This is a continuing activity from FY07.

FY08 funds will continue to support Ho Chi Minh City's (HCMC) strategy to expand PMTCT services in the

city. In FY08, activities will focus on: 1) expanding services to two general hospitals and reproductive health

centers; 2) improving the quality of services, especially referrals; 3) promoting early HIV testing during

antenatal care (ANC); 3) assessing the reasons for loss to follow up of women and evaluation of the

effectiveness of the program; and 4) finalizing and implementing the PMTCT monitoring and evaluation

software.

HCMC has the highest number of HIV-positive pregnant women (over 600 per year). From Aug 2006 to July

2007, 150,000 pregnant women received HIV counseling and testing and 751 HIV-positive women were

identified. Among those, 524 women and 526 children received ARV prophylaxis. HCMC also has the

highest service coverage in the nation, with 90% geographic and numeric coverage and all 24 districts and

208 communes providing PMTCT services.

In FY08, PEPFAR will continue to support HCMC Provincial AIDS Committee (HCMC PAC) to expand

PMTCT services to two city general hospitals and the City Reproductive Health Center where a significant

portion of the city's pregnant women come to seek ANC.

PMTCT is integrated into routine ANC, and "opt-out" testing will be implemented at all sites. Currently,

PEPFAR supports ARV prophylaxis at two obstetrics hospitals and six district health centers, where women

are referred from other districts. However, to ensure timely access to ARV prophylaxis and reduce travel

time for pregnant women, more district health centers will provide ARV prophylaxis in FY08. Clinical staging

and evaluation for OIs, TB, cotrimoxazole prophylaxis and treatment during and after pregnancy for mothers

are provided at affiliated out-patient clinics (OPCs). HIV-positive women will be referred for STI screening

and treatment, women with genital ulcers or urethral discharge will be counseled and provided with HIV

testing in order to improve primary prevention.

Activities will also focus on strengthening linkages between OB/GYN hospitals, community, and OPCs to

reduce loss to follow-up of mother-infant pairs. More OPCs, supported by different donors are now

available through out the city, making it easier to refer pregnant women before and after birth for follow-up

care and treatment. This will be accomplished through standardized referral forms and service providers

and OPC case managers' frequent communication to patients. The family-centered care model will be

applied at all levels if possible, where PMTCT, pediatrics and adult care and treatment will be provided in

the same location or area, making it more convenient for family members to access services.

Health workers at the commune level will receive refresher training to improve counseling, education and

care skills to support HIV-positive women, their partners, and children born to HIV-positive mothers and to

support early referral to OPCs, legal and vocational support, and other social support services. Community

health care workers and case managers will continue to serve as educators and adherence supporters

during the antenatal period. They will play an integral role in linking women, children and their families to

comprehensive services available in HCMC, including counseling and testing, care and treatment,

community- and home-based care and additional OVC services including a new drop-in center that will

provide psychosocial support through trained case manager and support groups.

More than 50% of HIV-positive pregnant women were identified at the two city OB hospitals where testing is

not free of charge. The result is about half of HIV-positive pregnant women delivering at city OB hospitals

were diagnosed at labor, too late for long term prophylaxis and sometimes even single-dose NVP. Starting

in FY07 and increasingly in FY08, PEPFAR will provide HIV test subsidization to the two city hospitals to

increase the number of HIV-positive pregnant women diagnosed during ANC. Social marketing activities

such as media interventions to increase awareness of HIV testing and PMTCT services will also aim to

increase service assessment and uptake of HIV testing among pregnant women.

In FY08, PEPFAR will support HCMC PAC to carry out a survey to determine the reasons for loss to follow

up of women once discharged from OB hospitals. PEPFAR will also support HCMC PAC to assess the

effectiveness of the program and identify program gaps.

Starting in FY06, PEPFAR has been supporting HCMC PAC to develop computer software for PMTCT

patient and data management. In FY08, in addition to continued improvement of the paper-based reporting

system, HCMC PAC will complete the development of PMTCT software and will pilot the software at

selected city and district sites. This reporting system is in line with and will support data collection and

reporting to the national monitoring and evaluation system.

