This activity is linked to MTCT MOH/VAAC (9384) and MTCT HCMC-PAC (9383).

PEPFAR will support UNICEF to raise awareness of HIV testing in pregnant women in the community, in support of the PEPFAR Vietnam 5-Year Strategy. This activity will address the issue of low antenatal care rate and low HIV testing uptake nationwide, including in provinces that receive PEPFAR support. The goal of this activity is to raise awareness among women, their partners and the general population about HIV and PMTCT.

Two main approaches will support this objective. First, at national and provincial levels, UNDP will support MOH/VAAC to provide information about HIV, PMTCT, the availability of services in the country and, upon completion, dissemination of information on the national implementation protocol and scale-up strategy to the general population, using national and provincial mass media events. This activity will be led by VAAC, Vietnam Women's Union (VWU), and provincial authorities. UNICEF will provide training and technical assistance for 10 national and provincial VWUs and other key stakeholders on messages to be disseminated. This activity will also strengthen the capacity and involvement of policy makers at the national and provincial level to include PMTCT programming in national and provincial action plan priorities.

Second, at the district and community levels, UNICEF will support local community and/or faith based organizations to be identified in each district/commune (including PLWHA groups if any) to disseminate information on PMTCT and other HIV services existing in the area. The goal of this activity is to provide information about HIV/AIDS and PMTCT and raise awareness about PMTCT for women of reproductive age and their family, thus making HIV testing more acceptable to women and their partners. Through this activity, women and their families will be informed about all services available to individuals testing positive, including ARV prophylaxis, alternative forms of breastfeeding, OVC and other social support services. Funds will be used to adapt BCC/IEC (Behavior Change Communication/Information Education Communication) materials, to work with and train 40 provincial and district Women's Union staff, village communicators and other local organizations to choose and train on a model of BCC to be used in that setting, and to provide "seed money" to support these locally chosen organizations to implement IEC/BCC activities.

A proposed mechanism to fund UNICEF through CDC is not available. $70,000 will be reprogrammed to USAID for funding UNICEF through UNDP. Additional $120,000 will support additional training workshops on BCC interventions for PMTCT targeting community-based communicators (additional 300 community collaborators in 5 districts reached); support a WHO/UNICEF/UNFPA joint initiative to develop and pilot innovative activities to increase men's involvement in PMTCT; support the production, reproduction and printing of extra IEC materials for use by trained community collaborators; technical assistance for both central and decentralized PMTCT activities such as policy and guideline development.

Added February 2008: A proposed mechanism to fund UNICEF through CDC is not available. $70,000 will be reprogrammed to USAID for funding UNICEF through UNDP. This additional $50,000 will support additional training workshops on BCC interventions for PMTCT targeting community-based communicators (additional 300 community collaborators in 5 districts reached); support a WHO/UNICEF/UNFPA joint initiative to develop and pilot innovative activities to increase men's involvement in PMTCT; support the production, reproduction and printing of extra IEC materials for use by trained community collaborators; technical assistance for both central and decentralized PMTCT activities such as policy and guideline development.

This activity is linked to OHPS MOD (9426) and OHPS MOH/VAAC (9414).

PEPFAR will support development and dissemination of national injection safety guidelines, and procurement of sharps disposal equipment for the 6 current and 1 new PEPFAR focus provinces.

WHO will work in partnership with the MOH/VAAC Nursing Division, the Vietnam Nursing Association, the Nursing Department of Hanoi Medical University, and the HHS/National Institute of Occupational and Environmental Health to strengthen the Government of Vietnam's (GVN) medical transmission/injection safety program. This will be accomplished through the following activities:

National guidelines on injection safety will be developed and training programs designed and implemented: WHO has, in the past, supported the GVN in the design and implementation of surveys to review practices on injection safety among health care workers. With support from PEPFAR, the results of these surveys along with other information will be used to develop a draft of national guidelines and a training manual on safe injection practices. Specifically, PEPFAR will support the establishment of a technical working group (TWG) which will collect comments from experts and finalize a set of national guidelines on injection safety. PEPFAR funding will also be used to design and print national guidelines.

