PEPFAR will implement 1 new HIV CT clinic in a TBD rehabilitation center for IDUs as part of the expansion of reintegration program. PEPFAR will support HCMC-PAC to provide CT education in centers through group discussion, CT talks, and personal communication by in-center peer outreach teams. PEPFAR will collaborate closely with peer outreach, case manager teams, and outpatient clinics to ensure continuation of care, treatment and support to residents after being released.

This activity is linked to MTCT PAC (9383), HBHC PAC (9533), and HKID MOH/VAAC (9531).

Ho Chi Minh City (HCMC) province has the largest number of HIV cases in Vietnam, accounting for 20% of infections in Vietnam. It is estimated that the number of new AIDS cases per year will increase from 4,800 in 2006 to 7,700 in 2010 (Analysis and Advocacy Project Report, June 2006). As of August, 2006, with PEPFAR support, HCMC-PAC has provided direct ARV support to 965 PLWHA (848 adults and 117 children) at 9 sites. HCMC-PAC has been effective in coordinating multiple donors and international partners and has developed an aggressive scale-up plan with support from multiple PEPFAR treatment partners. In FY07, PEPFAR will continue to support HCMC-PAC to advance the following objectives: 1) scale up ARV services; 2) improve quality of services, adherence and the network model especially for vulnerable populations such as current and former IDUs; and 3) build local capacity to sustain the HIV/AIDS response in HCMC.

By the end of FY07, HCMC-PAC will provide ART to 3,600 patients (3,300 adults and 300 children) at existing and new ARV sites throughout the province. Existing PEPFAR-supported sites that will scale up treatment include the Tropical Disease Hospital, 4 district outpatient clinics that will serve as ‘magnet' sites, Pham Ngoc Thach TB hospital (jointly supported by PEPFAR and Global Fund), 2 pediatric hospitals, and Nhi Xuan clinic linked to a government rehabilitation center for drug users (06 center). After an initial evaluation of lessons learned from early implementation at this clinic, 1 additional ARV site will be selected in conjunction with the PEPFAR team to support the PEPFAR plan for expansion of a complete package of clinic, home and community based services for current and former drug users.

In an effort to improve quality of services, adherence and access to other community based services, HCMC-PAC will recruit and train referral case managers for all adult and pediatric ARV sites. The case manager will support patients to adhere to treatment, to facilitate transfer of care, to monitor referrals between ARV services and other medical/support services in the network. These staff will assure women and families referred from PMTCT services receive ongoing treatment services as needed (key legislative issues: gender). Case managers will facilitate access to community- and home-based services providing care and support to adults and OVC in all districts. Case managers will work in teams with peer educators and support groups to counsel and prevent addiction relapse, help patients access substitution treatment as it becomes available, and facilitate referral to services for patients released from drug rehabilitation centers. To facilitate acceptance of PLWHA peer educators into service delivery, training on stigma reduction will be provided (key legislative issue: stigma).

ARV sites will be supported by PEPFAR care and treatment staff, experienced HCMC-PAC staff and Vietnam CDC Harvard Medical School AIDS Partnership (VCHAP) staff through training, supportive supervision, and mentoring of the OPC team. In addition, HCMC-PAC is piloting a Treatment Network Monitoring Unit. Members of this unit will serve as master educators and TA providers to the district-level sites. Training for new sites and refresher trainings will be provided to update staff on guideline changes and review lessons learned from previous models. In addition, HCMC-PAC will continue organizing monthly coordination meetings with service providers.

Collection of information for routine patient and program monitoring will be in line with the PEPFAR SI plan and with national standards, ensuring support for the national HIV/AIDS M&E system. Enhanced patient monitoring will be done at selected sites to monitor adherence, clinical outcomes, quality of life and program quality.

This activity is linked to HBHC HCMC-PAC (9546), HLAB MOH/VAAC (9505), HLAB HSPH (9504), HLAB APHL (9499), HVSI HCMC-PAC (9243), and HVCT HCMC-PAC (9509).

PEPFAR funds will continue to support HCMC-PAC to build capacity and improve sustainability of the laboratory infrastructure for diagnostic and clinical laboratories in HCMC. Activities planned include provision of technical assistance (TA) for the design of a biosafety level-three (BSL3) laboratory in HCMC, procurement of equipment for clinical laboratories, expansion of the Laboratory Information Systems (LIS) to 1 additional site and standardization of tools for laboratory data management.

PEPFAR will provide TA to HCMC-PAC in the design of a BSL3 facility for food, water and blood borne pathogens testing, including HIV. Funding for construction of the laboratory on a 1.8 hectare plot has been received from a non-PEPFAR source. In FY07 2 technical advisors from HHS/CDC Atlanta will travel to Vietnam for 2 weeks each to provide TA with the design of the facility.

