This activity is linked to HVAB TBD Provincial Outreach Coordinators (9486) and HVOP TBD Provincial Outreach Coordinators (9600).

(This TBD is being allocated to PACT. BCC innovation willbe indirect, assisting partners to improve outreach capacity. Accordingly, targets will also be indirect. Direct targets are not applicable.)

Pact/Vietnam, in consultation with MOH/VAAC, will lead behavior change communications (BCC) innovation efforts to adjust to a changing epidemic and access hard-to-reach commercial sex workers (CSW), injecting drug users (IDU) and other at-risk populations. Pact/Vietnam will initially support Pact partners, but eventually work with all PEPFAR partners to apply the results of the 2006 Boston University outreach assessment (to be completed) and the 2006 PEPFAR Prevention Technical Assistance visit to improve the effectiveness of BCC outreach to hard-to-reach, most-at-risk populations. Pact/Vietnam will work with partners targeting establishment-based female CSW, IDU and vulnerable youth in places where the epidemic is most severe and where timely intervention will contribute to population-level declines in HIV infection rates.

Ensuring that women and youth have equitable access to a culturally appropriate network of prevention, care and treatment services will contribute to the achievement of PEPFAR goals for Vietnam, including averting new HIV infections and providing ART to 22,000 PLWHA. The PEPFAR community outreach strategy in Vietnam currently employs two complementary approaches: a peer education approach and a health educator approach. In the peer education approach, current or former heroin injectors are employed to reach other IDU with HIV prevention messages and to promote CT. Under the second model, young people are employed and trained to work as health educators. Often based at drop-in centers, these health educators contact community IDU, teaching injectors how HIV can be avoided, supplying condoms, and referring clients to CT and other HIV services. No assessment has been performed to identify the most cost-effective outreach model(s) for Vietnam. Recent evidence, however, suggests that law enforcement efforts have driven most at-risk populations (MARPs) beyond the reach of traditional outreach models. For example, there is a shift among sex workers from the street and into entertainment establishments. Drug users are also more difficult to contact in the wake of large-scale assignment to 06 centers, government centers for rehabilitating drug users.

Using the findings and recommendations of the 2006 Boston University outreach assessment, Pact/Vietnam will work with partners to improve the quality and effectiveness of currently employed BCC outreach strategies. Technical assistance will likely include training workshops and one-on-one coaching and mentoring. Support will be undertaken in coordination with the PEPFAR provincial outreach coordinator. Improved interpersonal approaches will demonstrate how programs can reach entertainment establishment-based sex workers, hidden drug users in the community and vulnerable youth. In conjunction with the SI team, provincial outreach coordinators will monitor success in terms of contacts and referrals to CT and other HIV services including substance abuse treatment. As the innovative programs demonstrate success, PEPFAR will utilize joint training sessions with other donors, the MOH/VAAC, and Provincial AIDS Committees (PAC) to leverage resources, maximize coverage with improved strategies and build sustained national capacity to address local HIV prevention needs.

This program will address the following emphasis areas: Information, Education, and Communication; development of network/linkage/referral systems; and training. Specific target populations are most at risk populations including CSW, IDU and MSM.

In this technical assistance role, Pact/Vietnam will assist PEPFAR partners working in all six priority provinces to achieve greater outreach targets. Pact's own targets will be indirect.

This activity is linked to HVAB TBD Provincial Outreach Coordinators (9486), HVOP MOH (9627) and HCMC PAC (9625).

The funds for this activity will support a targeted program for commercial sex workers (CSW) who are injecting drug users (IDU), including a needs assessment, program design, and implementation. The goal of the activity is to provide equitable access to HIV prevention programs and meet the needs of vulnerable women and their families. Interactive outreach programs will reach 1,000 women at double jeopardy of HIV infection through sex work and injecting drug use.

Recent anecdotal and observational evidence suggests that CSW/IDU (CSW who also inject) is an increasing concern. Greater numbers of sex workers are also IDU, and IDU may serve as a catalyst for initiation of sex work. In some cases women use drugs because they have IDU boyfriends or partners. Others enter sex work to pay for drug habits and some start drug use after entering into sex work. Based on recommendations from a 2006 PEPFAR Prevention Technical Assistance visit, TBD partner will conduct a needs assessment, develop an innovative outreach model and implement the model, training 40 outreach workers to target HCMC and Haiphong CSW/IDU.

First, TBD partner will conduct a needs assessment, reviewing existing evidence and gathering field data in two key focus provinces where the epidemic is most severe. The assessment will employ confidential individual and group interviews. Detailed information will be collected on the numbers of CSW/IDU; their access to CT and the network model; access to drug and alcohol abuse treatment; resources available for those who want to leave sex work; and special services needed by CSW/IDU. This will be closely coordinated with a planned 2006 MOH/VAAC assessment of nationwide risk reduction HIV prevention activities.

Second, TBD partner will develop a model targeting CSW/IDU. The model may include special forms of outreach for CSW/IDU; alternately all CSW outreach teams may participate in specialized drug and alcohol counseling and education training. TBD partner will provide concrete advice on: how PEPFAR outreach programs can best access CSW/IDU; other donors or partners with whom PEPFAR might cooperate; key elements and strategies for CSW/IDU interventions; and suggestions for improving referral. The PEPFAR provincial outreach coordinators will work with TBD partner to ensure recommendations are included in new and innovative program activities.

Third, the model will be implemented in at least two provinces—including Haiphong and Ho Chi Minh City—where the case managers and addictions counselors have been trained with PEPFAR support in the past two years. At least 1,000 women will be given condoms, referrals to substance abuse treatment, resources for women who want to leave sex work, treatment for sexually transmitted infections (STI), access to CT and other care and treatment options. As necessary, interactive outreach will link women to PMTCT, family planning, and counseling for discordant couples.

This TBD is being allocated to PSI through Pact. Primary focus of this intervention during year 1 will be needs assessment and model development. Accordingly, we request the targets be reduced until full implementation is possible in year 2.

This activity is related to HBHC (#9558) and HVOP (#9627).

Building on experience working with Viet Nam's medical education system, the Ministry of Health and Ministry of Education and Training, Pathfinder International will introduce HIV prevention training into the six year undergraduate medical program in Viet Nam.

Through a pilot initiative, Pathfinder will develop a framework for integrating a comprehensive, skill-oriented curriculum for HIV prevention, including substance abuse prevention and treatment, at Hai Phong Medical School and one other medical school to be selected in discussion with the Ministry of Health, Ministry of Education and Training, the Vietnam PEPFAR team and others. Working closely with the dean board and relevant departments, Pathfinder will provide technical assistance to conduct a needs assessment, identify gaps in the current curriculum, propose new or updated topics to be taught, develop a clinical rotation plan, and provide selective HIV prevention technical updates to faculty members and staff.

The project will begin in Hai Phong Medical School, a current partner of Pathfinder's reproductive health medical education project. Pathfinder will collaborate with PEPFAR-supported programs operating in Hai Phong, including FHI's training initiative for addiction counselors and case managers, and the newly approved methadone pilot program, both of which provide an opportunity for field-based practicum for medical students. Technical inputs, particularly related to substance abuse prevention and counseling, will be provided from UCSF experts with experience working in Viet Nam.

Pathfinder will ensure strong engagement of other medical and secondary medical schools in the project, which will facilitate the application of the new prevention curriculum within other medical schools and adapted for use in the secondary medical schools and in university-level nursing and pharmacy programs. Efforts this year will focus on developing the framework for integrating an HIV prevention curriculum, conducting a needs assessment, and providing select technical updates to faculty and staff of Hai Phong Medical School, all of which will readily be taken-up in the following year on a broader scale.

(Need complete activity narrative).

Through a competitive process, Pact will provide financial and technical support to a local partner or local-international NGO partnership TBD to assess the extent, nature, and consequences of gender-based violence (GBV) among women living with HIV, with Sentinel surveillance data indicate that prevalence among pregnant women increased from 0.02% in 1994 to 0.37% in 2005, and had reached 1% in high prevalence provinces by 2005.

As in other countries, Vietnamese women living with HIV are more likely to e

Although PEPFAR has supported small-scale initiatives that respond to the particular needs of women living with HIV in Vietnam, these have limited reach and scalability. A more systematic response is needed, based on a careful assessment of women's exper