This is a continuing activity from FY07. The narrative below is unchanged from the FY07 COP. Major

updates to this activity since approval in the FY07 COP are:

• In the first six months of FY07, 3,582 new high-risk individuals were contacted through peer outreach and

provided with BCC messages and risk reduction counseling. Of these, 1,692 (47%) received voluntary

counseling and testing services. Peer education and referral services were also provided to 1,200 residents

in Nhi Xuan rehabilitation center. A core group of 10 non-using peer educators was formed to provide HIV

and relapse prevention services to returnees from rehabilitation centers in collaboration with drug addiction

counselors/case managers in Districts 1 and 4.

• In FY08, PEPFAR will continue to support HCMC-PAC to improve the quality of outreach services through

quality assurance mechanisms, refresher training, and ongoing technical support for peer educators.

Linkages/referrals between community outreach and VCT, HIV care and treatment services, STI services

for high-risk individuals, drug treatment, and job placement services will continue to be strengthened.

Enhanced risk reduction counseling, addiction and relapse prevention services will be added to the current

service package at MARP-friendly community centers.

• In FY08, PEPFAR will support HCMC-PAC to expand peer outreach activities into two additional districts:

Binh Chanh and Go Vap. With PEPFAR support, HCMC-PAC will hire 32 health educators in Districts 1, 3,

10, and Binh Thanh to adequately address the needs of establishment-based CSWs. Health educators will

be part-time female students studying medicine/health or the social sciences. In addition, HCMC-PAC will

pilot the provision of HIV prevention messages to migrant workers in their temporary housing in Binh Chanh

and District 7. Collaborators will be professional health workers and respected elders in the community.

Efforts will also be made to reach sexual partners of high-risk people through facilitating partner

notification/referrals among IDU, CSW and PLWHA.

• In FY08, 14,000 high-risk individuals will be reached with high quality BCC services, and 200 individuals

will be trained in promoting HIV prevention.

FY07 Activity Narrative:

The Ho Chi Minh City Provincial AIDS Committee (HCMC-PAC) takes the lead on peer driven outreach in

HCMC, coordinating all HIV services and assisting former residents of government centers for rehabilitating

drug users (06 centers), reintegrate into home communities. PEPFAR will partner with HCMC-PAC to train

90 peer educators in behavior change communication (BCC) for HIV prevention targeting intravenous drug

users (IDU), commercial sex workers (CSW) and their partners. HCMC-PAC peer educators will reach

4,000 IDU, 3,500 CSW, and 2,500 former 06 center residents. These activities support drug use and sex

work reduction goals outlined in the Vietnam National HIV/AIDS Strategy and the PEPFAR Vietnam Five-

Year Strategy. PEPFAR will work closely with the HCMC-PAC to provide financial and technical assistance

for implementation, monitoring, and evaluation.

With PEPFAR support, 64 trained peer educators will teach at-risk populations skills to adopt safer

behaviors and how to access network services such as counseling and testing, care and treatment, an array

of drug and alcohol abuse treatment options, and STI services. High-risk individuals will receive condoms

as part of a comprehensive ABC approach to reduce risk from drug injection and commercial sex. Outreach

workers will refer clients to peer support groups, drop-in centers, vocational skills training, and job

placement. PEPFAR will fund continued outreach in HCMC Districts 1, 2, 4, and 10; however, the 2006

outreach assessment will inform innovative interpersonal strategies to improve equitable access to

HIV/AIDS services for drug-using CSW, establishment-based CSW, and cell phone-based or scooter-based

CSW. Though many donors sponsor outreach in HCMC, peer interventions will be planned in cooperation

with the HCMC provincial outreach coordinator to avoid redundancy in districts where other partners (FHI,

TBD-PSI follow-on, Save US, MdM France, and non-USG funded) work.

FY07 funds will also support a HCMC-PAC HIV/AIDS Prevention and Education Center. This center will

offer space for group meetings, refresher training, and for clients to learn risk reduction skills. The HCMC

provincial outreach coordinator will host coordination meetings and training sessions in the Prevention and

Education Center, facilitating networking among different outreach groups and other service providers.

PEPFAR will build on the foundation of an FY06 pilot for comprehensive release planning and aftercare for

residents of the Nhi Xuan 06 center. To strengthen traditional outreach in target districts an additional 26

non-drug using peer educators will target former Nhi Xuan 06 center residents as they return to home

communities and to the Nhi Xuan industrial zone. Both center-based and community-based non-using peers

will counsel former residents to prevent relapse and refer them to counseling and testing, HIV care and

treatment, case managers, and employment services.

This is a continuing activity from FY07.