Nursing skills among 120 nurses will be strengthened: PEPFAR funds will be used to establish a TWG within the VAAC Nursing Division that will review existing material and information to develop a training document designed to address safe injection practices among nurses in Vietnam. Funding will also be used to coordinate and implement a series of 4 training programs that specifically address the issues of injection safety among the nursing profession. Four training-of-trainers (ToT) programs will be held for 120 nurses in the 7 PEPFAR focus provinces, who will subsequently coordinate and carry out training programs for their nursing colleagues within these provinces. It is expected that the ToTs will be completed in FY07, while the subsequent training activities will take place in FY08.

Sharps containers will be provided for 26 provincial and district hospitals in the 7 focus provinces: With the exception of a limited number of outpatient clinics that are currently supported with PEPFAR funding, hospitals in Vietnam use their own budgets to buy sharps containers for proper disposal of needles. Budget constraints preclude many hospitals, particularly those at the district level, from purchasing these containers, and they are therefore unable to adhere to universal precautions with regard to proper disposal of needles. Under this activity, PEPFAR funds will be used to expand current coverage to 26 provincial and district hospitals in the 7 focus provinces. Specifically, funding will be used to procure an estimated 3,300 sharps containers, and to support VAAC for distribution of the containers. The provision of other injection safety commodities will be considered in FY08.

This activity also relates to activities in Counseling & Testing (#9511), Basic Health Care and Support (#9529) and ARV Services (#9398).

The UN Office on Drugs and Crime (UNODC) will lead PEPFAR supported efforts to implement evidence-based community models for HIV/AIDS prevention through substance abuse treatment and aftercare without involuntary assignment to rehabilitation centers. Through this activity 80 counselors will provide community based substance abuse treatment for 1,200 ethnic minority people. UNODC will train 300 peer outreach workers to provide HIV prevention education and referrals to 2,100 drug users. Vocational training will be provided for 600 former drug users and 300 former users will find job placement. Culturally-appropriate prevention education materials will be distributed to 14,000 households.

This activity has three components. First, based on successful work funded by Denmark, Italy, and Luxembourg from 2002-2007, UNODC will train 80 workers to provide voluntary, community based substance abuse treatment for 1,200 ethnic minority people. This will include detoxification, after-care, relapse prevention support, and appropriate vocational training for recovering drug users in the Northwestern Highlands, an area neglected by mainstream HIV prevention, care and treatment interventions. These substance abuse treatment and HIV prevention services will be offered in clients' home districts and communes, avoiding the stigma, fear, and family difficulties associated with mandatory government detoxification centers. The program will be tailored to highland ethnic minority drug users and their families through service development that fits the unique situation of these close-knit communities, including voluntary participation, use of minority languages and support from drug users' relatives and neighbors. An additional 300 peer educators will reach 2,100 drug users with HIV prevention messages and referrals in these same communities.

Second, 600 former drug users will receive appropriate vocational training and local businesses will employ 300 recovering drug users, empowering them to rebuild their lives and regain community status. Alternative support measures will include microcredit support to encourage self-employment initiatives by recovering drug users. Experience has demonstrated this programming is particularly effective and appropriate for recovering highland drug users; past support has included livestock and foodstuff production, handicrafts, and other local skills promotion, like silversmithing.

Third, this activity will facilitate referral of clients to local USG and government supported wrap-around HIV prevention, care and treatment services. These will include substance abuse counseling, comprehensive ABC messaging for HIV prevention, counseling and testing, and a network of HIV services. As appropriate, drug users will be supplied with condoms and instructed in correct consistent condom use. This intervention will take place in Son La province, where Life-GAP HIV services are available, Lao Cai and one to two additional provinces selected in discussion with the PEPFAR team.

This activity is linked to HVCT MOH (9511) and HVCT FHI (9508).

This is a new activity for PEPFAR in Vietnam. In FY07, PEPFAR will support WHO, in collaboration and coordination with relevant ministries, technical institutions, beneficiaries including PLWHA and other vulnerable populations, and international partners, to implement three activities that include: collaboration with MOH/VAAC to conduct a rapid assessment of HIV Counseling and Testing (CT); working with VAAC to develop and disseminate the national CT guidelines; and support development of national training materials.

