This is a continuing activity from FY07.

This ongoing activity will support the national PMTCT scale-up strategy to reach 80% geographic coverage,

provide counseling to 90% and testing to 60% of pregnant women, provide prophylaxis to 100% of HIV-

positive mothers and their infants, and continuing care and treatment services to 90% of HIV-positive

mothers and their babies.

This activity focuses on five main objectives in support of the program area strategy: 1) expanding PMTCT

coverage; 2) strengthening referrals and linkages between PMTCT sites to out-patient clinics (OPCs) and

community-based programs providing counseling, care and treatment and other support services to

mothers, children and family members; 3) promoting early HIV testing during antenatal care (ANC); 4)

evaluating the effectiveness of the program; and 5) building capacity to oversee PMTCT programs at the

Vietnam Administration for HIV/AIDS Control (VAAC).

In FY08, VAAC will expand PMTCT services in 13 high-prevalence provinces that currently receive or will

begin to receive PMTCT services in FY07, and will expand services to three additional provinces that do not

have adequate PMTCT coverage, starting at the provincial level. The goal is to increase both geographic

and numeric coverage nationwide to increase the number and proportion of HIV-positive pregnant women

who are tested early and subsequently receive appropriate ARV prophylaxis and/or treatment.

At the national level, the National OB/GYN Hospital continues to act as the principal implementer, educator

and technical assistance (TA) and quality assurance (QA) provider, to provide training, implementation

assistance, produce information, education and communication (IEC) materials, provide QA and monitoring

of the provinces and to lead the implementation of the national PMTCT network.

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

provide HIV counseling and testing, aimed at identifying HIV-positive pregnant women early. ARV

prophylaxis will be provided on-site or at a designated adult OPCs closely linked to the PMTCT site. Clinical

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

mothers will be provided at affiliated OPCs. HIV-positive women will be referred for STI screening, and

provider-initiated counseling will be scaled up such that women with genital ulcers or urethral discharge will

be counseled and provided with HIV testing.

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. New PEPFAR-supported PMTCT sites will be started in areas where other

services, especially adult and pediatric OPCs and home-based care already exist. PEPFAR will work

closely with other donors such as Global Fund, Clinton Foundation HIV/AIDS Initiative, World Bank, and

with VAAC to coordinate service expansion for maximum use of resources and to promote the family-

centered care model.

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, including counseling and testing, care and treatment, community- and

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

psychosocial support through trained case manager and support groups.

Since FY06, PEPFAR has supported the Ministry of Health (MOH) to provide HIV testing free of charge at

the district level and lower, but not at the national and provincial level. However, the cost of HIV testing is

causing some women to delay HIV testing until delivery and program data show that many HIV-positive

pregnant women have received only single dose NVP as a PMTCT prophylaxis option. To promote early

identification of HIV-positive women, starting in FY07 and increasing in FY08, PEPFAR will continue to help

subsidize (full or partially) HIV testing at the provincial level and higher.

In FY08, PEPFAR will support VAAC to begin an assessment of the effectiveness of the national program.

The assessment will help to expose the gaps and weaknesses of the program systematically and provide

recommendations to strengthen the program.

PEPFAR will continue to support capacity building at VAAC through several activities: TA for development

of national guidelines, a national implementation protocol and scale-up plan, training and TA for new VAAC

staff in PMTCT programming and evaluation, and support to develop a national protocol and

implementation for DNA PCR utilizing dried blood spots (refer to Laboratory Infrastructure section).

PEPFAR will continue to advocate for the expansion of PCR for early infant diagnosis (EID) to two

additional regional laboratories, increasing the total number of laboratories providing PCR for EID to four

nationwide in FY08.

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:

• As of April 2007, an estimated 120,000 high-risk individuals had been reached through peer outreach and

provided with BCC messages and risk reduction counseling. In the first six months of FY 07 alone, 10,626

new clients were reached, and two MARP-friendly community centers were established in Hai Phong and

Quang Ninh.

• In FY08, PEPFAR will support MOH to continue 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. Options for integrating VCT and STI services in

these centers will be explored to improve access to care among high-risk populations.

• With PEPFAR support, outreach activities will be maintained in 29 provinces with expansion in focus or

high priority provinces to improve population coverage (see uploaded Geographic Coverage document).

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, 42,000 high-risk individuals will be reached with high quality BCC services, and 500 individuals

will be trained in promoting HIV prevention.

FY07 Activity Narrative:

The MOH takes the lead in peer-driven outreach for intravenous drug users (IDU) and commercial sex

workers (CSW) in focus- as well as non-focus provinces. PEPFAR will partner with MOH to train 480

outreach workers in behavior change communication (BCC) for HIV prevention targeting 22,000 IDU, 8,000

CSW, and 1,500 former residents of government centers for rehabilitating drug users (06 centers). These

activities support drug use and sex work reduction goals outlined in the Vietnam National HIV/AIDS

Strategy and the PEPFAR Vietnam Five-Year Strategy.

With PEPFAR support, and with overall coordination of BCC interventions led by outreach coordinators, 460

peer educators will give IDU (27 provinces) and CSW (nine provinces) relevant motivation and skills to

adopt safer behaviors. At-risk individuals will receive condoms and will be referred to network services

including counseling and testing, care and treatment, drug and alcohol abuse treatment options, and STI

services. Outreach workers will refer clients to peer support groups, drop-in centers, vocational skills

training, and job placement. Tailored interpersonal strategies will ensure equitable access to HIV/AIDS

services for drug-using CSW (based on CSW/IDU needs assessment results), establishment-based CSW

(with participation of establishment owners), and cell phone-based or scooter-based CSW. While MOH

outreach provides extensive coverage in multiple provinces, peer interventions will be planned in

cooperation with outreach coordinators to avoid redundancy in districts where other outreach partners (FHI,

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

FY07 funds will also support the MOH pilot of HIV/AIDS Prevention and Education Centers in the 7

PEPFAR focus provinces. These centers will offer space for group meetings, refresher training courses, and

for clients to learn risk reduction skills. Outreach coordinators will host coordination meetings and training

sessions in Prevention and Education Centers, facilitating networking among different outreach groups and

other service providers.

An additional 20 specialized peer educators will target former 06 center residents as they return to home

communities in Hanoi and Haiphong. Both center-based and community-based non-using peers will receive

training of trainers (TOT) training, learning to counsel former residents to prevent relapse, and refer them to

counseling and testing, HIV care and treatment, case managers, and employment.

PEPFAR funds will support three regional workshops for networking among outreach staff, managers, key

officials, health staff, community workers and others who serve at-risk populations. The workshops will

provide a forum for: promotion of best practices and standard service packages; exchanges of lessons

learned and results dissemination; and enhancing coordination among different donors and programs.

This is a continuing activity from FY07.

PEPFAR supports the Ministry of Health/Vietnam Administration for HIV/AIDS Control (MOH/VAAC)

through a cooperative agreement to provide clinical care and support for PLWHA at the provincial level in

the PEPFAR focus provinces, and provides palliative care services in selected districts and additional

provinces in coordination with Global Fund (GF)-supported programs.

In line with the PEPFAR Vietnam 5-Year Strategy to increase care and support services to 110,000 PLWHA

through FY08, VAAC 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 supported

by other PEPFAR partners. In FY07, VAAC handed over provincial out-patient clinics to GF in a phased

approach in order to maximize coverage and quality in higher-prevalence provinces. The PEPFAR Vietnam

2007 Semi-annual Progress Report (SAPR) reported that there were 14,754 adult and pediatric outpatients

provided palliative care services at 45 out-patient clinics; and 120 healthcare providers attended refresher

trainings on HIV/AIDS care and the national out-patient clinic operational protocol.

Based upon the National Palliative Care Guidelines and OGAC guidance, VAAC will support

comprehensive clinical palliative care services in focus provinces and in selected additional high-prevalence

provinces (see uploaded Geographic Coverage document). VAAC has partnered with the GF to ensure that

resources are not duplicated, and that geographic coverage is maximized. In addition, with PEPFAR

support, VAAC will maintain basic clinical palliative care services at provincial out-patient clinics in other

PEPFAR non-focus provinces. The package of services provided is described in the Palliative Care Basic

program narrative. VAAC will enhance STI diagnosis and treatment for outpatients through improvement of

referrals to STI clinics and enhancement of lab capacity at those clinics. 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 PEPFAR support, VAAC will strengthen its role in coordination, supply and distribution of OI drugs, lab

supplies and other commodities to out-patient clinics.

Due to the high HIV prevalence and need for palliative care services for PLWHA residents in government-

run drug rehabilitation ("06") centers where many injecting drug users reside, VAAC will continue to work

closely with the Ministry of Labor, Invalids and Social Affairs (MOLISA), and the Ministry of Public Security

(MOPS) to ensure quality care as patients move between the centers and the community. VAAC-supported

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

care, drug addiction treatment, and psychosocial and social support services in their communities through

PLWHA support groups and the SMARTWork employment program.

Family Health International and a number of community- and faith-based organizations (C/FBOs) supported

by PEPFAR will support home- and community-based care and support for PLWHA receiving care at VAAC

sites. In collaboration with PEPFAR partners, VAAC will continue standardizing the national training

curricula to provide initial and refresher training on stigma reduction in the health care settings, clinic

operational procedures, counseling and laboratory procedures for healthcare providers at different levels,

training on ART readiness and adherence for patients and caregivers, and training on methadone therapy

for healthcare providers in accordance with the National Methadone Guidelines. PEPFAR will work closely

with the government of Vietnam, including VAAC, to advocate to expand the methadone program to

additional patients, and additional sites, in order to increase access to these services for as many persons

as possible.

With support from the PEPFAR Strategic Information and Care and Treatment teams, VAAC will improve

patient care monitoring, and program monitoring and quality assurance tools, in support of the national

monitoring and evaluation system.

This is a continuing activity from FY07.

In FY08, PEPFAR will continue to support the Ministry of Health's (MOH) successful scale-up of TB/HIV

activities. The comprehensive package of services will be expanded from six provinces to eight provinces;

eight other provinces will continue to receive the basic package of services. Activities will include:

• Mechanisms of collaboration. Collaboration mechanisms between TB and HIV programs will be

strengthened at all levels. Provinces will convene joint monitoring and evaluation of TB/HIV activities, joint

training activities and regular meetings for district-level participants.

• Human resource development. Including direct technical assistance (TA) and training for 300 individuals to

strengthen TB/HIV clinical management and program monitoring.

• Monitoring and evaluation (M&E). In accordance with the PEPFAR Strategic Information plan, information

collection for TB/HIV activities will meet national standards ensuring integrated service delivery systems,

linkages across providers and programs, routine M&E and support for the National HIV/AIDS M&E System.

• Provider-initiated HIV testing and counseling (PITC). An estimated 28,000 TB patients will receive PITC in

TB clinics. Patients who are found to be HIV-infected are referred for HIV clinical services, and successful

referral is tracked on TB and HIV program forms.

• TB screening. PEPFAR will support TB disease screening in PLWHA that are attending HIV clinics and

are living in the community. PEPFAR will support TB screening for 10,000 PLWHA in 15 provinces.

• Clinical services for HIV-infected TB patients. HIV-infected TB patients will receive co-trimoxazole

preventive therapy, HIV staging, ART (if indicated) and other services. MOH will expand ART to three

provincial TB hospitals.

• INH preventive therapy. PEPFAR will support this service for 600 patients in two current provinces.

• TB lab capacity. Lab capacity will be expanded in an additional two provinces. The goal is to have at least

one facility in each focus province with sufficient skill and resources for rapid diagnosis and treatment of all

forms of TB, including smear-negative and drug-resistant, in HIV-infected patients.

• Infection control. MOH will receive support for ongoing assessments and implementation of administrative

controls and, where necessary, physical renovations. Additional support for this activity has been provided

to FHI and KNCV (see FHI and KNCV activity narratives).

• Public-private partnerships. Support for this intervention has been provided to the MOH through PATH

(see PATH activity narrative).

In FY07, PEPFAR provided both a basic and comprehensive package of TB/HIV services in selected

Vietnamese provinces. The basic package included PITC of TB patients, TB screening of HIV patients,

cotrimoxazole prophylaxis, training of health staff, and monitoring of TB services provided to HIV patients

and HIV services provided to TB patients. In focus provinces (six in FY07; refer to Geographic Coverage

document for clarification), the basic package was complemented by additional services, including

development of TB lab capacity, ART for HIV-infected TB patients and implementation of TB infection

control measures in HIV clinical settings. In addition to this package of services, PEPFAR also supported

pilot initiatives in selected provinces, including provision of HIV care and treatment at provincial TB

hospitals, molecular-based methods for rapid TB drug susceptibility testing, collaboration with private sector

HIV and TB providers, and provision of INH preventive therapy to PLWHA. At the national level, PEPFAR

supported creation of a national TB/HIV Technical Advisory Group that wrote a national TB/HIV policy and

developed training materials for healthcare staff. In FY07, over 18,000 TB patients and 7000 HIV patients

across 15 provinces received TB/HIV services through PEPFAR, and over 350 Vietnamese nationals were

trained in TB/HIV diagnosis and treatment.

This is a continuing activity from FY07.

In FY08, PEPFAR will support the Ministry of Health/Vietnam Administration for HIV/AIDS Control

(MOH/VAAC) pediatric program to continuously strengthen the provision of care and support services for

OVC and their caregivers in six focus provinces and other provinces where the pediatric program will be

extended. As planned in FY07, OVC services were added in pediatric clinics and at a drop-in center for

OVC and their caregivers which was established in Hanoi. In FY08, PEPFAR will continuously support the

provision of this wider range of services, designed to better meet the developmental needs of each child.

344 OVC will receive services, and 30 caregivers will be trained to provide services to OVC and their

families. Case managers at newly established clinics will be trained to provide OVC services at clinic

settings.

The 11 pediatric HIV/AIDS out-patient clinics (OPCs) will keep providing a core set of OVC services,

including needs assessment with OVC and caregivers; counseling and psychosocial support, food/nutrition

support (in accordance with PEPFAR guidance), provision of formula for PMTCT, support for transportation,

and referral to other services including PMTCT, clinical care for PLWHA caregivers, and social support

services for OVC and caregivers. 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.

PEPFAR will also support the provision of OVC services through the drop-in center. OVC and their

caregivers will be referred to the center from National Pediatric Hospital and Saint Paul Hospital, as well as

through other health care and community-based support services. The drop-in center will provide the same

assessment, referral and psychosocial support services offered through the pediatric OPCs. In addition, the

drop-in center will offer more comprehensive services to OVC and caregivers, including caregiver support

groups, educational activities and advocacy/support for enrollment of OVC in community schools,

therapeutic play groups for OVC, training of family caregivers in basic care and support for children, age

appropriate life-skills education for OVC including primary prevention of HIV/AIDS and primary prevention of

drug use, and on-going support to families at risk of institutionalizing children.

PEPFAR will keep providing intensive and ongoing capacity-building and technical assistance to ensure

consistent and quality programming, including training courses, mentoring, coaching, and support for fora to

bring OVC partners together to problem-solve, and share experiences and resources.

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 eight focus provinces based on the results of a

pilot in 2007.

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

provinces 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 three STI clinics in focus

provinces.

• HIV testing - with an emphasis on prevention counseling and couples counseling - will be integrated into

MARP-friendly drop-in centers in focus provinces, in coordination with PEPFAR prevention technical

working group.

• Support will be provided to the Vietnam Administration for HIV/AIDS Control (VAAC) to develop and

implement national guidelines for PITC based on the newly released WHO/UNAIDS PITC guidelines.

FY07 Activity Narrative:

In FY07, PEPFAR will support the Ministry of Health (MOH)/Vietnam Administration for HIV/AIDS Control

(VAAC) to expand CT coverage in the highest HIV-prevalence provinces and reduce support for CT

programmatic services in lower prevalence provinces targeting MARPs, including injecting drug users (IDU),

male and female commercial sex workers (CSW), men having sex with men (MSM), sex partners of HIV

infected persons and clients of injecting drug users and sex workers. PEPFAR will continue to support

VAAC for HIV counseling and testing (CT) services at 36 clinics in 18 provinces, establish ten new VCT

clinics, transfer HIV CT services at 12 clinics in 11 provinces from PEPFAR to Global Fund (GF) support,

train 140 health care workers, strengthen referral systems and work with different groups including PLWHA

groups to encourage test result disclosure. These activities will result in provision of CT services to 45,000

individuals through VAAC support and 14,400 individuals through GF support.

In FY07, PEPFAR will continue to support provision of confidential CT services at 36 existing sites in 18

provinces that form part of a comprehensive HIV network facilitating linkages and referrals between different

services at the provincial and district levels. In addition, PEPFAR funds will support the establishment of a

total of ten new CT clinics in four focus provinces, Hanoi, Haiphong, Quang Ninh and a TBD focus province,

that will be integrated into existing OPC or STI clinics using both client-initiated and provider-initiated

models to facilitate referral, linkages and service utilization. Under the new cooperative agreement with the

VAAC, PEPFAR will discontinue funding for programmatic activities in ten lower-prevalence provinces while

continuing to provide technical assistance to these sites to ensure continuation of quality service provision.

PEPFAR will explore alternative means of supporting these programs. Based on GF Round 6 approval,

PEPFAR will support VAAC to transfer CT programs to GF management from 12 VCT clinics in 11 lower-

prevalence provinces where GF also operates allowing $130,000 of unallocated funds to be used for HVCT

9518. Non approval of GF Round 6 applications will result in continued programmatic support by VAAC in

these 11 provinces until alternate resources are identified. VAAC will also receive PEPFAR funds to expand

support of counseling and testing services at TB clinics in the focus provinces.

PEPFAR funds will be used to improve service provision at all sites mentioned above through training 140

health care workers on couple counseling using HHS/CDC and OGAC TWG approved curricula, and

internal as well as external quality assurance and quality control (QA/QC) measures. With PEPFAR

support, VAAC will also provide technical assistance to GF and World Bank CT programs to standardize

service provision and coordinate a national HIV CT reporting system. To follow up on the previous national

meeting initiated in 2005, VAAC, with PEPFAR technical support, will take the lead in coordinating and

organizing a 2nd National CT conference with all VCT donors/partners including GF, World Bank, Asian

Development Bank (ADB), FHI, and TBD-PSI follow-on to facilitate experience-sharing and review of best

practices.

PEPFAR will support VAAC to collaborate with World Health Organization (WHO) and UNICEF to

encourage safeguard CT for children and adolescents, a method to ensure non-discrimination against

minors, with approval and presence of guardians. Education of safeguard CT will be provided to healthcare

workers through health information channels, training, and legislative regulations.

In collaboration with the UN, WHO, other major donors (GF, AusAID, World Bank), and international NGOs

(FHI, PSI, etc), PEPFAR will assist VAAC in developing and disseminating national guidelines for CT.

PEPFAR will coordinate with referral officers to enhance existing referral systems between HIV prevention

and care services through the development of a referral card tracking system. PEPFAR will also continue its

support of VAAC monthly coordination meetings at the provincial level.

With PEPFAR support, VAAC will closely collaborate with TBD-PSI follow-on to maximize outcome of social

marketing investment for greater uptake of CT. In addition, VAAC will pilot outreach CT communication

activities in select provinces, in which CT counselors, in coordination with peer outreach program and

organizations such as the Women's and Youth Unions, provide CT education to target population and

encourage referral to CT. To strengthen linkages with outreach programs, VAAC and PEPFAR will

coordinate activities with PLWHA groups, peer outreach programs, and organizations such Women and

Youth Unions and encourage test result disclosure, service utilization by families, and ensure non sero-

conversion of HIV negative partners of discordant couples. These activities will facilitate normalization of

HIV test seeking behavior and reduction of stigma and discrimination.

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 Vietnam Administration for HIV/AIDS Control (VAAC) will scale up ARV services in eight

focus provinces and expand services to nine non-focus provinces. ARV services will be in place at 25 adult

ART clinics with a total of 6,969 adults (including 3,179 newly initiating adults) on ART.

• Pediatric ART will be scaled up at 12 specialty pediatric clinics and seven family-centered clinics across 17

provinces. VAAC will provide treatment to a total of 787 children (including 307 new children) by September

2009.

• VAAC will start providing ART in one to two tuberculosis hospitals to increase the access of TB-infected

HIV patients to ART.

• In FY08 VAAC will coordinate with other donors (Global Fund (GF), PEPFAR, Clinton HIV/AIDS Initiative)

to increase treatment coverage effectively.

• VAAC will work closely with Vietnam CDC Harvard Medical School AIDS Partnership (VCHAP) to provide

on-site technical assistance (TA) for GF sites and non-PEPFAR provinces, especially on second-line

regimens that were supplied by PEPFAR.

• In FY08 VAAC will disseminate ART program-related outcomes and lessons learned from the Enhanced

Evaluation (link with SI).

• VAAC will take the lead in coordination of drug resistance program with support of PEPFAR and the World

Health Organization (WHO).

• National trainer teams will be set up and take the lead on updating training curricula and implementing a

treatment strategy to support national scale up of ART with technical support from international experts.

• To date, VAAC has established 11 national and provincial and one district level ART sites. With PEPFAR

support, VAAC has provided ART for 2,075 patients, including 1,890 adults and 185 children.

• Using FY07 funding, VAAC is currently expanding ARV services in a total of 24 ART sites to support 3,790

adults and 480 children on ART across 15 adult ART sites, nine specialty pediatric clinics and one family-

centered clinic.

FY07 Activity Narrative:

In FY05 and FY06, the Ministry of Health (MOH)/VAAC scaled up ART services to 1,135 adult and pediatric

patients at six adult out-patient clinics (OPCs) and four pediatric specialty clinics in five PEPFAR focus

provinces. In FY07, VAAC will expand treatment to provide direct support for 4,320 (existing and new)

patients at 18 provincial and district-level clinics in six focus provinces (clinics in Ho Chi Minh City, the

seventh province, are supported by the Ho Chi Minh City Provincial AIDS Committee). VAAC will provide a

limited package of support to provincial-level ART clinics in 12 non-focus provinces. VAAC will focus on

achieving four main objectives in FY07: expanding services at the provincial and district levels to support

initiation and monitoring of ART; enhancing services at the provincial level (via adult, TB, and pediatric

specialty clinics) to support secondary and tertiary level care; improving quality of services; and building

national and local capacity to ensure sustainability of ART service provision throughout Vietnam.

In each of the focus provinces, VAAC will support one provincial-level adult ART OPC and one pediatric

specialty clinic. These clinics are responsible for providing initial prescription of ARV as well as managing

referrals from district-level sites for management of side effects and second-line therapy. VAAC will also

support provincial-level ART clinics at TB hospitals in focus provinces where there is a 10-20% HIV

seroprevalence rate. Primary service delivery of ART in Vietnam is being decentralized to the district level

so that provincial-level sites can increasingly focus on tertiary care. In FY06, VAAC supported one district-

level ART clinic with PEPFAR funding. In FY07, VAAC will expand this clinic into a magnet clinic supporting

ART and home-based care (HBC) services for three surrounding districts, and will launch two new district-

level ART clinics targeting current and former injecting drug users (IDU). In addition to its work in the focus

provinces, VAAC will provide a limited package of support to provincial-level ART clinics in 12 non-focus

provinces with PEPFAR funding. This support package includes staffing, supervision and lab monitoring

and will be phased out over the next two years (refer to uploaded Geographic Coverage document).

VAAC will support a referral case manager in all clinics in the focus provinces to facilitate referrals to

TB/HIV and STI services as well as to home- and community-based care services provided by PEPFAR

and other partners. These staff will assure women and families referred from PMTCT services receive

ongoing treatment services as needed (key legislative issues: gender). Case managers at provincial-level

pediatric clinics will closely link with community-based OVC services and work part-time in PEPFAR

supported resource centers to be established in three provinces providing psychosocial assessments and

links to other social supports. At each of the sites a network of peer educators and volunteers will be trained

to provide treatment support and establish support groups. These networks will provide additional

adherence support and also facilitate access to care and treatment services. To facilitate acceptance of

these groups into service delivery, training on stigma reduction will be emphasized (key legislative issue:

stigma). Case managers will work in teams with peer educators and support groups to prevent addiction

relapse, help patients access to substitution treatment as it becomes available; and facilitate referral to

services for patients released from drug rehabilitation centers.

Finally, in collaboration with the Vietnam CDC Harvard Medical School AIDS Partnership (VCHAP), Family

Health International (FHI) and HHS/CDC, funds will support VAAC to continue leading the national ARV

training program using the national treatment protocol and other standardized curricula. HHS/CDC care and

treatment staff will work closely with new VAAC staff to build capacity on ART, patient monitoring, and use

of standardized quality assurance tools for ARV program implementation, management and monitoring.

Collection of information for implementing, monitoring, and evaluating activities will be in line with the

PEPFAR SI strategy and meet national standards ensuring integrated service delivery systems, linkages

across providers and programs, routine monitoring and evaluation, and support for the national HIV/AIDS

monitoring and evaluation system.

This is a continuing activity from FY07.

PEPFAR will support the Ministry of Health (MOH)/Vietnam Administration for HIV/AIDS Control (VAAC) in

capacity building and sustainability of the laboratory infrastructure through three new memorandum of

understandings with: a) the National Institute of Dermatology and Venerology (NIDV) to manage sexually

transmitted infections; b) the Department of Therapy (DoT) to strengthen quality in reporting results in

clinical labs; and c) the National TB Hospital to build capacity in basic TB diagnosis. Support will include:

equipment procurement; equipment maintenance contracts; External Quality Assessment (EQA) panels for

clinical laboratory network in seven focus provinces and some districts; practical training for five students

enrolled in laboratory/medical technology courses for HIV diagnosis and monitoring disease in Vietnam;

strengthening of laboratory data management through standardization and implementation of both paper-

based and electronic systems; coordination between VAAC subcommittees and donor agencies through

annual and quarterly meetings; and support for VAAC staff to coordinate these activities.

Through VAAC, NIDV will be provided funds to: strengthen and manage sexually transmitted infections;

translate and distribute standard operating procedures for specimen collection, bio-safety and syndromic

patient management at selected out-patient clinics (OPC); and testing and reporting results for gonorrhea,

chlamydia and syphilis.

One of the greatest challenges to a full-scale national implementation of clinical laboratory programs is the

lack of a designated National Reference Laboratory for clinical network. Until MOH designates such an

institute, VAAC and DoT will take the lead in ensuring the quality of results in the clinical laboratory network.

PEPFAR will facilitate this process by funding external quality assessment (EQA) panels for these

laboratories; the DoT is expected to implement the process of monitoring and evaluating the clinical

laboratories at district and provincial levels in the seven focus and selected additional provinces. Contracts

for centralized maintenance of equipment and two staff to support the distribution of EQA panels will also be

channeled through the memorandum of understanding between VAAC and DoT. PEPFAR will also provide

funds to: strengthen quality in testing and reporting results in clinical labs through training for opportunistic

infections; procure three hematology and three bio-chemistry analyzers to support laboratories in need of

replacement equipment; and support five student internships to build sustainability and to address the

shortage of trained laboratory staff.

Support will be provided to the National TB hospital to build capacity through refresher training-of-trainers

and the training of staff in laboratories at provincial and districts level in PEPFAR focus provinces to

diagnose TB using the AFB smear techniques. Funds will also be provided for translation and distribution of

this training material to participants.

In FY07, PEPFAR funded VAAC with equipment including bio-safety cabinets, ELISA systems, hematology

and biochemistry analyzers, and one CD4 machine. Given the additional expansion planned in FY08, as

well as the additional burden that has been placed on laboratory technicians performing CD4 counts,

PEPFAR will fund VAAC to procure additional CD4 equipment as well as to improve capacity of laboratory

technicians and/or hire additional workers to meet the increased work load and additional job

responsibilities. Funds will support two CD4 refresher trainings for all PEPFAR focus provinces, one annual

laboratory retreat, including all of VAAC's subcommittees, as well as staff to support EQA and the

laboratory information system (LIS).

In FY07, two more laboratories supporting testing for out-patient clinics that provide AART were selected for

implementation of the LIS, following the pilot at the National Institute of Infectious and Tropical Diseases

(NIITD). A Vietnam contractor was selected for customization of an open source LIS software developed

through collaboration between three U.S. state public health laboratories. In FY08, VAAC, together with the

software contractor and guidance from the PEPFAR Laboratory team will expand the LIS to two more sites.

The Vietnam contractor will also support instrument interfacing to allow the LIS to link seamlessly with the

analyzers in the laboratory, reducing data entry burden on the laboratory staff and ensuring greater

accuracy and timeliness of results.

In addition, three voluntary counseling and testing sites in Hanoi that refer specimens for confirmatory

testing will also be linked to the LIS, allowing timely access to results. Linkage between the LIS and patient

monitoring information systems (PMIS) will also be emphasized. For five laboratories that receive a high

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

and log information on the specimens into the LIS, leading to faster turnaround time.

PEPFAR will also provide support to six voluntary counseling and testing sites in focus provinces that are in

need of standardized paper-based specimen management to allow all specimens collected and referred for

HIV testing to be labeled with a barcode. VAAC will provide leadership in bringing together national

stakeholders to develop a core minimum data set for laboratory data to ensure that all laboratories and

information systems follow national standards when collecting and tracking specimens. All LIS activities will

be monitored by the VAAC LIS Project manager contracted in FY07.

These activities are similar to those being provided by the Ho Chi Minh City Provincial AIDS Committee

(HCMC PAC) and will require the VAAC LIS Project Manager to coordinate activities with the LIS Project

Officer in HCMC PAC to ensure standardized training for laboratories nationally.

All the above efforts will support the expansion of prevention, care and treatment activities.

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

activity since FY07 approval are:

• With the approval of the National Monitoring and Evaluation (M&E) Framework in January 2007, the

Vietnam Administration for HIV/AIDS Control (VAAC) is now leading efforts to implement the framework. As

the leader of the national M&E technical working group (TWG), VAAC is responsible for the oversight and

management of all national HIV program M&E. By partnering with other agencies in the Ministry of Health

(MOH), donors, UN, and implementing partners, VAAC will be charged with ensuring these programs are

coordinated through a single M&E system for national program management.

• PEPFAR funds to VAAC will support these activities by providing MOH with the resources to achieve the

activities defined in the framework through consensus building activities, program implementation and

contracted services for M&E, health management information system (HMIS) activities and surveys and

external technical support.

• Support to MOH will also be used to develop routine service delivery systems through the development of

national standards for data structures and information system design. Focus program areas for these

systems include care and treatment, VCT, PMTCT, prevention and community-based activities.

• Human capacity development will be supported through temporary contracts for immediate staffing needs

while in-service and pre-service trainings for specific program areas are developed and conducted with

VAAC's oversight.

• Finally, funds will support the development of a national HMIS drawing data from routine service delivery

information systems, surveillance activities, surveys, and program management databases, including

program coverage and quality data. This single national HMIS will be achieved through the guidance of a

national HMIS TWG led by VAAC with broad participation from UN, donors, and implementing agencies and

partners.

FY07 Activity Narrative:

Set up in 2005, the Vietnam Administration for HIV/AIDS Control (VAAC) is a newly formed body of the

Ministry of Health (MOH) that oversees all HIV/AIDS activities in Vietnam. Currently, VAAC's capacity for

providing oversight to strategic information (SI) activities is limited and needs strengthening. Prior to VAAC,

MOH/LIFE-GAP (the project management unit implementing the PEPFAR cooperative agreement in MOH),

NIHE, and the Hanoi School of Public Health (HSPH) were PEPFAR's primary MOH partners outside of

HCMC. Although LIFE-GAP will be absorbed into VAAC, memorandums of understanding (MOUs) for how

VAAC will work with HSPH and NIHE will need to be developed to ensure Vietnam continues to benefit from

PEPFAR capacity development support. As PEPFAR continues to support these partners, it will be

necessary to help build capacity in VAAC over the coming years to provide national oversight while

partnering with these other Vietnam government agencies. Activities to be led by VAAC include advocacy

and coordination of national HIV/AIDS SI activities. In the implementation of the National M&E Framework,

VAAC will also coordinate and lead systems assessments, data harmonization, physical and workforce

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

routine data supervision and M&E will be developed within VAAC through training, technical support, and

the development of a rational staffing plan. FY07 funds will be used by VAAC to scale-up solutions for M&E

and routine information systems, training, and information sharing infrastructures regionally and then to the

provincial level. PEPFAR will continue to support VAAC in consensus building, leadership, and oversight

roles in HIV/AIDS in Vietnam. These funds will also be used to help VAAC establish a secure network for

storage of national HIV/AIDS data and the receipt of data from the district and provincial to the national

level. Through this activity, PEPFAR will support SI technical assistance for four GVN HIV/AIDS

organizations and SI training for 24 staff. Additional funds will provide support to VAAC for a more rapid

deployment of the National M&E Framework which was presented and approved in January 2007. These

funds will allow an accelerated timeline for training and capacity building of regional and provincial levels.

This is a continuing activity from FY07.

The Ministry of Health (MOH)/Vietnam Administration for HIV/AIDS Control (VAAC) was established in

August 2005 and is responsible for overseeing and coordinating HIV/AIDS programs in all 64 provinces.

PEPFAR's success in Vietnam will depend in part on sustainable national program management solutions

as VAAC expands its mandate to coordinate HIV/AIDS activities nationwide. VAAC is mandated to oversee

all major donor assistance programs including PEPFAR, Global Fund, World Bank, and the Asian

Development Bank. PEPFAR funding currently supports activities in 30 provinces.

In 2007, PEPFAR substantially increased support to VAAC to enable capacity building in technical areas by

providing funds for 30 contract staff at the central level and partial support (temporary contract, overtime,

incentive bonuses) for provincial and district level staff. Funds also supported: a national summary

workshop to disseminate the results of the first five year cooperative agreement between HHS/CDC and

MOH; development of provincial-level work plans for the new follow-on cooperative agreement; provincial

joint PEPFAR/MOH program oversight visits, and the development of the VAAC office. However, given

substantially increased PEPFAR and other donor support, VAAC has requested additional support to build

management structure at the central and provincial levels, and infrastructure at the provincial level.

Several donors have come together to support the government of Vietnam (GVN) in its response to the

HIV/AIDS epidemic, including PEPFAR, Global Fund (GF), World Bank, and the Asian Development Bank.

With PEPFAR support, VAAC will strengthen its capability to serve as the coordinating agency by

conducting regular coordination meetings with PEPFAR partners, Vietnamese government officials and

other donor agencies. These meetings will serve as a forum for dialogue on program progress, overlap and

duplication, and will address key issues for strengthening the national program. In addition, VAAC will

sponsor technical workshops on prevention, care and treatment, and strategic information to disseminate

lessons learned, program results, as well as highlight innovative programs and ideas. These workshops will

be open to government staff, donor agencies and implementing partners.

In 2008, PEPFAR funds to VAAC will continue to support human capacity through temporary contract

technical and administrative staff at VAAC, whose principle role will be to coordinate donor programs at the

central and provincial levels. At the national level, key temporary technical contract staff will be recruited in

prevention, care and treatment, and program administration. VAAC administrative staff will undergo training

to manage PEPFAR funds provided through the HHS/CDC cooperative agreement. At the provincial level,

PEPFAR will continue to support temporary contract VAAC staff in each of the seven PEPFAR focus

provinces, and will support additional temporary contract staff in the eighth focus province. These

individuals will serve as primary liaisons for VAAC and other donor-funded activities, supporting the

coordination and communication between national and provincial programs. Each of these staff will

participate in a Total Quality Management (TQM) course offered in partnership with the Hanoi School of

Public Health (HSPH) (see OHPS HSPH activity narrative). Through a newly developed memorandum of

understanding between VAAC and HSPH, HSPH will provide additional management technical assistance

and training to national and provincial staff. PEPFAR will increase support for the development of provincial

AIDS centers (provincial VAAC) through material support, carefully selected infrastructure and renovation

support, and coordination activities in eight focus provinces plus at least two additional provinces in which

PEPFAR will provide expanded technical support. Also at the provincial level, VAAC will support a network

of regional program managers that will link HIV/AIDS programs and provide a forum for discussions on

implementation, key issues, challenges and solutions. This network will also provide a mechanism for the

dissemination of successful programmatic innovation. The network will meet on a regular cycle to bring

together provincial governments, PLWHA, local organizations and international donors, within the provinces

to foster a connected relationship between all sectors involved in HIV/AIDS programs.

In 2008, PEPFAR will support VAAC to develop a comprehensive national plan for geographic coverage of

HIV/AIDS programs, in collaboration with other donors including GF and World Bank,, including a tiered

approach for PEPFAR support comprising eight focus provinces, expanded targeted programmatic area

technical support in carefully selected provinces, and maintenance of existing services in a total of 32

provinces (see uploaded Geographic Coverage document).

PEPFAR is working with VAAC to develop a health workforce assessment that will be used as a basis for

developing a human capacity development (HCD) strategy. Currently critical staffing gaps are filled through

provision of funds to hire temporary workers on behalf of the MOH or other government bodies. It is

anticipated that the HCD strategy will identify key issues in human capacity (gaps and opportunities) to

enable a more effective response to the epidemic in Vietnam (see OHPS section).

PEPFAR will also support the MOH in establishing a Field Epidemiology Training Program (FETP). FETP

students will be trained to conduct epidemiologic investigations and field surveys to strengthen HIV/AIDS

surveillance, present their work at scientific and medical conferences, evaluate HIV/AIDS disease control

and prevention measures, and apply training and acquired skills to improve HIV/AIDS program

implementation in Vietnam. It is expected that 15 public health professionals will be part of the first cohort

of trainees in the first year. GVN is in the process of establishing the best coordinating mechanisms

between agencies involved in the establishment of the FETP, and support is expected to be distributed

among one or more agencies within the MOH.