The Ho Chi Minh City Provincial AIDS Committee (HCMC PAC) is the principle PEPFAR partner providing

clinical care and support for PLWHA in HCMC. The PEPFAR Vietnam 2007 semi-annual program report

(SAPR) reported that there were 8,444 PLWHA provided with basic palliative care services at nine HCMC

PAC-supported out-patient clinics (OPCs).

HCMC has the largest number of PLWHA of the 64 provinces in Vietnam. It is estimated that the number of

HIV cases in HCMC will increase from 72,400 in 2006 to 89,900 in 2010, including 1,750 HIV-infected

children in 2006 and 3,850 in 2010. In line with the PEPFAR Vietnam 5-Year Strategy to increase care and

support services to 110,000 PLWHA by September 2009, HCMC PAC will continue its partnership with

PEPFAR to boost local capacity to care for HIV-infected individuals in clinical settings, with strong linkages

to community- and home-based care. In FY08, HCMC PAC will maintain palliative care services at 11

existing OPCs and expand to two others, as well as maintain the two methadone clinics set up by HCMC

PAC in FY07. Based on the National Palliative Care Guidelines and OGAC guidance, HCMC PAC will

support a comprehensive package of services (see Palliative Care Basic program narrative). Sexually

transmitted infection (STI) diagnosis and treatment will be strengthened through linkages with STI services,

including the HCMC Dermato-Venereology (DV) Hospital and district DV clinics, and supported by PEPFAR

and the UK's Department for International Development (DfID). Patients registered at HCMC PAC OPCs

will also be provided quality counseling via case managers and referrals to PMTCT, TB/HIV care, drug

addiction treatment, and psychosocial support services in their communities, which include referrals to

PLWHA support groups and the SMARTWork employment program.

In collaboration with the central drug procurement agency, HCMC PAC will purchase and distribute

opportunistic infection (OI) and home-based care drugs, lab supplies, and other commodities to all PEPFAR

-supported sites in HCMC in a timely fashion. PEPFAR will support methadone procurement and

distribution to maintain three PEPFAR-supported HCMC PAC methadone clinics linked to HIV service

delivery in existing OPCs in HCMC. HCMC PAC will also procure drug urine test kits for all six pilot

methadone clinics in Vietnam.

PEPFAR will support home- and community-based care and support for all PLWHA receiving care at HCMC

PAC sites. PEPFAR will continue the efforts started in FY07 to assist very poor households to access low-

cost, nutritious meals and food supplements. In addition, programs will assist PLWHA with hospitalization

fees and transportation to clinics, and assist with referrals as needed.

With support from PEPFAR partners, HCMC PAC will provide initial and refresher training on stigma

reduction in the health care setting, clinic operational procedures, counseling and laboratory procedures for

healthcare providers, training to improve antiretroviral therapy (ART) readiness and adherence for patients

and caregivers, and training on medication assisted treatment (MAT) for healthcare providers in accordance

with national methadone guidelines.

With support from the PEPFAR Strategic Information and the PEPFAR Care and Treatment teams, HCMC

PAC will improve patient care monitoring, program monitoring, and quality assurance tools in support of the

national M&E system. PEPFAR will continue to support HCMC PAC to develop and apply patient monitoring

software in all OPCs in HCMC.

This is a continuing activity from FY07.

In FY08, activities in Ho Chi Minh City (HCMC) will closely follow those being implemented by the Ministry

of Health (MOH) at the national level.

• In TB patients, PEPFAR will continue to support provider-initiated HIV testing and counseling (PITC) in all

public TB clinics, with an expected target of testing 12,000 TB patients.

• In PLWHA, PEPFAR will support screening for TB disease, using symptom screening, physical

examination, and chest radiography. PEPFAR will support screening of TB disease in 5000 PLWHA and

INH preventive therapy in 400 PLWHA.

• HIV-infected TB patients will receive HIV care and treatment through district-based HIV clinics and through

an HIV clinic at the provincial TB hospital. In the provincial TB hospital, PEPFAR will provide ART for 400

and care for 800 HIV-infected TB patients. A comprehensive plan was developed in FY07 for transitioning

HIV-infected patients from the TB hospital to the current district ART sites; PEPFAR will support effective

implementation of this plan. PEPFAR will also support a new, 100-bed HIV/AIDS department at the

provincial TB hospital.

