This is a new activity in FY08.

Family Health International (FHI) will contribute toward the Vietnamese national PMTCT scale-up strategy

by providing PMTCT services at district sites, where FHI also has adult and pediatrics care and treatment

services in a family-centered model.

To date FHI provides PMTCT services at three sites: one district-level PMTCT site (Van Don District, Quang

Ninh Province) and two other sites implemented with partners (UNICEF in Tan Chau, An Giang and CDC-

LifeGAP in Cam Pha, Quang Ninh). A total of 60 women have received PMTCT counseling and testing

across these three sites since FHI became involved in PMTCT in March 2007 and a total of five mother-

infant pairs have received full ART/PMTCT coverage.

In FY07 FHI expanded PMTCT services to three new districts: Thot Not, Can Tho; Hai An, Hai Phong; and

Tinh Bien, An Giang. A total of 700 women will receive counseling and an estimated 53 mother-infant pairs

will receive full ART/PMTCT coverage. In FY08 FHI will expand PMTCT services to seven more districts,

bringing the total number of districts receiving PMTCT services to 13.

FHI's approach is based on family-centered care principles, integrating PMTCT into existing FHI-supported

continuum of care (CoC) sites which consist of linked HIV out-patient clinics (OPCs) and home-care teams.

PMTCT services will be integrated into ANC and "opt-out" HIV counseling and testing will be implemented in

all sites. Clinical staging and evaluation for OI, TB, cotrimoxazole prophylaxis and treatment will be

provided during and after pregnancy for mothers at FHI-supported OPCs, that are located nearby. ARV

prophylaxis and follow-up will be provided at the OPC.

Infants will be given single-dose Nevirapine and one week of AZT. Infant follow-up includes cotrimoxazole

at six weeks; formula for six months, if needed, and if mother and counselor agree that the option is

acceptable, feasible, affordable, safe, and sustainable; antibody testing at 18 months as directed by national

guidelines; and DNA PCR testing for early infant diagnosis (EID) at two and six months, currently through

two labs, one in the North and one in the South. HIV-infected babies will continue to receive formula

supplement until 12 months of age and will be closely monitored for growth and nutritional status.

FHI will support the development of strong referral links between PMTCT services at the commune and

district level. Home-based care teams will continue to be trained in how to provide follow-up services to

women/couples receiving PMTCT services. To create a more enabling environment, FHI will support local

stigma and discrimination reduction activities.

FHI will work closely with key partners to provide high-quality PMTCT services, in particular the Vietnam

Ministry of Health, US CDC, Management Sciences for Health, and UNICEF. This will include joint

development of standard operating procedures (SOPs) and services systems including the use of dried

blood spots (DBS) for PCR.

In order to ensure quality services, FHI will support the training, mentoring, QA/QI, and supportive

supervision of PMTCT providers in close coordination with the Vietnam Administration of HIV/AIDS Control

(VAAC) and other PEPFAR partners.

FHI: Outreach

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:

• From October 2006 through July 2007 FHI has provided BCC to a combined total of 177,000 most-at-risk

populations (this includes approximately 19,000 FSW, 130,000 clients, 8,000 IDU, and 20,000 MSM). Many

of these were potential clients of CSW reached through the "Live Like A Real Man" campaign targeting men

in entertainment establishments where commercial sex may be arranged. The follow-on CSW client work

was competitively awarded to a consortium of partners led by PSI. Hence, FY08 target numbers will be

lower than FY07 figures.

• In FY08, the PEPFAR prevention strategy will sharpen partners' focus on high risk populations to increase

capacity of existing interventions, reach more individuals, improve referral to counseling and testing, and to

offer more relevant services at MARP friendly community sites and on an outreach basis. To this end, skills

of outreach workers, case managers, health educators, and other personnel will be improved through

technical assistance from experienced, existing sites. Highly trained case managers and addiction

counselors will reduce program management functions to apply addiction counseling skills for IDU on a

regular basis.

• FHI will receive FY08 funding to support AB programming for truck drivers, a population identified as

engaging in high-risk behavior with female sex workers, along the national highway corridor. Peer outreach

workers and health educators will intercept men at truck stops and other locations along the national

highway to encouraged reduced use of commercial sex workers as part of a comprehensive ABC

prevention strategy.

• Through FY08 funding, FHI will implement HIV prevention programs in 10 provinces where PEPFAR

works. In one or more provinces FHI will be the primary partner providing HIV prevention, care and

treatment services for an entire province, in close partnership with the MOH VAAC.

FY07 Activity Narrative:

PEPFAR will support FHI to train health educators and peer educators to deliver effective AB messages to

appropriate most-at-risk populations (MARPs) in the six current and one planned focus provinces, in

addition to three prevention-oriented provinces, reaching a total of 48,000 people. Outreach teams will

incorporate AB messaging in daily contacts with drug users, men who have sex with men (MSM) and,

where possible, with peers and family members of MARPs, stressing the reduction of sexual partnerships.

Outreach workers will be trained in peer counseling skills to help clients develop strategies to reduce risk of

HIV transmission. Behavior Change Communication (BCC) materials stressing similar messages will be

distributed to key populations through outreach activities and at drop-in centers where clients can receive

additional counseling, HIV counseling and testing, and other services.

FHI will receive funding from PEPFAR to address male cultural and social norms to stress marital fidelity

among current or potential clients of female sex workers (FSW) in all focus provinces. The intervention is

based on FY05 and 06 research among FSW clients that identified situational factors—such as drinking

with co-workers and peer pressure—that often lead to sex worker visits. Health promoters will employ

intensive outreach to target 70,000 high-risk men in entertainment establishments, such as beer bars,

karaoke, hotels and other locations identified through mapping. One hundred health promoters will be

trained to convey abstinence and be faithful messages to men.

FHI will cooperate with Health Policy Initiative to promote greater involvement of People Living With

HIV/AIDS (PLWHA) in abstinence and faithfulness approaches, building PLWHA skills to counsel clients on

the importance of fidelity to one partner as part of a comprehensive prevention strategy (refer to HVOP FHI

10207). PEPFAR will support training for 50 service providers and 100 PLWHA peers who will counsel

clients at out-patient clinics, PLWHA support group meetings and home-based care visits. Twenty-five

hundred positive PLWHA will be reached through peer counseling sessions that stress fidelity as a primary

means to prevent infection or cross-infection.

FHI will provide a sub-grant and technical assistance to support Vietnam-based NGO Consultation of

Investment in Health Promotion's (CIHP) internet-based counseling and HIV/AIDS education program,

which aims to reach MSM nationwide, and will include discussions on being faithful and partner reduction as

part of its comprehensive prevention approach. Counseling will be provided in a manner that enables MSM

accessing on-line service to strategize appropriate ways to reduce risk of HIV transmission. Forty five MSM

peer educators will be trained to provide on-line counseling, and an estimated 2,400 individuals will be

reached. FHI will work closely with CIHP to build overall capacity and sustainability.

FHI will expand the scope and scale of substance abuse treatment options initiated in FY05 and FY06 by

FHI to enable Vietnam to attain and retain an adequate number of health workers needed to address drug

addiction sufficiently in focus provinces, and to accomplish PEPFAR goals. Training sessions will be

developed and delivered as a series of coordinated, strategic interventions that address the lack of

community based treatment options and absence of experienced substance abuse counselors. Both pre-

service and long term training will assist development of a skilled cadre of substance abuse counselors

through recruitment of new staff and leveraging existing resources by training government and other donors'

workforces. A comprehensive array of substance abuse treatment options supports the PEPFAR Vietnam 5

-Year Strategy to bolster Vietnam's national drug control policy. These activities will result in more than 300

individuals trained in substance abuse treatment and more than 6,000 reached with prevention messaging

based on abstinence from drug use (see HVOP FHI 10207) and abstinence and being faithful as an

essential means of preventing HIV transmission (6,000 person target).

FHI will expand a nationwide network of case managers, drug counselors, and social workers for inpatient

and community substance abuse programs. This activity began with FY05 and FY06 FHI training of

addictions counselors and case managers in Haiphong and Ho Chi Minh City. In 2007, PEPFAR will support

FHI to train more than 30 new counselors and will integrate a Training Of Trainers (TOT) for 12 of the most

qualified counselors. All trainees will be taught to employ a prioritized AB message in conjunction with

abstinence from drug use. Developing a nationwide core of counselors and case managers will help

Activity Narrative: "legitimize" the profession of addiction counseling and ensure sustainability without continued reliance on

expensive foreign technical assistance.

FHI: BCC Coordination

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:

• Family Health International was selected to implement this FY07 TBD activity.

• FY07 plans called for provincial outreach coordinators in four PEPFAR focus provinces. Through FY08

funding, the USG team will support FHI placement of provincial outreach coordinators in nine provinces

where the epidemic is most severe.

FY07 Activity Narrative:

Both HVAB and HVOP funding for this activity will support the recruitment and placement of a provincial

outreach coordinator in each of four focus provinces where the epidemic is most severe. Provincial outreach

coordinators will work closely with Provincial Health Departments and will take the lead coordinating all

PEPFAR Behavior Change Communication (BCC) activities and linking them to activities sponsored by

Government of Vietnam (GVN) and other donors. The PEPFAR outreach coordinators will be responsible

for improving the scope and scale of PEPFAR and other BCC programs which include AB interventions as

part of a broad strategic portfolio to avert 660,000 new HIV infections. Funding for this activity will ensure

that BCC innovation incorporates abstinence and fidelity messaging as a component integrated in outreach

messaging to appropriate at-risk populations and lower risk youth, including clients of sex workers, in- and

out-of-school youth, and women who are at increased vulnerability for sex work. Messaging on risk

hierarchy will emphasize that abstinence and/or faithfulness to one partner are effective means of avoiding

HIV transmission. Coordinators will ensure the availability of full network model services, including STI

treatment, AIDS care and support and addiction counseling.

FHI: Cross Border project

Funding for this new activity in FY08 will support an innovative new collaboration between two USG

PEPFAR country teams. The PEPFAR Vietnam Team and its prime partner, Family Health

International/Vietnam will partner with the PEPFAR Cambodia Team and its prime partner, Family Health

International/Cambodia to design and implement a targeted cross-border program for Vietnamese CSW

migrating between Vietnam and Cambodia.

Anecdotal information on both sides of the Cambodian-Vietnamese border suggests that Vietnamese

women from the Mekong Delta migrate across the border into Cambodia to earn money in sex work. There

is a major concern that this cross-border migration for sex work in Cambodia may be a significant factor in

driving the epidemic along the border provinces in both countries. There is also a growing concern that

development of new casinos on the Cambodian side of the border, as well as a new highway currently

under construction that will run from Bangkok through Cambodia and on into Ho Chi Minh City, will increase

mobility and draw both Vietnamese sex workers and clients to the Cambodian border provinces. It is also

reported that many Vietnamese sex workers make their way to Phnom Penh, and from there migrate to

other Cambodian provinces or other countries.

In FY07, members of the Vietnam and Cambodia PEPFAR teams identified that existing sentinel

surveillance and behavioral surveillance data available in both countries did not provide sufficient

information to analyze the situational context along the border. The two teams jointly agreed to conduct

small-scale qualitative studies/assessments to collect preliminary data on cross-border migration and

transactional sex in the border provinces.

Funding in FY08 will support: (1) rapid assessments in the provinces on both sides of border where the

epidemic is most severe; (2) the development, implementation, and monitoring of a model interactive

outreach program of peer networks of Vietnamese former or current female sex workers who would ensure

that women have knowledge of and gain access to services and also have options for returning home.

The goal of this joint work is to apply improved knowledge about the situational context around the border

region to develop a model outreach program to provide CSW with access to HIV prevention programs, meet

the needs of vulnerable women at risk for HIV infection, and provide options for these women to return

home.

FHI: BCC Coordination

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:

• Family Health International was selected to implement this FY07 TBD activity.

• FY07 plans called for provincial outreach coordinators in four PEPFAR focus provinces. Through FY08,

the USG team will support FHI placement of provincial outreach coordinators in nine provinces where the

epidemic is most severe.

FY07 Activity Narrative:

Both HVAB and HVOP funding will support PEPFAR outreach coordinators the four focus provinces where

the country's epidemic is most severe, namely Hanoi, Haiphong, Quang Ninh and HCMC. Provincial

outreach coordinators will: coordinate all PEPFAR BCC activities; and ensure the coordination of PEPFAR

activities with other activities sponsored by government and other donors at the provincial level. In

accordance with Vietnam's National HIV/AIDS Strategy to employ proactive behavior change

communication to reduce HIV transmission, TBD partner will place a provincial outreach and referral

coordinator in each of the four focus provinces. Provincial coordinators will be responsible for thousands of

upstream targets reached through improved scope and scale of PEPFAR and other BCC programs.

The coordinators will be employed through a local or international non-governmental organization (NGO) to

synchronize efforts with the Provincial AIDS Committee (PAC), and will sit inside the PAC. They will work

closely with Provincial Health Departments. Each provincial outreach coordinator will serve as a focal point

for all BCC including, but not limited to, injecting drug users (IDU), commercial sex workers (CSW) and men

having sex with men (MSM) as well as referrals to prevention, care and treatment and an increasing array

of drug and alcohol abuse treatment services.

Provincial coordinators will develop and maintain comprehensive knowledge of all BCC activities supported

by PEPFAR, government agencies and other donors. They will facilitate ongoing monitoring and evaluation

of outreach programs to ensure programs prioritize key prevention messages and that quality prevention

programming is mainstreamed into care and treatment services for clients and their families. Coordinators

will facilitate regular meetings among PEPFAR and other staff to ensure maximum coverage of target

populations, to facilitate dovetailing of donors' efforts, to improve BCC efforts and to minimize waste or

overlap. As suggested by 2006 PEPFAR Prevention Technical Assistance visits, outreach coordinators will

bear particular oversight responsibility for BCC innovations targeting establishment-based sex workers,

hidden drug users and vulnerable youth to ensure equitable access to HIV prevention services. The

coordinator position will serve as a model for VAAC and PACs, allowing the government to sustain these

activities with little additional financial input.

FHI: Outreach

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:

• From October 2006 through July 2007 FHI has provided BCC to 177,000 most-at-risk populations. Many

were potential CSW clients reached through the "Live Like A Real Man" campaign targeting men in

entertainment establishments where commercial sex may be arranged. Follow-on CSW client work was

competitively awarded to a consortium of partners led by PSI. Hence, FY 08 target numbers will be lower

than FY07 figures.

• The FY08 PEPFAR prevention strategy will sharpen partners' focus on high risk populations to increase

capacity, improve VCT uptake and offer more services at MARP friendly community sites and on an

outreach basis. Drop-in centers for MARPs will be enhanced with services such as job placement and skills

training to increase first-time and repeat visits.

• Highly trained case managers will reduce program management functions to provide addiction counseling

for IDU on a regular basis. Linkages and integration of prevention interventions into "one-stop" centers will

be promoted so that services are consolidated and efficient.

• Through FY08 funding, FHI community outreach programs will scale up to include prevention activities in

10 provinces where PEPFAR works. In one or more provinces FHI will be the primary partner providing HIV

prevention, care and treatment services for an entire province, in close partnership with the MOH VAAC.

Targets will include 21,000 IDU; 31,000 FSW; 40,000 current or potential clients of sex workers (truckers);

29,000 MSM; and will train 100 peers in discordant couple counseling skills.

• FHI will also receive FY08 funding to support programming for truck drivers, a population identified as

engaging in high-risk behavior with female sex workers, along the national highway corridor. Peer outreach

workers and health educators will intercept men at truck stops and other locations along the national

highway to encouraged reduced use of commercial sex workers as part of a comprehensive ABC

prevention strategy.

FY07 Activity Narrative:

PEPFAR supports Family Health International (FHI) to take the lead NGO role working with MOH to

promote health education outreach for high risk clients. FHI plays a strong role in prevention for commercial

sex worker (CSW) clients (with new Pact TBD partner 9494) and PLWHA (through cooperation with HPI).

This activity will reach the following most at-risk populations with effective ABC behavior change

communication; 14,000 IDU, 22,000 FSW, 70,000 current or potential clients of sex workers, 14,400 MSM;

and will train 100 peers in discordant couple counseling skills. Interventions will incorporate OGAC technical

guidance on ABC and IDU prevention programming, and the PEPFAR Vietnam Five-year Strategy to avert

HIV infections. FHI will implement high quality HIV prevention services targeting key populations and

geographic areas where Vietnam's epidemic is most severe.

All BCC outreach activities are coordinated with the PEPFAR-supported provincial outreach coordinators to

ensure coverage is efficient. FHI will support HIV prevention in the seven focus provinces, addressing

unique needs of male and female injectors, in conjunction with MOH outreach (complementing districts with

unmet needs). Health educators and peers will contact intravenous drug users (IDU), stressing the

importance of learning HIV status to protect one's health and the health of their family. This interpersonal

approach will encourage drug users to access the network model, including drop-in centers, where IDU

have access to CT, care and treatment, and an array of drug and alcohol abuse treatment options. A

methadone treatment program will be piloted in three focus provinces. For IDU who are unable to stop

using, clients will be encouraged to avoid sharing injecting equipment and reduce other risky behaviors.

Building on FY05 and FY06 outreach and drop-in center activities, services will be expanded to Lang Son

and Khanh Hoa provinces where significant IDU populations are found. FHI will develop the provinces of

Quang Ninh, Haiphong, Ho Chi Minh City (HCMC), and Lang Son as learning sites to build capacity of

government agencies and other donors. In-country study tours will foster local capacity, leverage other

resources and build sustained national capacity to address local HIV prevention needs.

FHI will scale up targeted behavior change interventions for female sex workers (FSW) in Can Tho, HCMC,

Hanoi, Haiphong, and three new provinces. Services for FSW include STI diagnosis and treatment, condom

negotiation skills to ensure vulnerable women are empowered to prevent HIV infection, links to vocational

training for women who wish to leave sex work, and comprehensive network services. To facilitate women's

equal access to HIV/AIDS services, "one-stop shop" model women's health clubs will be enhanced to offer

CT and STI treatment as well as referral for OI prophylaxis, PMTCT and ART treatment. Women who desire

to leave prostitution will be referred to vocational training and job placement. Women who require

assistance with substance abuse problems will have access to an increasing array of treatment options to

include counseling and, potentially, medication assisted therapy.

FHI will target clients and potential clients of sex workers to change male norms, reducing transactional sex

and multiple partners in the seven focus provinces, in conjunction with the Pact/TBD "Live Like a Real Man"

program, and coordinated by the outreach coordinator to maximize coverage. FY07 efforts will expand

interpersonal outreach as teams of trained educators explain the risks to health, family, and employment

associated with visiting sex workers. For men who are unable to remain faithful to one partner, outreach

workers will promote partner reduction and correct, consistent condom use.

FHI will employ a range of activities to address issues of discrimination and the double stigma attached to

MSM. Current programs advocate a comprehensive ABC approach to HIV prevention with interactive

outreach programs and drop-in centers where MSM can access an integrated network model. Programs will

be scaled up in Ho Chi Minh City (HCMC), Hanoi, Can Tho, Khanh Hoa and a new site in Ha Long. FHI will

expand outreach in MSM hotspots identified through mapping of bars, dance clubs, cafes, sauna-massage

locations and public "cruising" areas. MSM learning centers will be established with help from staff of local

NGO SHAPC in Hanoi, and HCMC-PAC will provide technical assistance (TA) for scale-up of interventions

Activity Narrative: at new MSM intervention sites. Additionally, FHI will provide a sub-grant and technical assistance to the

local non-governmental organization (NGO) Center of Investment for Health Promotion (CIHP) to develop

internet-based efforts to reach men having sex with men (MSM). FHI will assist CIHP in training 45 MSM

peer educators to provide prevention education, counseling, and referrals to 2,400 MSM through a website-

based service. CIHP will develop a website with updated information on HIV/AIDS programs and services

targeting MSM, including referral for CT, MSM drop-in centers offering peer support, MSM outreach

programs/support clubs offering access to condoms and additional information and education.

Increasing incidence of HIV among partners of drug users necessitates effective interventions among

discordant couples, to empower women to refuse unsafe sexual practices, and encourage correct and

consistent condom use. FHI will leverage existing structures, supporting PLWHA groups to use peer

counseling and group meetings in districts in 10 PEPFAR focus provinces. FHI will create links and stronger

referral between OPCs and treatment services for discordant couples. Condoms will be provided and

promoted intensively during outreach opportunities and at all drop-in-centers for FSW, MSM and IDU, and

outpatient centers (OPCs).

Plus up funds will be used to support and expand two peer education and outreach activities.

1. Family Health International and its local partners will train 100 non-using peer educators who will provide

support to an estimated 2,500 recovering drug users who are in the process of transitioning from

rehabilitation centers to their communities. These peers will provide a critical role in helping recovering drug

users to stabilize their lives, specifically in the area of drug use relapse prevention and accessing drug

treatment services, VCT, and, if HIV+, care and treatment services. They will work in existing PEPFAR

focus provinces of Ho Chi Minh City, An Giang, Can Tho, Hanoi, Hai Phong, and Quang Ninh. Existing peer

educators who have remained off of drugs will assist in training new peers. In collaboration with case

managers, non-using peer educators will lead support groups for recovering drug users and assist them to

stay off of drugs.

2. Family Health International will work with its local partners to train 200 peer educators who will provide

HIV risk reduction information and motivation support to an estimated 2,000 female sex workers (FSW),

1,500 injection drug users (IDU), and 1,000 men who have sex with men (MSM). These peers will be drawn

from areas within the PEPFAR focus provinces of Ho Chi Minh City, An Giang, Can Tho, Hanoi, Hai PHong,

and Quang Ninh that lack sufficient coverage. Urban areas in 2-3 non-focus provinces will be selected in

discussion with the PEPFAR Vietnam Team. These will be areas where there are large concentrations of

former drug users who are leaving rehabilitation centers and moving back to their communities. Mappings of

high concentrations of FSW, IDU, and MSM will be used to plan which areas are in need of peer

programming.

FHI staff together with trained peers will scale up these interventions.

FHI: Addiction Counseling

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:

• FHI has trained and placed 50 case managers/addiction counselors to support drug abuse and relapse

prevention. In FY08, an additional 50 case managers will be trained to provide addiction counseling

services in five additional provinces. Additionally, continuing education activities to build advanced

counseling skills will be provided to the previously trained case managers.

• Case managers will be trained to provide individual, group and family counseling through peer support

groups, partner and family education groups, and community education activities.

• Case managers will be stationed at additional approved methadone implementation sites to support

relapse prevention and promote other complementary services, such as CT, care and treatment, and peer

support.

• Approximately 3,000 high-risk individuals will be reached by the case managers with activities that

promote HIV/AIDS prevention through behavior change beyond abstinence and/or being faithful.

FY07 Activity Narrative:

Family Health International will continue to build the capacity and skills of individuals who have been trained

in addictions counseling and case management. This cadre of approximately 30 new professionals was

initially trained in 2006 but requires continual skill upgrading to meet the demands of approximately 2,000

recovering drug users with services and strategies that promote drug use relapse prevention, drug

treatment, including methadone, and HIV prevention. Case managers will also help HIV+ drug users with

ARV drug adherence. They are currently stationed in existing outreach centers for drug users or outpatient

care (OPC) clinics in the existing PEPFAR focus provinces of Ho Chi Minh City, An Giang, Can Tho, Hanoi,

Hai Phong, and Quang Ninh. Metropolitan areas of other provinces will be added where an expressed need

is identified in collaboration with PEPFAR partners.

These case managers build off of the experience from work started in the previous year in Ho Chi Minh City

under the 06 center pilot for recovering drug users leaving rehabilitation centers. More experienced case

managers from Ho Chi Minh City who have undergone a training-of-trainers program will serve as trainers

for new recruits in other provinces. They will provide training in helping recovering drug users understand

and negotiate solutions to their drug cravings, relapse triggers, and family and social support issues. They

will also help them to set up local non-drug using peer support groups. Case managers will also be

stationed in methadone sites. Finally, case managers will remain up-to-date on the building array of

services available in localities and ensure that their clients are actively taking advantage of these services.

FHI: Sustainable addictions training

International evidence supports the efficacy of a skilled and well-trained addiction workforce to reduce drug

use, criminal activity and sexual behavior that place individuals at high risk for HIV infection. Recognizing

that heroin injection remains the upstream cause of most new HIV infections in Vietnam, PEPFAR has

invested significant resources to recruit and train 50 professional drug addiction counselors since 2005.

High demand for these key staff and tremendous unmet needs among clients highlight the need for a

sustainable system of training and professional development for future leaders in the substance abuse field.

The system must reinforce skills in case management and evidence-based substance abuse treatment to

develop a workforce of competent health care, social service and law enforcement professionals for clients

whose drug using behaviors place them at risk. To this end, FHI will implement a capacity building program

to develop an addiction workforce through technical assistance and training for treatment providers, social

workers and related professional groups. Through this process, FHI will also develop and maintain an

interdisciplinary consortium of health care and related fields, and government personnel knowledgeable

about research-based approaches to substance abuse treatment and recovery.

This activity has 3 components. First, partners will develop basic training courses on the principles of

addiction and the relationship between addiction and HIV and other infectious diseases. These basic

courses will offered to staff from a cross-section of agencies that serve populations at high risk for

substance abuse and HIV infection. Examples include staff from government and non-governmental

organizations (NGOs) involved in home- and clinic-based HIV care and treatment, government social

workers who monitor current and former drug users in the community, medical and other public health

students, and outreach workers supported by PEPFAR and other donors. Through this component

PEPFAR will train 100 individuals in the basics principles of addiction.

Second, FHI will provide a basic introductory course on addiction counseling, promoting comprehensive and

consistent service, for international NGOs and government organizations. An advanced course on

addiction counseling will improve skills of those already trained but in need of specialized training for work

with families, adolescents or other groups affected by addiction. Two training of trainer sessions (TOT) will

provide for continuation beyond the life of this activity and publication of the curricula will enable sustained

training for future drug counselors. Through this component PEPFAR will train 40 individuals as

professional addictions counselors.

Through the third component, FHI will expand efforts to train DOLISA social workers as case managers for

recovering drug users. Basic social work principles will refocus function from parole officer to that of

supportive case manager, responsible for following up with drug users in the community and referring them

to needed HIV care, addiction services, and vocational and other training and support. Basic case manager

training will be supported by advanced guidance on working with special populations, the family and youth.

An advanced course will be provided to case manager supervisors in the selected province. Program

evaluation will be accomplished through routine data collection. Through this component PEPFAR will train

50 individuals.

Food and nutrition has been a major concern for PEPFAR partners to better meet the needs of

undernourished children and adults on ART in Vietnam. With OGAC's new Food and Nutrition guidelines,

which allow for a broader use of PEPFAR funds for severely undernourished HIV+ clients, Vietnam is ready

to gear-up needed services. In order to stay within the guidelines, technical assistance from the FANTA

project is needed to work with local food and nutrition experts to develop guidelines for diagnosis and a

training curriculum for case managers within the cultural context of Vietnam.

While Vietnam has had a minimal food and nutrition program since PEPFAR started, it is insufficient in

providing needed foods to babies, and positive children and mothers. Some COP07 Plus-Up funding was

available to PEPFAR partners to strengthen this nascent program and additional progress is being

observed. However, there is still a large gap between the need for food and nutrition by some of our very

poor clients and the services that are available to them. It is timely to scale-up the food and nutrition

program to better assist HIV positive clients in adapting to their drug regimes. The area of emphasis for this

activity will focus on new-borns, babies and young children. It is important to obtain specialized

professionals who have PEPFAR experiences in diagnosis, both clinical and non-clinical, and skills in

determining criteria for entrance and exiting food programs for this particular aduience. The FANTA project

staff can provide this experience and expertise.

It is expected that FANTA will provide a short TDY in June/July 2008 to help the USG Care and Treatment

TWG plan activities for COP09. With these funds for COP08 implementation, FANTA will provide technical

assistance to help develop regulations and guidelines and training curriculum. A list of some of the

expected activities includes:

Review current F&N feeding programs in PEPFAR clinics and at community level.

Review guidelines available and in progress that promote feeding programs

Assess need for supplemental feeding programs for adults and pediatric clients with approximate length of

feeding needed

Assess what foods are needed and what local foods can be used for food packages

Determine the best way to distribute food packages

Make recommendations of how best to implement a comprehensive supplemental feeding program

Implement a pilot feeding program, to be initiated during COP08 implementation period

Develop a work plan to gear-up F&N activities under COP09

This is a new activity in FY08.

Under COP07, PEPFAR initiated the national medication assisted therapy (MAT) program, which provides

methadone for injecting drug users (IDU). Expansion of MAT has recently been approved by the Ministry of

Health (MOH) without waiting for the "required" annual report. Observational reports to date have shown

government officials the benefits of MAT and based on these case reports, the MOH approved the opening

of 6 additional methadone clinics, primarily for Hanoi.

USAID currently supports Family Health International (FHI) which has opened three pilot methadone sites

(with FY07 funding), one in HCMC and two sites in Hai Phong. These three sites will be funded in 2008 with

monies in the FY08 FHI activity narrative. FHI has been chosen to open three more sites, with at least two

in Hanoi. A third site for FHI will need to await MOH decisions as to location.

In FY08, USAID will also provide substantial technical assistance (TA) to the methadone program in

collaboration with other PEPFAR partners and the MOH/Vietnam Administration for AIDS Control (VAAC).

This TA is expected to include program and technical management, training, and on-site monitoring for

service providers and is funded under several other activities.

This is a continuing activity from FY07.

• In FY08 Family Health International (FHI) will maintain 17 current continuum of care (CoC) sites and

establish five new CoC sites in locations TBD based on the new priority provinces. The CoC consists of HIV

out-patient clinics (OPCs), TB screening and treatment, community- and home-based care (H/CBC) and

referral support, services for OVC, PLWHA and family support groups and prevention counseling.

• FHI will continue to provide an updated package of technical assistance (TA) and tools to all CoC palliative

care and treatment sites including training, mentoring and supervision and the development and provision of

technical tools to assist local partners in implementation of palliative care services.

• FHI will continue to provide OPC based palliative care to people with HIV in 22 CoC sites; and provide

H/CBC and referral support to people with HIV and families through 65 teams in all 22 sites with referrals to

counseling, testing and care and treatment as necessary.

• In FY08 FHI will pilot integrated palliative care in two to four sites. Integration of palliative care includes

training in palliative care for adults and children in OPC, CBC and introduction of oral morphine where

feasible. It will also include development of clinical tools to aid integration of full palliative care package and

an evaluation of the effectiveness of the approach.

• FHI will continue providing TA to the Ministry of Health (MOH) on developing the national palliative care

program (MOH working group, dissemination of and training in national palliative care guidelines, reform of

opioid regulations, certification training of nurses, improving opioid supply, monitoring opioid use for

palliative care across the country, etc).

• In FY08 FHI will continue to support the Department of Therapy (DOT) to strengthen palliative care at

central and provincial levels through training with TBD follow-on to VCHAP partner to include national

guidelines, PLWHA rights to pain management, and opioid policies.

• FHI will continue to integrate family centered care into CBC and OPC services through training of pediatric

HIV clinicians, family care case managers and CBC teams in each CoC. FHI will also create family-centered

care (FCC) training and service tools to support FCC integration.

• In FY08 FHI will continue to support the pilot methadone program; continue to provide technical support to

the Vietnam Administration for HIV/AIDS Control (VAAC) in developing technical guidelines, training and

supporting capacity building for methadone programming.

• In FY08 FHI will conduct a program assessment of the quality and effectiveness of CBC and OVC

services; roll-out of nutrition tools and training among all sites; and establish and/or continue quality

assurance/quality improvement (QA/QI) of all palliative care programs in all 23 CoC sites.

• Continue to provide technical support to VAAC to operationalize CBC services. Continue to provide

technical support to the VAAC and provincial centers in establishing a CoC at the provincial and district

levels.

• By April 2007 FHI reached 5,700 PLWHA with palliative care services through the continuum of care from

both clinic and community-based care activities. Two international NGOs (Catholic Relief Services and

Nordic Assistance to Vietnam) along with 30+ local governmental partners and community-based

organizations (CBOs) are working with FHI to provide palliative care services.

• FHI trained more than 100 individuals in community and home-based care, and built the capacity of more

than 200 clinicians.

• FHI produced an H/CBC training curriculum in Vietnamese, a caregiving guide for CBC teams, QA/QI tools

for PMTCT and TB and a number of SOPs for clinical service delivery.

FY07 Activity Narrative:

Family Health International (FHI) takes the lead in supporting MOH/VAAC and HCMC PAC in providing

technical assistance for the provision of palliative care and support services at the district and commune

levels, complementing districts that are not covered comprehensively by VAAC and GF. FHI also takes the

lead in developing and training PEPFAR partners including VAAC on H/CBC and support. In collaboration

with VAAC, GF, HCMC-PAC, Catholic Relief Services (CRS) focus province provincial AIDS centers, and

additional F/CBOs, FHI will support 7,900 PLWHAs in 21 sites in 7 focus provinces.

The PEPFAR-supported care network consists of provincial level tertiary care with the full range of clinical

services, district level secondary care with out-patient and in-patient care (with the exception of treatment of

complex OIs and HIV-related complications), TB/HIV referral, ART, and commune level H/CBC with support

to OVC. In FY07 FHI will scale up district and commune-level services to include: (1) urban care sites in

HCMC and Hanoi, (2) rural care sites in An Giang, Can Tho, and Quang Ninh, and 3) integrated prevention

and medication-assisted therapy in select focus provinces for injecting drug users (IDU).

FY07 district care sites will be managed by current and newly trained provincial management and district

care provider staff composed of PLWHA, Communist Party officials, health care workers, religious leaders,

and CBO personnel. These staff will improve referral systems by coordinating with PEPFAR partners to

utilize uniform referral forms and standard operating procedures at care sites. FHI will also work with

PEPFAR partners to develop HIV care and prevention service guides for PLWHA and providers, which will

be provided to all PEPFAR and GF-supported sites.

Coverage will be increased to additional sites via care provider training, and onsite mentoring and

supportive supervision. District outpatient services will be integrated into existing district health centers

(DHCs). OPCs will be linked with inpatient care at DHCs, and, in addition to H/CBC, will continue to provide

prevention counseling and commodities, assessment of psychosocial situation and OVC needs, regular

clinical evaluation and monitoring, OI prophylaxis and treatment of common OIs, screening for TB, related

laboratory services; treatment literacy and intensive treatment preparedness; referral of complex OIs and

TB, management of symptoms, pain, and HIV/AIDS-related complications, nutrition and emotional support.

To facilitate rapid care scale-up, Binh Thanh, Thu Duc and Cam Pha districts (from HCMC and Quang Ninh

provinces - one southern and one northern) will be used as HIV care and support learning centers.

All OPC services are linked with HBC teams to ensure seamless follow-up between home care and hospital

care. HBC teams play a critical role in providing palliative care to PLWHA and families providing pain relief,

symptom management, adherence counseling support, nutrition and livelihood assistance, emotional

counseling, links to spiritual care, end-of-life care and planning and care for OVC. Home care and PLWHA

groups will work with health center staff to promote ART and methadone adherence (for those sites

providing methadone to drug users). Referrals to tertiary care for PLWHA clients will be managed by the

district health center staff and home care teams. H/CBC services will be linked with services implemented

Activity Narrative: by other PEPFAR partners.

IDU access to a full range of prevention, treatment, and care interventions will be increased through case

management in all districts, but with emphasis on those released from government rehabilitation centers

and involved in the methadone pilot. Case managers and former IDU peers for drug users and former drug

users (supported by HCMC PAC) will ensure that all residents released from government rehabilitation

centers have access to relapse prevention counseling, family supportive counseling, and other risk-

reduction. In Haiphong and Quang Ninh, IDU who are HIV positive will be able to enroll in medication-

assisted therapy (MAT) co-administered with ART where clinically eligible, provided the government of

Vietnam (GVN) approves the pilot protocol. Clinicians, adherence counselors, case managers, and HBC

teams will receive comprehensive training in addiction, ART, methadone co-therapy, and ART adherence

support for IDU. Providers in HCMC and Haiphong will be trained as mentors for future IDU care training

sessions.

At the national level, technical support and capacity building will be provided to PEPFAR H/CBC partners,

GF and VAAC to develop guidelines, standard operating procedures, and training packages. FHI will also

assist in the review and revision of national opioid policies (see FHI Policy System Strengthening 9430).

FHI will support implementatation of three methadone clinics linked to HIV service delivery in existing

outpatient clinics. Methadone will be procured in collaboration with other international partners and MOH.

Additional funding will support five activities: 1) Assessment and development of existing Vietnam nutrition

guidelines, incorporation of international recommendations and development of procedures for

implementation in all PEPFAR funded palliative care sites; 2) Additional provincial level advocacy will be

provided in the 7 focus provinces to increase awareness of the national palliative care guidelines and boost

support for the national palliative care fellowship program; 3) Funding for DOT to produce and disseminate

national home-based care guidelines; 4) Implementation of enhanced STI diagnostics and treatment into

selected outpatient clinics; 5) Expansion of training for staff in PEPFAR and other funded OPCS in providing

psychosocial assessment, support and appropriate referrals. Funding will improve quality of current

services and plans, but will not add to targets.

This is a continuing activity from FY07.

In FY08, Family Health International (FHI) will expand its activities to 20 continuum of care (CoC) sites in 10

provinces. Activities will include TB disease screening, referral of TB patients to TB treatment services,

improved coordination of TB and HIV services, and capacity building for TB and HIV clinicians. TB-HIV

screening and referral will be provided for 7,500 PLWHA, and TB treatment for 1,500 HIV-infected TB

patients. At least 150 clinical personnel will be trained to provide screening and treatment of HIV-associated

TB and to support TB/HIV coordination activities at the district level. FHI will provide funding to strengthen

district TB and HIV coordination, including annual technical meetings between TB and HIV clinicians,

development of standard operating procedures, quarterly network model coordination meetings, regular

monthly case conferences between TB and HIV clinicians at clinical sites and quarterly supportive

supervision visits.

In FY07, FHI supported expanded TB and HIV services in nine CoC sites in six provinces. An estimated

5,000 PLWHA were screened for TB using symptoms and chest radiography, and 1,100 PLWHA were

treated for TB disease.

FHI will support implementation of the recommendations of an FY07 PEPFAR-funded assessment of

infection control practices for TB and other airborne diseases in HIV care and treatment settings.

FY07 Activity Narrative:

Funding will provide TB screening and appropriate referral for 7,900 HIV-infected persons in 21 outpatient

clinics in the seven focus provinces, referral to TB treatment for 790 PLWHA, train 250 individuals to

provide clinical prophylaxis and/or treatment for TB to PLWHA and will support TB/HIV coordination

activities at the district level.

Family Health International (FHI) will support HIV outpatient clinics in 21 districts in the seven focus

provinces where clients receive care, support, counseling and ART services. Funding will support training

sessions for HIV and TB physicians and staff time. As with all PEPFAR-supported clinics, clients will receive

TB screening once per year and additional screening as needed for symptoms and prior to commencement

of ART. All patients with suspected or confirmed TB will be referred to the adjoining district TB clinic for

further management. A PEPFAR strategic goal is increasing the collaboration and linkages between the TB

and HIV programs at the district, provincial and national levels. Funding will be provided to strengthen the

district TB and HIV coordination activities implemented through VAAC through several targeted activities,

including annual technical meetings between TB and HIV clinicians, development of Standard Operating

Procedures (SOPs), quarterly network model coordination meetings, regular monthly case conferences

between TB and HIV clinicians at clinical sites and quarterly supportive supervision visits.

This is a continuing activity from FY07.

In FY08:

• Family Health International (FHI) will continue to work with children infected and affected with HIV/AIDS

using the case management approach (adapted from OGAC's Child Status Index) to assess needs, and will

follow up to ensure identified needs are met and comprehensive programs for OVC are available. OVC care

services will continue to be integrated into continuum of care (CoC) sites and made available in 22

locations.

• FHI will continue to ensure comprehensive care and support to OVC including health care, access to

school, emotional support, psychosocial counseling, sufficient nutritional support, safety and security.

• FHI will increase their efforts to identify potential children with HIV through community groups, CoC

coordination committees and mass media and encourage high risk children to get counseling and testing.

• FHI will expand early childhood development-focused playgroups to all CoC sites.

• FHI will continue to work with the government, other PEPFAR partners and other donors in developing

national policies, guidelines and systems to support children affected by HIV.

• FHI will provide training and support in family-centered care case management to grantees and PEPFAR

partners.

• FHI will increase its efforts to reduce stigma and discrimination of OVC affected by HIV/AIDS through

district campaigns.

• In FY08, FHI will provide 3,500 OVC with relevant services and train 350 care givers, directly through the

CoC and along with its two international partners (Catholic Relief Services and Nordic Assistance to

Vietnam) and its 30+ local governmental and community-based organization (CBO) partners.

• By April 2007, FHI's activities reached 1,497 OVC with services addressing the six basic needs.

• FHI established comprehensive family-centered care services in three CoC and partial services in three

additional locations.

• FHI contributed to the development of the draft national plan of action for children and HIV/AIDS.

FY07 Activity Narrative:

FHI will provide family-centered care for OVC and caregivers through out-patient clinics and home- and

community-based care and support services in the PEPFAR focus provinces. This activity will help ensure

that children's developmental needs are met through a range of services, as appropriate to meet the unique

needs of each child. FHI will help ensure quality of care by building the capacity of OVC care providers and

expand coverage OVC care services through partnerships with home-based care teams, local NGOs, the

Women's Union, the Ministry of Labor, Invalids and Social Affairs (MOLISA) and the Vietnam Commission

for Population, Families and Children (VNCPFC). Through this activity, 1,030 OVC will receive services, and

350 professional and family caregivers will be trained.

OVC services will be provided through case-management services at eight district out-patient HIV/AIDS

clinics (OPCs) which provide comprehensive health care services, including pediatric ART. OVC services

will also be provided through home-based care services that extend the reach of these clinics to the

community.

OVC services will be provided in accordance with the PEPFAR core OVC services package, and will

include: comprehensive needs assessment, counseling and psychosocial support, development of a service

plan to assist OVC and their caregivers in meeting prioritized needs and service referral in the community.

Direct services will also be provides including: health care services, adherence support, food/nutrition

support for children (in accordance with OGAC guidelines), and referral to other social and health care

services including referral to MOH pediatric hospitals and links to Integrated Management of Childhood

Illnesses services (C-IMCI) offered through commune health stations. FHI will train families to provide care

and support at home, including adherence support for pediatric ART and other medications. The project will

support school enrollment and provide educational activities/therapeutic play groups with children. FHI will

also support PLWHA and caregiver support groups, link parents and OVC caregivers to income generation

services and employment referral services, and provide succession planning, including preparing wills and

identifying stand-by caregivers.

Through this activity, OVC services will also be offered through partnerships with community based

organizations in Haiphong (Nordic Assistance to Vietnam [NAV]) and Hanoi (Hien Quang Pagoda). OVC

services will be delivered in a way that supports family-centered care, partnering with and building the

capacity of caregivers' to address their children's needs.

In addition, FHI will collaborate with UNICEF, Save the Children, PEPFAR and other stakeholders to

provide technical support and assistance for the development of OVC care and protection guidelines,

including the development of the Vietnam National HIV/AIDS Strategy.

FHI staff will continuously strengthen their capacity for OVC service delivery, through training, mentoring,

and program monitoring and feedback from PEPFAR and FHI management. FHI will contribute to meetings

among implementing partners, to establish consensus on core service packages, facilitate exchange of

materials and lessons learned, and identify and address gaps in services and referrals. FHI will also provide

capacity-building and technical assistance to other PEPFAR partners in implementing OVC (especially in

the context of home- and community-based care).

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:

• Ten VCT clinics have been established using a provider-initiated HIV testing and counseling (PITC) model

in both public and private STI clinics in focus provinces.

• In FY08, same-hour test result notification will be expanded to all eight focus provinces based on the

results of a pilot in 2007.

• Outreach-based VCT will be piloted targeting sex partners and family members of PLWHA in Hanoi in

coordination with PLWHA groups.

• HIV testing - emphasizing prevention counseling and couples counseling - will be scaled up at most at-

risk population (MARP)-friendly drop-in centers in focus provinces in coordination with the PEPFAR

prevention technical working group.

• Three trainings will be held in preparation for the national roll-out of rapid testing, in coordination with

PEPFAR laboratory team, and the National Institute for Hygiene and Epidemiology.

FY07 Activity Narrative:

In FY07, PEPFAR will support FHI to train 200 counselors and provide counseling and testing (CT) services

for 16,500 clients at twelve VCT sites in seven PEPFAR focus provinces.

FHI will expand and strengthen CT services in the Network model, strengthen the absorptive capacity of

eight existing CT sites in Hanoi, Haiphong, Quang Ninh and Ho Chi Minh City (HCMC) and develop four

new CT sites in HIV hotspots in Hanoi, Can Tho, An Giang and the seventh PEPFAR focus province. All

sites will be fully integrated into district care out-patient clinics (OPC) and PEPFAR funded drop-in centers

(DIC) and will have strong referral links to all Network model prevention and care and treatment services.

CT counselors will function as case managers, providing client-centered initial and follow-up counseling

services to negative and positive clients, and facilitating client referral to relevant services. Training and TA

will be provided to existing CT sites to restructure counselor workload and to increase their efficiency and

absorptive capacity, particularly in HCMC where thousands of residents from 06 centers, government

centers for rehabilitating drug users (06 centers), will be released by the end of FY07.

FHI will also promote CT among most at-risk populations (MARP). MARP outreach workers and PLWHA

will encourage testing among networks of injecting drug users (IDU), commercial sex workers (CSW) and

their clients, and MSM to prevent infection and to interrupt rapid transmission patterns among the newly

infected, linking them to CT offered in local DICs. CT social marketing and MARP-focused outreach to

reduce stigma and discrimination will increase the awareness of CT benefits while decreasing barriers to

seeking testing.

FHI will work with HCMC Provincial AIDS Committee (PAC) to strengthen the referral system between 06

centers, CT, Care and Treatment, and PMTCT by training healthcare workers and developing clear referral

guidance and tools for peer educators (PE), counselors, and case managers.

FHI will form a national cadre of CT counselors. The Anonymous Testing Sites (ATS) and Bach Mai VCT

Centers will provide technical assistance (TA) to developing CT services supported by other PEPFAR

partners. TA services will include study tours, one to two weeks of in-service practicum, supportive

supervision visits to newer VCT sites, and basic and advanced HIV counseling training. Both sites will lead

case consultation meetings for CT counselors.

FHI will also focus on strengthening the national CT program with a view to sustainability. FHI will work with

the Ministry of Health/Vietnam Administration of HIV/AIDS Control (MOH/VAAC) and other partners to

develop a national CT training curriculum based on HHS/CDC guidance and other resources. In addition,

FHI will contribute to the finalization of national CT guidelines and the development of CT SOPs and QA/QC

tools to establish national standards of quality CT services. Capacity building of health providers in CT will

contribute to sustainability of future CT service provision. TA for the development of national counseling and

testing standards will also strengthen national capacity in CT.

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, Family Health International (FHI) will scale up ART in a total of 20 district-level continuum of care

(CoC) adult ART sites across nine of the PEPFAR provinces (five new adult ART sites in FY08). FHI will

provide treatment for a total of 5,458 adults (including 1,073 newly initiating adults).

• Pediatric ART will be scaled up such that 13 of the 20 adult ART sites will offer pediatric ART through a

family-centered care model (seven new pediatric ART sites in FY08). FHI will provide treatment to a total of

207 children by September 2009.

• In FY08 FHI will strengthen the linkage between PMTCT and care and treatment services to enable the

early detection of both pregnant women and infants who need ART for their own health.

• FHI will scale up the number of joint ARV/methadone sites (total number TBD).

• During FY08 FHI will support the development of an advanced adherence training curriculum.

• To date FHI has established eight CoC ART sites which have enrolled a total of 2,265 adults and 41

children on ART (three of the eight CoC sites are currently providing ART to children).

• Using FY07 funding, FHI is currently scaling up adult ART services in a total of 15 CoC sites across the

seven PEPFAR provinces as described in the FY07 narrative. FHI plans to support 4,385 adults (2,120 new

adult individuals) on ART across these 15 adult ART CoC sites. Using FY07 funding, FHI is currently

scaling up pediatric ART in six of the 15 CoC sites and will support 107 children on ART.

FY07 Activity Narrative:

This activity will focus on four main objectives: coverage and access, quality, support for injecting drug

users (IDUs), and capacity building. In FY07, PEPFAR will fund FHI to provide treatment for a total of 3,690

adult and pediatric patients (including 1,900 new patients).

ARV therapy will be provided to adults and children through community-based ART sites providing a

comprehensive package of integrated care, treatment and prevention services. In support of the PEPFAR

strategy of improving support for vulnerable populations, particularly current and past IDUs, the strategy will

focus on client-centered adherence, additional psychosocial and addiction counseling and case

management support to facilitate access to services in the community (key legislative issue: stigma). Family

-centered ART sites will increase access to treatment services for HIV infected mothers and children (key

legislative issue: gender). As of August 2006, FHI is supporting 710 patients on ART in six treatment sites in

three provinces and, in accordance with the PEPFAR geographic scale up and coverage plan, will expand

to 20 sites in seven focus provinces. All new sites will function as district magnet sites covering surrounding

districts linked to community- and home-based care (C/HBC) services in each of the districts. Each site will

be selected in conjunction with the Ministry of Health/Vietnam Administration of HIV/AIDS Control

(MOH/VAAC) and the PEPFAR care and treatment technical working group (TWG).

ARV sites will be supported through training, supportive supervision, and mentoring of a multidisciplinary

out-patient clinic (OPC) team responsible for providing treatment services as well as care and support and

prevention with positives services. Sites will support sustainability by functioning as model training sites for

health care workers at new clinics as Vietnam continues to scale up. In accordance with the PEPFAR SI

plan for monitoring and evaluation, outcomes of the ARV program will be evaluated in some sites, including

clinical outcomes, psychosocial well-being, adherence and patient retention. Program lessons learned will

guide future programming.

In Ho Chi Minh City (HCMC), all FHI-supported ART sites will be linked to 06 centers, which are

government centers for rehabilitating drug users. Case management support and discharge planning will be

provided to 06 center residents, and adherence preparation supported for the sub-set of residents eligible

for ART. FHI will continue to equip case mangers, OPC and HBC teams, peer educators, and PLWHA

groups in Binh Thanh District, District 8, Thu Duc District and Hoc Mon District, to provide appropriate

referral, coordinated care, and intensive adherence support for all clients to be re-integrated into the

community.

FHI will begin implementation of a medication-assisted therapy program in a joint ARV/methadone

substitution therapy program (pending development of VAAC implementation guidelines and approval) in

two provinces. Intensive adherence and psychosocial support will be provided to IDU clients through a

directly assisted therapy program of methadone and ARV therapy with intensive support from OPC

adherence counselors, PLWHA groups, family, and HBC teams where appropriate. FHI will work with

Vietnam CDC Harvard Medical School AIDS Partnership to develop didactic training on ARV-methadone

therapy and will provide ongoing mentorship from experienced providers. This program will be evaluated

and results disseminated as an advocacy tool and to improve methadone/HIV programming both within

Vietnam and across the region.

As a part of PEPFAR/Global Fund (GF) collaboration, FHI will provide intensive mentoring, infrastructure

development and lab monitoring support at two district-based clinics jointly supported by GF. These sites

will be scaled up as "magnet" sites and then taken over by the government of Vietnam with support from GF

Round 6 funding. If Round 6 funding is not approved, FHI will support ongoing services at these two sites.

FHI will continue to provide capacity-building in ART adherence support to VAAC and other PEPFAR

partners for the development of adherence counseling systems to prepare and support PLWHA on ART.

FHI will support VAAC to develop an adherence toolkit for adults and children containing training for

adherence counselors, job aids for counselors, and client information and training in use of the toolkit.

PLWHA support groups will be equipped with the skills and materials necessary to provide treatment

adherence support to members and their families; and provide HBC teams with lay adherence counseling

skills.

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

activity since FY07 approval are:

• As a continuation of FY07 support for evaluation of PEPFAR activities in 06 rehabilitation centers, Family

Health International (FHI) will monitor outcomes of the "Integrated HIV and Drug Abuse Prevention, Care

and Treatment Pilot Program in Ho Chi Minh City" to ensure appropriate PEPFAR prevention and care

programs. With clear guidance from both OGAC and the PEPFAR team, FHI will work with local partners to

collect data from center participants returning to the community to collect information on relapse to drug

use, injecting and sexual behaviors, and other health and social outcomes, including quality of life, mental

health, and social integration. Successful interventions in this population will be critical for prevention and

reducing the burden of the epidemic in Vietnam. Rigorous monitoring of these activities will help ensure

program success.

• FHI will continue to provide technical assistance (TA) to Vietnam's National Institute of Hygiene and

Epidemiology (NIHE) on the acquisition of improved epidemiologic data on most-at-risk populations

(MARPS), especially injecting drug user (IDU) populations. FHI will continue to explore various options for

better population size estimations, enhancements of Integrated Biological and Behavioral Surveillance

(IBBS) activities, and improved surveillance methodologies. As these specific activities are developed in

conjunction with the PEPFAR prevention, care and treatment, and strategic information (SI) teams, they will

be submitted for human subjects research clearance or non-research determination as appropriate. FHI as

a primary implementer of PEPFAR programs, and NIHE as the government of Vietnam (GVN) agency

responsible for HIV epidemiology are the best suited partners for improving information for program

planning and focus. FHI is the primary SI partner for improving data quality and use capacity amongst local

organizations. These resources will focus on further developing these activities. Considered activities

include measuring incidence and prevalence, assessing risk factors for HIV infection and exposures to

interventions, and evaluation of the effectiveness of interventions in preventing the spread of HIV. In

addition, the evaluation will incorporate BED capture enzyme immunoassay validation.The adjustment

factor derived from the BED assay validation will be applied to sentinel surveillance specimens to obtain

incidence trend data in Vietnam.

• Another component of FHI's strategic information activities is to conduct a survey among long distance

truck drivers and migrant workers, who are potentially high risk groups for HIV infection. A behavioral survey

in 2001 showed that one half of long distance truck drivers and one third of male migrant workers in

Vietnam have had sex with a commercial sex worker (CSW) in the past year. A more comprehensive sexual

risk behavior survey among these groups would help program planners understand the transmission risks of

these potential bridging populations. FHI will partner with local organizations to conduct a cross-sectional

survey among mobile groups in provinces where they can be accessed and provided with interventions.

• FHI will provide TA to NIHE in obtaining population size estimates as needed for program coverage

assessment and planning. A variety of methodologies is currently being piloted and applied to obtain size

estimates of IDU, CSW and men who have sex with men (MSM) populations in the PEPFAR focus

provinces. FHI will work with NIHE to support program areas needing population size estimates, to

potentially include OVC and MARP populations in non-focus provinces where substantial prevention

interventions are planned.

• FHI has contributed to the development of the national monitoring and evaluation (M&E) framework and

will continue to provide TA to VAAC to implement M&E at the central and provincial levels, with particular

attention to data quality assurance. FHI will identify methodologies and approaches to improving data

quality across prevention and care and treatment programs, including standardizing data collection and

quality assurance instruments, and will build local capacity at provincial AIDS centers for conducting data

quality assurance.

FY07 Activity Narrative:

In the first component of this activity PEPFAR will partner with FHI to collect biologic and behavioral data

among MARPs for appropriate program planning and policy development. In FY05, PEPFAR supported the

Ministry of Health (MOH) to implement an additional round of second generation, integrated biological and

behavioral surveillance (IBBS) among MARPs in the six current PEPFAR focus provinces (Hanoi,

Haiphong, Quang Ninh, HCMC, Can Tho, and An Giang) and Danang. The survey was implemented by FHI

and NIHE, in collaboration with Provincial Preventive Medicine Centers (PMC) and HCMC Provincial AIDS

Committee (PAC), a provincial coordination body. Findings from the survey are being finalized. In FY07,

PEPFAR will support another round of IBBS in previous survey provinces and one new focus province to be

selected in collaboration with MOH. These data will be linked to previous IBBS surveys and will provide

information on impact and outcomes for prevention programs and provide an updated state of Vietnam's

epidemic for focused program planning. The information will also be used to support advocacy and policy

activities. The survey activity will be linked to routine surveillance activities through GVN partners to ensure

continued development of surveillance information systems, methodologies, and skills of public health

personnel. FHI will partner with NIHE to develop a more sustainable behavioral sero-surveillance program

in Vietnam. FHI will provide technical support for the survey and partner with NIHE (for the north) and

HCMC Pasteur Institute (for the south), which will serve as implementing agencies in collaboration with

provincial public health personnel. In the second component of this activity PEPFAR will support FHI to

provide oversight to surveillance of the clients of CSWs. FHI will partner with NIHE to conduct this activity.

This is a particularly hard to identify at-risk population where little information is available on their risk and

estimation of population size. FHI will provide TA to NIHE to develop methodology that will be incorporated

into other routine sentinel surveillance activities and assist with capacity building at NIHE to conduct this

surveillance independently in the future. In the third component of this activity FHI will continue to implement

the Analysis and Advocacy (A2) project funded by PEPFAR from FY 2005 to produce quality data analysis

and synthesis and work in collaboration with Health Policy Initiative (HPI) (related activity HVSI 9369) to

advocate for appropriate responses to the Vietnam HIV/AIDS epidemic. In FY07, FHI will: continue national

and provincial-level data collection so that implication of surveillance, survey, targeted evaluation, and

program assessment results and other data are fully utilized for modeling the HIV/AIDS epidemic, policy

implications and interventions; conduct workshops in collaboration with HPI on the use of data; provide

concrete programmatic implications to the PEPFAR team as well as PEPFAR partners; collaborate with

other international and local partners to continue supporting VAAC in integrated and advocacy under the

Activity Narrative: framework of A2 - this project will utilize the strengths of both VAAC and PEPFAR for the appropriate use of

data in policy-making and intervention development; and apply the A2 framework to implement advocacy

activities in other focus provinces including Hanoi, Quang Ninh, Can Tho and An Giang. The ultimate goals

of this activity are to: 1) provide outcome indicators and coverage information for PEPFAR-supported

prevention programming among MARPs in Vietnam; 2) strengthen the capacity of government staff on data

utilization; 3) provide information to explain changes in HIV prevalence, including the impact of PEPFAR-

funded prevention programming; 4) provide epidemiologic and behavioral data in specialized formats

tailored for advocacy to policymakers; and 5) to develop a clear understanding of the HIV/AIDS epidemic in

Vietnam so that that effective national policies and appropriately targeted programs can be developed.

Finally, FHI will continue to partner with the University Training Center for Health Care Professionals-HCMC

and HCMC PAC in conducting enhanced patient monitoring and quality improvement. The abstraction of

these data from either electronic or hard-copy patient medical records in 4 outpatient clinics in HCMC will

provide information beyond routine patient monitoring important for program planning and continuous

quality improvement. The activities will be coordinated with related activities described under the HCMC

PAC activity narrative (HVSI 9243).