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.
ACTIVITY 1: $100,000
This activity provides funding for a national multi-day conference that will offer a comprehensive overview of
current evidenced based drug addiction treatment practices, emerging trends and existing programs offered
internationally, and nationwide. It also offers an excellent platform to move the nacent addictions field in
Vietnam to the next level, by providing an opportunity to promote change in current thinking, programming
and improve the quality of treatment services in Vietnam. Through a series of plenary and workshop
presentations participants will learn of alternative methods to drug treatment that are tailored to not only the
Heroin issue but other drug use that is taking place in Vietnam. During this conference it would also be an
opportunity where PLHIV and recovering drug users meet with policy makers, program planners, service
providers (including NGOs & CBOs) to discuss what they need in order to help them rehabilitate effectively
- to reintegrate into mainstream society, to repair and restore relationships with friends and family, to stop
drug use or use drugs safely, to avoid HIV transmission and other health risks, to get a reasonable job and
to help avoid drug-related crime.
A theme for the conference could be "A Life In the Community for Everyone".
One approach to organizing the conference could be to leverage our connections to International and
National Organizatons to our comparative advantage & links with (a) NGO/CBO networks to invite
PLHIV/IDU groups, and (b) UN & GVN agencies to access the right people and apply the right pressure to
achieve broad and relevant GVN participation.
Make use of PEPFAR and the UNRC's high-level connections with DPM Truong Vinh Trong, in his capacity
as the Chair of the National Committee on AIDS, Prostitution and Drug Prevention & Control, and with the
Minister of MOLISA, firstly to agree to co-lead the conference and secondly to help get the right people to
come and commit to and participate in the conference, i.e. relevant representatives from:
? Party Central Committee and National Assembly (ensuring we invite National Assembly reps who
attended the Phnom Penh HIV & IDU workshop);
? Party Commission on Science & Nature and the Party Commission on Culture and Ideology (these bodies
may have changed names);
? MPS - high level Policy, SODC and Uniformed police departments;
? MOLISA - high level policy and DSEP;
? MOH - VAAC and higher-level policy areas;
? MOJ - court system/judges and high-level policy areas/departments around sentencing and prospective
community/MMT diversion.
? VYF - leaders and 06 managers from HCMC
Other expert speakers (regional/international), I/NGOs, CBOs and donors working in Vietnam would also be
invited to make presentations.
Kick off the conference introducing the various organizations represented, and move straight into having
some regional/international experts make some VERY short, punchy evidence-based presentations with an
education & advocacy slant (with simultaneous translation - enforce this through strong facilitation) on:
1) drug use & addiction
2) the effects of heroin/opiates & amphetamines/ATS on the brain
3) drug-related HIV
4) MMT
5) closed settings, and
6) the police role in helping addicts to access quality services, reduce the risk of HIV transmission and
facilitate drug users to stop using.
7) Other topics welcome to add
It is our hope that participants would leave this conference inspired, motivated and armed with new
information that you can take back to your work. It would provide an opportunity to network with other
attendees, to share what it is they are doing at home and to find out what is happening around the country.
This is an exciting time for those of us that work in the behavioral health arenas specifically addictions.
ACTIVITY 2: $360,000
This request is for a 1-year temporary contract for an MMT Medical Officer.
The Medicated Assisted Therapies (MMT) Medical Officer (1) coordinates, and collaborated on planning,
scientific evidence based practice related to the use of pharmacologic treatments for drug abuse; (2)
Provides options and recommendations to the SAMHSA Treatment Advisor For PEPFAR, PEPFAR and
HHS Health Attache regarding program changes for such treatments; (3) identifies, supports, or conducts
short-term and long-term ana1yses of new and existing key issues related to drug abuse and addiction
treatment with medications, including technical assistance, treatment standards, and knowledge
development and application projects; (4) monitors MMT in Vietnam in collaboration and coordination with
PEPFAR agencies in VN for clinical and other issues through site visit and report reviews; and (5) develops
technical assistance materials and conducts and delivers in-service medical education training to
physicians involved in substance abuse treatment.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.06:
The reported number of PLHIV in Vietnam as of Oct 31, 2008 is 135,169. It was estimated that at least 25%
of HIV infected people have not accessed to care and treatment services in Vietnam.
We have been receiving feedback from partners on the difficulty of enrolling new patients in the community
in spite of the fact that data show the needs of the population are quite high. In order to provide more
support to the program and maximize the utilization of PEPFAR care and treatment services, this new
activity will focus on Behavior Change Communication (BCC) activity targeting PLHIV who have not yet
registered for or delayed access to care and treatment services.
This activity will consist of two elements: 1) Support an assessment to understand the existing barriers to
access to available services by this harder-to-reach population and 2) The development of a tailored
communication campaign aimed at increasing new patients that are positive and in need of care and
treatment services including ARV based on the assessment data.
It is request that this will be one-time funding; however, we may need to look for continuing funding to
support communication campaign in the coming years.
Prime Partner is TBD, pending additional in-country discussions.
Table 3.3.08:
In 2004, the Government of Vietnam issued the National Strategy on HIV/AIDS to 2010 which committed to
provide care and treatment for 90% of HIV infected adults and 100% of HIV infected and affected children,
in which 70% of AIDS patients will receive ART. With major support from PEPFAR program, Viet Nam
Administration of HIV/AIDS Control (VAAC) in the Ministry of Health (MOH) has been remarkably successful
in identifying those who are HIV infected, preventing new infections, and offering HIV care and treatment.
As of June 2008, after five years of intensively rolling out the program, Vietnam MOH has reported 21,658
people on ART and 100,000 PLHA receiving basic care and support and has successfully integrated HIV
care and treatment into existing health care services. A large amount of resources have been contributed to
the program, both from international donors and government of Vietnam. In FY08, PEPFAR is collaborating
with MOH to conduct an evaluation of patient outcomes in the ART program in 5 provinces receiving direct
PEPFAR support. Results from these activities will provide key program monitoring information and will be
used by PEPFAR and VAAC to improve services ART services.
