This activity is linked to HBHC MOH/VAAC (9529), HBHC FHI (9558), HTXS VAAC (9398), HTXS FHI (9415), HKID VAAC (9531), and HLAB NIHE (9506).

This activity focuses on 3 main objectives in support of the program area strategy: increasing coverage in the 7 focus provinces and 3 additional high-prevalence provinces in support of the national PMTCT scale-up strategy; strengthening of referrals and linkages between outpatient clinics (OPC) and community-based programs providing counseling, care and treatment and support services to mothers, children and other family members; and capacity building at the MOH/VAAC.

In FY06, MOH strengthened existing PMTCT services in 3 focus provinces: Hanoi, Haiphong and Quang Ninh and expanded PMTCT service to An Giang, another high-prevalence province. PEPFAR has provided technical assistance to the National OB/GYN Hospital to act as the national implementer, educator and Quality Assurance provider (QA), to provide training at the provincial level, produce Information Education and Communication (IEC) materials, provide QA and monitoring of the provinces and to lead the implementation of the national PMTCT network.

FY07 activities will support the national strategy by increasing both geographic and numeric coverage in order to increase the number of HIV-positive pregnant women tested early and receiving appropriate ARV prophylaxis and/or treatment. PEPFAR will support VAAC to expand PMTCT services in the 6 current focus provinces and in 3 additional high-prevalence provinces that will be guided by the National PMTCT scale-up plan currently in development. Expansion of PEPFAR-supported services will be coordinated with other planned VAAC expansion if GF Round Six funding is obtained. 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 an affiliated outpatient clinic.

Community health care workers in each commune 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 each district or province, as described in the ARV and palliative care program areas, including counseling and testing, care & treatment services, community and home based care and additional OVC services to be supported in 2007 including drop-in centers in 3 provinces (refer to OVC program area). These sites will be closely linked to IEC/BCC (Behavior Change Communication) activities described in the UNICEF activity narrative which strives to increase counseling and testing uptake among women presenting for ANC as well as among their children and partners (Key Legislative issue: gender). Increased awareness in the community will decrease stigma and help to normalize HIV testing in ANC (Key Legislative issue: stigma). Through formal communication mechanisms and regular meetings between service delivery areas in each district, forms will be standardized across donors through development of an implementation protocol, and standardized quality assurance and reporting tools.

PEPFAR will support capacity building at VAAC through several activities: TA for development of national guidelines, implementation protocol, and scale-up plan, training and TA for new VAAC staff in PMTCT programming and evaluation, and support to develop a national protocol and implementation for DNA PCR utilizing dried blood spots (refer to Laboratory Infrastructure section).

In accordance with the PEPFAR SI plan, collection of information for implementing, monitoring, and evaluating activities will meet national standards ensuring integrated service delivery systems, linkages across providers and programs, routine monitoring and evaluation, and support for the National HIV/AIDS M&E System.

Additional funds will support: 1)Further expansion of counseling and testing at district and city level ANC sites to increase the uptake of women being tested earlier in pregnancy and link to established sites providing the full package of PMTCT services including ART; 2) Support for 5 sites at the provincial level in urban ares in provinces with prevalence of 0.5% or higher that will provide the minimum package of PMTCT services and link to adult and pediatric care and treatment services. 3) Subsidization of testing at ANC sites to improve PMTCT uptake 4) Increased training at new sites and support for training

curriculum development to implement new National PMTCT procedures now in development.

This activity is linked to HCT MOH (9511), HVOP TBD Provincial Outreach Coordinators (9600), HVOP TBD CSW/IDU (9602), and HVOP FHI (10207).

The MOH takes the lead in peer-driven outreach for intravenous drug users (IDU) and commercial sex workers (CSW) in focus- as well as non-focus provinces. PEPFAR will partner with MOH to train 480 outreach workers in behavior change communication (BCC) for HIV prevention targeting 22,000 IDU, 8,000 CSW, and 1,500 former residents of government centers for rehabilitating drug users (06 centers). 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.