In order to develop the National Guidelines on CT, WHO will collaborate with MOH/VAAC to conduct a rapid CT assessment to identify strengths and constraints of existing CT services supported by different initiatives with regard to availability, access and quality of services with an emphasis on most-at-risk population (MARP). The assessment will also look at linkages between CT services and other services such as HIV/AIDS care and treatment, TB diagnosis and treatment, antenatal care, harm reduction and other HIV prevention interventions.

WHO will work with VAAC and PEPFAR on the development of national guidelines and information and advocacy materials on CT that will be disseminated in FY07. The national CT guidelines will identify organization, management and operating procedures of CT services including different models for effectively reaching MARP, specific counseling approaches for different populations, and linkages with relevant services. Issues of service quality including confidentiality and partner involvement will receive special attention. Provider-initiated CT should also be introduced where needed and appropriate. The guidelines will be developed based on the rapid assessment, global guidelines and experiences of other countries. Information and advocacy materials emphasizing the role of CT in HIV prevention among MARP and human rights protection will be developed from the guidelines. WHO will support VAAC efforts to organize a series of provincial meetings to disseminate the guidelines and advocacy materials to relevant bodies and PEPFAR partners.

WHO will support the development of national standard training materials based on the national guidelines and existing training materials, especially OGAC TWG approved training curricula for CT to ensure standardization of all future CT training activities.

This activity is linked to HVSI HCMC-PAC (9243), HVSI MOH/VAAC (9376), HVSI HSPH (9242), and HVSI NIHE (9244).

In FY07, PEPFAR will continue to support UNAIDS efforts to facilitate the coordination of donors and other international agencies working with GVN on effective implementation and use of the national HIV/AIDS M&E framework to ensure program success.

With FY06 support from PEPFAR, UNAIDS is initiating a program of advocacy and coordination of M&E activities to political, government and other leaders at the national level and to international partners. In FY07, UNAIDS will continue in this role, supporting consensus-building to ensure effective national coordination of M&E activities across government agencies and administration levels, programs, and partners. Activities will include 1) advocacy on the importance of the national M&E framework for program accountability; 2) information sharing with political, government and other leaders at national level; 3) promotion of appropriate data use for program planning and policy making; 4) standardization and harmonization of indicators and data management systems; and 5) distribution of information materials on M&E. UNAIDS will advocate for the establishment of provincial M&E frameworks in HCMC, Hanoi, and Haiphong provinces in compliance with the national framework.

This activity will also provide UNAIDS resources to advocate for and promote solutions for national M&E framework support through study tours and hosting meetings where successes from other PEPFAR countries and UNAIDS activities in the region will be highlighted. One example of such facilitation is using the Country Response Reporting System (CRIS) as promoted by the UNAIDS/PEPFAR collaboration. Other consensus building activities will include facilitating sharing of successes in SI activities both within Vietnam and from other countries affected by the epidemic.

This activity is linked to HVOP UNAIDS (9477) and OHPS HPI (9528).

PEPFAR will continue to support UNAIDS to conduct 2 main policy activities: 1) strengthening of coordination and advocacy for HIV/AIDS activities targeting men who have sex with men (MSM); 2) general coordination of international support to the Government of Vietnam (GVN) and key players in responding to the epidemic, and engagement of the Communist Party on civil society involvement in the HIV/AIDS response.

Due to strong social stigma, many MSM do not self-identify in Vietnam and are reluctant to access services. In 2006, PEPFAR funded the UNAIDS MSM Consortium to develop an advocacy strategy targeting national and local authorities, the broader community including MSM, donors, and other organizations, to promote and integrate HIV/AIDS activities targeting MSM into existing programs. In FY07, UNAIDS will continue supporting the MSM Consortium to develop advocacy materials, conduct regional advocacy workshops, and collaborate with mass media to promote understanding of MSM-related HIV issues. The Consortium will also conduct regular bi-monthly meetings in Hanoi; coordinating study tours; and translate and distribute key information on lessons learned from other Asian countries. This informal working group will be expanded to include other organizations/institutions that are interested in working with MSM, most notably with representation from MOH/VAAC and focal point representatives from focus provinces. The Consortium is also a member group of the Greater Mekong Regional MSM Working Group.

