This is a continuing activity from FY07.

In FY08, PEPFAR will continue supporting the activities below:

• Technical assistance (TA) in expanding TB lab capacity in eight focus provinces, including implementing

standard operating procedures for smear, culture, identification, and susceptibility testing. KNCV

Tuberculosis Foundation (KNCV) will also provide on-site training and mentoring of laboratory staff, and

assist with reporting standardized TB lab indicators.

• Maintaining lab infrastructure and performance for mycobacterial culture in two focus provinces (An Giang,

Can Tho), and for molecular-based drug-susceptibility testing in Hanoi and Ho Chi Minh City (HCMC).

• Implementation of stronger infection control procedures and structural renovation in eight provincial TB

hospitals and rehabilitation (05/06) centers that manage both drug-resistant TB and HIV patients. This

activity includes implementing administrative measures, health education on TB and TB transmission,

structural renovations, use of personal protection measures, and training.

In FY07, PEPFAR began supporting partner KNCV for activities to strengthen multiple drug-resistant TB

control in high HIV-prevalence settings. Specific activities included building capacity for TB culture in two

focus provinces, providing technical assistance for laboratory capacity expansion in six focus provinces,

evaluation of molecular methods for drug-susceptibility testing in two focus provinces, and infection control

in two provincial TB hospitals.

FY07 Activity Narrative:

Funding will be provided to partner KNCV Tuberculosis Foundation (The Hague, The Netherlands) for the

following activities to strengthen MDR-TB control in HIV-prevalent settings. KNCV is the closest

international partner of the Vietnam national TB program (NTP). KNCV will provide technical assistance for

TB laboratory performance improvement in six focus provinces, enhanced TB culture capacity in two focus

provinces, implementation of rapid MDR-TB diagnostic testing in two focus provinces (HCMC, Hanoi),

upgrading of inpatient wards that manage both MDR-TB and MDR-TB/HIV patients in six provinces, and

evaluation and implementation of infection control in high HIV prevalence 05/06 centers and prisons in one

province (HCMC). A description of each activity is provided below.

KNCV will provide external technical assistance to the NTP for strengthening TB laboratory capacity in the

six focus provinces. Technical assistance will focus specifically on:

(a) Developing standard operating procedures for collection, transport, processing, and culture of sputum

specimens on both solid and liquid media, and for identifying and drug-susceptibility testing mycobacterial

isolates. (b) Developing and implementing laboratory safety procedures and adequate biosafety facilities (c)

Developing and measuring standardized indicators to monitor TB laboratory performance (d) Training and

on-site mentoring of laboratory staff in standard operating procedures.

Enhanced laboratory capacity:

KNCV will work with the NTP to provide equipment, training, and consumables for laboratory upgrades to

perform both conventional and liquid culture in An Giang and Can Tho provinces.

Upgrading of MDR-TB treatment facilities for improved infection control:

Hospitals have been documented to serve as powerful amplifiers of TB transmission. With support from

other donors, Vietnam is scaling up treatment of MDR-TB. As part of this plan, patients will be hospitalized

for the first 1-2 months of treatment at TB hospitals. In the six focus provinces, rates of HIV are high in

patients hospitalized at these facilities, and TB hospitals serve as sites for TB screening of HIV patients.

MDR-TB inpatient facilities need to be upgraded to insure that MDR-TB is not transmitted to HIV-infected

patients receiving TB diagnostic or treatment at these facilities. This activity will include an assessment of

the present situation and implementation of infection control measures, including administrative measures

and health education on TB and TB transmission, structural adaptations (building and construction

adjustments, forced ventilation, UV), use of personal protection measures, and training.

Evaluation and implementation of infection control in 05/06 centers and prisons:

In HCMC, there are 18 05/06 centers and two prisons, which have high rates of HIV and TB. KNCV will

work with the NTP to assess and implement infection control measures to prevent (MDR) TB among these

confined populations, including administrative measures and health education on TB and TB transmission,

structural adaptations (building and construction adjustments, forced ventilation, UV), use of personal

protection measures, and training.