With PEPFAR support, and with overall coordination of BCC interventions led by outreach coordinators, 460 peer educators will give IDU (27 provinces) and CSW (9 provinces) relevant motivation and skills to adopt safer behaviors. At-risk individuals will receive condoms and will be referred to network services including counseling and testing, care and treatment, drug and alcohol abuse treatment options, and STI services. Outreach workers will refer clients to peer support groups, drop-in centers, vocational skills training, and job placement. Tailored interpersonal strategies will ensure equitable access to HIV/AIDS services for drug-using CSW (based on CSW/IDU needs assessment results), establishment-based CSW (with participation of establishment owners), and cell phone-based or scooter-based CSW. While MOH outreach provides extensive coverage in multiple provinces, peer interventions will be planned in cooperation with outreach coordinators to avoid redundancy in districts where other outreach partners (FHI, TBD-PSI follow-on, Save US, Medicins du Monde (MdM) France, and non-USG funded) work.

FY07 funds will also support the MOH pilot of HIV/AIDS Prevention and Education Centers in the 7 PEPFAR focus provinces. These centers will offer space for group meetings, refresher training courses, and for clients to learn risk reduction skills. Outreach coordinators will host coordination meetings and training sessions in Prevention and Education Centers, facilitating networking among different outreach groups and other service providers.

An additional 20 specialized peer educators will target former 06 center residents as they return to home communities in Hanoi and Haiphong. Both center-based and community-based non-using peers will receive training of trainers (TOT) training, learning to counsel former residents to prevent relapse, and refer them to counseling and testing, HIV care and treatment, case managers, and employment.

PEPFAR funds will support three regional workshops for networking among outreach staff, managers, key officials, health staff, community workers and others who serve at-risk populations. The workshops will provide a forum for: promotion of best practices and standard service packages; exchanges of lessons learned and results dissemination; and enhancing coordination among different donors and programs.

This activity is linked to HTXS VAAC (9398), HKID VAAC (9531), MTCT VAAC (9384), and HBHC VCHAP (9551).

MOH/VAAC is the principle PEPFAR partner in providing clinical care and support for PLWHA at the provincial level and in selected districts in focus provinces and additional provinces in conjunction with Global Fund support. In FY07, PEPFAR will support VAAC to provide HIV-related palliative care to 29,240 individuals in 30 services outlets via training 330 individuals to provide care.

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 VAAC 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 the GVN to provide palliative care services in 30 provinces. PEPFAR is phasing out support from 10 provinces previously supported in FY06 to maximize coverage and quality in higher-prevalence provinces (from 40 to 30 - see uploaded Geographic Coverage document). As of July 2006, 10,000 adult outpatients and 250 pediatric outpatients have received palliative care services; and 150 healthcare providers have attended refresher training on HIV/AIDS care and outpatient clinic operational protocol.

Based on the National Palliative Care Guidelines and O/GAC guidance, PEPFAR will support comprehensive clinical palliative services in 6 focus provinces (the 7th focus province is through a separate cooperative agreement - see Ho Chi Minh City Provincial AIDS Committee), and in an additional 23 provinces. 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.

To maximize coverage, and address high-prevalence provinces beyond the focus provinces, PEPFAR has partnered with the GF to ensure that resources are distributed geographically. PEPFAR will complement support to VAAC and the GF to provide additional palliative clinical services in 11 provinces where PEPFAR and GF currently work together. In addition, PEPFAR will support 12 other provinces with basic clinical palliative care support in provincial outpatient clinics.

If Vietnam's GF Round 6 application is approved, PEPFAR will transfer management and oversight of outpatient clinics (OPCs) to the GF, in 11 provinces where GF and PEPFAR would overlap. PEPFAR will redirect this funding to support other activities including diagnosis and treatment of sexually transmitted infections (STI) and technical assistance (TA) for care provision to additional providers. PEPFAR will help build VAAC capacity to ensure systematic supply and distribution of OI drugs, lab supplies and other commodities to OPCs in a timely fashion. PEPFAR will support procurement of OI drugs for all PEPFAR supported clinics. Due to the high prevalence and need for palliative care services for PLWHA residents in government drug rehabilitation centers or 06 centers (where many injecting drug users reside), PEPFAR will work closely with VAAC, the Ministry of Labor, Invalids and Social Affairs, and the Ministry of Public Security to ensure quality care as patients move between the centers and the community. PEPFAR will also ensure that patients in VAAC 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).

FHI and a number of C/FBOs supported by PEPFAR will support home- and- community based care and support for PLWHA receiving care at VAAC sites. In collaboration with PEPFAR partners including VCHAP, FHI and HHS/CDC, and Partner TBD-Stigma and Discrimination Reduction (OHPS TBD 9532), VAAC will standardize the national training curriculum 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. With support from the PEPFAR Strategic Information and Care and Treatment teams, VAAC 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.