The OGAC Adult Care and Treatment TWG Technical Assistant team visited Vietnam in September 2008,
and one of their recommendations was that the MOH should routinely evaluate (bi-annually) the quality and
outcomes of the National Care and Treatment Program, focusing on patient retention in care and on ARV
and patient response to treatment (i.e. CD4 change). In FY09, PEPFAR will build on lessons learned from
the FY08 evaluation, and provide support for a larger, national outcome evaluation. PEPFAR's goal is to
support development of a sustainable, routine bi-annual evaluation process. The design and implementation
of the evaluation will be conducted in collaboration with VAAC, local government authorities, program
managers, donors, service providers and PLHA. The evaluation will be divided into program and treatment
outcome evaluation. Program evaluation will include data on service quality, drug management, training
needs, adequacy of staff and linkage between treatment program and other services. Outcome evaluation
will include retention and outcomes of patients before ART, and response and adherence to ART. A simple
tool will be developed and standardized for this activity so it can be applied routinely on a national, planned
basis.
PEPFAR Vietnam will form an internal team that will solicit input from OGAC Care and Treatment TWGs to
develop a model for supporting a national care and treatment basic program evaluation. In collaboration
with VAAC, and with the intention of building the capacity of VAAC, appropriate capable consultants and
partners will be selected for this activity.
The agency and partner for this activity have yet to be determined thus we are placing the funding into the
State/OGAC - TBD funding mechanism.
Program Budget Code: 10 - PDCS Care: Pediatric Care and Support
Total Planned Funding for Program Budget Code: $1,378,782
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
PROGRAM AREA SETTING
The Vietnam Ministry of Health (MOH) does not routinely collect data on the number of HIV-infected children. However, the
Government of Vietnam (GVN) estimates that up to 10,000 children in Vietnam are living with HIV/AIDS. In addition, there are an
estimated 5,000 to 6,000 HIV-exposed infants born every year. Unfortunately, most HIV-infected children are not receiving care
and treatment. In 2007, the GVN and international donor programs provided support to 1,500 HIV-infected children.
Vietnam's national HIV/AIDS strategy states that 100% of HIV-infected children are to receive care and treatment by 2010. This
goal will be challenging to meet. Vietnam's national HIV/AIDS program initially focused much of its efforts on scaling up programs
and medications for adults; less attention was given to pediatric patients. A great deal of work remains to be done in order to
identify each patient, set up appropriate infrastructure, and care for all HIV-infected children in need.
PEPFAR began supporting the pediatric care and treatment program in Vietnam in 2005. Its involvement was initially through
training and technical assistance to hospital-based out-patient clinics (OPCs), which focused on providing support to infants born
to infected mothers and to children that had been previously diagnosed. Pediatric formulations of antiretroviral (ARV) medicines
were initially not available, so adult formulations were used where feasible. In late 2006, the Clinton HIV/AIDS Initiative (CHAI)
formalized its support for Vietnam, assisting the government with procuring ARV drugs, and providing additional training and
technical assistance. Since CHAI's entrance into Vietnam, PEPFAR and CHAI have been working together on pediatric issues to
coordinate procurement and technical assistance to maximize coverage and to develop a comprehensive support package. In
2008, PEPFAR began scaling up pediatric services in 18 of the 30 PEPFAR-supported provinces. Meanwhile, CHAI is expanding
support for pediatric programming in sites supported by the Vietnam government and the Global Fund where services for adults
are already being provided by these programs.
Pediatric care and treatment services provided in PEPFAR-supported OPCs include all health facility-based activities for HIV-
exposed and infected children and their families, including HIV PCR testing, counseling on prevention and treatment, antiretroviral
therapy (ART), co-trimoxazole prophylaxis, treatment of opportunistic infections, palliative care, nutritional assessments, and food
support. Social support includes help with transportation and hospital fees, as well as linking patients to other community-based
services in the area.
KEY ACCOMPLISHMENTS
As of September 2008, the GVN reported that of the estimated 10,000 HIV-infected children, 1,700 (20%) were receiving care and
support, and 1,200 (14%) were on ART.
By the end of FY08, 18 provinces are expected to have pediatric HIV/AIDS care and treatment programs. Among those, 10
provinces will have OPCs located in a pediatric hospital or facility separate from an adult OPC (Hai Phong, Quang Ninh, Hanoi,
Ho Chi Minh City (HCMC), Nghe An, Can Tho, An Giang, Da Nang, Thai Binh, and Son La) and nine provinces will have pediatric
out-patient services integrated with adult OPCs (Nam Dinh, Cao Bang, Ba Ria-Vung Tau, Soc Trang, Bac Ninh, Ha Tay, Binh
Duong, Dien Bien, and Long An). Pediatric care and treatment has also been introduced in two orphanages in Hanoi and HCMC --
cities with the highest number of orphaned children.
PEPFAR, through Supply Chain Management System (SCMS), Family Health International (FHI), and the Harvard Medical School
AIDS Initiative (HAIVN) has been working with CHAI to support the national pediatric care and treatment program by providing
technical assistance in drug procurement; advising on distribution and management; developing training materials and standard
operating procedures; and providing on-site supervision and assistance revising national HIV treatment guidelines.
PEPFAR has worked to build the capacity of local experts by setting up networks of pediatric specialists throughout the country.
These health care worker networks were started through the establishment of monthly clinical conferences held to review difficult
cases and provide clinical updates. Discussions continue through an online forum where health care workers can pose
management questions to other clinicians around the country. Principles are reinforced through onsite supportive supervision. The
National Pediatric Hospital in Hanoi is the designated lead for the Vietnam pediatric HIV/AIDS program, and is in charge of
developing standard national protocols and guidelines. In addition, the National Pediatric Hospital is the main referral site in
northern Vietnam. In southern Vietnam, Pediatric Hospitals No. 1 and 2 are the lead referral sites. PEPFAR has worked to build
the capacity of physicians in each of these hospitals, who in turn provide training and supervision for provincial-level programs.
In FY08, PEPFAR supported locally-relevant aspects of basic preventive care packages for exposed children, including nutrition
counseling, formula (where determined acceptable, feasible, affordable, safe, and sustainable), and nutrition support. Co-
trimoxazole prophylaxis is provided to all exposed infants starting at 4 to 6 weeks of age until their HIV status is learned, as well
as to older infected children according to national guidelines. Exposed children receive HIV PCR testing as early as two months of
age in some, though not yet all, pediatric HIV sites. Designated staff at each clinic is trained in support services to strengthen the
linkages to routine child health services, prevention of mother-to-child transmission (PMTCT) treatment, orphan and vulnerable
children (OVC) and home-based care services.
Extensive effort has been put into implementing early infant diagnosis (EID), which is currently in place in HCMC where HIV PCR
is available. However, there is no national protocol for EID.
In order to advance data-driven interventions in nutrition, a formal assessment was done in August 2008. Vietnam's national
guidelines on nutrition care and support will soon be issued for use in pediatric outpatient clinics and in the community.
Fortunately, due to an excellent government anti-malaria program, this disease is no longer a danger in most PEPFAR-supported
provinces. This well-established program continues to function effectively in regions where malaria is still present. Safe water has
also been a priority of the GVN. The country's national program, which aims to ensure greater access to clean water supplies and
sanitation, is supported by the GVN and international donors. All HIV clinics counsel patients on the importance of using safe and
clean water.
PEPFAR provides technical and financial support to improve ARV adherence, and substantial progress has been made. Support
includes social support (e.g., transportation fees), nutrition supplementation, and hospital fees for HIV-infected patients admitted
to the hospital. Treatment supporters, who are primarily social workers in pediatric hospitals, have been recruited. These
treatment supporters play important roles in improving linkages between clinical care sites and between the clinics and the
community. Their work has helped reduce loss to follow-up, increase treatment adherence, and identify the six basic needs of
OVC, which are shelter, health care, education, psychosocial, legal aid and protection, and food and nutrition needs.
Under the national care and treatment guidelines, pediatric patients are monitored routinely using CD4 tests. They also undergo
routine testing for medication side effects.
CHALLENGES/OPPORTUNITIES
Despite initial progress, challenges still exist if the government is going to reach its goal of providing care and treatment to all
infected children. First, without routine data collection, the number of HIV-infected children is only an estimate. Pediatric cases are
considered a priority but due to a lack of data, the magnitude of the problem is not fully appreciated by policymakers. As a
consequence, the GVN has allocated only limited resources for pediatric care and treatment.
It is widely recognized that early treatment of perinatally-infected children leads to better outcomes. However, as described above,
there has been a delay of the application of EID since there is currently no national EID protocol. A proposal jointly developed by
the National Institute of Hygiene and Epidemiology (NIHE), the Pasteur Institute, PEPFAR, and CHAI is awaiting approval.
In Vietnam, only one laboratory (the Pasteur Institute in HCMC) can officially perform HIV PCR testing. As a result, diagnosis and
treatment in many provinces is delayed. Currently, HIV diagnosis using dried blood spots (DBS) is not available for use in Vietnam
and transportation of whole blood samples from distant provinces to this laboratory is problematic. Though planned in FY07, the
EID protocol has not yet been approved by the Vietnam MOH.
Linkages with community-based care and other social supports need strengthening. Although efforts have been made by
PEPFAR partners to provide networking, case managers, treatment supporters, referral forms, trainings, and shared experience
workshops, the linkages between clinics and home-based care still need to be strengthened in order to ensure that the basic care
package is available to vulnerable children in their communities.
KEY STRATEGY ELEMENTS
PEPFAR is committed to supporting the GVN's strategy to provide HIV care and treatment to all HIV-infected children by 2010.
Knowing the true number of HIV-infected children contributes greatly to our ability to effectively plan, implement, and monitor the
success of pediatric programs. PEPFAR will support the government to collect better data through several projects. PEPFAR
funds will support the government to institute better testing and reporting procedures in PMTCT settings. Funds will also be used
to support follow-up of infants in PEPFAR-supported provinces. PMTCT programs will emphasize the testing of all family
members of mothers presenting to PMTCT programs. Adults presenting for HIV care will be encouraged to bring their partners
and children for testing. These programs should improve data on the number of HIV-infected children, and will be used to
advocate for better service planning.
After MOH approves the HIV PCR test for EID, PEPFAR, in collaboration with CHAI, NIHE, the Pasteur Institute, and the National
Pediatric Hospital, will institute training on dried blood spots and advocate for rapid expansion of the implementation. With the aim
of getting all infants diagnosed and in to treatment as soon as possible, training will also focus on instituting fast-track protocols to
work with families and caregivers to rapidly start treatment. PMTCT, counseling and testing, and pediatric teams will work
collaboratively to improve access to testing for children at all entry points.
Expanding pediatric services, along with PMTCT and adult programs, should make access to prevention, care and treatment
services easier for the entire family. All sites will be designed or modified to provide easier access and improved referrals between
these programs. Regular meetings between health care workers at PMTCT, pediatric, and adult OPCs will facilitate
communication, and improve follow-up and management of women, children, and their families. Specially trained staff in each
clinic and in the community will facilitate referrals for children and caregivers either to other clinical specialty services or to
available services for orphans and vulnerable children in the community. If necessary, mother-child pairs will be escorted to health
care facilities or community-based services, ensuring that services are received. This will also improve outreach to families in the
community and decrease losses to follow-up. All new and established sites will receive regular onsite supportive supervision,
quality assurance and technical assistance (TA) visits from PEPFAR and/or government TA providers with an emphasis on
continuous quality improvement.
As requested by the MOH, PEPFAR will continue supporting the purchase of formula for exposed and infected children. The focus
will be on making sure that there is a long-term plan so that this intervention is affordable, feasible, acceptable, sustainable, and
safe. Nutrition assessments and counseling will be strengthened and expanded. There will also be additional training for
caregivers in these principles and an emphasis on better implementation of routine growth monitoring. PEPFAR will continue to
implement food by prescription in collaboration with MOH and other partners to train care givers on correct practices for
therapeutic and supplemental food and nutrition guidelines.
At the national level, PEPFAR will continue to coordinate with CHAI to support technical assistance, training, and drug
management. PEPFAR will also work with CHAI, the MOH, and the Global Fund to ensure that there is no interruption in drug
supplies to pediatric patients when CHAI transitions out of drug procurement at the end of 2010. PEPFAR will continue to support
national and referral hospitals to be centers of expertise for ART while supporting other provincial hospitals to start treatment for
pediatric patients. National and provincial hospitals will eventually function as tertiary facilities. PEPFAR will continue supporting
regional pediatric networks through monthly meetings and web-based discussions. Through these networks, referral centers will
support provincial outpatient clinic staff to improve their knowledge in care and treatment, strengthen the referral chain, and confer
on difficult cases. The networks, PEPFAR, the World Health Organization, and CHAI, will work with the MOH to develop and
update a national training curriculum based on national guidelines currently in development. PEPFAR will support the MOH to
organize an annual national workshop for clinicians to hear about and discuss recent advances, new guidelines, and clinical
management problems in pediatric care and treatment.