• At least 150 persons will be trained in the public and clinical management of TB/HIV to improve timeliness,

completeness and quality of reporting about TB/HIV collaborative activities.

In FY07, PEPFAR supported the HCMC Provincial AIDS Committee ( HCMC PAC) to implement routine

PITC for TB patients and referral to HIV services for HIV-infected TB patients, covering 12,000 TB patients

in 24 districts annually. All PEPFAR-supported districts in HCMC perform active case finding for TB in HIV

patients presenting for care and treatment, and have implemented modified national TB program registers

to monitor and evaluate HIV services provided to HIV-infected TB patients. In 2007, the provincial TB

hospital provided ART for 300 and care for 600 HIV-infected TB patients and their family members. Over

100 Vietnamese nationals have received training in TB/HIV diagnosis, treatment, and management.

FY07 Activity Narrative:

At one provincial TB hospital, PEPFAR will support expansion of RCT in TB settings to 8,000 persons in all

districts in HCMC, provide ART for 200 TB/HIV patients, care for 600 TB/HIV patients, support treatment for

TB disease for 3,000 PLWHA and train 50 persons to provide clinical prophylaxis and/or TB treatment for

PLWHA.

RCT for TB patients and TB screening for HIV patients in HCMC: In FY06, PEPFAR supported HCMC

Provincial AIDS Committee (HCMC PAC), a provincial coordination body, to begin RCT in 50% of all

districts. For FY07, PEPFAR will support HCMC PAC to scale-up this model to include all districts with an

additional focus on supporting drug rehabilitation centers, as requested by HCMC PAC and approved by

OGAC, to improve diagnosis and outcomes and to assure adequate screening to facilitate the transition of

clients from the centers to the community. The program monitoring system will also be strengthened

through refinement of paper-based data collection instruments, and routine data analysis and feedback to

sites, to improve timeliness, completeness and quality of reporting about TB/HIV collaborative activities in

HCMC.

HIV Care and ART at Provincial TB Hospitals: An out-patient clinic (OPC) for TB/HIV patients has been

established at Pham Ngoc Thach TB Center in HCMC through a joint effort by the Global Fund (GF),

HHS/CDC and HCMC PAC. As agreed upon with GF, PEPFAR will take over the management of this clinic

in FY07. Funding through PEPFAR palliative basic and ARV services will be used to continue support for

cotrimoxazole, routine laboratory testing, care and when appropriate ART in this clinic (no TB/HIV PEPFAR

funds are requested for this activity). Diagnostic services will continue to be supported through infectious

disease regional funds provided through USAID (non-PEPFAR funds) as part of a targeted evaluation to

establish clinical algorithms to diagnose TB in HIV-infected patients.

This is a continuing activity from FY07.

In FY08 PEPFAR will support Ho Chi Minh City Provincial AIDS Committee (HCMC PAC) to strengthen the

provision of care and support services for OVC and their caregivers. This activity will focus on HIV-positive

children and infants exposed to HIV served by pediatric out-patient clinics (OPCs) at Pediatric Hospital #1

and Pediatric # 2 in HCMC, which serve children from a number of neighboring provinces. Through this

activity initiated in FY07, PEPFAR will keep supporting the provision of a wider range of services, designed

to better meet the developmental needs of each child. OVC services will be mainly provided at both

pediatric hospitals, as well as through referring for more comprehensive services to available sources in the

city. Through this activity, 190 OVC will receive services, and 240 caregivers will be trained to provide

services to their families at home.

The pediatric HIV/AIDS OPCs will provide a core set of OVC services including needs assessment with

OVC and caregivers, counseling and psychosocial support, food/nutrition support (in accordance with

PEPFAR guidelines), provision of formula for PMTCT, support for transportation, and referral to other

services including PMTCT, clinical care for PLWHA caregivers, and social support services for OVC and

caregivers. In coordination with other PEPFAR partners and other donors, case managers will refer patients

of pediatric clinics to other OVC services which are available in the city and to ensure duplication of services

does not happen. Case managers in collaboration with clinic staff will provide trainings on caring for children

at home for caregivers.

PEPFAR will support HCMC PAC to coordinate OVC implementers in HCMC including PEPFAR partners

and other donor agencies through a network with quarterly conferences.

PEPFAR will provide intensive and ongoing capacity-building and technical assistance to ensure consistent

and quality programming, including training courses, mentoring, coaching, and support to bring OVC

partners together to problem-solve, and share experiences and resources. (See HKID TBD 9552).