VACC will support implementation of one methadone clinic linked to HIV service delivery in Hanoi. Methadone will be procured in collaboration with other international partners and MOH. VAAC will collaborate with FHI to implement enhanced STI diagnostics and treatment into selected outpatient clinics.

This activity is linked to HVCT VAAC (9511), HBHC VAAC (9529), HLAB VAAC (9505), and HTXS VAAC (9398).

In 4 of the 7 PEPFAR focus provinces, PEPFAR will expand routine HIV counseling and testing (RCT) in TB settings to all districts, provide care and support services in district TB clinics, ensure enhanced TB diagnostic services for HIV-infected persons, treat 4,000 PLWHA for TB disease, expand HIV care (including ART) from 1 to 4 provincial TB hospitals, train 150 health care workers in HIV management of TB-infected persons and pilot INH preventive therapy for 100 persons in selected districts.

RCT for TB patients and TB screening for HIV patients in 5 PEPFAR focus provinces: PEPFAR is currently supporting 50% of all districts in 3 provinces (Hanoi, Haiphong, Quang Ninh) to implement this activity. By the end of 2006, a successful model will be firmly established. For FY07, PEPFAR will support VAAC to scale up this model to all districts within these 3 provinces and to begin implementation in two additional focus provinces (Can Tho, An Giang). As part of scale-up, PEPFAR will also strengthen the monitoring system to improve timeliness, completeness and quality of reporting about TB/HIV collaborative activities.

Care and support services will be provided in district TB clinics: District-level TB clinics may be the best place to initiate basic HIV care, such as co-trimoxazole preventive therapy and measurement of CD4 count for immunological staging. Providing these services within district-level TB clinics will help bridge patients between their initial TB diagnosis and first evaluation within an HIV clinic and accelerate their evaluation for ART once they first arrive in an HIV clinic. In FY07, all districts implementing RCT in Hanoi, Haiphong and Quang Ninh will be provided with co-trimoxazole and funding to support phlebotomy and CD4 testing (with testing performed at the provincial level). Funding for this activity is budgeted under palliative basic.

Provide enhanced TB diagnostic services to HIV-infected patients: More than 50% of HIV-infected TB patients cannot be diagnosed with smear-microscopy, which leads to increased mortality from undiagnosed TB. The technical capacity to perform liquid-based sputum culture, which is more sensitive than microscopy and more rapid than conventional culture, for diagnosing TB, exists in Hanoi, Haiphong and HCMC, but is underutilized because of limitations in cost, technical skill and clinical knowledge. Lab staff in Quang Ninh can perform conventional solid-based culture, but not liquid-based culture. For provinces that already have the capacity to perform liquid-based culture, human and laboratory resources will be supplied. For Quang Ninh, the laboratory infrastructure and skills will have to be developed and then human and additional laboratory resources supplied. PEPFAR staff will assess needs in these provinces and provide appropriate resources.

HIV Care and ART at Provincial TB Hospitals in 3 provinces: HIV-infected TB patients often receive care at provincial TB hospitals because they are seriously ill. Yet these hospitals are not authorized or do not have the capacity to provide HIV-related services, such as co-trimoxazole and ART. The high mortality rate in HIV-infected TB patients could be reduced with more intensive management of HIV at provincial TB hospitals. In this activity, 3 centers will be established for TB/HIV care in provincial TB hospitals in Quang Ninh, Haiphong and Hanoi (OPCs for TB/HIV inpatients). Funding for this activity is included under palliative basic and ARV services.

Building human resources and establishing mechanisms for TB/HIV collaboration: Few health care workers at the district-level and below understand the programmatic and clinical issues related to management of HIV-infected TB patients. Further, adequate mechanisms to promote collaboration between these programs have not been fully established. Funding will be used to further develop human resources and mechanisms to insure adequate care for HIV-infected TB patients. Planning will occur in collaboration with VAAC. Specifically, funding will support training in TB/HIV clinical care, public health management and monitoring, evaluation, and data analysis. Activities could include training courses, academic coursework for resource persons and workshops and study tours in focus provinces.