PEPFAR will provide support to HCMC-PAC for procurement of laboratory equipment including 3 hematology and biochemistry analyzers to monitor patients on ARV therapy in 3 laboratories in 3 of the 7 focus provinces; HCMC, An Giang and Can Tho.

To enable laboratories to provide accurate results and manage their information effectively, in FY06 PEPFAR supported the implementation of a pilot laboratory information system (LIS) at the District 4 Health Center in HCMC. In FY07, PEPFAR will support HCMC-PAC to expand LIS activities at the current pilot site and introduce LIS software to one additional site while providing guidance on the selection of a contractor for customization and implementation of the selected LIS solution for the additional site. HCMC-PAC will be responsible for ensuring linkage between the LIS and patient monitoring systems in HCMC as well as training new sites in the LIS solution. PEPFAR will also provide support to HCMC-PAC for introduction of bar coding and labeling technology in 15 laboratories in HCMC that do not yet have a LIS but are in need of standardized specimen management. For care-providers to access the data they need for routine HIV patient care and monitoring as well to support routine monitoring and reporting of national laboratory indicators, PEPFAR will provide assistance to HCMC-PAC in the strengthening of paper-based systems in laboratories in HCMC. This activity will include training for 25 staff at points of entry into care such as CT, STI and TB. All data management activities will be supervised by an LIS project officer hired by HCMC-PAC who will also coordinate training with the LIS Project Manager in MOH/VAAC. The LIS Project Officer will participate in consensus building and data harmonization workshops to ensure standardization of data being collected and sharing of information between patient monitoring information systems and LIS.

This activity is linked to HBHC HCMC-PAC(9533), HVTB HCMC-PAC(9569), HVCT HCMC-PAC(9509), HTXS HCMC-PAC(9409), and HLAB HCMC-PAC (9503).

HCMC Provincial AIDS Committee (HCMC-PAC), a provincial coordination body, provides oversight to all HIV/AIDS activities in HCMC. As HCMC-PAC implements and oversees GVN and PEPFAR-supported prevention, care and treatment services in HCMC, it will be necessary to establish a provincial M&E framework with a strategic plan for collecting, analyzing and using program data. In FY07, HCMC-PAC will work within HCMC to localize the national M&E framework and engage in activities related to advocacy, coordination, systems assessment, data harmonization, building physical and staffing capacity, and systems development, support and maintenance. Capacity for data use, analysis, routine data supervision and M&E will be developed within HCMC-PAC.

HCMC-PAC will also build SI capacity through routine information systems (IS) development, data management and supervision, and M&E supporting HCMC-PAC-managed programs funded by MOH/VAAC, PEPFAR, GF, the World Bank, the Department for International Development (DFID), and other international donors. M&E training, including data management and analysis training, will be necessary at HCMC-PAC and at the provider level. HCMC-PAC will partner with local universities to incorporate SI-related certificate based training into their curriculum. These academic partners will provide a combination of pre-service and in-service training solutions.

Improved information systems, whether exclusively paper-based or a combination of paper-based and electronic, are also critical for successful implementation and maintenance of quality HIV/AIDS prevention, care, and treatment programs. Information systems are vital for client management, client monitoring, and program management from the service center to the national level. The planning, development, implementation and maintenance of these routine information systems require leadership, collaboration, resources, technical expertise and most importantly a strong plan. HCMC-PAC will contract local software development companies to develop solutions for HCMC that adhere to national standards and guidelines. HCMC-PAC will also develop their staff to provide oversight to these partners and to participate on national M&E and IS TWGs, including the CAREWare pilot implementation in Hanoi.

PEPFAR will also support HCMC-PAC to develop the computer network infrastructure of the HCMC-PAC office as well as their training partners University Training Center for Health Care Professionals-HCMC (UTCHCP HCMC) and the School of Public Health in the University of Medicine and Pharmacy in HCMC. This will include both the development of secure networks and server rooms for the storage of HIV/AIDS program data and the establishment of networked computer training rooms for conducting trainings describe above.

Finally, HCMC-PAC will subcontract with UTCHCP HCMC to conduct enhanced patient monitoring activities in selected clinic supported by PEPFAR in HCMC. The training center will be responsible for the abstraction, entry and analysis of data from either electronic or paper-based patient medical records as described in the enhanced patient monitoring activities under the HVSI FHI (9370). All of these activities will provide SI training to 64 individuals and TA to 12 GVN and service providing organizations.