This is a continuing activity from FY07. The narrative below is unchanged from the FY07 COP. Major

updates to this activity since approval in the FY07 COP are:

• Same-hour test result notification will be expanded to all VCT clinics in Ho Chi Minh City (HCMC) based

on results of a pilot in 2007.

• An outreach-based VCT model targeting most at-risk populations (MARPs) will be replicated in HCMC

based on the results of a pilot in 2007 in Hai Phong.

• A provider-initiated HIV testing and counseling (PITC) model will be initiated in two STI clinics in HCMC.

FY07 Activity Narrative:

PEPFAR will support HCMC Provincial AIDS Committee (HCMC PAC) to implement counseling and testing

(CT) services at nine CT clinics in FY07, train 60 healthcare workers in CT, provide HIV test results to

13,000 individuals, and strengthen the social marketing program.

In FY06, through a cooperative agreement with HCMC PAC, PEPFAR, as part of a comprehensive

reintegration program, is supporting seven CT clinics; five clinics in Districts 1, 2, 4, 10, and Dermato-

Venerology Hospital (DVH) and two clinics in Nhi Xuan drug rehabilitation center and Nhi Xuan Industrial

Park (NXIZ), a site providing favorable employment to former IDUs. In the first quarter of FY06, CT services

were provided to 1,140 individuals and 32 healthcare workers were trained in HIV CT. In FY07, PEPFAR

will continue to support service delivery in these seven established sites and the one existing mobile CT

clinic will expand its services to District 7, Thu Duc and Tan Binh to facilitate access to CT and STI services

for hard-to-reach populations.

PEPFAR will fund HCMC PAC to enhance service provision and improve the quality of service delivery by

providing training and innovative quality assurance and quality control (QA/QC) measures including

introduction of client exit interviews; provision of training to healthcare workers on advanced counseling

skills and couples counseling protocol based on the HHS/CDC and OGAC TWG curricula; and

enhancement of existing referral systems between HIV prevention and care services by hiring provincial

referral coordinators and holding monthly referral coordination meetings for partners working within the HIV

prevention and care network. PEPFAR funds will also be used to provide technical assistance to World

Bank and GF CT programs through training and QA/QC measures as well as provision of enzyme

immunoassay (EIA) confirmatory test kits to 17 World Bank-supported CT clinics in 17 drug rehabilitation

centers.

In collaboration with a PEPFAR partner (TBD-PSI follow on), HCMC PAC will strengthen the CT social

marketing program in HCMC to maximize service utilization and link HIV-positive individuals to care and

treatment. HCMC PAC will pilot outreach communication through CT counselors who, in collaboration with

outreach programs, PLWHA groups, and Women's and Youth Unions will provide CT education to target

populations. This CT education activity, in conjunction with the social marketing activity, will encourage CT-

seeking behavior, help eliminate stigma and discrimination, and facilitate recruitment of families and couples

into the HIV prevention and care network. This collaboration will also support HCMC PAC CT program in

encouraging test result disclosure and notification, especially for discordant couples, and in ensuring that

HIV negative partners do not seroconvert.

PEPFAR CT programs target most at-risk populations (MARPs), including injecting drug users (IDUs) and

their partners, male and female commercial sex workers (CSW) and their clients, men having sex with men

MSM), and sex partners of HIV infected persons. To reach this population, in FY07, PEPFAR will continue

to support HCMC PAC in service delivery of optional anonymous/confidential CT in two established sites in

Nhi Xuan rehabilitation center and NXIZ. PEPFAR will implement one new HIV CT clinic in a TBD

rehabilitation center for IDUs as part of the expansion of reintegration program. PEPFAR will support HCMC

PAC to provide CT education in centers through group discussion, CT talks, and personal communication

by in-center peer outreach teams. PEPFAR will collaborate closely with peer outreach, case manager

teams, and outpatient clinics to ensure continuation of care, treatment and support to residents after being

released.

This is a continuing activity from FY07. The narrative below is unchanged from the FY07 COP. Major

changes to this activity since approval in the FY07 COP are:

• In FY08 the Ho Chi Minh City Provincial AIDS Committee (HCMC PAC) will scale up ART in a total of 13

ART sites, including two new adult ART sites and 11 existing adult and specialty pediatric ART sites. HCMC

PAC will provide treatment for a total of 6,231 adults (including 1,486 adults newly initiating ART).

• Pediatric ART will be scaled up in two existing specialty pediatric clinics at City Pediatric Hospital #1 and

#2, and two existing family-centered clinics.

• An estimated 672 (including 176 new individuals) children will receive ART by September 2009.

• HCMC PAC will coordinate with other donors to: 1) provide technical assistance/quality assurace (TA/QA)

for ART sites through CDC, Vietnam-CDC- Harvard Medical School AIDS Partnership (VCHAP) follow-on

partner TBD experts and other PEPFAR and international donor supported TA providers; 2) supply adult

ARV drugs through the Supply Chain Management System (SCMS) and pediatric medicines through

Clinton Foundation.

• In the context of expansion of PMTCT program, pediatric ART services will enhance linkages to PMTCT

services.

• HCMC PAC will support strong linkages to methadone sites in HCMC.

• HCMC PAC will strengthen capacity for physicians and nurses at Global Fund sites in addition to PEPFAR

sites, and will continue to strengthen the city infectious disease referral hospital to provide tertiary care and

lead the ART network in HCMC.

• Collaborate closely with VCHAP to provide trainings, TA and establish city master trainers. The local

trainers will conduct all relevant trainings with back up from VCHAP follow-on partner TBD.

• In FY07 HCMC PAC continued scaling up ART services at seven existing adult out-patient clinics (OPCs),

two specialty pediatric clinics, and two family-centered clinics. In addition, ARV services were expanded to

two new adult district OPCs. HCMC PAC estimated support for 4,745 adults (1,269 new patients) on ART

across these nine adult sites and 526 children (174 new children) in four pediatric ART sites, including two

specialty pediatric clinics.

FY07 Activity Narrative:

Ho Chi Minh City (HCMC) province has the largest number of HIV cases in Vietnam, accounting for 20% of

infections in Vietnam. It is estimated that the number of new AIDS cases per year will increase from 4,800 in

2006 to 7,700 in 2010 (Analysis and Advocacy Project Report, June 2006). As of August 2006, with

PEPFAR support, HCMC PAC has provided direct ARV support to 965 PLWHA (848 adults and 117

children) at nine sites. HCMC PAC has been effective in coordinating multiple donors and international

partners and has developed an aggressive scale-up plan with support from multiple PEPFAR treatment

partners. In FY07, PEPFAR will continue to support HCMC PAC to advance the following objectives: 1)

scale up ARV services; 2) improve quality of services, adherence and the network model especially for

vulnerable populations such as current and former IDUs; and 3) build local capacity to sustain the HIV/AIDS

response in HCMC.

By the end of FY07, HCMC PAC will provide ART to 3,600 patients (3,300 adults and 300 children) at

existing and new ARV sites throughout the province. Existing PEPFAR-supported sites that will scale up

treatment include the Tropical Disease Hospital, four district outpatient clinics that will serve as ‘magnet'

sites, Pham Ngoc Thach TB hospital (jointly supported by PEPFAR and Global Fund), two pediatric

hospitals, and Nhi Xuan clinic linked to a government rehabilitation center for drug users (06 center). After

an initial evaluation of lessons learned from early implementation at this clinic, one additional ARV site will

be selected in conjunction with the PEPFAR team to support the PEPFAR plan for expansion of a complete

package of clinic, home and community based services for current and former drug users.

In an effort to improve quality of services, adherence and access to other community based services,

HCMC PAC will recruit and train referral case managers for all adult and pediatric ARV sites. The case

manager will support patients to adhere to treatment, to facilitate transfer of care, to monitor referrals

between ARV services and other medical/support services in the network. These staff will assure women

and families referred from PMTCT services receive ongoing treatment services as needed (key legislative

issues: gender). Case managers will facilitate access to community- and home-based services providing

care and support to adults and OVC in all districts. Case managers will work in teams with peer educators

and support groups to counsel and prevent addiction relapse, help patients access substitution treatment as

it becomes available, and facilitate referral to services for patients released from drug rehabilitation centers.

To facilitate acceptance of PLWHA peer educators into service delivery, training on stigma reduction will be

provided (key legislative issue: stigma).

ARV sites will be supported by PEPFAR care and treatment staff, experienced HCMC PAC staff and

Vietnam CDC Harvard Medical School AIDS Partnership (VCHAP) staff through training, supportive

supervision, and mentoring of the OPC team. In addition, HCMC PAC is piloting a Treatment Network

Monitoring Unit. Members of this unit will serve as master educators and TA providers to the district-level

sites. Training for new sites and refresher trainings will be provided to update staff on guideline changes

and review lessons learned from previous models. In addition, HCMC PAC will continue organizing monthly

coordination meetings with service providers.

Collection of information for routine patient and program monitoring will be in line with the PEPFAR SI plan

and with national standards, ensuring support for the national HIV/AIDS monitoring and evaluation system.

Enhanced patient monitoring will be done at selected sites to monitor adherence, clinical outcomes, quality

of life and program quality.

This is a continuing activity from FY07.

PEPFAR funds will continue to support Ho Chi Minh City Provincial AIDS Committee (HCMC PAC) to:

procure equipment for clinical laboratories; expand implementation of a Laboratory Information System

(LIS) to two additional sites in HCMC; support maintenance and upgrades at sites where the LIS was

implemented in FY07; introduce instrument interfacing between analyzers and the LIS; create linkages

between referral laboratories, VCT and PMTCT; train data management staff; provide technical advice for

design of a proposed bio-safety laboratory in HCMC.

HCMC PAC has received funding from a non-PEPFAR source to build a bio-safety level 3 (BSL3) facility for

food, water and blood-borne pathogens, including HIV. At the request of HCMC PAC, PEPFAR will continue

to provide technical assistance (TA) to design the BSL3 facility.

PEPFAR has allocated additional funds to: scale up laboratory testing for patients continuing ART and

those eligible to start ART; support laboratory services to current non-PEPFAR ART patients at the Tropical

Diseases Hospital. A needs assessment will be conducted to determine where three hematology and

biochemistry analyzers should be located in the region.

Currently HCMC supports CD4 testing for six PMTCT sites, two ObGyn hospitals, and 21 out-patient clinics

(OPCs), including two pediatric hospitals. In FY07, PEPFAR supported CD4 testing at three government-

run drug rehabilitation (06) centers to provide ART to residents. PEPFAR will fund CD4 test kits at the

Tropical Disease Hospital and provide support to ensure that human resources are built through additional

training and support for additional staffing as needed to ensure the increased demand can be met.

PEPFAR will continue to strengthen the quality of the laboratory network for CD4 testing at the provincial

and district levels through refresher trainings, on-site visits to monitor CD4 procurement with support from

the Supply Chain Management System (SCMS), and formation of a CD4 technical working group. To

promote a standardized approach, CD4 and all other clinical testing associated with monitoring patients on

ART as well as training on quality assurance (QA), universal precautions, and external quality assessment

(EQA) will be supported through a central budget.

PEPFAR will support HCMC PAC in the strengthening of laboratory data management methods, including

the standardization and implementation of both paper-based and electronic systems. The goal is to

introduce methods that will not only provide care providers the data they need for care and monitoring, but

that will also allow for improved national reporting of laboratory indicators. In FY07, two more laboratories

providing testing support for OPCs providing ART were selected for implementation of the LIS following the

pilot at the District 4 facility. A Vietnam contractor was selected for customization of an open-source LIS

software developed through collaboration between three US state public health laboratories. In FY08,

HCMC PAC, together with the software contractor and guidance from the US laboratory team, will expand

the LIS to two more sites. This will include hardware procurement for the sites to enable them to access

their data securely 24 hours a day. The Vietnam contractor will also support instrument interfacing to allow

the LIS to link seamlessly with the analyzers in the laboratory, reducing burden on the laboratory staff to

enter results manually and allowing for greater accuracy and timeliness of results.

In addition, six VCT sites and six PMTCT sites that refer specimens for confirmatory testing will also be

linked to the LIS, allowing them to send data on specimens before they are received by the testing

laboratory and access results on the specimens as soon as they are available. Linkage between the LIS

and existing patient monitoring information systems (PMIS) being implemented at OPCs will also be

emphasized for a patient's results to be transmitted electronically from the LIS to the PMIS. For laboratories

that receive a high volume of specimens per day, support will be provided in the form of contractual staff to

receive specimens, log specimen information into the LIS, attach a barcode, and provide it to the staff for

required testing, leading to faster turnaround time. The US laboratory team will also provide support to VCT

sites that are in need of standardized specimen management to allow all specimens collected and referred

for HIV testing to be labeled with a barcode. The US laboratory team will collaborate with HCMC PAC to

develop a minimum core data set for laboratory data.

Progress of the LIS and use of standardized paper based systems will be monitored by the PAC LIS Project

Officer who was hired in FY07.

This is a continuing activity from FY07. The narrative below is unchanged from FY07. Major changes to this

activity since FY07 approval are:

• The Ho Chi Minh City Provincial AIDS Committee (HCMC PAC) will continue to focus on providing primary

technical oversight for monitoring and evaluation (M&E), health management information system (HMIS),

surveillance, and human capacity development (HCD) activities in the province.

• In FY08, HCMC SI activities will focus on continued HCD for M&E, HMIS and public health evaluation

(PHE) activities around the Nhi Xuan pilot.

• Activities with HCMC PAC will continue to focus on SI, data quality assurance, M&E, and reporting

technical assistance at the provincial and service delivery levels. Funds will support contracted staff,

training, implementation and supervision at all levels across all PEPFAR program areas.

• Collaboration with two technical training universities focused on curriculum development in HIV program

management; data collection, management, and use; as well as HMIS implementation and support will be

expanded through national TWG support.

• HCMC PAC will continue to recruit qualified strategic information (SI) staff using FY07 funds.

• Achievements to date include the standardization of routine program monitoring and reporting for ART,

PMTCT, VCT and Nhi Xuan rehabilitation center activities and HMIS activities supporting centralized client

registration for HIV/AIDS services in HCMC province.

FY07 Activity Narrative:

HCMC Provincial AIDS Committee (HCMC PAC), a provincial coordination body, provides oversight to all

HIV/AIDS activities in HCMC. As HCMC PAC implements and oversees government of Vietnam (GVN) and

PEPFAR-supported prevention, care and treatment services in HCMC, it will be necessary to establish a

provincial M&E framework with a strategic plan for collecting, analyzing and using program data. In FY07,

HCMC PAC will work within HCMC to localize the national M&E framework and engage in activities related

to advocacy, coordination, systems assessment, data harmonization, building physical and staffing

capacity, and systems development, support and maintenance. Capacity for data use, analysis, routine data

supervision and M&E will be developed within HCMC PAC. HCMC PAC will also build SI capacity through

routine information systems (IS) development, data management and supervision, and M&E supporting

HCMC PAC-managed programs funded by the Ministry of Health/Vietnam Administration for HIV/AIDS

Control (MOH/VAAC), PEPFAR, Global Fund (GF), the World Bank, the Department for International

Development (DfID), and other international donors. M&E training, including data management and analysis

training, will be necessary at HCMC PAC and at the provider level. HCMC PAC will partner with local

universities to incorporate SI-related certificate based training into their curriculum. These academic

partners will provide a combination of pre-service and in-service training solutions. Improved information

systems, whether exclusively paper-based or a combination of paper-based and electronic, are also critical

for successful implementation and maintenance of quality HIV/AIDS prevention, care, and treatment

programs. Information systems are vital for client management, client monitoring, and program

management from the service center to the national level. The planning, development, implementation and

maintenance of these routine information systems require leadership, collaboration, resources, technical

expertise and most importantly a strong plan. HCMC PAC will contract local software development

companies to develop solutions for HCMC that adhere to national standards and guidelines. HCMC PAC

will also develop their staff to provide oversight to these partners and to participate on national M&E and IS

TWGs, including the CAREWare pilot implementation in Hanoi. PEPFAR will also support HCMC PAC to

develop the computer network infrastructure of the HCMC PAC office as well as their training partners

University Training Center for Health Care Professionals-HCMC (UTCHCP HCMC) and the School of

Public Health in the University of Medicine and Pharmacy in HCMC. This will include both the development

of secure networks and server rooms for the storage of HIV/AIDS program data and the establishment of

networked computer training rooms for conducting trainings describe above. Finally, HCMC PAC will

subcontract with UTCHCP HCMC to conduct enhanced patient monitoring activities in selected clinic

supported by PEPFAR in HCMC. The training center will be responsible for the abstraction, entry and

analysis of data from either electronic or paper-based patient medical records as described in the enhanced

patient monitoring activities under the HVSI FHI (9370). All of these activities will provide SI training to 64

individuals and technical assistance to 12 GVN and service providing organizations.