Piloting of INH preventive therapy (IPT) within TB and HIV clinics in selected districts: IPT

is recommended for HIV-infected persons who have TB infection but no evidence of TB disease. Public health programs in Vietnam do not currently implement this activity, despite its proven benefit, because of concerns about how to exclude TB disease in HIV-infected persons and limited resources within the TB program. In this activity, selected districts with a high burden of HIV would be selected and IPT programs would be developed jointly between VAAC TB and HIV programs to assess the feasibility and effectiveness of providing this treatment to HIV-infected persons. Success of these projects will determine scale-up in focus provinces.

PEPFAR/Vietnam will expand HIV counseling and testing of TB patients and TB screening to all districts in 6 focus provinces. Plus-Up funds will be used to support additional data entry personnel and computers for improving data collection related to this activity.

PEPFAR/Vietnam has established a highly-successful model for HIV testing of TB patients and has worked with the national TB and HIV programs to develop guidelines for HIV testing of TB patients. Plus-Up funds will be used to expand HIV counseling and testing to non-focus provinces to accelerate national implementation of the HIV testing of TB patients. Support will be directed to non-focus provinces with existing, quality HIV treatment facilities and high TB case notification rates.

In COP07, PEPFAR/Vietnam has supported an assessment of infection control in outpatient HIV and TB care and treatment settings. Plus-Up funds will be used to support implementation of the recommendations that come from this assessment and training.

This activity is linked to MTCT MOH/VAAC (9384), HBHC MOH/VAAC (9529), HTXS MOH/VAAC (9398), and HKID TBD (9552). Note this activity has the same components as HKID HCMC-PAC (9535).

In FY07, PEPFAR will support MOH/VAAC Pediatric program to strengthen the provision of care and support services for OVC and their caregivers in five focus provinces. To date the pediatric program has focused mostly 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. These services will be provided at five national pediatric hospitals, as well as at nearby drop-in centers. Through this activity, 536 OVC will receive services, and 110 caregivers will be trained to provide services to OVC and their families. This group of caregivers consists of 5 case managers who divide their time between a pediatric hospital and drop-in center for OVC and their caregivers, as well as 5 full-time trained lay caregivers at each drop-in center (with strong preference for PLWHA women with children). In addition, 100 family caregivers will be formally trained to care for OVC at home.

The five pediatric HIV/AIDS outpatient clinics (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 guidance), 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 of OVC services through drop-in centers. OVC and their caregivers will be referred to the centers from pediatric hospitals as well as through other health care and community-based support services. Where PEPFAR is supporting the establishment of AIDS Service Organization (ASO), these services will be provided through the ASO; in other provinces, a small drop-in center will be established. The drop-in centers will provide the same assessment, referral and psychosocial support services offered through the Pediatric OPC. In addition, the drop-in centers will offer more comprehensive services to OVC and 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 on-going capacity-building and technical assistance to ensure consistent and quality programming, including training courses, mentoring, coaching, and support for fora to bring OVC partners together to problem-solve, and share experiences and resources. (See HKID TBD 9552.)

This activity is linked to HLAB MOH (9505), HLAB NIHE (9506), HVTB MOH (9570), HVCT TBD-PSI Follow-on (9513), HVCT UNDP (9516), and HVCT TBD (9518).

In FY07, PEPFAR will support the MOH/VAAC to expand CT coverage in the highest HIV-prevalence provinces and reduce support for CT programmatic services in lower prevalence provinces targeting MARPs, including injecting drug users (IDU), male and female commercial sex workers (CSW), men having sex with men (MSM), sex partners of HIV infected persons and clients of injecting drug users and sex workers. PEPFAR will continue to support VAAC for HIV counseling and testing (CT) services at 36 clinics in 18 provinces, establish 10 new VCT clinics, transfer HIV CT services at 12 clinics in 11 provinces from PEPFAR to Global Fund (GF) support, train 140 health care workers, strengthen referral systems and work with different groups including PLWHA groups to encourage test result disclosure. These activities will result in provision of CT services to 45,000 individuals through VAAC support and 14,400 individuals through GF support.