UNAIDS will also support coordination of international support to the GVN and relevant players in responding to the HIV/AIDS epidemic. UNAIDS will work closely with international and local partners including PEPFAR partners and major donors (GF, DfID, ADB, World Bank) to promote transparency and share information, build partnerships with senior national leaders, and promote respect for the rights of PLWHA. Specifically UNAIDS will support the continuation of national level policy dialogues, including seminars with the Communist Party Commissions on Culture and Ideology, and Science and Technology, and mass organizations. To complement the Harvard training program, which supports new cadres in the Communist Party taking office for the first time, UNAIDS will work closely with existing Communist Party members in the Party Commission for Culture and Ideology to raise awareness on the importance of involvement of civil society in the HIV/AIDS response. PEPFAR funds will support a UNAIDS-coordinated Secretariat whose goal will be to strengthen the impact of national policy/advocacy and technical coordinating mechanisms, and the HIV/AIDS Technical Working Group (TWG) and subgroups. This Secretariat will provide leadership for the mapping of major HIV inventions and sharing of information at national and provincial levels through information advocacy, web-based information access, and the distribution of CD ROMs.

These activities will help PEPFAR reach the vision outlined in the PEPFAR Vietnam 5-Year Strategy by enhancing donor coordination and high-level policy-maker engagement.

This activity is linked to OHPS UNAIDS (9536).

PEPFAR will support UN Volunteers (UNV) in partnership with UNAIDS to develop the capacity of the Vietnam Women's Union (VWU) to: reduce stigma and discrimination through PLWHA advocacy (key legislative issue: stigma); build greater understanding of and support for the greater involvement of people living with HIV/AIDS (GIPA); and increase opportunities for PLWHA to participate voluntarily in the HIV/AIDS response. This activity will be implemented at the national level and in 4 of the focus provinces. A total of 60 people will be trained in HIV-related stigma and discrimination reduction and GIPA.

UNV will partner with the central VWU, a quasi-governmental mass organization, to promote HIV/AIDS stigma and discrimination reduction messages targeting Communist Party Commissions, the National Assembly, the 6 ministries working in HIV/AIDS, and the general public. Via placement of 9 Vietnamese and 2 international UN volunteers in key Women's Union offices at the central and provincial levels (4 focus provinces), UNV will support the VWU to partner with PLWHA leaders to develop appropriate HIV/AIDS awareness-raising messages designed to reduce stigma and discrimination against PLWHA and to promote involvement of PLWHA in the HIV/AIDS response. Messages will be delivered through national and local media outlets, including television, internet and print media. UN volunteers will convene 1 workshop in each of the 4 focus provinces for provincial AIDS authorities, mass organizations, and social service providers (health, micro-finance, child care, education and training, and other social services), to develop local-level stigma reduction policies/plans (20 government and non-government organizations will be targeted). The number of people who will be trained in HIV-related stigma and discrimination reduction is 60 (15 per province).

UNV will also support the VWU to provide guidance on how to implement GIPA, targeting VWU HIV program managers in 7 focus provinces and at the central office (60 individuals will be trained). Guidance will be based on lessons learned internationally from UNV/UNAIDS and from the Health Policy Initiative (HPI), and on local consultation with the VWU technical experts. In addition, the volunteers, many of whom are PLWHA, will advocate for GIPA in the focus provinces by using the guidance to conduct awareness raising information sessions with provincial leadership including local VWU, People's Committees and People's Councils (60 trained). Materials will be developed in conjunction with the HPI and Harvard training modules (targeting local People's Committee and People's Council members).

UNV will also support the VWU to expand its Empathy Club model which creates a venue and safe space where PLWHA and affected friends and family can meet to prioritize needs, formulate strategies to cope, and liaise with the government to provide feedback. These less formal clubs also serve as informal referral centers to clinical and community-based services, and will link with the ASOs (see Policy TBD-ASO) where applicable. UNV will train PLWHA and VWU staff in HIV-related community mobilization for prevention, and care and support treatment (60 individuals trained—as above). The Empathy Clubs specifically engage young women infected and affected by HIV/AIDS (key legislative issue: increasing gender equity in HIV/AIDS programs), and empower them to take control of their lives. UNV volunteers—many of whom are PLWHA—will contribute to the development of guidelines for self-support groups and associations that wish to form with the VWU as their umbrella. In addition, the VWU will serve as a conduit for policy recommendations to the Communist Party and the Prime Minister's Office.