PEPFAR will also provide support to improve patient monitoring and program monitoring at PEPFAR-supported pediatric sites.
PEPFAR will continue supporting VAAC and the HCMC Provincial AIDS Committee to develop and apply patient monitoring
software at all OPCs. PEPFAR, in collaboration with WHO, will support VAAC to establish HIV drug resistance monitoring sites.
Table 3.3.10:
In FY08, PEPFAR supported the Vietnam Ministry of Health (MOH)/Vietnam Administration for HIV/AIDS
Control (VAAC) to provide in-service training for the pediatric HIV/AIDS program in Vietnam. Following their
in-service training, pediatric outpatient clinicians spent one day in a high-volume pediatric outpatient site as
part of their practicum training and to see how to run a pediatric outpatient clinic (OPC). PEPFAR also
supported the Harvard Medical School AIDS Initiative in Vietnam (HAIVN) to continue to provide both basic
and advanced clinical training for both adult and pediatric OPC doctors.
In FY08, UNICEF supported the MOH to develop an advanced training curriculum for pediatric HIV/AIDS.
In FY09, TBD partner will work with PEPFAR and non-PEPFAR partners to continue supporting MOH to
provide in-service pediatric HIV/AIDS training, including refresher training, in Vietnam. Pediatric HIV/AIDS
master trainers will receive technical skills update training. They will then be supported to provide in-service
training in pediatric HIV/AIDS clinical sites nationwide. TDB will work with HHS-CDC, LIFE-GAP, the Ho Chi
Minh City Provincial AIDS Committee, and other partners, to support VAAC to provide four pediatric
HIV/AIDS in-service training workshops during FY09. They will train a total of 120 pediatric HIV/AIDS
providers during these sessions. In FY09, a formal pediatric HIV/AIDS clinical mentoring network will be
established. A total of six experienced pediatricians will be trained as clinical mentors and paired with
experienced national and international technical assistance providers to work with newly trained pediatric
HIV/AIDS clinicians. These experienced pediatric mentors will spend time in newly established and
underperforming sites, helping the clinicians and the rest of the clinical team to improve the quality of
services. They will provide ongoing clinical supervision and on-the-job training as sites mature and become
more established.
TBD partner will work with PEPFAR, VAAC, UNICEF, and others in developing a basic pediatric HIV/AIDS
training curriculum. TBD will also work with PEPFAR and VAAC to develop technical assistance tools for
future use. These tools will be useful in providing on-site technical assistance, site monitoring, and feedback
in order to help improve the quality of pediatric care and treatment services.
Emphasis Areas
Health-related Wraparound Programs
* Child Survival Activities
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Program Budget Code: 12 - HVTB Care: TB/HIV
Total Planned Funding for Program Budget Code: $2,554,011
Vietnam has the 12th highest burden of tuberculosis in the world with an estimated 173 cases per 100,000 persons. In 1997,
Vietnam reached 100% national coverage for its National TB Program and was one of only two high-burden TB countries to
achieve World Health Organization-recommended program targets of diagnosing 70% of all new cases and successfully treating
85% of them. Nevertheless, the TB case notification rate in Vietnam has not declined. One major reason has been the rapid
spread of HIV and the symptomatic presentation of many TB/HIV cases. National HIV prevalence in TB patients is estimated to be
5%, up from 1.5% in 2000. For HIV-infected persons in Vietnam, TB is the primary cause of severe illness and death.
Identifying those with TB has been problematic in Vietnam. Twenty percent of HIV-infected persons have radiographic evidence of
the disease when first screened. Even after TB is initially ruled out, an estimated 20% of HIV patients are diagnosed with TB
within a year of starting antiretroviral therapy (ART). This is either due to inadequate screening for TB or because patients have
developed immune reconstitution syndrome. During TB treatment, death rates in HIV-infected TB patients average 20-30%, with
most deaths occurring in the first three months after TB diagnosis. Program experience suggests that delayed diagnosis of HIV
and TB, and inadequate HIV treatment and care during TB treatment, are contributing factors. Based on a 2005 national drug
resistance survey, the prevalence of isoniazid-resistant and multidrug-resistant strains of TB in new patients is 19% and 2.7%,
respectively. There is no national data on TB drug resistance among HIV-infected TB patients.
In the past four years, PEPFAR and the Vietnam Ministry of Health (MOH) have made substantial progress in responding to the
TB/HIV epidemic. PEPFAR implemented routine HIV provider-initiated testing and counseling (PITC) for TB patients and referral
to HIV services for 36,000 TB patients in 18 provinces in FY08. All PEPFAR-supported sites are using National TB Program
registers that record HIV-related information and provide referral forms to ensure successful referral of HIV-infected TB patients to
HIV treatment facilities. In FY08, these sites achieved a 76% success rate when it came to referral and patient follow through.
PEPFAR-supported health facilities performed intensified case finding for TB in HIV-infected persons living in the community and
in HIV patients presenting for care and treatment using a symptom screen. Every patient with symptoms was provided a chest
radiography and sputum microscopy. Since 2007, PEPFAR has funded isoniazid preventive therapy for 1,200 patients in three
provinces, carefully checking for the occurrence of active TB and monitoring for drug resistance. PEPFAR has also funded
antiretroviral therapy at TB hospitals in two provinces to expedite HIV-related care and treatment for 856 HIV-infected TB patients.
Successful implementation of TB/HIV activities in PEPFAR-supported provinces from 2005-2007 led the Ministry of Health in 2008
to adopt national policies mandating PITC and the use of intensified case finding across the entire country. To help strengthen
linkages between TB and HIV programs, PEPFAR supported the creation of a national TB/HIV technical working group. This
group, which included participants from PEPFAR in-country staff and WHO, prepared the Ministry of Health guidelines that require
TB and HIV programs to provide provider-initiated testing and counseling to TB patients, perform intensified case finding in HIV-
infected persons, and establish provincial- and district-level TB/HIV coordination committees.
PEPFAR has also continued support for laboratory capacity building in eight provinces. This includes expanding capacity in five
provinces for solid- and liquid-based mycobacterial culture in order to improve the diagnosis of sputum smear-negative TB. In
three additional provinces, PEPFAR supported the KNCV Tuberculosis Foundation to help establish the capacity for molecular
diagnosis of drug-resistant TB. The Foundation also conducted infection control assessments in five inpatient multidrug-resistant
TB treatment facilities and in high TB and HIV congregate settings, where TB prevalence was 8-10%. This included two prisons
and two government-run mandatory rehabilitation centers for sex workers and injecting drug users (IDUs), facilities that are
officially known as "05/06" centers. In FY09, KNCV will implement stronger infection control procedures in two prisons in two
provinces and in the 05/06 centers that manage both drug-resistant TB and HIV patients. This activity includes implementing
administrative measures, providing health education on TB and TB transmission, training, making structural renovations, and
encouraging the use of personal protection measures.
In 2008, PEPFAR began supporting care and treatment of TB for HIV-infected children in one provincial hospital. Pediatric TB
rates in Vietnam, as in the rest of Southeast Asia, are among the lowest of all high burden countries, with good evidence that the
data are strong and not a result of under diagnosis. Therefore, with a limited PEPFAR budget for TB, pediatric TB is not a focus
area for this plan.
PEPFAR has continued to support PATH to work with private pharmacies and clinicians in two provinces to promote collaboration
between the public and private sectors in the management of patients with TB and HIV. Over 500 Vietnamese health
professionals have received training to improve their capacity for TB/HIV diagnosis, treatment, and management.
Coordination has been strengthened at the national level through a TB/HIV technical working group and issuance of Ministry of
Health policies promoting TB/HIV services. At the local level, collaboration between the two programs remains challenging. Part of
the problem is that the TB and HIV programs are vertically designed and operated. In some provinces, poor referral between the
two programs has led to the delayed diagnosis of TB and the delayed entry of HIV-infected TB patients into the HIV care system.
PEPFAR technical staff continues to support and facilitate this collaboration at all levels in the PEPFAR-supported projects.
Rapid expansion of PEPFAR TB/HIV activities into TB laboratory capacity development has created a need for stronger in-country
technical resources to implement, monitor, and evaluate these specialized activities. Identifying appropriate hiring mechanisms
and recruiting appropriately trained laboratory staff with program management skills remains a challenge.
In 2008, PEPFAR-supported programmatic infrastructure helped support a USAID/TB-funded (non-PEPFAR funding) clinical
research study to develop an evidence-based strategy for TB screening in HIV-infected patients. Final results of this study are
expected in December 2008 and will guide the development of a revised strategy for using intensified case finding in HIV-infected
patients.
Based on the success of initial PEPFAR TB/HIV collaborative activities, PEPFAR will work to enhance the existing programs and
expand their reach. Consistent with the Vietnam National HIV/AIDS Strategy and the PEPFAR/Vietnam 5-Year Strategy,
expansion of provider-initiated testing and counseling continues to be one of the highest priorities. In HIV clinical care settings, the
focus will be on reducing the burden of TB in HIV-infected persons by promoting the three "I's", consisting of intensified TB case-
finding, infection control, and isoniazid preventive therapy. Special attention will continue to be paid to the development of a
successful, evidence-based model for screening HIV patients for TB disease, strengthening of human resources at the district
level, and provision of co-trimoxazole, ART, and other services to HIV-infected TB patients. To achieve these goals, PEPFAR has
charted specific objectives that are described in the following paragraphs. All activities have been planned in coordination with
other donors, such as the Global Fund, in order to fulfill the National TB Program's five-year development plan and the Vietnam
National HIV/AIDS Strategy.
Human resource development is key to ensuring a sustainable TB/HIV care system for the future. To meet this goal, PEPFAR will
support direct technical assistance and additional training of 700 individuals who will offer TB diagnosis and treatment and ensure
proper data recording and reporting practices. PEPFAR will expand TB laboratory capacity support from six to eight provinces and
will support national efforts for training and quality assurance in smear microscopy.
Formal collaboration mechanisms between TB and HIV programs will continue to be maintained and strengthened at the national,
provincial, and district levels in the focus provinces. PEPFAR will support focus provinces to convene joint monitoring and
evaluation of TB/HIV activities, joint training activities, and regular meetings for district-level participants. Technical guidance will
come from the National TB Program, the Vietnam Administration for HIV/AIDS Control (VAAC), PEPFAR, and other international
partners.
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 monitoring and
evaluation, and support for the national HIV/AIDS monitoring and evaluation system. In order to help improve the national system
for monitoring and evaluating TB/HIV activities, PEPFAR will support WHO to recruit one Vietnamese national program officer.
This person will help refine the national guidelines for TB/HIV, based on evidence collected from program implementation, to
ensure the guidelines clearly address poorly performing elements and ways for frontline staff to address these. They will also help
strengthen relationships between PEPFAR and other donor-supported TB/HIV activities, such as those of the Global Fund.
PEPFAR will also support efforts to improve HIV diagnosis and care among TB patients. TB patients in PEPFAR-supported
provinces will receive provider-initiated testing and counseling for HIV, and referrals to HIV services will be tracked. PEPFAR will
support VAAC and the Ho Chi Minh City Provincial AIDS Committee to expand provider-initiated testing and counseling to 40,000
TB patients in 20 provinces, and will continue to support training to promote patient and provider acceptance of PITC.
HIV-infected TB patients will receive co-trimoxazole preventive therapy, CD4 testing, antiretroviral therapy (if indicated), and other
HIV-related services in PEPFAR-supported HIV clinics. PEPFAR will expand support for ART and HIV care from two to four
provincial TB hospitals to provide a "fast track" to ART for HIV-infected TB patients. As part of PEPFAR support to residents of
government 06 centers for IDUs, more than 1,000 center residents will receive equivalent TB and HIV services.
In an effort to improve diagnosis and management of TB among those known to be HIV infected, patients will undergo TB
screening at least annually. Screening will occur at HIV diagnosis, before commencing ART, and during routine care and
treatment. The current screening method involves asking about TB-related symptoms and performing chest radiography, followed
by a smear microscopy and, if the smear is negative, performing a sputum culture in those suspected of having TB disease. HIV-
infected persons diagnosed with TB will be registered for TB treatment. PEPFAR, in collaboration with WHO, will support the
national TB/HIV technical advisory group to update its guidelines on TB screening in HIV-infected patients once new evidence and
recommendations are available.