In FY07, PEPFAR will continue to support provision of confidential CT services at 36 existing sites in 18 provinces that form part of a comprehensive HIV network facilitating linkages and referrals between different services at the provincial and district levels. In addition, PEPFAR funds will support the establishment of a total of 10 new CT clinics in 4 focus provinces, Hanoi, Haiphong, Quang Ninh and a TBD focus province, that will be integrated into existing OPC or STI clinics using both client-initiated and provider-initiated models to facilitate referral, linkages and service utilization. Under the new cooperative agreement with the VAAC, PEPFAR will discontinue funding for programmatic activities in 10 lower-prevalence provinces while continuing to provide technical assistance to these sites to ensure continuation of quality service provision. PEPFAR will explore alternative means of supporting these programs. Based on GF Round 6 approval, PEPFAR will support VAAC to transfer CT programs to GF management from 12 VCT clinics in 11 lower-prevalence provinces where GF also operates allowing $130,000 of unallocated funds to be used for HVCT 9518. Non approval of GF Round 6 applications will result in continued programmatic support by VAAC in these 11 provinces until alternate resources are identified. VAAC will also receive PEPFAR funds to expand support of counseling and testing services at TB clinics in the focus provinces.

PEPFAR funds will be used to improve service provision at all sites mentioned above through training 140 health care workers on couple counseling using HHS/CDC and OGAC TWG approved curricula, and internal as well as external quality assurance and quality control (QA/QC) measures. With PEPFAR support, VAAC will also provide technical assistance to GF and World Bank CT programs to standardize service provision and coordinate a national HIV CT reporting system. To follow up on the previous national meeting initiated in 2005, VAAC, with PEPFAR technical support, will take the lead in coordinating and organizing a 2nd National CT conference with all VCT donors/partners including GF, World Bank, Asian Development Bank (ADB), FHI, and TBD-PSI follow-on to facilitate experience-sharing and review of best practices.

PEPFAR will support VAAC to collaborate with World Health Organization (WHO) and UNICEF to encourage safeguard CT for children and adolescents, a method to ensure non-discrimination against minors, with approval and presence of guardians. Education of safeguard CT will be provided to healthcare workers through health information channels, training, and legislative regulations.

In collaboration with the UN, WHO, other major donors (GF, AusAID, World Bank), and international NGOs (FHI, PSI, etc), PEPFAR will assist VAAC in developing and disseminating national guidelines for CT. PEPFAR will coordinate with referral officers to enhance existing referral systems between HIV prevention and care services through the development of a referral card tracking system. PEPFAR will also continue its support of VAAC monthly coordination meetings at the provincial level.

With PEPFAR support, VAAC will closely collaborate with TBD-PSI follow-on to maximize outcome of social marketing investment for greater uptake of CT. In addition, VAAC will pilot outreach CT communication activities in select provinces, in which CT counselors, in coordination with peer outreach program and organizations such as the Women's and Youth Unions, provide CT education to target population and encourage referral to CT. To strengthen linkages with outreach programs, VAAC and PEPFAR will coordinate activities

with PLWHA groups, peer outreach programs, and organizations such Women and Youth Unions and encourage test result disclosure, service utilization by families, and ensure non sero-conversion of HIV negative partners of discordant couples. These activities will facilitate normalization of HIV test seeking behavior and reduction of stigma and discrimination.

Currently access to counseling and testing is limited in part due to lack of same day rapid test result notification. The Vietnam Administration of HIV/AIDS Control (VAAC) will pilot an innovative model of providing counseling and testing services to high risk populations in Hai Phong City, with the possibility of expanding to other PEPFAR focus provinces based upon implementation and achievement of the pilot.

A static VCT clinic will be developed in Do Son District, Hai Phong Province, where currently there is an active commercial sex industry as well as injecting drug use. Three mobile VCT teams will be established in conjunction with existing peer outreach, to work as a satellite of the static VCT site. Trained health educators and peer educators will provide on-site counseling and rapid screening test for clients at "hot spots" such as injecting venues, karaoke bars, and guets houses. Clients who test negative upon will be provided post-test counseling and immediate test result notification, while clients who are classified as "suspected positive" will be actively referred to their choice ofstatic VCT clinic for confirmation, and then will be linked to care and treatment services if confirmed HIV positive. Peer outreach workers will work closely with mobile VCT teams to ensure maximum coverage and access to mobile counseling and testing services as well as referring clients to other care, treatment and support services.

If rapid test confirmation is approved for HIV diagnosis, VAAC will move to employ this advantage to provide on-site counseling and testing to clients with rapid test confirmation provided immediately after the pretest counseling session. This will greatly facilitate access to counseling and testing for populations in need, and also expand coverage to remote areas andmarginalized populations.

VAAC will incoporate recommendations from OGAC Counseling and Testing Technical Assistance trip in May 2007 and revise program as necessary to address priority needs identified in this TA trip.

This activity is linked to MTCT MOH/VAAC (9384), HBHC MOH/VAAC (9529) and HKID MOH/VAAC (9531).

In FY05 and FY06, the MOH/VAAC scaled up ART services to 1,135 adult and pediatric patients at 6 adult outpatient clinics (OPCs) and 4 pediatric specialty clinics in 5 PEPFAR focus provinces. In FY07, VAAC will expand treatment to provide direct support for 4,320 (existing and new) patients at 18 provincial and district-level clinics in 6 focus provinces (clinics in Ho Chi Minh City, the 7th province, are supported by the HCMC-Provincial AIDS Committee). VAAC will provide a limited package of support to provincial-level ART clinics in 12 non-focus provinces. VAAC will focus on achieving 4 main objectives in FY07: expanding services at the provincial and district levels to support initiation and monitoring of ART; enhancing services at the provincial level (via adult, TB, and pediatric specialty clinics) to support secondary and tertiary level care; improving quality of services; and building national and local capacity to ensure sustainability of ART service provision throughout Vietnam.

In each of the focus provinces, VAAC will support 1 provincial-level adult ART OPC and 1 pediatric specialty clinic. These clinics are responsible for providing initial prescription of ARV as well as managing referrals from district-level sites for management of side effects and second-line therapy. VAAC will also support provincial-level ART clinics at TB hospitals in focus provinces where there is a 10-20% HIV seroprevalence rate. Primary service delivery of ART in Vietnam is being decentralized to the district level so that provincial-level sites can increasingly focus on tertiary care. In FY06, VAAC supported 1 district-level ART clinic with PEPFAR funding. In FY07, VAAC will expand this clinic into a magnet clinic supporting ART and home-based care (HBC) services for 3 surrounding districts, and will launch 2 new district-level ART clinics targeting current and former injecting drug users (IDU). In addition to its work in the focus provinces, VAAC will provide a limited package of support to provincial-level ART clinics in 12 non-focus provinces with PEPFAR funding. This support package includes staffing, supervision and lab monitoring and will be phased out over the next two years (refer to uploaded Geographic Coverage document).

VAAC will support a referral case manager in all clinics in the focus provinces to facilitate referrals to TB/HIV and STI services as well as to home- and community-based care services provided by PEPFAR and other partners. These staff will assure women and families referred from PMTCT services receive ongoing treatment services as needed (key legislative issues: gender). Case managers at provincial-level pediatric clinics will closely link with community based OVC services and work part-time in PEPFAR supported resource centers to be established in 3 provinces providing psychosocial assessments and links to other social supports. At each of the sites a network of peer educators and volunteers will be trained to provide treatment support and establish support groups. These networks will provide additional adherence support and also facilitate access to care and treatment services. To facilitate acceptance of these groups into service delivery, training on stigma reduction will be emphasized (key legislative issue: stigma). Case managers will work in teams with peer educators and support groups to prevent addiction relapse, help patients access to substitution treatment as it becomes available; and facilitate referral to services for patients released from drug rehabilitation centers.

Finally, in collaboration with the Vietnam CDC Harvard Medical School AIDS Partnership (VCHAP), Family Health International (FHI) and HHS/CDC, funds will support VAAC to continue leading the national ARV training program using the national treatment protocol and other standardized curricula. HHS/CDC care and treatment staff will work closely with new VAAC staff to build capacity on ART, patient monitoring, and use of standardized quality assurance tools for ARV program implementation, management and monitoring. Collection of information for implementing, monitoring, and evaluating activities will be in line with the PEPFAR SI strategy and meet national standards ensuring integrated service delivery systems, linkages across providers and programs, routine monitoring and evaluation, and support for the national HIV/AIDS M&E system.

This activity is linked to HVCT FHI (9508), HVCT MOH/VAAC (9511), HTXS MOH (9398), HLAB HCMC-PAC (9503), HLAB HSPH (9504), HLAB APHL (9499), HLAB USLabco (9719), and HVSI MOH/VAAC (9376).

In FY07, through a new cooperative agreement, PEPFAR will support MOH/VAAC in capacity building and sustainability of the diagnostic and clinical laboratory networks. The activities will focus on procurement of equipment including training and service contracts, practical training for laboratory students and staff and strengthening laboratory data management. All PEPFAR laboratory activities will be integrated into the national laboratory strategy.