This action will strengthen health policy in Vietnam, with a direct augmentation of HIV/AIDS policy and coordination, and contributes to sustainability of PEPFAR investments. Funds for this increase are reduced from activity 9381 and are available because of savings in ARV drug costs.

Table 3.3.15: Program Planning Overview Program Area: Management and Staffing Budget Code: HVMS Program Area Code: 15 Total Planned Funding for Program Area: $ 3,724,361.00

Program Area Context:

Program Area Setting

The US Ambassador leads the PEPFAR team in Vietnam with agency representation from the Department of State (DOS), US Agency for International Development (USAID), Health and Human Services (HHS), and Department of Defense (DOD). Under the Ambassador's supervision, the role of the interagency coordinator brought on in August 2006 is to coordinate activities of the unified team as they plan, manage and monitor programs. An interagency "staffing for results" assessment conducted in Vietnam in August 2006 provided recommendations on management approaches and staffing needs in Vietnam. In accordance with these recommendations, newly refined agency roles and processes for communication and interagency decision-making are now in place.

PEPFAR staffing has not kept pace with the financial and programmatic growth of PEPFAR in Vietnam. The FY07 program budget will increase to 59M, representing a more than 70% increase over FY06. In addition, the PEPFAR team will be managing activities in new program areas, such as safe injection, pediatric treatment and medication assisted therapy for drug addiction. Given the broadening scope of the PEPFAR program in Vietnam and the recommendations from the "Staffing for Results" assessment (see uploaded document), the PEPFAR team will require and is proposing additional staffing in FY07 to implement this program effectively.

The priority for additional staff is based on "staffing for results" as described in the FY07 COP guidance and in the message delivered by Ambassador Mark Dybul at the annual PEPFAR conference in Durban. Specifically, the range of short- and long-term skills needed to implement PEPFAR Vietnam include: technical assistance (TA) and program management in the areas of prevention, treatment and strategic information. In addition, as the program grows and program coverage increases, PEPFAR will need to strengthen program management and administrative support in the Ho Chi Minh City Office. Given the increase in PEPFAR funding, the expanding number of PEPFAR partners and programs in southern Vietnam, a key USAID US direct hire position is required to support the inter-agency activities and provide technical oversight to prevention programs. The relative mix of short- and long-term skills has been, and will continue to be determined annually by the individual agencies with oversight by the PEPFAR management team, led by the Ambassador.

Short-term TA needs will include discrete technical assistance (TA) in a variety of program areas, includes development of a national laboratory quality control manual, etc. These short-term needs are met with agency TDY staff, consultants or fellows whenever possible. In addition, PEPFAR Vietnam will need to increase locally employed staff (LES) in specific technical areas (see prevention, treatment, laboratory and strategic information). These new LES will have primary responsibility for developing and implementing a sustainability plan in collaboration with government counterparts and other partners and for providing capacity building TA to the government across all program areas. For both sustainability and cost efficiency, the PEPFAR Vietnam team plans to gradually transfer the majority of international hire positions to LES positions. As a result, most new positions will be LES positions with 3 exceptions. In addition, several of these new staff positions will lead to further localization in FY08 and beyond.

1) PEPFAR Vietnam is requesting the placement of a US direct hire position for the USAID office. The USAID office is presently staffed by contractors with oversight from the USAID Bangkok regional office. The addition of this new position will improve cost efficiency and improve the management of this program. Also, given the recent guidance on the role of regional USAID missions, it is anticipated that US direct hire oversight would be best placed within the USAID office in Vietnam. 2) A new international-hire senior Prevention Specialist position (HVOP USAID 9597) is being proposed to provide technical leadership and assistance for the PEPFAR prevention portfolio. 3) a PEPFAR program officer fellowship position would be created for 2 years to assist the team with workplan and other program management oversight. This

position would be filled in the future by a senior LES staff member. It is anticipated that if these staffing needs are approved, no new positions will be necessary in FY08.

Table 3.3.15: