This activity is linked to MTCT MOD (9728) and MTCT UH (9727).

The Center of Excellence - DMHA, the executing agent for US DOD's Pacific Command, will provide program oversight and coordination of activities with DOD partners and the Vietnam Ministry of Defense. Requested funds will be used to cover costs incurred by the DOD HIV Prevention and Treatment team, in provision of technical oversight, program design, implementation and evaluation of PMTCT activities.

This activity links to HVAB MOD (9479) and HVAB UNAIDS (9489).

Funds requested will be used to provide technical assistance and oversight for DOD-managed AB programs. This includes coordinating with MOD and other USG partners, on all activities related to program design, implementation and evaluation of AB interventions targeting military recruits.

Targets

Target Target Value Not Applicable Number of individuals reached through community outreach that
promotes HIV/AIDS prevention through abstinence (a subset of total reached with AB) Number of individuals reached through community outreach that
promotes HIV/AIDS prevention through abstinence and/or being faithful Number of individuals trained to promote HIV/AIDS prevention
programs through abstinence and/or being faithful

Table 3.3.02:

This activity is linked to HVCT MOD (9510), HBHC UH (9583), HBHC COE (9595), HTXS UH (9393), HTXS AFRIMS (9395), and HLAB AFRIMS (9502).

The objectives of the US Department of Defense (DOD) and Vietnam Ministry of Defense (MOD) blood safety program are: to establish the standard for HIV blood safety within the MOD healthcare system; to promote a robust, voluntary blood donor program; to support the establishment of sustainable, quality-focused blood safety programs; and to strengthen linkage of blood safety, appropriate HIV counseling and testing, and referral for identified HIV positive persons. The number of DOD-supported service outlets carrying out blood safety activities this year will reach 4, and 60 individuals will receive training.

The Center of Excellence (COE) will implement the following activities with technical assistance (TA) from other agents of the US military (components of US PACOM, Armed Forces Research Institute for Medical Sciences and US Army Blood Program): evaluation of laboratory sites, procurement of key equipment and supplies, training of laboratory workers, implementation of planned physical and technological upgrades, support for the development and implementation of additional communication materials, community engagement for voluntary blood drives, renovation of blood transfusion facilities, and establishment of a counseling and referral system at Military Hospitals 121 in Can Tho and 17 in Danang.

Consistent with needs expressed by the host country's implementing partner, MOD, and the lack of resources provided by other donors, support for blood safety activities at sites identified in FY05 and FY06 will continue with quality management for HIV diagnosis, and maintain linkage for the counseling and referral system. In addition, the US Army Blood Program and the US PACOM staff will provide technical assistance to MOD blood safety programs through a joint workshop. A key activity in FY07 will be the development of a voluntary blood donor program within the MOD system, which will replace the existing dependence on paid blood donors over time. Support will be provided for community volunteer blood drives. Finally, site visits to Military Hospitals 121 and 17 will be undertaken to assess HIV blood safety and counseling and testing needs. Plans for renovation will be obtained as needed and appropriate equipment ordered.

This blood safety program was included in FY05 and FY06 COP and has been linked to counseling and testing services for HIV testing at blood banks and military treatment facilities (Military Hospitals 103 in Hanoi, 175 in Ho Chi Minh City). HIV-positive persons identified at these sites will be referred to the treatment programs located at these facilities. In addition, the trained staff at the centers will be able to assist other hospital staff in providing appropriate counseling services to persons receiving HIV tests.

Blood safety will address 1 of the 9 action areas established by the Government of Vietnam (GVN) in the Vietnam National HIV/AIDS Strategy.

This activity is linked to HVOP MOD (9478) and UNAIDS (9477).

The Center of Excellence-DMHA, the executing agent for US DOD's Pacific Command, will provide program oversight and coordination of activities with DOD partners and the Vietnam Ministry of Defense. Requested funds will be used to cover costs incurred by the DOD HIV Prevention and Treatment team, in provision of technical oversight, program design, implementation and evaluation of program activities, including official travel and logistical support. Funds will also cover 1 full time LES Program Officer, including salaries benefits, official travel and percentages of ICASS.

This activity is linked to HBHC MOD (9546), HBHC UH (9555), HTXS UH (9397), MTCT UH (9727), and MTCT MOD (9728).

This is a new activity in the continued collaboration between the Center of Excellence (COE), executing agent for US Pacific Command (PACOM), and the Vietnam Ministry of Defense (MOD) to develop the human capacity to address the scaling up of care and treatment services at the military medical facilities. This activity will improve the quality of health care provided and the number of health care providers to support a minimum of 1000 HIV patients at 4 military treatment sites. Additionally 200 nurses will be trained. The specific objectives are: to provide ward and clinic supervisors/nurses with the knowledge base to provide optimal care of HIV patients in hospital ward inpatient settings and outpatient clinic settings and to promote awareness of infection control, universal precautions, post-exposure guidelines and confidentiality needs.

To achieve these objectives, the following activities are proposed: intensive training in the basics of HIV nursing care to ward and clinic supervisors/nurses; support a "visiting Professor" nursing expert to make "rounds" at clinics and hospitals providing care to HIV infected patients; and facilitate and assist in the development of practical steps to implement universal precautions and post-exposure guidelines. COE will also coordinate with the University of Hawaii, John A Burns Medical School (UH), and various experts from the US military to provide technical assistance when needed. Training will also include the basics of HIV care and management, specific symptomatic treatment/prevention protocols, confidentiality protocols and infection control procedures. An overview of HIV nursing care issues relevant to a broader nursing population and other allied health professions will also be offered. The training will be offered at key military hospitals and clinics and military ARV sites: Military Hospital 103 (Hanoi), Military Hospital 175 (Ho Chi Minh City), Military Hospital 121 (Can Tho City), Military Hospital 17 (Danang province).

Training of nurses and other allied health professionals will increase the human resources and build the capacity of the Vietnamese military medical professionals to provide quality HIV/AIDS treatment, care and support.

Funds requested for this activity will include official travel costs and technical oversight for DOD HIV treatment & prevention in program design, implementation and evaluation.

This activity is linked to HVCT MOD (9510).

The Center of Excellence - DMHA, the executing agent for US DOD's Pacific Command, will provide program oversight and coordination of activities with DOD partners and the Vietnam Ministry of Defense. Technical assistance and oversight will be provided for program design, implementation and evaluation of CT activities. Funds will cover official travel and cost incurred by the DOD HIV Prevention and Treatment team.

This activity is linked to HVOP MOD (9478) and HVOP UNAIDS (9477).

The Center of Excellence in Disaster Management and Humanitarian Assistance (COE), the executing agent for US DOD's Pacific Command, will provide program oversight and coordination of activities with DOD partners and the Vietnam Ministry of Defense. Requested funds will be used to cover costs incurred by the DOD HIV Prevention and Treatment team, in provision of technical oversight, program design, implementation and evaluation of program activities, including official travel and logistical support. Funds will also cover a percentage of salaries benefits, official travel of 1 LES Program Officer.

Targets

Target Target Value Not Applicable Number of service outlets providing antiretroviral therapy
Number of individuals who ever received antiretroviral therapy by
the end of the reporting period Number of individuals receiving antiretroviral therapy by the end of
the reporting period Number of individuals newly initiating antiretroviral therapy during
the reporting period Total number of health workers trained to deliver ART services,
according to national and/or international standards

Table 3.3.12: Program Planning Overview Program Area: Laboratory Infrastructure Budget Code: HLAB Program Area Code: 12 Total Planned Funding for Program Area: $ 2,700,000.00

Program Area Context:

Program Area Setting In support of Vietnam's National HIV/AIDS Strategy, PEPFAR provides support to both MOH/Vietnam Administration of HIV/AIDS Control (VAAC) and the Ministry of Defense (MOD) to establish laboratories of national and international standards for HIV diagnosis, surveillance, and monitoring of care and treatment. VAAC manages laboratory operations for the civilian population through two divisions: VAAC, which provides oversight to the National Institute of Hygiene and Epidemiology (NIHE) that is responsible for the HIV diagnostic network; and the Department of Therapy, which oversees the clinical laboratory network. Each network is composed of 3 regional and 64 provincial laboratories, with PEPFAR supporting HIV diagnostic laboratories in all 64 provinces and clinical provincial laboratories in the current 6 focus provinces. The MOD diagnostic and clinical laboratory network comprises 4 hospitals supported by PEPFAR and is autonomous from the civilian laboratory system. Laboratory activities in Vietnam build upon recommendations from a 2004 international laboratory consultation. Gaps identified from this consultation include the need for a lead quality assurance (QA) agency, provision of External Quality Assessment (EQA) for national, regional and provincial laboratories, improved laboratory capacity for treatment and monitoring, participation by national institutes in planning for improving laboratory systems, and guidelines to implement government laboratory policy.

Key Accomplishments As reported in the FY06 semi-annual report, PEPFAR has supported diagnostic and clinical laboratory services in 59 VCT sites, 22 PMTCT and ART monitoring sites and 58 palliative care sites. Over the past 6 months, 3,248 PLWHAs received clinical monitoring (i.e. CD4, hematology, biochemistry, TB and syphilis). NIHE received PEPFAR support for critical laboratory activities including training in BED incidence testing; implementation of the first national EQA program for HIV diagnostic testing; development of protocols for evaluating rapid HIV test algorithms; and introduction of an HIV drug resistance threshold survey. Other accomplishments in the last year include initiating a Laboratory Information System (LIS) at two sites for specimen tracking; training the National Institute for Infectious and Tropical Diseases on diagnosis of opportunistic infections (OI); and procurement of CD4+ T-lymphocyte count equipment including training. In the past year, PEPFAR and WHO co-sponsored the first Asia Regional Conference on HIV drug resistance, which resulted in the establishment of national HIV drug resistance planning committees for 6 countries in the region.

Challenges/Opportunities Outreach CT has been limited in Vietnam because there is no VAAC policy for using rapid tests alone for HIV diagnosis (rapid testing is approved only for use in combination with the ELISA technique and for surveillance and research purposes). Only 3 of the 12 rapid tests kits approved by VAAC have been evaluated for HIV strains prevalent in Vietnam. PEPFAR and VAAC are currently coordinating an evaluation of rapid HIV testing algorithms. When the results are available in early 2007, NIHE and partners will develop an algorithm for broader field evaluation, which will allow increased use of outreach CT. However, given the current policy constraints, PEPFAR has not allocated funds for a HIV rapid testing and training package. Other challenges for the strengthening of the national laboratory network include poor data capturing practices preventing accurate estimations of laboratory indicators. In addition, the existence of 2 separate VAAC laboratory networks for HIV diagnostic testing and clinical monitoring hinders efficient referral practices and prevents the designation of a single supervisory body responsible for managing all HIV-associated laboratory practices and standardized implementation of policies.

Key Strategy Elements The FY07 PEPFAR laboratory strategy for Vietnam complies with the Vietnam National HIV/AIDS Strategy as well as the PEPFAR Vietnam 5-Year Strategy that emphasizes prioritization of laboratory capacity and strengthening of laboratory QA/QC to support HIV/AIDS diagnosis, monitoring and surveillance. Laboratory activities will focus on strengthening and building capacity in the clinical laboratory network while still

meeting the needs of the HIV laboratory diagnostic network. To support PEPFAR FY07 targets for prevention, care, and treatment, laboratory networks in Vietnam will expand to support HIV diagnosis and patient monitoring and increase targets to 300,000 tests including monitoring of patients on methadone. Through new cooperative agreements with NIHE, VAAC and implementing partners in the US Laboratory Consortium, PEPFAR will support the drafting of the first five-year national strategic plan for laboratories through: the development and implementation of a comprehensive needs assessment for the two laboratory networks in the 7 focus provinces; development of national standards for laboratory management, strengthening of QA measures including development of standard operating procedures (SOPs) for all laboratory operations and a phased approach for systems strengthening; implementation of the national strategy through national training with a focus on bio-safety and preventive maintenance; monitoring and evaluation of the laboratory network through EQA including procuring panels and expanded on-site supervision; and expansion of the LIS to include more laboratories and use of standardized paper-based methods to link the 2 laboratory networks. LIS will also support program M&E activities and collection of STI, OI, TB diagnosis data and other routine patient monitoring indicators. PEPFAR will support the Government of Vietnam (GVN) with commodity management strengthening, including examining the potential for the use of the Supply Chain Management System (SCMS) for procurement assistance and service contracts for equipment maintenance. To build sustainability in laboratory infrastructure and human capacity, PEPFAR will assist NIHE in the development of a training program for laboratory students, support training for national and provincial laboratory staff, and strengthen the referral network by using the diagnostic laboratory network as a model for building regional hubs for complex clinical testing. PEPFAR will support referral of 24,000 TB patients for HIV screening and confirmatory testing in 4 focus provinces. All PEPFAR laboratory activities will be integrated into this National Laboratory Strategy.

These laboratory activities are being planned and implemented in collaboration with other major laboratory partners in Vietnam, including the Global Fund, Ensemble Solidarite Therpeutique Hospitaliere En Reseau (ESTHER), Medecins du Monde (MDM) and MOD for clinical testing to monitor patients on ART; the Clinton Foundation and SCMS/Management Sciences for Health for equipment and test kit procurement and forecasting; the National Serology Reference Laboratory, Australia, the Ministry of Public Health/Thailand and the US Laboratory Consortium for national training on QA, EQA and laboratory management; NIHE for HIV drug resistance monitoring including genotypic sequencing, designation of a National Reference Laboratory for clinical testing to standardize and monitor testing procedures centrally and approval for use of DNA PCR test and dried blood spots (DBS) for infant diagnosis; Ho Chi Minh City Provincial AIDS Committee (HCMC-PAC), a provincial coordination body, for design of a Biosafety level-three laboratory; and the Association of Public Health Laboratories (APHL), the Hanoi School of Public Health (HSPH) and VAAC for the implementation of LIS and record keeping. PEPFAR will support MOD to implement blood safety activities in 4 hospitals.

Program Area Target: Number of tests performed at USG-supported laboratories during the 350,000 reporting period: 1) HIV testing, 2) TB diagnostics, 3) syphilis testing, and 4) HIV disease monitoring Number of laboratories with capacity to perform 1) HIV tests and 2) CD4 tests 10 and/or lymphocyte tests Number of individuals trained in the provision of laboratory-related activities 351

Table 3.3.12:

The US Pacific Command, Center of Excellence (COE) will work in partnership with the Vietnam Ministry of Defense (MOD) to promote policy development and leadership in HIV/AIDS within the MOD by supporting participation of key military leaders at workshops and training programs.

In FY07, this activity will support the participation of 6 key military leaders in international conferences, training programs and professional exchanges. This activity will enable military leaders to engage in dialogues on policies with the international military and civilian communities. Four international meetings, including a regional HIV/AIDS conference and the Asia Pacific Military Medicine Conference (APMMC), will provide a forum for professional exchange of information and will serve as platforms for MOD officers to share ideas and best practices in HIV/AIDS policy development. It is expected that these exchanges will also promote documentation and experience sharing of the MOD's work in HIV, and will support linkages with regional and international military medicine and HIV activities.

The international military community offers a variety of perspectives and policies that MOD can explore and reference to address HIV/AIDS with its own troops and the civilians served within the military health care system. PEPFAR funding will promote exchanges to enable MOD to explore what other militaries offer as evidence-based solutions and share their own experiences with HIV/AIDS activities. This will engage MOD leadership in the HIV/AIDS international dialogue and sustain support for other critical HIV activities such as capacity building for counseling and testing and care and treatment within the military health care system. These exchanges and similar engagements will be planned with military counterparts in the Asia-Pacific region and MOD officials.

PEPFAR will support technical consultation for this program area. The HIV prevention and treatment team from the COE will provide technical oversight in program design, implementation and evaluation.

Funds requested will support overall PEPFAR DOD program management and oversight, including operations, management, procurement, coordination and staff salaries, benefits and official travel costs for a USDH Program Manager and a LES Program Management Assistant.

These funds will also be used to pay for related office support including communications, equipment, miscellaneous procurement of supplies and services etc.

Table 3.3.15:

The DOD program in Vietnam subscribes to ICASS services to cover administrative and personnel costs associated with supporting 1 US Direct Hire and 2 LES. DOD FY07 estimate for ICASS costs for DOD is $65,000.

Table 3.3.15:

Funds will be used to contribute to the State Department's OBO Capital Security Cost Sharing (CSCS) program for the PEPFAR/DOD team. The funds collected under this program are used to provide the State Department Overseas Buildings Office funding to build and renovate chanceries and consulates throughout the world. Costs are calculated based upon the per capita costs associated with 1 US direct hire, and 2 LES housed in non controlled access areas within US Embassy.

Table 5: Planned Data Collection

Is an AIDS indicator Survey(AIS) planned for fiscal year 2007?  Yes
No If yes, Will HIV testing be included?  Yes  No When will preliminary data be available? Is an Demographic and Health Survey(DHS) planned for fiscal year 2007?  Yes
No If yes, Will HIV testing be included?  Yes  No When will preliminary data be available? Is a Health Facility Survey planned for fiscal year 2007?  Yes
No When will preliminary data be available? Is an Anc Surveillance Study planned for fiscal year 2007?  Yes
No if yes, approximately how many service delivery sites will it cover? When will preliminary data be available? Is an analysis or updating of information about the health care workforce or the
Yes  No workforce requirements corresponding to EP goals for your country planned for fiscal year 2007?

Other significant data collection activities

Name: Routine M&E for all program activities Brief description of the data collection activity: All program activities will have routine monitoring and evaluation data collected for program planning and mid-course adjustments as necessary. Preliminary data available:

Name: Enhanced patient monitoring Brief description of the data collection activity: Enhanced patient monitoring will be conducted in a sample of clinics to provide beter outcome data on treatment. These data will be used for continuous quality improvement of services. Preliminary data available:

Name: IBBS Brief description of the data collection activity: Integrated behavioral and biomarker surveillance will be incorporated into sentinel surveillance beginning in FY07 Preliminary data available:

Name: Sentinel Surveillance Brief description of the data collection activity: Routine Sentinel surveillance with focus on ANC and MARPs Preliminary data available:

Name: Clients of CSW Brief description of the data collection activity: This will be a general population survey focusing on identifying clients of commercial sex workers (CSW) Preliminary data available: