PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
ADDICTIONS CAPACITY BUILDING: $520,000
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 100 professional drug addiction counselors between fiscal
years 2005-2008. Addiction counselors provide individual and group counseling as well as community
education. They work at methadone sites to support relapse prevention, and to promote access to and
uptake of CT and other HIV services. Nevertheless, drug addiction counseling remains new to Vietnam and
local expertise remains limited. High demand 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. To this end, FHI will develop and implement a program to develop addiction workforce capacity
through technical assistance and training for treatment providers, social workers and related professionals.
Activities
FHI will develop an interdisciplinary consortium of government and non-government health workers and
those in related fields who will be well-versed in evidence-based approaches to substance abuse treatment
and recovery. This activity has four components.
First, FHI partners will develop basic courses on the principles of addiction and the relationship between
addiction and HIV and other infectious diseases. These basic courses will be offered to staff from agencies
that serve populations at high risk for substance abuse and HIV infection. Examples include 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 basic principles of addiction.
Second, FHI will support trained trainers from institutional partners to provide introductory courses on
addiction counseling, promoting the capacity to provide comprehensive services among international NGOs
and government organizations. An advanced course on addiction counseling will improve the skills of those
already trained but in need of specialized skills for work with families, adolescents or other groups affected
by addiction. One training of trainers session (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. Participants will be
carefully selected based on their job positions and background. Only those who are slated to become
professional drug addiction counselors will participate in these courses.
In the third component, FHI will expand efforts to train 120 DOLISA social workers as case managers for
recovering drug users. Basic social work principles will refocus social workers' historical role in Vietnam as
parole officers to that of becoming supportive case managers, 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 provinces. Developing a nationwide core of counselors and case managers will
help "legitimize" the profession of addiction counseling and ensure sustainability without continued reliance
on expensive foreign technical assistance. In addition, these curricula will be incorporated into the
university system to provide a sustainable venue for training counselors and case managers.
The fourth component will develop ongoing mentoring, supervision and support for trained case managers
and drug addiction counselors. After training, they will be strategically placed and will participate in ongoing
mentoring to ensure professional development and high service standards.
Number of individuals reached through community outreach that promotes HIV/AIDS prevention through
prevention of drug use: N/A
Number of individuals trained to promote HIV/AIDS prevention through prevention of drug use: 260
METHADONE MAINTENANCE THERAPY: PRE-SERVICE TRAINING, IN-SERVICE TRAINING AND
MENTORING: $400,000
A. PRE-SERVICE TRAINING IN METHADONE MAINTENANCE THERAPY (MMT)
In FY08 Pathfinder International (PI) received PEPFAR funding to pilot an integrated HIV prevention
curricula with a focus on MMT and basic addiction counseling for medical and nursing students at Hai
Phong University and Hai Phong Secondary Medical School. Using FY08 PEPFAR funds, FHI partnered
with Pathfinder to strengthen the capacity of the Hai Phong University to provide distance education in HIV
prevention, care and treatment for post graduate health professionals. This involved supporting the school
to design and develop two distance learning curricula. One course will be an "Introduction to HIV/AIDS Care
and Treatment and the second course will be an "Introduction to Addiction Medicine and MMT". The
curricula were developed using existing material from the Hai Phong pre-service curricula and various MOH
approved in-service training courses. Faculty in the Hai Phong University were trained in both the technical
and administrative skills required to implement these distance learning packages using technical assistance
from FHI when necessary.
In FY08, two distance learning packages were developed for post graduate health professionals in HIV
prevention care and treatment at Hai Phong University. At least 20 faculty members were trained and
supported to implement these distance curricula in preparation for implementation in FY09.
In FY09 FHI will partner with Pathfinder International (PI) to continue the foundation work in institutionalizing
quality HIV prevention, care and treatment training with a focus on MMT and addictions counseling for
undergraduate doctors and nurses in Hai Phong University and Hai Phong Secondary Medical School.
Pathfinder will continue to work with both schools to review and build the curricula, while improving the
Activity Narrative: quality of expertise required to implement them, by providing mentoring and support as pre-service lecturers
implement the newly designed curricula.
In FY09 Pathfinder will provide further support to Hai Phong University to actually roll out the two distance
learning packages developed in FY08. It is estimated that 75 post graduate health professionals will be
trained using the two distance learning courses; In addition, in FY09, Pathfinder will identify another Medical
University in a PEPFAR province TBD to strengthen their capacity to provide distance education in HIV
prevention, care and treatment for post graduate health professionals. This will involve supporting them to
review and adapt the two distance learning curriculum "Introduction to HIV/AIDS Care and Treatment and
"Introduction to Addiction Medicine and MMT". developed in Hai Phong University. It will also involve
Pathfinder training faculty in both the technical and administrative skills required to implement these
distance learning packages using technical assistance from FHI where necessary. In FY09 Pathfinder will
collaborate with the Working Group of deans and vice-deans to disseminate the distance learning curricula
and advocate for the future scale-up and delivery of this curricula in additional pre-service faculties over the
following years.
It is estimated that in FY09, 2 distance learning packages for post graduate health professionals in HIV
prevention care and treatment will be developed in a Medical University TBD. At least 20 faculty members
will be trained and supported to implement these distance curricula. A total of 75 individuals will be trained
in key HIV prevention, care and treatment program areas using the distance learning education package
from Hai Phong University.
A: Number of individuals trained to promote HIV/AIDS prevention through prevention of drug use: 95
B. METHADONE MAINTENANCE THERAPY (MMT): IN-SERVICE TRAINING AND MENTORING
During FY08 FHI supported the Vietnam MOH to review and finalize a national methadone maintenance
therapy curriculum for training clinicians, counselors and pharmacists working in methadone clinics in
Vietnam. A methadone curricula review committee was established within MOH. FHI supported the training
of 10 clinical master trainers in MMT. Two in-service training workshops were carried out in FY08 for 22
new methadone clinicians (doctors) from the six new MMT sites in Hanoi. These newly trained doctors each
spent one week in established MMT clinics as part of their practicum training and to certify them as MMT
clinicians. FHI supported the establishment of a methadone clinical mentoring network in Hanoi, Hai Phong
and HCMC.
In FY08 FHI worked with Pathfinder International to adopt their nationally approved Integrated Supervision
methodology for work with MMT providers. Using this methodology, a total of 10 experienced MMT
clinicians were trained as clinical supervisors and paired with experienced national and international TA
providers as they commenced their mentoring of new MMT colleagues. These experienced MMT mentors
spent time in new sites helping clinicians and the clinical team start up MMT services. Once service was up
and running, they helped the service providers set indicators to monitor service quality and design action
plans for further improvement. Clinical mentors provided ongoing clinical supervision and on the job training
- at first monthly and then every 3 months as sites matured. During FY08, two 3-day refresher MMT training
workshops were held, one in the North and one in the South, attended by 60 MMT clinicians. FHI also
supported one 2-day annual national clinical MMT experience sharing workshop where MMT clinicians met
for 2 days to share clinical cases, complex clinical scenarios and input for revision of national MMT clinical
guidelines.
In FY09 FHI will continue supporting the MOH scale up of MMT by institutionalizing methadone in-service
training, clinical mentoring and supervision, and building national capacity for medical doctors in clinical
MMT management. FHI will continue to support MMT in-service training, refresher training and clinical
mentoring. In-service training for new MMT clinicians will be held on an as needs basis (at least 2 per year)
depending on MOH scale up plans. At least four 3-day redresser training workshops will be held in FY09.
FHI will continue development of new and existing MMT master trainers and clinical supervisors. In FY09 at
least 10 additional clinicians will be trained as MMT clinical supervisors using the Integrated Supervision
methodology. A curriculum on mentoring and supervision will be developed, along with supervision forms
and checklists. Trained mentors will continue to supervise existing MMT sites and will help start up new
ones, though supervision will become less frequent as sites mature. An annual clinical MMT experience
sharing workshop will also be supported in FY09.
B Number of individuals trained to promote HIV/AIDS prevention through prevention of drug use: 94
TOTAL A and B (ALL MMT Tanning):
Number of individuals reached through community: N/A
Number of individuals trained to promote HIV/AIDS prevention through prevention of drug use: 189
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $920,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Program Budget Code: 07 - CIRC Biomedical Prevention: Male Circumcision
Total Planned Funding for Program Budget Code: $0
Program Budget Code: 08 - HBHC Care: Adult Care and Support
Total Planned Funding for Program Budget Code: $13,573,836
Program Area Narrative:
PROGRAM AREA SETTING
The Adult Care and Treatment (C&Tx) program strategy is focused on providing comprehensive care, treatment and support at
the clinic and community level, applying a family-centered approach. Given that the HIV/AIDS epidemic in Vietnam is
concentrated in and driven mainly by most at-risk populations (MARPs), such as injecting drug users (IDU), commercial sex
workers, and men who have sex with men, C&Tx services are linked closely with prevention activities, including substance abuse
treatment, addiction counseling, and peer outreach to bring MARPs to C&Tx services. PEPFAR supports a variety of clinical and
community- and home-based services (CBC/HBC), with a range of partners, in coordination with the government of Vietnam
(GVN), other donors, and CBOs/FBOs.
The Vietnam National HIV/AIDS Strategy includes a target of providing care and treatment to 90% of the estimated 302,000
PLHIV and providing antiretroviral therapy (ART) to 70% of all patients who need it by the year 2010. Vietnam reported that in
August 2008, 22,226 adults and 1,315 children across the country were enrolled in public ART programs. PEPFAR directly
supported 65% of those on ART. With support from WHO and PEPFAR, the Ministry of Health's (MOH) Vietnam Administration
for HIV/AIDS Control (VAAC) conducted a survey at 17 adult ART sites in seven provinces to review treatment results, which
demonstrated excellent outcomes and the low need for second-line antiretrovirals (ARV). Preliminary reports indicate 81% of
patients were living 12 months after starting ART. The percentage of patients who died, who were lost to follow-up, and who had
discontinued ART at six months, was 12%, 1.6%, and 0.8% respectively. At 12 months, the figures were 15%, 3%, and 0.9%. The
percentage of first-line retention after six and 12 months was 85% and 81%, respectively.
As of September 2008, PEPFAR provided direct care and support for 61,261 HIV-infected patients and family members. VAAC,
responsible for coordinating all HIV activities, is working closely with PEPFAR, the Global Fund (GF), and the World Bank (WB) to
scale-up treatment access. PEPFAR supports a core package of clinical and CBC services designed to optimize pre-ART care
and facilitate access to long-term treatment. The package includes: co-trimoxazole and INH prophylaxis; food and nutrition
support; TB screening, diagnosis, treatment, and prophylaxis; fungal and bacterial opportunistic infections (OI) treatment; pain and
symptom management; and sexually transmitted infections (STI) diagnosis and treatment. Counseling on positive living, hygiene,
family planning, risk reduction, and treatment adherence, along with psychological, spiritual, social support, and relapse
prevention services are offered. Spiritual support is provided through NGO and FBO partners. Legal services are offered to PLHIV
and their families through Health Policy Initiatives' five legal clinics and the Hanoi-based hot line. The supply chains of OI/STI
drugs are managed through VAAC and the Ho Chi Minh City Provincial AIDS Committee (HCMC PAC); ARVs and
therapeutic/supplemental food are managed by SCMS.
Approximately 60,000 of an estimated 180,000 IDU in Vietnam are detained in 84 government rehabilitation ("06") centers for up
to four years. HIV prevalence in these centers may be as high as 70%. In 2006, PEPFAR began supporting a pilot project of
comprehensive HIV services at Nhi Xuan 06 center in HCMC. WB and GF have also been supporting ART for residents in other
centers on a limited scale. Supporting recently released 06 residents to achieve the social and economic stability necessary to
stay off of drugs is not only a key HIV prevention priority in Vietnam but also a priority of the adult C&Tx program.
WHO, PEPFAR, and other donors are supporting MOH's Department of Medical Administration to revise the national HIV
diagnosis and treatment guidelines. In August 2008, VAAC introduced a set of national indicators for all HIV-related programs.
VAAC is currently leading development of software for managing the C&Tx program and patient monitoring. Family Health
International (FHI) is providing technical assistance to VAAC to develop the HBC/CBC protocol. FANTA will work with the National
Institute of Nutrition in 2009 to develop national food and nutrition guidelines for PLHIV.
KEY ACCOMPLISHMENTS
PEPFAR has supported MOH to achieve a number of successes, including ART initiation and scale-up, quality program
monitoring, establishment of a care and support package of care, development of high-quality guidelines and protocols, and
strengthening human capacity. The Team has achieved end of program ART targets for PEPFAR phase 1 one year early: by
September 2008, PEPFAR supported ART for 24,538 persons. In FY08, PEPFAR will expand ART support from 11 to 20
provinces, and increase the number of adult ART sites to 72 from 46. Expansion of care and support services will be coupled with
clinical services and include referrals, transportation to clinics, and assistance with hospitalization. The C&Tx team is addressing
gender equity by focusing on improved access to care and support through an assessment and mapping of women living with
HIV, indicating their accessibility to existing HIV/AIDS and social services. Tools for incorporating gender issues, including
addressing gender-based violence, into service provision, are being developed and shared with PEPFAR's implementing
partners.
To address pervasive stigma and discrimination, PEPFAR supports stigma reduction training for community health care workers,
and will support CBOs to integrate anti-stigma components into interventions. PEPFAR also supports the integration of STI
programs into HIV/AIDS programs based on successes and lessons learned from the TB/HIV model. A situational assessment on
nutrition status and needs among HIV-infected people conducted in July 2008 is contributing to a national strategy on nutrition,
including microcredit initiatives.
PEPFAR supports VAAC and local authorities to build technical and management capacity within the HIV C&Tx programs.
Monthly C&Tx technical working group (TWG) meetings, led by VAAC, include all donors and WHO to improve coordination on
drug supply, commodity distribution, CD4 testing, and ART scale-up. PEPFAR also provides support to build capacity for health
care workers through basic and refresher trainings on ART and data management; workshops on coordination and building
management capacity; ART network meetings addressing complicated cases and referral systems among different services;
annual C&Tx workshops for outpatient clinic (OPC) staff; and on-site technical assistance (TA) and quality assurance at OPC
sites.
PEPFAR is collaborating with VAAC to conduct a programmatic evaluation of selected PEFPAR-supported ART sites; preliminary
results will be available by the end of 2008.
CHALLENGES/OPPORTUNITIES
The government of Vietnam (GVN) continues to encourage PEPFAR to support a rapid nationwide increase in C&Tx coverage;
however, to do so, a long-term sustainability plan that includes clear policies on human resource management is paramount. The
most serious issue is the shortage of qualified staff and staff turnover, especially experienced doctors and counselors. Even well-
established OPCs face high staff turnover, mainly due to low financial incentives and misconceptions about the risk of acquiring
HIV and TB from patients. Pervasive stigma and discrimination affects access and negatively impacts the ability to rapidly expand
programs.
Poor national ART protocol adherence and data recording still exists at some ART sites. In addition, the government wants to
distribute OPCs evenly throughout Vietnam, placing some in low prevalence areas at the expense of high prevalence regions.
With support from PEPFAR, there have been attempts to develop ART networks of highly experienced and trained health care
workers. But training and quality assurance have not been established at the national and regional levels. So far, trainings and on-
site mentoring have been primarily provided by PEPFAR implementing partners at PEPFAR-supported OPCs. VAAC has started
to develop national training curricula on ART but it has yet to establish a national training group.
Strengthening coordination between donors, ministries, and partners is critical to increase service access, and decrease treatment
interruption. Linking clinics and community- and home-based care with other services is a challenge that needs to be addressed in
several provinces. There are networks of PLHIV and peer educators in most provinces but their involvement in providing support
for ARV services is limited, as they have not been officially recognized by the government. In addition, national standard operating
procedures (SOPs) for OPCs have not yet been developed, resulting in a range of models and service packages provided to
PLHIV.
The C&Tx team is currently considering an assessment of cervical cancer screening. Pap smears are widely available in some
places in Vietnam and cervical cancer rates may be decreasing, but data is likely poor quality.
OPCs supported by GF and the National Program provide only first-line ARVs. PEPFAR will provide 2nd-line ARVs to provinces
supported by GF and/or the National Program as requested. However, few patients in these programs have access to second-line
ARVs because of long delays in screening patients with suspected treatment failure in these sites. This is typically a result of a
lack of staff experience, difficulties with specimen transportation, and the cost and availability of CD4 and viral load tests.
KEY STRATEGY ELEMENTS
The C&Tx program strategy will focus on continuing to develop comprehensive care, treatment and support at the clinic and the
community level, improve program linkages, support quality scale-up, improve program monitoring and evaluation, and improve
human capacity. In September of 2008, the OGAC Adult Treatment TWG visited Vietnam. The C&Tx team is addressing
recommendations from this visit in order of priority, and includes refining resource allocation, providing services to 06 centers,
improving linkages with community and methadone services, piloting a task-shifting model, and evaluating the national program.
In line with the TWG's recommendation to allocate resources in accordance with need, PEPFAR will continue working with the
GVN, GF, and WB to develop coverage plans and treatment targets to guide scale up of ART. In 2009, PEPFAR will support five
additional (a total of 77) adult OPCs, at the national, provincial, and district level in 20 provinces. Some OPCs in PEPFAR focus
provinces will function as family-centered clinics to provide ART for adults, as well as children where no specialized OPC for HIV-
infected children exist. PEPFAR will support ART and care and support services for two hospices and five 06 centers through
existing health facilities.
The Vietnam PEPFAR team recognizes that the HIV epidemic in Vietnam can best be addressed by integrating addiction
treatment with HIV programs. Linkages between the methadone program and OPCs and community-based care will be
strengthened to increase access to comprehensive treatment, care, and support services that will maximize adherence to ART
and drug treatment.
With FY09 funds, PEPFAR will continue support of a micro-credit initiative to provide PLHIV and their families the means to
improve their economic stability.
PEPFAR will directly support 29,000 patients on ART by September 2010, consisting of 26,550 adults and 2,450 children. Care
and support will be directly provided to 90,000 and indirectly to 30,000 adults and children. PEPFAR will collaborate with GVN and
other donors, to use epidemiological data and demonstrated provincial commitment as main determinants to open additional
OPCs concurrent with closing or augmenting services at existing OPCs. PLHIV will be included in discussions about community-
based need and geographic location of services, and will be involved to help scale-up services, maximize access, and support
treatment adherence. Marketing of new and existing services will be enhanced through television and newspapers to ensure
optimal community awareness of services.
PEPFAR will support OPC service quality improvement via TA and standard quality assurance, including addressing stigma and
discrimination and equitable service access across gender. Routine programmatic evaluation will continue using tools developed
in FY08 to assess program improvement. PEPFAR SI and C&Tx teams will continue working with the Hanoi Public Health School
(HSPH) and HCMC PAC to conduct routine evaluations. PEPFAR will work with VAAC to develop SOPs and training manuals
focused on clinical, psychological, social, spiritual, and preventive aspects of HIV care and treatment. These will include OI
management, palliative care including pain management, prevention among positives, and malnutrition. Prevention with positives
will include assessing family members' risk factors, counseling for healthy living, condom distribution, addiction counseling, and
linkages to social and community services. The nutrition program, started in 2008, will move into Phase II with development of
nutritional guidelines and a training strategy. PEPFAR will support VAAC to develop training curricula and workshops to
implement the newly revised national ART guidelines. PEPFAR will continue to work with VAAC and WHO to monitor for
emergence of drug resistance among ART patients.
To increase human capacity, PEPFAR will continue supporting master trainers through development of curricula for the training of
trainers. PEPFAR will support a pilot task-shifting model at a small number of OPCs, moving some clinical roles from doctors to
nurses. PEPFAR will provide technical and programmatic support for this important pilot initiative and for follow-on activities to
scale-up.
FY09 funds will support nutrition assessment, micronutrient supplementation and therapeutic food as necessary. PEPFAR will
continue to expand food by prescription initiatives begun with FY08 funds. Use of PLHIV as treatment supporters will be started at
all OPCs. Treatment supporters will assist patients to access services, provide adherence support, and assist with HBC activities.
Training and workshops for treatment supporters will be organized by PEPFAR and VAAC.
To provide essential services for 06 center residents, PEPFAR will support prevention, ART, care, and support for residents of five
additional 06 centers. PEPFAR will continue working with GVN, GF and WB to improve referral between community-based OPCs
and 06 centers to prevent treatment interruptions and increase residents' access to services.
Table 3.3.08:
Palliative Care In-Service Training
In FY08, FHI enhanced and scaled up the existing in-service palliative care training for physicians, and
initiated plans to develop in-service training for nurses and pharmacists.
During FY08 FHI conducted a two-stage review of the previously developed 5-day in-service palliative care
training
package for clinicians. The first review was undertaken by local and international experts including the
MOH, K Hospital, PEPFAR partners and the Asia Pacific Hospice and Palliative Care Network (APHPCN).
FHI standardized the curriculum, adding session plans, enhanced participatory adult learning methods,
handouts and other tools essential for roll-out of the curriculum to a cadre of local master trainers. A
curriculum review committee was established to provide a final review of the full curriculum. FHI worked
with the Department of Therapy (DOT) and submitted the palliative care in-service training curriculum for
approval through the MOH Department of Science and Training.
In FY08, FHI funded and provided technical and training assistance for two palliative care in-service training
workshops and trained approximately 50 physicians. FHI also supported an advanced palliative care in-
service training workshop for 25 physicians. FHI undertook a review of the list of previously trained
participants to ensure that future palliate care training workshops included targeted participants - from high
prevalence provinces and districts where HIV or cancer care is currently being provided - this included
working with the MOH, PEPFAR, LIFE-GAP and other partners to prioritize future training participants. In
FY08 FHI worked with Pathfinder Intl. to adopt their nationally approved Integrated Supervision
methodology for work with palliative care providers. Using this methodology, a total of 1 experienced
palliative care clinicians were trained as clinical supervisors and paired with experienced national and
international TA providers as they commenced their mentoring and supervision of newly trained palliative
care
colleagues. These experienced palliative care mentors spent time in the new sites helping the clinicians and
the rest of the clinical team start up palliative care services. Once a service was up and running, they
helped the service providers set indicators to monitor service quality and design action plans for further
service improvement. In FY08, FHI also initiated the development of a palliative care clinical mentoring
network . This network consists of Vietnamese physicians (including the master trainers and supervisors),
supplemented in FY08, and to a lesser degree in FY09, with mentors from APHPCN. MOH/FHI worked with
partners in developing a schedule for clinical mentoring. Priority was given to PEPFAR-supported services.
In FY08 FHI, MOH and other key partners reviewed the existing 3-month palliative care fellowship program
developed initially by Harvard Medical School AIDS Initiative in Vietnam (HAIVN). The program was found
to be human resource intensive, reaching only 5 fellows in each round of training. Following a review of the
fellowship training it was adapted as a continuing education program for palliative care master trainers,
clinical mentors and supervisors. A total of 15 individuals were enrolled into the modified fellowship program
in FY08.
Palliative care master trainers were selected based on time available, placement in high client load HIV and
cancer care services and support from supervisors to participate in the program. By the end of FY08, a total
of 15 master trainers were identified. TOT was provided for existing and new master trainers who in turn
became lead trainers for the 5-day in-service course.
The above palliative care activities did not in any way overlap with other existing palliative work supported
by PEPFAR, rather they strategically complimented them. In FY08, with PEPFAR support, FHI continued to
work with the MOH and PEPFAR partners to implement palliative care policies and develop a fellowship
training program for nurses. With PEPFAR resources, FHI also developed palliative care learning sites,
where clinicians trained through the PEPFAR-funded Vietnam Network to Strengthen HIV/AIDS Care and
Treatment Capacity Project as part of their training.
In FY09, the palliative care in-service training curriculum will be reviewed and revised based on trainee and
external feedback. A total of two in-service palliative care trainings will be offered, reaching 50 physicians.
These trainings will reach participants beyond PEPFAR-supported sites. As in FY08, trainees will be
selected strategically and will receive post-training follow-up visits from supervisors/clinical mentors. In
FY09 more clinicians will be trained as clinical supervisors using the Integrated Supervision methodology.
They will continue to help supervise existing sites and will help start up news sites. In FY09, the number of
master trainers and clinical mentors/supervisors will increase to 30. A total of 15 new fellows will be
recruited and receive intensive professional in-service training in palliative care.
In-service training courses for nurses and pharmacists will be established in FY09. A curriculum
development committee will be formed for each curricula. The 5-day palliative care nurse training curriculum
will be led by the DOT in partnership with the Viet Nam Nurses Association, K Hospital, FHI, PEPFAR and
other key partners. The training curriculum will be presented to the MOH Department of Science and
Training for approval. In FY09 one nurse training workshop will be held and 25 nurses trained.
Training of pharmacists in palliative care is essential for improving access to oral morphine and other
palliative care medicines. The DOT and the drug administration department will lead the development of the
curriculum with FHI, SCMS and other key PEPFAR partners. It is envisaged this training will run 2-3 days.
As with the nurse in-service training, the curriculum will be submitted to the MOH for review and approval.
One training workshop will be held in collaboration with SCMS with 25 pharmacists trained.
Starting in FY09, FHI will work with the Viet Nam Medical Association to establish an palliative care provider
group. To facilitate this process, 1-2 palliative care symposiums or grand-rounds will be organized with clinic
mentors/supervisors, master trainers and previous trainees invited to present their work and learn from
national experts.
PEPFAR will coordinate the two agreements awarded to FHI by collaborating on annual work plans and
Activity Narrative: meeting periodically. A total of 130 individuals will receive in-service training in palliative care.
Pre-Service Training in Adult HIV Care and Treatment including Palliative Care and CHBC.
In FY 08 Pathfinder International (PI) received PEPFAR funding to pilot an integrated HIV prevention
curricula that included palliative care and community and home based care (CHBC) for medical and nursing
students at Hai Phong University and Hai Phong Secondary Medical School. Using FY 08 PEPFAR funds,
FHI partnered with Pathfinder to strengthen the capacity of the Hai Phong University to provide distance
education in HIV prevention, care and treatment for post graduate health professionals. This involved
supporting the school to design and develop two distance learning curricula. One course that was
developed was an "Introduction to HIV/AIDS Care and Treatment and the second course was an
"Introduction to Addiction Medicine and MMT". The curricula were developed using existing material from
the Hai Phong pre-service curricula and various MOH approved in-service training courses. Faculty in the
Hai Phong University were trained in both the technical and administrative skills required to implement
these distance learning packages using technical assistance from FHI when necessary. In FY08, 2 distance
learning packages were developed for post graduate health professionals in HIV prevention care and
treatment at Hai Phong University. At least 20 faculty members were trained and supported to implement
these distance curricula in preparation for implementation in FY09.
In FY 09 FHI will partner with Pathfinder International (PI) to continue to support work in institutionalizing
quality HIV prevention, care and treatment training including palliative care and community and home based
care for undergraduate doctors and nurses in Hai Phong University and Hai Phong Secondary Medical
School. Pathfinder will continue to work with both schools to review and build the curricula, while improving
the quality of expertise required to implement them, by providing mentoring and support as pre-service
lecturers implement the newly designed curricula.
review and adapt the two distance learning curriculum an "Introduction to HIV/AIDS Care and Treatment
and an "Introduction to Addiction Medicine and MMT" developed in Hai Phong University. It will also involve
prevention careand treatment will be developed in a Medical University TBD. At least 20 faculty members
Gender
* Increasing gender equity in HIV/AIDS programs
In FY 2008, Family Health International (FHI) partnered with Pathfinder International (PI) to strengthen the
capacity of Hai Phong University to provide distance education in HIV care and treatment for postgraduate
health professionals. This involved supporting the university to design online distance learning curricula.
Two online courses were developed, including one called an "Introduction to HIV/AIDS Care and Treatment"
and the other was related to prevention programming. The curricula were developed using material from Hai
Phong University's integrated HIV pre-service curricula and various Vietnam Ministry of Health-approved in-
service training courses. Hai Phong University faculty were trained in both the technical and administrative
skills required to implement the online distance learning packages with technical assistance provided by FHI
when necessary. In FY08, at least 20 faculty members were trained and supported to implement this HIV
care and treatment online distance curricula in preparation for implementation in FY09.
In FY09, FHI will again partner with Pathfinder International to provide further support to Hai Phong
University to actually roll out the online distance learning package in HIV care and treatment developed in
FY08. It is estimated that 75 postgraduate health professionals will be trained using the online distance
learning program. In addition, in FY09, PI will work with MOH's Department of Science and Training to
advocate for the accreditation of the distance learning package to enable it to be scaled-up and
implemented nationwide in the future.
In FY09, FHI will also partner with Pathfinder International to further consolidate the implementation of the
integrated HIV pre-service curricula, including antiretroviral therapy (ART) contents for medical and nursing
students at Hai Phong University and the Hai Phong Secondary Medical School, which was developed with
USAID funding in FY08. PI will continue to work with both schools to review and build the curricula, while
improving the quality of expertise required to implement them, by providing mentoring and support as pre-
service lecturers implement the newly designed curricula.
In FY09, Pathfinder International will collaborate with the Working Group of university deans and vice-deans
to advocate for the dissemination and scale-up of both the distance learning curricula and the integrated
HIV pre-service curricula in additional pre-service faculties over the coming years.
It is estimated that in FY09, at least 75 postgraduate students will be trained in HIV care and treatment
using the online distance learning education package implemented in Hai Phong University. A total of 500
undergraduate students will take basic orientation training in HIV, including ART.
Estimated amount of funding that is planned for Human Capacity Development $100,000
Table 3.3.09:
