United Nations Office on Drugs and Crime (UNODC)

This is a continuing activity from FY07.

The narrative below is unchanged from the FY07 COP. Major updates to this activity since approval in the

FY07 COP are:

• In accordance with the PEPFAR Vietnam 5-Year Strategy and a refined prevention focus, UNODC

counselors and peer educators will sharpen their BCC communication focus on individuals at highest risk

for HIV infection.

• Project workers will improve linkages between community based substance abuse interventions and

PEPFAR or other donor sponsored HIV counseling and testing sites with referral to care and treatment for

those who are HIV positive.

• Project workers will expand the scale and coverage of community based substance abuse and HIV

prevention programs, aftercare management, and relapse prevention programs in Lao Cai and Son La

provinces. Program interventions will also be implemented in one to two additional highland provinces

identified in conjunction with the Vietnam Ministry of Health and the PEPFAR team.

• Scale up of project activities will allow project staff to increase the number of individuals trained to provide

comprehensive HIV prevention messaging to 410 and the number of individuals reached through

interpersonal communication to 3,300.

FY07 Activity Narrative:

The UN Office on Drugs and Crime (UNODC) will lead PEPFAR supported efforts to implement evidence-

based community models for HIV/AIDS prevention through substance abuse treatment and aftercare

without involuntary assignment to rehabilitation centers. Through this activity 80 counselors will provide

community based substance abuse treatment for 1,200 ethnic minority people. UNODC will train 300 peer

outreach workers to provide HIV prevention education and referrals to 2,100 drug users. Vocational training

will be provided for 600 former drug users and 300 former users will find job placement. Culturally-

appropriate prevention education materials will be distributed to 14,000 households.

This activity has three components. First, based on successful work funded by Denmark, Italy, and

Luxembourg from 2002-2007, UNODC will train 80 workers to provide voluntary, community based

substance abuse treatment for 1,200 ethnic minority people. This will include detoxification, after-care,

relapse prevention support, and appropriate vocational training for recovering drug users in the

Northwestern Highlands, an area neglected by mainstream HIV prevention, care and treatment

interventions. These substance abuse treatment and HIV prevention services will be offered in clients' home

districts and communes, avoiding the stigma, fear, and family difficulties associated with mandatory

government detoxification centers. The program will be tailored to highland ethnic minority drug users and

their families through service development that fits the unique situation of these close-knit communities,

including voluntary participation, use of minority languages and support from drug users' relatives and

neighbors. An additional 300 peer educators will reach 2,100 drug users with HIV prevention messages and

referrals in these same communities.

Second, 600 former drug users will receive appropriate vocational training and local businesses will employ

300 recovering drug users, empowering them to rebuild their lives and regain community status. Alternative

support measures will include microcredit support to encourage self-employment initiatives by recovering

drug users. Experience has demonstrated this programming is particularly effective and appropriate for

recovering highland drug users; past support has included livestock and foodstuff production, handicrafts,

and other local skills promotion, like silversmithing.

Third, this activity will facilitate referral of clients to local USG and government supported wrap-around HIV

prevention, care and treatment services. These will include substance abuse counseling, comprehensive

ABC messaging for HIV prevention, counseling and testing, and a network of HIV services. As appropriate,

drug users will be supplied with condoms and instructed in correct consistent condom use. This intervention

will take place in Son La province, where Life-GAP HIV services are available, Lao Cai and one to two

additional provinces selected in discussion with the PEPFAR team.

Joint United Nations Programme on HIV/AIDS (UNAIDS)

This is a continuing activity from FY07.

Because the scope of UNAIDS's prevention work for FY08 has changed slightly to place greater emphasis

on technical support for implementation, a new narrative is provided below:

PEPFAR will continue to support UNAIDS to conduct two main activities: 1) capacity building to strengthen

the response to HIV/AIDS among MSM, and 2) strengthening of coordination and partnerships for HIV

activities targeting men having sex with men (MSM). These are distinct, but complementary, areas that are

key to strengthening the Vietnam response in this area.