PEPFAR will support VAAC efforts to strengthen procurement mechanisms for laboratory equipment, reagents and development of service contracts for both diagnostic and clinical laboratory networks. Guidance will be provided on vendor selection, central procurement, central storage of reagents and kits, establishment of distribution chains, and procurement forecasting. These procurements and services will support the HIV diagnostic National Reference Laboratory at National Institute of Hygiene and Epidemiology (NIHE) and provide equipment such as ELISA systems to prioritized diagnostic laboratories nationally. In the absence of a reference laboratory for the clinical laboratory network, VAAC will receive support from PEPFAR to collaborate with the Department of Therapy to manage the distribution of External Quality Assessment panels for clinical laboratories in each of the 7 focus provinces which will be a part of monitoring and evaluation activities for clinical laboratories. PEPFAR will also assist VAAC with the procurement of 3 hematology and biochemistry analyzers and 1 CD4+ T lymphocyte count machine including essential testing accessories and equipment training for clinical laboratories. This support will develop increased capacity for forecasting for reagents and equipment. Funds have been provided for VAAC to hire 1 local staff to assist with training and procurement activities.

In keeping with the practice of building sustainability in host countries, PEPFAR will support training for 5 students enrolled in laboratory technician/medical technology courses to acquire hands-on training at national and regional laboratories for HIV diagnosis and disease monitoring. PEPFAR will also support VAAC to facilitate a national training program for detection of opportunistic infections.

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 National Institute of Infectious and Tropical Diseases Hospital in Hanoi. In FY07, PEPFAR will support VAAC to expand LIS activities at the current pilot site and introduce LIS software to 1-2 additional sites while providing guidance on the selection of a contractor for customization and implementation of the selected LIS solution. VAAC will be responsible for ensuring linkage between the LIS and patient monitoring systems. PEPFAR will also provide support to VAAC for introduction of bar coding and labeling technology in laboratories nationally 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 as to support routine monitoring and reporting of national laboratory indicators, PEPFAR will provide assistance to VAAC in the strengthening of paper-based systems in laboratories nationally. This activity will include training for staff at points of entry into care such as VCT, STI and TB. All data management activities will be supervised by a LIS project manager hired by VAAC who will also coordinate training with the LIS Project Officer in HCMC-PAC.

This activity is linked to MTCT MOH (9384), HVOP MOH (9627), HBHC MOH (9529), HVTB MOH (9570), HKID MOH (9531), HVCT MOH (9511), HTXS MOH (9398), HLAB MOH (9505), HLAB HCMC-PAC (9503), HLAB HSPH (9504), and HLAB APHL (9499).

Set up in 2005, the Vietnam Administration for AIDS Control (VAAC) is a newly formed body of MOH that oversees all HIV/AIDS activities in Vietnam. Currently, VAAC's capacity for providing oversight to strategic information (SI) activities is limited and needs strengthening. Prior to VAAC, MOH/LIFE-GAP (the project management unit implementing the PEPFAR cooperative agreement in MOH), NIHE, and the Hanoi School of Public Health (HSPH) were PEPFAR's primary MOH partners outside of HCMC. Although LIFE-GAP will be absorbed into VAAC, memorandums of understanding (MOUs) for how VAAC will work with HSPH and NIHE will need to be developed to ensure Vietnam continues to benefit from PEPFAR capacity development support. As PEPFAR continues to support these partners, it will be necessary to help build capacity in VAAC over the coming years to provide national oversight while partnering with these other Vietnam government agencies.

Activities to be led by VAAC include advocacy and coordination of national HIV/AIDS SI activities. In the implementation of the National M&E Framework, VAAC will also coordinate and lead systems assessments, data harmonization, physical and workforce capacity building, and systems development, support and maintenance. Capacity for data use, analysis, routine data supervision and M&E will be developed within VAAC through training, technical support, and the development of a rational staffing plan. FY07 funds will be used by VAAC to scale-up solutions for M&E and routine information systems, training, and information sharing infrastructures regionally and then to the provincial level.

PEPFAR will continue to support VAAC in consensus building, leadership, and oversight roles in HIV/AIDS in Vietnam. These funds will also be used to help VAAC establish a secure network for storage of national HIV/AIDS data and the receipt of data from the district and provincial to the national level. Through this activity, PEPFAR will support SI technical assistance for 4 GVN HIV/AIDS organizations and SI training for 24 staff.

Additional funds will provide support to VAAC for a more rapid deployment of the National M&E Framework which was presented and approved in January 2007. These funds will allow an accelerated timeline for training and capacity building of regional and provincial levels.

This activity is linked to HBHC MOH/VAAC (9529), HVOP MOH/VAAC (9627), HVSI MOH/VAAC (9376), and OHPS HSPH (9424).

The MOH/Vietnam AIDS Administration and Control (VAAC) was established in August 2005 and is responsible for overseeing and coordinating HIV/AIDS programs in all 64 provinces, funded through national and international resources. PEPFAR's success in Vietnam will depend in part on sustainable national program management solutions, as VAAC expands its mandate to coordinate HIV/AIDS activities nationwide. VAAC is mandated to oversee all major donor assistance programs including PEPFAR, Global Fund, World Bank, and the Asian Development Bank. PEPFAR funding currently supports activities in 40 provinces. However, in order to maximize coverage and quality in focus provinces, this number will be scaled back over the next 2 years (see uploaded Geographic Coverage document).

In 2006, PEPFAR supported the establishment of VAAC by providing funds to contract 3 temporary staff to supervise program sites supported by PEPFAR. Funds also supported a workshop to disseminate the national care and treatment guidelines that were developed by MOH in close collaboration with PEPFAR and other international donors working in Vietnam. VAAC used PEPFAR funds in its first year to build leadership skills and capacity to provide program oversight. However, given growing donor support, VAAC has requested additional support to build is management structure at the central and provincial levels.

Several donors have come together to support the Government of Vietnam in its response to the HIV/AIDS epidemic, including PEPFAR, Global Fund (GF), World Bank, and the Asian Development Bank. With PEPFAR support, VAAC will strengthen its capability to serve as the coordinating agency by conducting regular coordination meetings with PEPFAR partners, Vietnamese government officials and other donor agencies. These meetings will serve as a forum for dialogue on program progress, overlap and duplication, and will address key issues for strengthening the national program. In addition, VAAC will sponsor technical workshops on prevention, care and treatment and strategic information to disseminate lessons learned, program results and highlight innovative programs and ideas. These workshops will be open to government staff, donor agencies and implementing partners.

In 2007, PEPFAR funds to VAAC will support human capacity by including 6 additional temporary contract technical and administrative staff at VAAC whose principle role will be to coordinate donor programs at the central and provincial levels. At the national level, key temporary technical contract staff will be recruited in prevention, care and treatment and program administration. VAAC administrative staff will undergo training to manage PEPFAR funds provided through the HHS/CDC cooperative agreement.

At the provincial level, PEPFAR will support temporary contract VAAC staff each of the 7 PEPFAR focus provinces. These individuals will serve as primary liaisons for VAAC and other donor-supported activities supporting the coordination and communication between national and provincial programs. Each of the staff recruited will participate in a Total Quality Management (TQM) course offered in partnership with the Hanoi School of Public Health (HSPH) (OHPS 9424). At the provincial level, VAAC will support a network of regional program managers that will link HIV/AIDS programs and provide a forum for discussions on implementation, key issues, challenges and solutions. This network will also provide a mechanism for the dissemination of successful programmatic innovation. The network will meet on a regular cycle to bring together provincial governments, PLWHA, local organizations and international donors, within the provinces to foster a connected relationship between all sectors involved in HIV/AIDS program.

In line with "Guidance on Support for Host Government Staffing", PEPFAR will work with VAAC to develop a health workforce assessment that will be used as a basis for developing a human capacity development (HCD) strategy. Currently critical staffing gaps are filled through provision of funds to hire temporary workers on behalf of the MOH or other government bodies. It is anticipated that the HCD strategy will identify key issues in human capacity (gaps and opportunities) to enable a more effective response to the epidemic in Vietnam.

PEPFAR will also support the Vietnam Ministry of Health (MOH) in establishing a Field

Epidemiology Training Program (FETP). FETP students will be trained to conduct epidemiologic investigations and field surveys to strengthen HIV/AIDS surveillance, present their work at scientific and medical conferences, evaluate HIV/AIDS disease control and prevention measures and apply training and acquired skills to improve HIV/AIDS program implementation in Vietnam. It is expected that 15 public health professionals will be in the first cohort of trainees in the first year.

Since the Government of Vietnam is in the process of establishing the best coordinating mechanisms between agencies involved in the establishment of the FETP, it is not yet clear where these funds will be directed, and are thus currently "TBD".