PEPFAR will support TB treatment for 7,500 HIV-infected patients (i.e., all HIV-infected patients diagnosed with TB in the
PEPFAR-supported provinces, or 80% of the estimated true number of patients with TB co-infection). More facilities in each focus
province will be equipped and additional staff will be trained to conduct rapid diagnosis and treatment of smear-negative and extra
-pulmonary TB in HIV-infected persons. In PLHIV found not to have TB disease, PEPFAR will support the use of isoniazid
preventive therapy (IPT), with IPT projects expanding from three to five provinces.
PEPFAR-funded HIV care and treatment settings will continue to implement infection control practices to limit TB transmission,
with expansion from 14 to 20 provinces in FY09. PEPFAR will support TB infection control through national and regional trainings
with a focus on administrative controls (i.e., triage and screening for cough, patient flow in facilities, cohorting those with cough,
and fast-tracking TB suspects to minimize their time in HIV care settings) and support for minor renovations and equipment to
improve airflow and environmental safeguards.
Table 3.3.12:
This is a new activity funded for a single year in FY09 using available funds due to DoD yellow-lighted FY08
Funds.
These funds would be used to accelerate the development of electronic information systems for prioritized
program areas. Systems to be considered are commodities management (methadone, condoms, ART),
facility-based (adult ART, PMTCT, LIS, TB/HIV, methadone, drop-in center), and community-based
(outreach, OVC, care). Partners would include TA partner for development of functional specifications for
software, implementers for participating in scope development, contracted software developers, and
possibly implementation. Although there are on-going costs to software maintenance, use, and
improvement, these funds would be used to accelerate the development life-cycle of prioritized systems.
Table 3.3.17:
This is a new activity in FY09.
This activity is TBD agency and prime partner. In order to be able to better focus and implement SI
resources in the coming year, these funds have been allocated to SI, but unallocated by agency or partner.
These resources will be used for HCD through epidemiology training. PEPFAR SI will identify an
appropriate partner(s) to provide technical assistance to the Vietnam MOH in developing local human
capacity in epidemiology through both pre-service and in-service training programs. One of the largest gaps
in the national surveillance and M&E system is a lack of trained staff in epidemiology at all governmental
levels, from provincial to central administration and health units. Compounding the difficulty in meeting
demands for epidemiologic data is the inability to attract highly skilled health professionals into the
governmental system due to the growing non-governmental and private sectors offering attractive
compensation. The selected TA provider will partner with local medical and public health universities,
coordinated by the Hanoi School of Public Health, to establish epidemiology concentrations at these
universities as well as short-course basic epidemiology programs with an HIV focus for the public health
workforce in HIV programs. The partner will also provide counsel to the MOH on the establishment of tuition
scholarships for epidemiology and biostatistics concentrations at national universities.
This is a continuing activity from FY08.
These resources will be used to fill the gaps of HMIS systems development in prioritized program areas.
Funds will be used specifically to contract locally the development of software based on functional
specifications developed by program area and complying with national standards defined by the national IS
technical working group.
Zeroed out due to duplicate entry
Table 3.3.18:
Note that both the agency and partner are to be determined for this activity. Per core team guidance, we
are placing this in the State/OGAC TBD funding mechanism until a suitable partner is selected.
The proposed activity would provide funding for two project staff within the Ministry of Labor, Invalids and
Social Affairs (MOLISA) to support capacity-building in MOLISA around improved services for HIV and drug
addiction treatment. Funds would provide salary support, local travel and some local training support. In
collaboration with FHI, which is already providing technical assistance, MOLISA will work to improve
services and training curriculum around drug addiction and HIV into its training universities.
Vietnam's primary response to injecting drug use -mainly heroin- is through mandatory treatment in
custodial rehabilitation centers, locally referred to as ‘06 centers', in which detoxification is followed by one
to four years of rehabilitation through labor and vocational training. Managed by MOLISA, 06 centers have
been politically popular, but subscribe to a punitive approach that is not based on international best practice.
The centers have limited medical and other psycho-social support services a relapse rate (over 70 percent
relapse into regular injecting drug use) and HIV prevalence rates that have been estimated to be as high as
70 percent. The 06 system has failed to effectively treat drug addiction in Vietnam, and there are few drug
rehabilitation, HIV/AIDS or other psycho-social support services available.
Addressing the needs of the IDU population is complicated by the GVN's continued reliance on the 06
centers as a means to address drug use. Additionally, concerns around human rights within the 06 system
are many, as there is no judicial process for remanding individuals to the centers, and few mechanisms to
ensure continuity of care and treatment for HIV+ IDU in the centers and in the community after release.
There are also concerns about the cost and sustainability maintaining the 06 center system in the future.
These issues all point to the need to identify and develop more efficient community- and evidence-based
drug treatment models.
There are significant human resource gaps in the field of addictions treatment. It is difficult to find qualified
people willing to work in addictions treatment due to low prestige, poor pay and limited career advancement
opportunities. Furthermore, addiction counseling and treatment is a new concept in Vietnam, a country in
which the mental health field is underdeveloped and an unpopular career choice.
Supporting MOLISA to institutionalize drug addiction and HIV curricula into its staff training universities, and
to develop alternative, evidence-based, drug treatment services in the community, would lead to a more
sustainable PEPFAR intervention and the establishment of more effective drug treatment modalities in
Vietnam. MOLISA would be seen as taking the lead in identifying and developing a quality alternative to the
government-run 06 system.
Furthermore, the two proposed project-staff positions would fortify support to MOLISA priorities around HIV
Prevention and Addictions in two key activities:
1. Institutionalizing addiction counseling and case management training programs in MOLISA universities,
in collaboration with FHI; and
2. Identification and development of alternative drug treatment approaches and models, based on
international best practice.
The PEPFAR-funded positions would provide two mid-level managers who would be trained in project
management and analysis through the HSPH SMDP program and would provide expert managerial support
to technical activities as well as upward support to senior-level MOLISA managers on policy advocacy and
strategic planning.
As stipulated in the OGAC Partnership Framework (PF) Guidance (March 2009), the PEPFAR/Vietnam
team is required to carry out several key assessments as part of the completion of the PF implementation
plan. The PEPFAR/Vietnam team will need to fund several assessment projects (either building on existing
or new) in order to identify and make available the necessary information and data that will populate much
of the PF implementation plan for Vietnam.
The PEPFAR/Vietnam team has agreed to set aside funding for the following possible assessment needs
(although, the team will use existing evaluation data in-country to the extent possible):
- HIV/AIDS epidemic and response situation assessment
- HIV/AIDS policy reform situation assessment
- HIV/AIDS financing situation assessment
- PEPFAR 5 Year Program Review/Assessment
The PEPFAR/Vietnam team will also plan several participatory conferences and meetings with the objective
of engaging GVN officials, inter-ministerial representatives, and key donors and stakeholders during the PF
development process.
A portion of these funds will go to supporting the implementation of recommendations originating from
technical assistance visits. The recommendations, in general, relate to direct implementation and
coordination of activities, as well as address long term sustainability issues.
The total cost associated with this activity is $350,000.
Program Budget Code: 19 - HVMS Management and Staffing
Total Planned Funding for Program Budget Code: $7,676,502
The United States' PEPFAR program in Vietnam is represented by the Department of State, USAID, the Department of Defense
(DOD), HHS/CDC, and HHS/SAMHSA. The U.S. Deputy Chief of Mission (DCM) serves as the U.S. Ambassador's representative
on the PEPFAR Inter-agency Management Team (IAMT) and has an excellent understanding of the PEPFAR/Vietnam program.
The PEPFAR Coordination Office (PCO), which in the last year has become fully staffed up, plays a key role in representing
PEPFAR programs, communicating challenges and successes to the embassy, and in working with the Government of Vietnam
(GVN) and other partners in the fight against HIV/AIDS. Moreover, the PCO is responsible for calling regular meetings of the
PEPFAR IAMT and arranging face-to-face discussions between the IAMT and the PEPFAR/Vietnam Technical Working Groups
(TWGs) for the purpose of strategic program planning, monitoring, reporting, and conducting other PEPFAR-related activities.
As one of the first countries to host a Staffing for Results (SFR) headquarters visit in 2006, Vietnam has had the opportunity to
incorporate and refine SFR recommendations into subsequent programming. As a result, Vietnam's PEPFAR program has
benefited from strengthened inter-agency coordination and cooperation. On an operational level, the agencies follow the principle
that through teamwork, one agency can access the programmatic strengths of another, thereby maximizing efficiencies and
complementary functions. For example, in the care and treatment program area, USAID, working closely with non-governmental
partners, provides an important portion of the needed technical assistance and program implementation activities, and is
particularly strong in community-based care settings, system strengthening, and logistics. USAID's strategies complement the
programs and abilities of HHS/CDC, whose staff collaborate directly with Vietnam's Ministry of Health (MOH) and other GVN
agencies to provide expert medical/clinical and laboratory technical assistance and training related to HIV/AIDS treatment. At the
same time HHS/SAMHSA works across all agency programs to ensure that cross-cutting issues related to addiction and
substance abuse are appropriately addressed. DOD works exclusively with Vietnam's Ministry of Defense (MOD) to provide
treatment services to military as well as civilian populations. All agencies provide a wide range of support in the areas of HIV
prevention and care and, along with HHS/SAMHSA and the HHS Health Attaché's office, participate together with the GVN and
other key partners to plan programs and determine funding needed to provide a comprehensive package of services.
In 2007, the IAMT reached consensus regarding the ideal organizational structure for the PEPFAR/Vietnam program. Since then,
agencies formalized and empowered TWGs and began the process of staffing up. In March 2008, the IAMT and TWG leads held
a half-day retreat to further review the operating procedures of the organization and terms of reference for each TWG. During this
retreat, the team formalized the Policy System Strengthening (PSS) group into an interagency team, to be chaired by USAID. The
PSS team, which had previously functioned in an ad hoc manner, has developed a strategic approach to support a strengthened
health care system to benefit HIV/AIDS programs and achieve a progressive level of sustainability as Vietnam plans, manages,
and implements HIV programs designed to mitigate the concentrated epidemic. Because of the cross-cutting nature of PSS it was
determined that this group would function as an inter-agency team with the goal of supporting all TWGs and addressing issues
that impact all technical areas. The team reviews and makes recommendations on cross-cutting PSS issues by strengthening
national and organizational policies and systems including policy development, human capacity development, stigma and
discrimination, advocacy for PLHIV, public-private partnerships, and gender issues.
The functional organization chart (see uploaded PEPFAR VN Functional Chart document) defines PEPFAR/Vietnam's
interagency relationships. PEPFAR/Vietnam has three TWGs: Care and Treatment and Strategic Information, which are chaired
by CDC; and the Prevention TWG, which is chaired by USAID. The inter-agency Policy and Systems Strengthening team is
headed by USAID. Within each TWG there are designated points of contact for each technical area. These staff, many of whom
are PEPFAR/Vietnam locally employed staff serve as the focal point for a specific technical area, responsible for responding to
questions from in-country PEPFAR management, OGAC or outside organizations as needed. In addition, they work closely with
the entire TWG to coordinate strategy development and convene meetings. For example, the technical point of contact for PMTCT
is a CDC locally employed Vietnamese staff member. This is also true for special programs implemented in Vietnam, including
Methadone, where a USAID locally employed staff member serves as the point of contact, but others are closely involved with the
program. The PEPFAR/Vietnam model also incorporates four cross-cutting areas with working sub-committees, including
Substance Abuse, Gender, Laboratory, and Procurement. PEPFAR/Vietnam is in the process of documenting the roles and
responsibilities of the PCO, agencies, TWGs, and PSS team, as well as individual responsibilities within these TWG's, in order to
better harmonize the COP development process.
A well-communicated organizational structure and appropriate staffing, along with the development and improvement of
operational systems, has enabled PEPFAR/Vietnam to more effectively address ad hoc and ongoing issues encountered during
the day-to-day running of the program. The PEPFAR team began to formally incorporate most of the recommendations from the
SFR report in FY07, carrying them forward in FY08. To date, the following recommendations have been incorporated: naming
single points of contact for technical areas and PSS; identifying and filling key positions in the PCO; adopting an inter-agency
hiring process for all technical positions, including determination of staffing gaps, development of standardized position
descriptions, and an inter-agency interview and selection process; conducting IAMT meetings on a routine basis; familiarizing new
staff in the PEPFAR inter-agency approach; developing intra-PEPFAR cost norms for various technical areas; and including
partners in PEPFAR TWG meetings and strategic planning discussions where appropriate. Finally, PEPFAR/Vietnam is working
closely with the U.S. Embassy on an inter-agency co-location strategy and it is expected that all agencies will be located together
in the same building in FY 2009.
The positions that were approved in FY07 and FY08 are currently being filled. This means that staffing has nearly caught up with
PEPFAR/Vietnam's sizeable financial and programmatic growth. However, with a budget of $88 million in FY09, an amount that
supports expansion of most activities in almost all program areas, including prevention, laboratory, prevention of mother-to-child
transmission (PMTCT), antiretroviral therapy (ART) and medication assisted therapy for drug addiction, there is still a need for
focused expertise, especially in the areas of program management and prevention, to sustain programming and to enable
PEPFAR/Vietnam to provide needed support to existing budgets and activities.
The request for additional staff in FY09 is based on SFR principles and PEPFAR/Vietnam programmatic priorities established by
the IAMT. These new positions will enhance the depth of expertise needed to maintain and sustain programming that has been
established in Vietnam. The PEPFAR team is therefore proposing the hiring of: 1) a U.S. direct hire at CDC to serve as a Senior
Prevention Advisor, who will work 50% of the time in intravenous drug use prevention and 50% in other prevention; and, 2) a U.S.
direct hire at CDC to provide leadership to the program management unit formed in FY08 to ensure appropriate fiscal and
programmatic oversight of CDC's cooperative agreements, which are primarily with GVN partners. As it is currently focused on
filling the FY08-approved staff positions, USAID is not proposing any additional staff positions in FY09. Given USAID/Vietnam's
promotion to full mission status in April 2008, USAID has decided to fill the approved Program Development Officer's position with
an OE-funded direct hire to work on all of USAID/Vietnam's programs. The OGAC-approved position will now be designated as a
program-funded Monitoring and Evaluation (M&E) Technical Advisor, which will strengthen the PEPFAR team and its partners'
M&E capacity, as was recommended during the Strategic Information TWG visit in FY08. A local DOD hire will provide SI support
to the DOD program and help create an "SI culture" within Vietnam's MOD, so that data is used as a basis for program planning,
evaluation, and improvement.
The short- and long-term skills needed this year include discrete technical and management assistance in specific program areas
and at specific times. For example, during the development of the annual COP, writer/editor skills may be needed on an ad hoc
basis. Such short-term needs are met with agency TDY staff, consultants, or visiting fellows whenever possible.
PEPFAR/Vietnam recognizes that developing and establishing programs for long-term implementation can only be sustained by
professional and technically sound expertise in-country. PEPFAR/Vietnam is therefore committed to continuing to develop the
leadership, management, and technical skills of our critically-important locally employed staff. Their skills can be enhanced by
identifying appropriate technical and management/leadership training opportunities, having them attend conferences directly
related to their work, encouraging them to make presentations at international meetings, providing mentorship opportunities, and
empowering staff with leadership positions within the in-country team.
Finally, both the IAMT and the U.S. Embassy leadership in Hanoi believe it is critical to co-locate the three agencies that comprise
PEPFAR, along with the HHS Health Attaché's office and HHS/SAMHSA, in order to improve the efficiency of operations.
Currently the agencies are housed in different buildings, separated by a 30-minute commute. Weekly management and technical
meetings form the cornerstone of good communication practices between the agencies and guarantee an inter-agency approach
to PEPFAR. Through the use of digital video communication technology and careful planning, the agencies have succeeded in
carrying out meetings and maximizing attendance to the extent possible. However, all agencies and the embassy leadership
believe that further improvements in communication will result from co-location. In FY08, the U.S. Ambassador to Vietnam
requested the IAMT set aside $500,000 so that this process could begin. This amount was allocated to the U.S. State Department
through the July 2008 reprogramming round and has not yet been spent. It is anticipated that additional funds will be required to
complete the co-location plan in FY09. Therefore, in addition to the $500,000 allocated for this project in FY08, the amounts of
$180,000 (CDC) and $140,000 (USAID) have been set aside as one-time costs related to the move; likewise, $360,000 of
unallocated funds has been set aside. Once it is determined how these funds will be spent they will be programmed to the
appropriate agency. This will be a positive move toward fostering and strengthening interagency collaboration. However, the
additional funds programmed in the COP 2009 for the co-location project have increased the overall percentage of the
Management and Staffing budget to a total of 7.8%. Since these funds are for one-time activities, such as retrofit and moving
costs for all USG agencies involved, it is expected that the PEPFAR/Vietnam Management and Staffing budget will return to its
normal levels of just below 7% in COP 2010.
Table 3.3.19:
The OGAC Partnership Framework (PF) Guidance (March 2009), has stipulated the PEPFAR/Vietnam team
must develop a PF which identifies and establishes a collaborative relationship with the government of
Vietnam and other relevant counterparts. The establishment of an in-country design team to lead necessary
developmental consultations, assessments, and discussions will be required.
Currently the PEPFAR/Vietnam staff, (and throughout the year), is engaged at a maximum operating level
providing management and oversight for the activities of PEPFAR implementing partners, including working
with the VN government to strengthen their technical and management capacity. The team is also
substantially engaged in the lengthy COP development process.
Due to the existing work loads of staff in Vietnam and in order for Vietnam to develop an effective and
quality PF and implementation plan, a PF Coordinator will need to be hired with the responsibility to
coordinate, lead the development, and write the Vietnam PF. The PEPFAR/Vietnam team has agreed to
set aside funding for the hiring of a contractor to serve as PF Project Coordinator, starting in the fall of 2009
and working through a Level of Effort (LOE) contract for the period of 9 months to a year (based on in-
country needs and the rate at which the PF is developed and negotiated in Vietnam). The total cost
associated with this activity is $320,000.
The progressive increase in the PEPFAR budget (nearly 30%) between FY 2007 and FY 2008 has required
a commensurate strengthening of operational and management capacity to plan, implement, monitor and
evaluate the increasing scale and scope of programs. To enhance operational and management efficiency
and effectiveness, the PEPFAR Management Team has taken actions to: increase the number of key
management and technical staff; open opportunities for training; and focus on means to improve program
coordination. An important strategy to augment program coordination and more efficiently utilize staff time
and resources is to co-locate PEPFAR-implementing agencies, which are presently dispersed widely across
Hanoi. Currently Embassy administrators have identified office space, and are making final arrangements
with agency headquarters on moving forward with the leasing of this space. The State Department has
estimated $1.8M as the partial costs associated with this activity. However, agencies have learned that
setting up Information and Technology systems will cost an additional $500,000 (approximately).