Capacity Building on Prevention Education and Services to MSM

In FY06 and FY07, UNAIDS supported a detailed country-level capacity-building needs assessment of

MSM groups and other stakeholders - including the Vietnam Administration of AIDS Control (VAAC) and

selected Provincial AIDS Centers - for the purpose of strengthening MSM HIV prevention services.

Additional work has been conducted on developing MSM-friendly services and training materials for the

prevention of stigma and discrimination.

For FY08, the findings from the needs assessment will be applied to the development of a series of

coordinated, strategic interventions to address gaps and imbalances in skills and practice. UNAIDS will

continue to support the MSM community and its partners in training and capacity building to strengthen

program development, implementation and service delivery. This includes conducting training sessions with

the materials developed in FY07 and supporting national and provincial stakeholders in the building of their

capacity to provide prevention education and services to MSM. Depending on the recommendations from

the needs assessment, this could include training for health care providers in counseling for MSM and

advocacy training for MSM groups and management and leadership development.

Coordination and Partnerships

In FY08, UNAIDS will support the GVN in developing a clear strategic vision for HIV prevention, treatment,

care and support programmes for MSM through the development of a National Strategic Framework on

MSM and HIV, and a budgeted, multi-year Operational Plan. This will also provide an opportunity to involve

ministries beyond the Ministry of Health (MoH). The development of an MSM-specific Strategic Framework

and Operational Plan will assist in further: 1) strengthening a supportive legal and policy environment

through the operationalization of the Programme of Action; 2) developing successful targeted interventions

to ensure effective HIV prevention among MSM, and; 3) providing greater access to health services for

MSM by mainstreaming quality HIV prevention programming for MSM in care and treatment services.

To support program implementation, monitoring, and evaluation, UNAIDS will continue to provide leadership

for coordination and advocacy in this sensitive area of work. This includes facilitating the functioning of

MSM working groups at the national and provincial levels, and strengthening linkages with the regional

Purple Sky MSM Network. The focus will be on trying to further build on strategic partnerships with key line

ministries beyond the MoH, media and local leaders.

UNAIDS will also continue to strengthen channels of information exchange (including web-access, a mailing

list and an electronic or printed bulletin), as well as advocate for the promotion of greater participation of the

MSM community in HIV activities.

All these activities will assist in scaling up effective, evidence-informed intervention models, approaches and

materials with the ultimate aim of a coordinated and sustained national response in the area of MSM and

HIV.

World Health Organization (WHO)

This is a new activity in FY08.

WHO is a strong partner in the deliberations on HIV/AIDS in Vietnam. Along with UNAIDS, WHO has taken

a leadership role in coordinating donors and government partners on discussions about needs, challenges

and solutions for health sector response to HIV/AIDS pandemic in Vietnam. WHO will complement the

coordination work of UNAIDS in the area of care and treatment. PEPFAR has supported WHO in the past to

carry out activities in policy system strengthening, TB/HIV, injection safety and counseling and testing. As

these program have expanded across Vietnam and implementation partners have taken over more

comprehensive programming, WHO can focus on its role to facilitate policy planning and care and treatment

guideline development. PEPFAR will support WHO to expand its coordination role in FY08.

In FY08, WHO will improve operational linkages and coordination at national and provincial levels. This will

include activities such as:

1. Further discussions on operational procedures including referral protocols.

2. Continued discussions on the framework for coordination and joint planning in HIV prevention, care and

treatment.

3. Development of training materials and supervision tools for provincial and district coordinators for

Vietnam's Ministry of Health (MOH) and Ministry of Labor, Invalids, and Social Affairs (MOLISA).

4. Further coordination among MOH, MOLISA, the Ministry of Public Security (MOPS) and other partners to

facilitate the establishment of an agreement and coordination framework to scale-up HIV treatment, care

and prevention activities within the 05/06 centers.

5. Facilitate the updating and completion of the Inter-Ministerial Agreement/Circular/Guidelines on provision

of HIV services for injecting drug users (IDUs) and sex workers within the 05/06 centers and in their

transition to communities.

6. Support regional information-sharing within Vietnam through workshops to introduce new policies,

procedures and guidelines.

Improved coordination between and among UN agencies, HIV implementing partners and the government

will contribute to the development of leadership capacity and sustainability as described in the PEPFAR

Vietnam 5-Year Strategy.

World Health Organization (WHO)

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:

• WHO will support the Ministry of Health/Vietnam Administration for HIV/AIDS Control (MOH/VAAC) to

develop and implement national guidelines on provider-initiated HIV testing and counseling (PITC) based on

the newly released WHO/UNAIDS PITC guidelines.

FY07 Activity Narrative:

This is a new activity for PEPFAR in Vietnam. In FY07, PEPFAR will support WHO, in collaboration and

coordination with relevant ministries, technical institutions, beneficiaries including PLWHA and other

vulnerable populations, and international partners, to implement three activities that include: collaboration

with MOH/VAAC to conduct a rapid assessment of HIV Counseling and Testing (CT); working with VAAC to

develop and disseminate the national CT guidelines; and support development of national training

materials.

In order to develop the National Guidelines on CT, WHO will collaborate with MOH/VAAC to conduct a rapid

CT assessment to identify strengths and constraints of existing CT services supported by different initiatives

with regard to availability, access and quality of services with an emphasis on most-at-risk population

(MARP). The assessment will also look at linkages between CT services and other services such as

HIV/AIDS care and treatment, TB diagnosis and treatment, antenatal care, harm reduction and other HIV

prevention interventions.

WHO will work with VAAC and PEPFAR on the development of national guidelines and information and

advocacy materials on CT that will be disseminated in FY07. The national CT guidelines will identify

organization, management and operating procedures of CT services including different models for

effectively reaching MARP, specific counseling approaches for different populations, and linkages with

relevant services. Issues of service quality including confidentiality and partner involvement will receive

special attention. Provider-initiated CT should also be introduced where needed and appropriate. The

guidelines will be developed based on the rapid assessment, global guidelines and experiences of other

countries. Information and advocacy materials emphasizing the role of CT in HIV prevention among MARP

and human rights protection will be developed from the guidelines. WHO will support VAAC efforts to

organize a series of provincial meetings to disseminate the guidelines and advocacy materials to relevant

bodies and PEPFAR partners.

WHO will support the development of national standard training materials based on the national guidelines

and existing training materials, especially OGAC TWG approved training curricula for CT to ensure

standardization of all future CT training activities.

This is a continuing activity from FY07.

Because UNAIDS and WHO activities have been combined under a single narrative (UN Resident

Coordinator) and an FY07 OHPS activity was moved to HVSI, this activity narrative has been rewritten to

reflect all UNRC activities supported by the HVSI program area, both new and ongoing. Where applicable,

previous narratives are provided for reference.

UNAIDS

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

activity since FY07 approval are:

• In FY08, PEPFAR will continue to support UNAIDS' efforts to facilitate the coordination of donors and

other international agencies working with the government of Vietnam (GVN) on the effective implementation

and use of the National HIV/AIDS Monitoring and Evaluation (M&E) Framework to ensure program success.

Other emerging strategic information (SI) issues that will need more support are HIV program M&E and a

national health management information system (HMIS).

• Proposed activities for FY08 are:

-Advocacy for the importance of using the National M&E Framework for consistent program accountability in

line with the ‘Three Ones';

-Information sharing with political, government and other leaders at the national level;

-Promotion of appropriate data use for program planning and policy making;

-Standardization and harmonization of indicators and data management systems;

-Distribution of information materials on M&E;

-Coordination of HMIS activities ensuring broad representation of stake holders and systems developed

based on national standards;

-Development of a GIS database of coverage of HIV and related program activities for better program

planning;

-On-going coordination and advocacy for appropriate data and data use for program M&E.

• UNAIDS will participate as a member of the national TWG and their activities will be subject to vetting by

the TWG.

UNAIDS FY07 Activity Narrative:

In FY07, PEPFAR will continue to support UNAIDS efforts to facilitate the coordination of donors and other

international agencies working with GVN on effective implementation and use of the national HIV/AIDS

M&E framework to ensure program success. With FY06 support from PEPFAR, UNAIDS is initiating a

program of advocacy and coordination of M&E activities to political, government and other leaders at the

national level and to international partners. In FY07, UNAIDS will continue in this role, supporting

consensus-building to ensure effective national coordination of M&E activities across government agencies

and administration levels, programs, and partners. Activities will include 1) advocacy on the importance of

the national M&E framework for program accountability; 2) information sharing with political, government

and other leaders at national level; 3) promotion of appropriate data use for program planning and policy

making; 4) standardization and harmonization of indicators and data management systems; and 5)

distribution of information materials on M&E. UNAIDS will advocate for the establishment of provincial M&E

frameworks in HCMC, Hanoi, and Haiphong provinces in compliance with the national framework. This

activity will also provide UNAIDS resources to advocate for and promote solutions for national M&E

framework support through study tours and hosting meetings where successes from other PEPFAR

countries and UNAIDS activities in the region will be highlighted. One example of such facilitation is using

the Country Response Reporting System (CRIS) as promoted by the UNAIDS/PEPFAR collaboration. Other

consensus building activities will include facilitating sharing of successes in SI activities both within Vietnam

and from other countries affected by the epidemic.

WHO

This is a new activity in FY08.

The World Health Organisation (WHO) will be supported by PEPFAR in 2008 for the following activities:

1. Strengthening of the routine reporting system for health sector interventions

• Strengthening of the Decision 26 system (revision of reporting form, instruction manual, training materials)

and stregthening of the pilot of the new system to be completed in FY07

• In FY08, the focus will be to strengthen the new Decision 26 system throughout the country, including

promotion of data use at provincial and district levels, and introduction of data quality management

procedures. For this purpose, WHO proposes developing standard operational procedures for data quality

management, and training curricula for provincical AIDS centers (PACs) and district HIV coordinators in

data management and data use.

• Quarterly HIV program data review workshops will be supported in a few pilot provinces. These workshops

will be facilitated by PAC staff and attended by district HIV coordinators and provincial management unit

staff from different projects (e.g. PEPFAR, Department for International Development, Global Fund to Fight

AIDS, Tuberculosis and Malaria, World Bank). The workshops will serve as a forum to share the data within

the province, and to use the data for planning and improving service delivery.

• WHO will also facilitate and provide technical assistance for VAAC to disseminate the data on a regular

basis as HIV program reports.

2. ART patient monitoring and pharmacovigilance

• In FY08, WHO will participate on a national HMIS TWG to scale up patient monitoring tools and assist in

data quality assurance and analysis, as the cohorts grow and expand.

• WHO will develop a pharmacovigilance database for the sentinel sites to establish in-country evidence on

the prevalence of ARV toxicity, and physicians' practices in substitution and switching of ARV regimens.

This information will be used to inform future guideline revisions. These activities will be vetted through the

national care and treatment TWG

3. Implementation of a comprehensive HIV drug resistance (HIV DR) strategy

• Based on successful collaborative experiences between WHO and CDC/PEPFAR at all levels on HIV DR

Activity Narrative: work, WHO will continue to collaborate with CDC/PEPFAR to implement a comprehensive HIV DR strategy

in Vietnam.

• WHO will activate and facilitate the National HIV DR Working Group, which will play a coordinating role for

a range of HIV DR work in the country.

• WHO will support the HIV DR working group to develop annual HIV DR country reports.

• WHO will provide technical assistance through the national HIVDR TWG to VAAC in setting a mechanism

to collect HIV DR early warning indicators.

4. Personnel

• To implement proposed activities, PEPFAR will support the following WHO staffing:

o National staff (Strategic information - ) 1 person x 100 %

o Secretary 1 person x 30%

Joint United Nations Programme on HIV/AIDS (UNAIDS)

This is a continuing activity from FY07.

UNAIDS plays a key role in coordinating international efforts to support the Communist Party of Vietnam,

the national government and other partners in scaling up the response to HIV/AIDS and moving towards

universal access to prevention, treatment, care and support. UNAIDS's strategic focus includes promoting

transparency and sharing of information, building partnerships with senior national leaders, and promoting

respect for the rights and participation of PLWHA. In FY08 PEPFAR will provide funding to UNAIDS to

promote, coordinate and support this key policy level work. Activities fall into two main categories. The first

is strengthening coordination, harmonization and alignment within Vietnam's response to HIV/AIDS. The

second is advocacy for the active participation and meaningful involvement of civil society and PLWHA in

the response to the epidemic.

International development partners have committed themselves to aligning with the Government of

Vietnam's (GVN) national strategy and to strengthening national systems. In FY07, UN agencies, donors

and international NGOs followed the lead of the Ministry of Planning and Investment and the Ministry of

Health to develop a joint GVN-Donor Coordination Action Plan (CAP) for the coordination and utilisation of

resources on HIV/AIDS. The CAP is set within the framework of the "Three Ones" and is aligned with the

principles of the Hanoi Core Statement. UNAIDS has played a crucial role in the development of the CAP

and plans to continue supporting its implementation and strengthening of the existing coordination

mechanisms. UNAIDS will continue to provide technical support for the implementation of the CAP at both

the national and provincial level.

UNAIDS will also support the strengthening of the Ho Chi Minh City (HCMC) and Hanoi provincial

coordination models. UNAIDS will further strengthen this mechanism through overall advocacy, coordination

and capacity-building, and proposes to expand this model of coordination to an additional two provinces in

participation with other UN organizations. UNAIDS will coordinate joint advocacy meetings and workshops

on the implementation of the national strategy with the Communist Party, National Assembly and key

government ministries (e.g. following a multisectoral approach, pursuing program versus project financing,

and strengthening the National Committee for AIDS, Drugs and Prostitution Prevention and Control).

UNAIDS will provide coordination and technical support to strengthen existing international, national and

provincial coordination mechanisms, including the following three groups: the Ambassador and Donor

Informal HIV/AIDS Group, the HIV Coordination Group and the HCMC Coordination meeting.

In Vietnam, civil society organizations can promote greater government accountability and bolster

government services at the central and local levels. They can encourage and support the participation of

PLWHA in program development, planning, implementation and monitoring, thereby strengthening their

voice in policy making and implementation. Civil society is also well placed to deliver services that

contribute to the national response to HIV/AIDS, particularly in gaining access to marginalized and often

hidden most-at-risk populations, and in building and utilising networks of community- and home-based

treatment, care and support. In FY07, UNAIDS supported the HIV/AIDS Technical Working Group and

provided technical assistance to a range of partners in promoting the Greater Involvement of People Living

with HIV (GIPA).

In FY08, PEPFAR will support UNAIDS to strengthen the role of civil society and PLWHA in the national

response. UNAIDS will continue to provide coordination support to the HIV/AIDS Technical Working Group

and the sub-working groups, including the local NGO sub-group established in FY07. Continuing to support

the promotion of GIPA principles, UNAIDS will strengthen coordination through information-sharing and

networking fora, and support capacity-building for leadership and stakeholders to ensure meaningful

participation of PLWHA at all levels of the national response. This includes supporting the Communist Party

and GVN in exploring alternative models/structures to establish a national PLWHA network. UNAIDS will

also support the capacity-building of mass media through the provision of opportunities to promote GIPA

principles in existing media outlets.