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.
Years of mechanism: 2008 2009
This is a continuing activity from FY08.
FY09 funds will continue to support HCMC PAC's strategy to maintain prevention of mother-to-child
transmission (PMTCT) services in the city and expand antiretroviral prophylaxis to more sites. In FY09,
activities will focus on: 1) maintaining services in 24 sites; 2) expanding the coverage of the minimum
service package with antiretroviral (ARV) prophylaxis in two current antenatal care (ANC) sites; 3) improving
the quality of services, especially referrals; and 4) promoting early HIV testing during ANC.
HCMC has the highest number of HIV-infected pregnant women (about 600 per year) in Vietnam. From
April 2007 to March 2008, 135,446 pregnant women received HIV counseling and testing and 590 HIV-
positive women were identified. Among those, 534 women and 594 infants received ARV prophylaxis.
HCMC also has the highest service coverage in the nation with PMTCT service outlets available in all 24
districts and 228 communes.
PMTCT is integrated into routine ANC, with "opt-out" testing employed at all sites. Currently, PEPFAR
supports antiretroviral prophylaxis at two obstetric hospitals, two general city hospitals, and eight district
health centers, which treat women who are referred from other districts. Clinical staging and evaluation for
opportunistic infections and TB, co-trimoxazole prophylaxis and ART during and after pregnancy, are
provided at affiliated OPCs. HIV-positive women will be referred for sexually transmitted infection (STI)
screening and treatment. Women with STI symptoms will be counseled and provided with HIV testing in
order to improve primary prevention. The STI model will be expanded to one more site in FY09.
More OPCs are now available throughout the city, making it easier to refer pregnant women before and
after delivery for follow-up care and treatment. Tools, such as standardized referral forms, routine service
provider coordination meetings, and facilitators, such as treatment supporters and OPC case managers,
have improved communication with patients and strengthened linkages between OB/GYN hospitals, the
community, and OPCs, reducing loss to follow-up of mother-infant pairs. If feasible, the family-centered care
model will be applied at all levels where PMTCT and pediatric and adult care and treatment will be provided
in the same location or area, making it more convenient for family members to access services.
Health workers at city and district levels will receive refresher training to introduce the new Ministry of
Health (MOH) guidelines on PMTCT and Decision 28 on data management. This will improve counseling,
education, and care skills to support HIV-positive women, their partners, and children born to HIV-positive
mothers and to support early referral to OPCs, legal and vocational support, and other social support
services. Community health care workers, treatment supporters, and case managers will continue to serve
as educators and adherence supporters during the antenatal period. They will play an integral role in linking
women, children, and their families to comprehensive services available in HCMC, including counseling and
testing, care and treatment, community and home-based care and additional OVC services.
PEPFAR support will also focus on building the capacity of PMTCT staff by supporting quarterly technical
assistance (TA) and quality assurance (QA) activities provided by an experienced TA team. This TA team
includes the master trainers who will provide supportive supervision to PMTCT staff in the city in terms of
clinical, management and laboratory assistance. In addition, PEPFAR will support HCMC PAC to organize
semi-annual sharing experience meetings, which participants from all PMTCT and pediatric sites in the city
will be invited.
Social marketing activities such as regular media campaigns to increase the awareness of HIV testing and
the importance and availability of PMTCT services in the city, will aim to increase access to PMTCT
services and increase the number of pregnant women getting tested for HIV during antenatal care visits.
Since FY06, PEPFAR has been supporting the HCMC's Provincial AIDS Committee to develop computer
software for PMTCT patient and data management. It is expected that this software will be available for use
by the end of 2008. In FY09, in addition to continued improvement of the paper-based reporting system,
HCMC PAC will complete the development and pilot of the PMTCT software at selected city and district
sites. This reporting system is in line with, and will support data collection and reporting to, the national
monitoring and evaluation system.
COP08 narrative:
This is a continuing activity from FY07.
FY08 funds will continue to support Ho Chi Minh City's (HCMC) strategy to expand PMTCT services in the
city. In FY08, activities will focus on:
1) expanding services to two general hospitals and reproductive health centers;
2) improving the quality of services, especially referrals;
3) promoting early HIV testing during antenatal care (ANC);
4) assessing the reasons for loss to follow up of women and evaluation of the effectiveness of the program;
and
5) finalizing and implementing the PMTCT monitoring and evaluation software.
HCMC has the highest number of HIV-positive pregnant women (over 600 per year). From Aug 2006 to July
2007, 150,000 pregnant women received HIV counseling and testing and 751 HIV-positive women were
identified. Among those, 524 women and 526 children received ARV prophylaxis. HCMC also has the
highest service coverage in the nation, with 90% geographic and numeric coverage and all 24 districts and
208 communes providing PMTCT services.
In FY08, PEPFAR will continue to support HCMC Provincial AIDS Committee (HCMC PAC) to expand
PMTCT services to two city general hospitals and the City Reproductive Health Center where a significant
portion of the city's pregnant women come to seek ANC.
PMTCT is integrated into routine ANC, and "opt-out" testing will be implemented at all sites. Currently,
Activity Narrative: PEPFAR supports ARV prophylaxis at two obstetrics hospitals and six district health centers, where women
are referred from other districts. However, to ensure timely access to ARV prophylaxis and reduce travel
time for pregnant women, more district health centers will provide ARV prophylaxis in FY08. Clinical staging
and evaluation for opportunistic infections (OIs), TB, cotrimoxazole prophylaxis and treatment during and
after pregnancy for mothers are provided at affiliated out-patient clinics (OPCs). HIV-positive women will be
referred for STI screening and treatment, women with genital ulcers or urethral discharge will be counseled
and provided with HIV testing in order to improve primary prevention.
Activities will also focus on strengthening linkages between OB/GYN hospitals, community, and OPCs to
reduce loss to follow-up of mother-infant pairs. More OPCs, supported by different donors are now
available through out the city, making it easier to refer pregnant women before and after birth for follow-up
care and treatment. This will be accomplished through standardized referral forms and service providers
and OPC case managers' frequent communication to patients. The family-centered care model will be
applied at all levels if possible, where PMTCT, pediatrics and adult care and treatment will be provided in
the same location or area, making it more convenient for family members to access services.
Health workers at the commune level will receive refresher training to improve counseling, education and
care skills to support HIV-positive women, their partners, and children born to HIV-positive mothers and to
support early referral to OPCs, legal and vocational support, and other social support services. Community
health care workers and case managers will continue to serve as educators and adherence supporters
during the antenatal period. They will play an integral role in linking women, children and their families to
comprehensive services available in HCMC, including counseling and testing, care and treatment,
community- and home-based care and additional OVC services including a new drop-in center that will
provide psychosocial support through trained case manager and support groups.
More than 50% of HIV-positive pregnant women were identified at the two city OB hospitals where testing is
not free of charge. The result is about half of HIV-positive pregnant women delivering at city OB hospitals
were diagnosed at labor, too late for long term prophylaxis and sometimes even single-dose NVP. Starting
in FY07 and increasingly in FY08, PEPFAR will provide HIV test subsidization to the two city hospitals to
increase the number of HIV-positive pregnant women diagnosed during ANC. Social marketing activities
such as media interventions to increase awareness of HIV testing and PMTCT services will also aim to
increase service assessment and uptake of HIV testing among pregnant women.
In FY08, PEPFAR will support HCMC PAC to carry out a survey to determine the reasons for loss to follow
up of women once discharged from OB hospitals. PEPFAR will also support HCMC PAC to assess the
effectiveness of the program and identify program gaps.
Starting in FY06, PEPFAR has been supporting HCMC PAC to develop computer software for PMTCT
patient and data management. In FY08, in addition to continued improvement of the paper-based reporting
system, HCMC PAC will complete the development of PMTCT software and will pilot the software at
selected city and district sites. This reporting system is in line with and will support data collection and
reporting to the national monitoring and evaluation system.
city. In FY08, activities will focus on: 1) expanding services to two general hospitals and reproductive health
centers; 2) improving the quality of services, especially referrals; 3) promoting early HIV testing during
antenatal care (ANC); 3) assessing the reasons for loss to follow up of women and evaluation of the
effectiveness of the program; and 4) finalizing and implementing the PMTCT monitoring and evaluation
software.
PEPFAR supports ARV prophylaxis at two obstetrics hospitals and six district health centers, where women
and evaluation for OIs, TB, cotrimoxazole prophylaxis and treatment during and after pregnancy for mothers
are provided at affiliated out-patient clinics (OPCs). HIV-positive women will be referred for STI screening
and treatment, women with genital ulcers or urethral discharge will be counseled and provided with HIV
testing in order to improve primary prevention.
Activity Narrative: care skills to support HIV-positive women, their partners, and children born to HIV-positive mothers and to
New/Continuing Activity: Continuing Activity
Continuing Activity: 15267
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15267 5543.08 HHS/Centers for Ho Chi Minh City 7107 3093.08 $679,950
Disease Control & Provincial AIDS
Prevention Committee
9383 5543.07 HHS/Centers for Ho Chi Minh City 5101 3093.07 HCMC PAC $132,000
Disease Control & Provincial AIDS Cooperative
Prevention Committee agreement
5543 5543.06 HHS/Centers for Ho Chi Minh City 3093 3093.06 Cooperative $102,000
Disease Control & Provincial AIDS agreement
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $250,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Estimated amount of funding that is planned for Food and Nutrition: Commodities $5,000
Economic Strengthening
Education
Water
Table 3.3.01:
PEER OUTREACH PROGRAMMING: $100,000
PEPFAR supports the Ho Chi Minh City Provincial AIDS Committee (HCMC PAC) to take the lead
governmental role to implement community-based peer outreach programs as well as coordinate activities
by multiple donors in the city. Outreach workers are responsible for accessing high-risk populations and
providing them with the skills to adopt safer behaviors as well as linking them to CT clinics, HIV care and
treatment outlets, and STI services. Outreach workers may also refer clients to peer support groups,
PEPFAR-funded drop-in centers, vocational skills trainings, and microfinance projects. Women engaging in
sex work as well as male clients of sex workers will receive condoms and condom education as part of a
comprehensive ABC approach to reduce risk.
PEPFAR has been supporting outreach activities through HCMC PAC since 2005 and in FY09 will continue
to support HCMC PAC to improve the quality of outreach services through quality assurance mechanisms,
refresher trainings, and ongoing technical support for peer educators. All BCC outreach activities will be
coordinated by the HCMC PAC to ensure coverage is sufficient and avoid duplication and redundancy of
efforts across donors and partners.
In the first six months of FY08 funding, PEFPAR-funded outreach workers reached more than 3,700 new
high-risk individuals and provided them with BCC messages and risk reduction counseling. Thirty percent of
these new contacts were successfully referred to CT services. In addition, 24 health educators in two
districts—District 10 and Binh Thanh District—were hired to provide HIV prevention messages inside
entertainment establishments to owners and female staff. In Binh Chanh district, eight health
collaborators—professional health workers and respected elders in the community—were trained to provide
HIV prevention messages to high-risk migrant workers inside their temporary housing.
For strategic and capacity reasons, there will be no geographic expansion of outreach activities in FY09.
Efforts will focus on improving service quality, increasing referral rates to HIV services, and better accessing
MARPs in the targeted districts. Novel techniques for contacting hard-to-reach groups of sex workers,
including establishment-based CSW, cell phone-based CSW, and scooter-based CSW, will be developed
based on the results of the FY08-funded Transactional Sex Assessment.
In FY09, PEPFAR will continue to fund outreach activities in six districts (Districts 1, 2, 4, 10, Binh Thanh
and Binh Chanh) and train 56 peer educators, health educators, and health collaborators in behavior
change communication (BCC) for HIV prevention targeting commercial sex workers (CSW), migrant
workers, and their partners. Outreach workers will access 4,300 new CSW, a decrease from FY08, but will
focus on increasing successfully referrals to CT and STI services to 50%.
Number of targeted condom service outlets: 6
Number of individuals reached through community outreach that promotes HIV/AIDS prevention through
behavior change other than abstinence and/or being faithful: 4,300
Number of Individuals trained to promote HIV/AIDS prevention through behavior change other than
Abstinence and/or being faithful: 56
Continuing Activity: 15268
15268 5811.08 HHS/Centers for Ho Chi Minh City 7107 3093.08 $255,000
9625 5811.07 HHS/Centers for Ho Chi Minh City 5101 3093.07 HCMC PAC $170,000
5811 5811.06 HHS/Centers for Ho Chi Minh City 3093 3093.06 Cooperative $78,000
Estimated amount of funding that is planned for Human Capacity Development $25,000
Table 3.3.03:
IDU PEER EDUCATION: $136,250
The Ho Chi Minh City Provincial AIDS Committee (HCMC PAC) is the city's lead government agency in
coordinating and implementing peer education for current and recovering injecting drug users (IDUs).
PEPFAR has been funding these activities since FY05 and has supported opioid substitution therapy
(methadone maintenance treatment) since FY07.
There are three main groups of peer educators (PE) supported through PEPFAR: 1) PE that target active
IDUs in the community; 2) PE that assist recovering former residents of government drug rehabilitation
centers to reintegrate into their home communities and access support services after release; and 3) PE
that work inside rehabilitation centers as a component of the center-to-community transition program.
In the first six months of FY08, PE provided BCC messages, risk reduction counseling, referrals, and a
range of medical and psycho-social services to 2,700 high-risk individuals in the community, 35% of whom
were successfully referred to HIV counseling and testing (CT) services. Twenty PE targeting former
rehabilitation center residents in target city districts 1, 4, 8 and Binh Thanh provided assistance to 689
former center residents as they reintegrated into their communities. Former residents were referred to HIV
and relapse prevention services in collaboration with government social workers and PEPFAR-funded
addiction counselors/case managers. Inside the Nhi Xuan rehabilitation center, peer education and referral
to medical and case management services were provided to 1,000 residents, 95% of whom accessed CT
services.
PEPFAR provides enhanced assistance to the Nhi Xuan rehabilitation center and to four counseling and
community support centers in four city districts, to pilot the delivery of comprehensive pre- and post-release
support services designed to facilitate social reintegration and reduce the risk of relapse and HIV. PE play a
vital role in this program by providing recovering IDU in the community and residents of the centers with
information on HIV and drug use, and encouraging them to access HIV, medical and psychosocial support
services. PEPFAR will continue to strengthen the quality and effectiveness of the Nhi Xuan pilot, assessing
opportunities to further reduce post-release relapse rates among clients through improving individual pre-
release planning around life-skills and relapse avoidance.
In FY09, PEPFAR will partner with HCMC PAC to train peer educators in referral techniques and behavior
change communication (BCC) for HIV prevention, targeting those most at-risk for HIV infection. Peer
educators will reach 4,800 new clients in the community (including former rehabilitation center residents)
and 1,000 residents inside the Nhi Xuan center. Activities will aim to decrease injection-related HIV
transmission through reducing relapse among most at-risk populations (MARPs). These activities also
contribute to the drug use reduction goals outlined in the Vietnam National HIV/AIDS Strategy and the
PEPFAR Vietnam 5-Year Strategy. PEPFAR will work closely with the HCMC PAC to provide financial and
technical assistance for implementation, monitoring, and evaluation.
There is no proposed geographical expansion in FY09 outside of the focus high-risk city districts. PEPFAR
will continue to support HCMC PAC to improve the quality of outreach services through quality assurance
mechanisms, in-service training and ongoing technical support for peer educators. Linkages and referral
mechanisms will continue to be strengthened between community outreach and CT, STI, and HIV care and
treatment services for high-risk individuals, as well as drug treatment, job placement and other social and
economic support services. Enhanced risk reduction counseling and addiction and relapse prevention
services continue to be core elements of the current service package at MARP-friendly community centers.
PEPFAR will maintain outreach services in seven districts—1, 2, 4, 8, 10, Binh Thanh, and Binh Chanh—as
well as in Nhi Xuan drug rehabilitation center. The 120 peer educators will be employed and trained to
counsel current and recovering drug users on the HIV risks associated with sharing injecting equipment, on
relapse prevention techniques, and continue to refer them to CT, HIV care and treatment, addiction
counseling, case management, employment and other support services.
Knowing that many injecting drug users partake in high-risk sexual behavior, clients will also receive
condoms as part of a comprehensive ABC approach aimed at reducing the risks associated with injecting
drug use and commercial sex. Outreach workers will refer clients to peer support groups, drop-in centers,
vocational skills training, and job placement.
prevention of drug use: 5,800
Number of individuals trained to promote HIV/AIDS prevention through prevention of drug use: N/A
TRANSITIONS PROGRAM: $50,000
In August 2006 the Ho Chi Minh City Provincial AIDS Committee and PEPFAR launched a pilot program to
provide comprehensive substance abuse, psychosocial care and HIV prevention, care and treatment for
residents of the Nhi Xuan drug rehabilitation center prior to their release. Similar services (peer education,
CT, case management/addictions counseling, and HIV care and treatment) were established in counseling
and community support centers (CCSCs) in target city districts 1, 4, 8 and Binh Thanh to ensure continuity
of care as residents transitioned from the center to their home communities. Since the program's inception,
HCMC PAC has played a key role in the pilot, training and placing peer educators, providing salary support
for key staff and managing HIV outpatient care in Nhi Xuan center and in districts 1 and 4. Another
PEPFAR partner, FHI, has played a closely coordinated role in this pilot, training and placing addiction
counselors/case managers in Nhi Xuan center and all target districts, providing salary support for key staff
and managing HIV outpatient care in districts 8 and Binh Thanh.
With FY09 funds, HCMC PAC will continue its support for the original pilot transition program by promoting
family and community reintegration for returnees, preventing drug relapse, and providing medical care for
HIV patients in the Nhi Xuan center and in four CCSCs. This will be accomplished through: 1) ongoing
support for peer educators in Nhi Xuan and the CCSCs - detailed in the IDU Peer Education section above;
Activity Narrative: 2) collaboration with full-time and voluntary DOLISA health educators & social workers participating in the
transitional pilot; 3) referral mechanisms to drug relapse prevention counseling and psychological
counseling in CCSCs; 4) improved access to HIV treatment and social support for returnees; and 5) linking
clients to available methadone therapy. All services will strive to integrate HIV and substance abuse
prevention, care and treatment and other psychosocial services, and to assure quality through mentoring
and supervision.
Based on available data, the PEPFAR team has determined that while the package of transitional services
provided in Nhi Xuan center and the four CCSCs is essential for recovering drug users, precise replication
of this model in other rehabilitation centers and districts is prohibitively expensive. In order to provide HIV
and substance abuse prevention, care and treatment to the highest possible number of recovering center
residents, PEPFAR partners used FY 08 resources to develop a model that both builds the capacity of
center staff and makes good use of experienced technical assistance and training from established
PEPFAR partners. Existing rehabilitation center health staff have been trained to administer ART and to
improve CT services. Trained case managers (also selected from existing rehabilitation center staff) work
inside the centers to provide addiction counseling and to coordinate referral and assignment to services in
the home community upon release. This model eliminates costly investments in center infrastructure,
avoids problems associated with "service saturation" at fixed in-center CT sites, promotes sustainability
leading up to gradual reductions in donor funding in ensuing years and precludes investment in a
Vietnamese rehabilitation center system that may change due to recent political influences.
With FY09 funding, HCMC PAC will support the original Nhi Xuan pilot model, but will also play a leading
role in strengthening addiction counseling/case management capacity in more districts of HCMC and in
developing and implementing the alternative model for other rehabilitation centers. Funding will support
salaries and associated activities for five trained case managers in each of five new city districts (a total of
25 case managers; districts yet to be determined) in addition to the existing 26 FHI-funded case managers
in the four Nhi Xuan pilot target districts. At an additional three HCMC area rehabilitation centers, the PAC
or centers themselves will provide salary support for in-center case managers. If a formal and sustainable
partnership mechanism can be established between case managers and DOLISA social workers (full-time
and voluntary) in city districts, new case managers will mentor and work closely with these social workers,
with back-up support from FHI's training program for social workers around drug addiction, HIV and
addiction counseling. HCMC PAC will lead efforts to develop basic program monitoring information to
inform improvements of transition programming citywide.
In recognition of Vietnam taking increased responsibility for covering the financial and resource costs of
programs and salaries, and in light of the fact that donor funding will reduce incrementally over the next five
years, PEPFAR proposes a phase-out funding approach for the salaries of the 25 new case managers. In
FY 09 PEPFAR will provide USD 50,000 and this sum will be reduced by USD 10,000 per year thereafter.
This approach should lead to increased national and provincial ownership of programs and more
sustainable interventions.
prevention of drug use: 750
METHADONE: $143,000
In response to the problems associated with illicit drug use, the government of Vietnam has approved a pilot
program in medication-assisted opioid dependence treatment using methadone maintenance therapy
(MMT). The Vietnam Ministry of Health's (MOH)/Vietnam Administration for HIV/AIDS Prevention and
Control (VAAC) is designated as the coordinating agency for this program. PEPFAR, through USAID and
CDC, provides substantial technical and financial support to MOH/VAAC and partners in this effort.
In FY08, as part of GVN's pilot methadone maintenance treatment (MMT) program, PEPFAR supported
HCMC PAC to establish two MMT clinics in Districts 4 and 6 and provide MMT services to approximately
500 individuals.
In FY09, PEPFAR will continue to support HCMC PAC to maintain MMT services in Districts 4 and 6 (in
addition to another PEPFAR partner-supported clinic in Binh Thanh District). Funds will also support the
expansion of MMT services to one additional district, bringing the total number of patients on MMT at the
HCMC PAC-supported sites to approximately 750. Clients will be linked to medical services, such as CT
and HIV care and treatment, as well as social support services, including support groups, vocational skills
training, job placement, and microfinance programs.
Number of individuals provided with MMT: 750
Estimated amount of funding that is planned for Human Capacity Development $187,000
Table 3.3.06:
This is a continuing activity from FY 08.
The Ho Chi Minh City Provincial AIDS Committee (HCMC PAC), with PEPFAR assistance, will support
strong linkages and referrals between methadone maintenance therapy (MMT) programs and antiretroviral
therapy (ART) clinics. A multi-disciplinary technical working group, composed of staff from HIV/AIDS, TB,
and mental health facilities, will be formed to provide training and technical assistance as required.
Clinicians from MMT and ART clinics will (i) meet biweekly to share experiences, knowledge and skills; and,
(ii) participate in monthly rounds of selected hospitals to view and discuss care and treatment approaches
for HIV-positive patients on MMT.
PEPFAR will assist HCMC PAC in developing standard operating procedures around official linkages
between ART clinics and PLHIV networks. These procedures will increase the likelihood that (i) out-patient
clinics (OPCs) can track clients who miss appointments; and (ii) clients stay in the program. PLHIV
networks will be engaged to assist with ART adherence and counseling.
PEPFAR will continue to support HCMC PAC in improving skills within the HCMC PAC Strategic
Information team, around the provision of quality assurance (QA) and technical assistance (TA) services,
and the implementation of routine program monitoring and evaluation (M&E). This critical assistance will
build local capacity to sustain the HIV/AIDS response in HCMC, and will be delivered in close collaboration
with the Ministry of Health's Vietnam Administration of HIV/AIDS Control (VAAC) and other PEPFAR
partners, including the World Health Organization and Family Health International.
As part of this effort to increase local QA, TA and M&E skills, PEPFAR and VAAC will support HCMC PAC
to develop a standardized quality assurance tool that can be employed across all outpatient clinics (OPCs)
in HCMC. Furthermore, PEPFAR will continue supporting HCMC PAC to (i) complete the installation of, and
apply, patient monitoring software in all OPCs across HCMC, (ii) set up two HIV drug-resistance monitoring
sites in HCMC and (iii) support the evaluation of early warning indicators of drug resistance.
Although not funded under this activity narrative, PEPFAR will provide funding to other partners in support
of HCMC PAC's HIV care and treatment efforts, including: social and nutritional support for HIV/AIDS
patients through FHI and PACT; technical assistance for MMT and palliative care through FHI; and training
and mentoring on ART clinical management for all OPCs in HCMC, through the Harvard Medical School
AIDS Initiative in Vietnam.
2) COP 08 narrative
COMPILED 2008 ACTIVITY SUMMARY: <<2008 ActID-5518.08; $2,275,000>>Clinical care and support for
PLWHA<<<2008 NARRATIVE FOR 5518.08>>> BEGIN NARRATIVE: This is a continuing activity from
FY07.The Ho Chi Minh City Provincial AIDS Committee (HCMC PAC) is the principle PEPFAR partner
providing clinical care and support for PLWHA in HCMC. The PEPFAR Vietnam 2007 semi-annual program
report (SAPR) reported that there were 8,444 PLWHA provided with basic palliative care services at nine
HCMC PAC-supported out-patient clinics (OPCs).HCMC has the largest number of PLWHA of the 64
provinces in Vietnam. It is estimated that the number of HIV cases in HCMC will increase from 72,400 in
2006 to 89,900 in 2010, including 1,750 HIV-infected children in 2006 and 3,850 in 2010. In line with the
PEPFAR Vietnam 5-Year Strategy to increase care and support services to 110,000 PLWHA by September
2009, HCMC PAC will continue its partnership with PEPFAR to boost local capacity to care for HIV-infected
individuals in clinical settings, with strong linkages to community- and home-based care. In FY08, HCMC
PAC will maintain palliative care services at 11 existing OPCs and expand to two others, as well as maintain
the two methadone clinics set up by HCMC PAC in FY07. Based on the National Palliative Care Guidelines
and OGAC guidance, HCMC PAC will support a comprehensive package of services (see Palliative Care
Basic program narrative). Sexually transmitted infection (STI) diagnosis and treatment will be strengthened
through linkages with STI services, including the HCMC Dermato-Venereology (DV) Hospital and district DV
clinics, and supported by PEPFAR and the UK's Department for International Development (DfID). Patients
registered at HCMC PAC OPCs will also be provided quality counseling via case managers and referrals to
PMTCT, TB/HIV care, drug addiction treatment, and psychosocial support services in their communities,
which include referrals to PLWHA support groups and the SMARTWork employment program.In
collaboration with the central drug procurement agency, HCMC PAC will purchase and distribute
opportunistic infection (OI) and home-based care drugs, lab supplies, and other commodities to all PEPFAR
-supported sites in HCMC in a timely fashion. PEPFAR will support methadone procurement and
distribution to maintain three PEPFAR-supported HCMC PAC methadone clinics linked to HIV service
delivery in existing OPCs in HCMC. HCMC PAC will also procure drug urine test kits for all six pilot
methadone clinics in Vietnam.
PEPFAR will support home- and community-based care and support for all PLWHA receiving care at HCMC
PAC sites. PEPFAR will continue the efforts started in FY07 to assist very poor households to access low-
cost, nutritious meals and food supplements. In addition, programs will assist PLWHA with hospitalization
fees and transportation to clinics, and assist with referrals as needed. With support from PEPFAR partners,
HCMC PAC will provide initial and refresher training on stigma reduction in the health care setting, clinic
operational procedures, counseling and laboratory procedures for healthcare providers, training to improve
antiretroviral therapy (ART) readiness and adherence for patients and caregivers, and training on
medication assisted treatment (MAT) for healthcare providers in accordance with national methadone
guidelines. With support from the PEPFAR Strategic Information and the PEPFAR Care and Treatment
teams, HCMC PAC will improve patient care monitoring, program monitoring, and quality assurance tools in
support of the national M&E system. PEPFAR will continue to support HCMC PAC to develop and apply
patient monitoring software in all OPCs in HCMC.
Continuing Activity: 15269
15269 5518.08 HHS/Centers for Ho Chi Minh City 7107 3093.08 $2,275,000
9533 5518.07 HHS/Centers for Ho Chi Minh City 5101 3093.07 HCMC PAC $2,108,000
5518 5518.06 HHS/Centers for Ho Chi Minh City 3093 3093.06 Cooperative $780,000
Estimated amount of funding that is planned for Human Capacity Development $435,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $100,000
and Service Delivery
Table 3.3.08:
1) FY09 narrative:
In FY09 the Ho Chi Minh City Provincial AIDS Committee (HCMC PAC) will scale up antiretroviral therapy
(ART) in 11 existing adult ART sites and expand to two new sites. FY09 funds will be used to provide basic
palliative care for a total of 20,000 adult patients, of whom 11,600 will be on antiretroviral medicines
(including 5,350 new patients).
HCMC PAC will coordinate with the Harvard Medical School AIDS Initiative in Vietnam (HAIVN) and
PEPFAR to provide technical assistance and quality assurance (TA/QA) for ART sites. PEPFAR will fund
HCMC PAC to strengthen the Tropical Disease Hospital as the city tertiary referral hospital, which leads the
ART network in HCMC. In addition, referral systems and service linkages will be improved so that patients
who receive antiretroviral drugs in HCMC can transfer to ART sites closer to their home provinces, primarily
An Giang, Can Tho, Ba Ria-Vung Tau, and Soc Trang. The transfer will be based on the patient's informed
consent.
PEPFAR will keep strengthening ART sites through building the skills of physicians and nurses regardless
of whether they work at clinics receiving PEPFAR support. With support from PEPFAR and the Ministry of
Health's Vietnam Administration for HIV/AIDS Control (VAAC), HCMC PAC will apply standard quality
assurance tools to all OPCs in HCMC and do routine treatment evaluation, including the assessment of the
family-centered clinic model at the Tropical Disease Hospital and two additional sites. The PEPFAR
Strategic Information team will support HCMC PAC to complete and apply patient monitoring software to
OPCs in HCMC. In addition, PEPFAR will support HCMC PAC to set up two HIV drug resistance monitoring
sites in HCMC and evaluate drug resistant early warning indicators. Eligible ART patients to will be offered
viral load testing, allowing them to access second-line regimens in a more timely fashion.
HCMC PAC will use FY09 funds to pilot the task-shifting model in two selected OPCs in order to address
the shortage of doctors while increasing ARV patient uptake. This follows the Global Recommendations and
Guidelines for Task Shifting published in 2008 as well as recommendations from the OGAC Adult team.
Physician assistants and nurses who are selected based on their commitment and experience in HIV/AIDS
care and treatment will be trained and certified to provide routine ART follow-up services to patients who
have been on ART for six to 12 months. These non-physician staff will provide follow-up services under the
supervision of an experienced physician and follow strict ARV protocol. The pilot program will be evaluated
to determine the quality and outcomes of programs.
The model of ART provision in government drug rehabilitation ("06") centers continues in the Nhi Xuan "06"
facility. In FY09, PAC will consider piloting a model of mobile care and treatment provision in two "06"
centers. In addition, a mobile HIV/TB team led by the Tropical Disease Hospital and the city tuberculosis
hospital will continue providing technical assistance and onsite mentoring for health staff in the Nhan Ai
hospice. Continued collaboration with PEPFAR, the Global Fund, the World Bank, and other donors to
ensure further adequate technical and financial support will be emphasized in FY09.
HCMC PAC will support strengthening linkages and referrals between methadone maintenance therapy
(MMT) and ART clinics. A technical work group composed of staff from HIV, TB, and mental health facilities
will be established to provide training and technical assistance, and share information. Moreover, clinicians
from MMT and ART clinics will learn from each other through biweekly meetings and monthly case
discussions.
Development of standard operating procedures for official linkages between ARV clinics and PLHIV
networks will allow people living with HIV/AIDS a greater chance becoming involved in patient treatment
adherence practices and home-based care. The objective is that all PEPFAR-supported OPCs will have
treatment supporters and receive effective support from PLHIV networks.
2) FY08 narrative:
Ho Chi Minh City (HCMC) province has the largest number of HIV cases in Vietnam, accounting for 20% of
infections in Vietnam. It is estimated that the number of new AIDS cases per year will increase from 4,800 in
2006 to 7,700 in 2010 (Analysis and Advocacy Project Report, June 2006).HCMC PAC has been effective
in coordinating multiple donors and international partners and has developed an aggressive scale-up plan
with support from multiple PEPFAR treatment partners. In FY08, PEPFAR will continue to support HCMC
PAC to advance the following objectives: 1) scale up ARV services and maintain a high quality of existing
ARV clinics; 2) improve quality of services, adherence and the network model especially for vulnerable
populations such as current and former IDUs; and 3) build local capacity to sustain the HIV/AIDS response
in HCMC.
By the end of FY08, HCMC PAC will provide ART to 7,400 adult patients at PEPFAR-supported existing
and new ARV sites throughout the province. Existing sites that will scale up treatment include the Tropical
Disease Hospital, seven district outpatient clinics that will serve as ‘magnet' sites, Pham Ngoc Thach TB
hospital (jointly supported by PEPFAR and Global Fund), two pediatric hospitals, Mai Khoi clinic run by the
HCMC Catholic church and Nhi Xuan clinic linked to a government rehabilitation center for drug users (06
center).
In an effort to improve quality of services, adherence and access to other community based services,
HCMC PAC will strengthen treatment supporters for all adult and pediatric ARV sites. The standard
operation procedure for linking treatment supporters and existing PLWHA network will be set up to involve
PLWHA actively in support HIV/AIDS care and treatment for AIDS patients, Treatment supporters will also
work in teams with peer educators and support groups to counsel and prevent addiction relapse, help
patients access substitution treatment , and facilitate referral to services for patients released from drug
rehabilitation centers.
ARV sites will be supported by PEPFAR care and treatment staff, experienced HCMC PAC staff and
Activity Narrative: Vietnam Harvard Medical School AIDS Partnership (VCHAP) staff through training, supportive supervision,
and mentoring of the OPC team. In addition, HCMC PAC strengthen a ARV Treatment Network. Members
of this network will serve as master educators and TA providers to the district-level sites. Training for new
sites and refresher trainings will be provided to update staff on guideline changes and review lessons
learned from previous models. In addition, HCMC PAC will continue organizing monthly coordination
meetings with service providers and weekly medical consultation meetings between TDH/VCHAP and OPC
staff .
Collection of information for routine patient and program monitoring will be in line with the PEPFAR SI plan
and with national standards, ensuring support for the national HIV/AIDS monitoring and evaluation system.
Enhanced patient monitoring will be done at selected sites to monitor adherence, clinical outcomes, quality
of life and program quality.
Continuing Activity: 15273
15273 5829.08 HHS/Centers for Ho Chi Minh City 7107 3093.08 $1,665,000
9409 5829.07 HHS/Centers for Ho Chi Minh City 5101 3093.07 HCMC PAC $720,000
5829 5829.06 HHS/Centers for Ho Chi Minh City 3093 3093.06 Cooperative $435,000
Health-related Wraparound Programs
* TB
Estimated amount of funding that is planned for Human Capacity Development $120,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $116,400
Table 3.3.09:
1) COP09 narrative:
In FY09, activities will focus on: 1) maintaining services at three current sites, and expanding to one
additional site; 2) strengthening linkages between pediatric outpatient clinics (OPCs) and other services
such as prevention of mother-to-child transmission, TB, voluntary counseling and testing, and home-based
care; and 3) improving the capacity of OPC staff through onsite quality assurance and technical assistance,
monthly pediatric conferences, and refresher trainings aimed at improving the quality of services.
Services will be maintained at two pediatric outpatient clinics and one family-centered OPC, which provide
services for HIV-infected children and infants born to HIV-infected mothers and are referred from PMTCT
sites. Care and support services provided include: formula provision to reduce transmission to exposed
infants from six weeks until 18 months (from birth to six weeks, formula is provided by PMTCT sites); PCR
testing for early diagnosis; diagnosis and treatment of opportunistic infections; providing general medication
and co-trimoxazole (CTX) prophylaxis; and providing transportation, food and nutrition counseling and
support, hospitalization, and psychosocial support to children.
PEPFAR will support OPCs to provide trainings to improve the capacity of caregivers to assist with
treatment adherence, provide home-based care, and give psychosocial support to children.
In FY08, pediatric services were introduced to an existing district adult OPC to make services more
convenient for families. Parents and their children receiving services in clinics close together will save travel
costs and reduce loss to follow-up. With the lessons learned from this family-centered clinic, the model will
be expanded to an additional OPC in FY09, bringing the number of CDC-supported pediatric OPCs in the
city to four.
Similar to adult OPCs, pediatric OPCs in HCMC provide care and support for children from outside of the
city. Patients and families from other southern provinces will receive care and support services, along with
ARV treatment, at OPCs in HCMC.
PEPFAR will continue funding treatment supporters who play a key role in linkages between the different
clinics and between the clinics and the community. These treatment supporters will assess OVC's six basic
needs and refer them to other support, if required. Quarterly meetings of community groups that assist
children in the community will be maintained in FY09. PEPFAR will continue supporting HCMC PAC
organizing semi-annual meetings between PMTCT and pediatric sites in the city to strengthen linkages
aimed at reducing loss to follow-up. PEPFAR's support will also focus on building the capacity of pediatric
OPC staff. Health care providers at pediatric OPCs will receive new and refresher trainings in pediatric care
and support, especially psychosocial counseling skills, and in dry blood spots for early infant diagnosis.
Onsite technical assistance and quality assurance will be provided to pediatric OPCs on a regular basis.
This is a continuing activity from FY07. The narrative below is unchanged from the FY07 COP. Major
changes to this activity since approval in the FY07 COP are:
• In FY08 the Ho Chi Minh City Provincial AIDS Committee (HCMC PAC) will scale up ART in a total of 13
ART sites, including two new adult ART sites and 11 existing adult and specialty pediatric ART sites. HCMC
PAC will provide treatment for a total of 6,231 adults (including 1,486 adults newly initiating ART).
• Pediatric ART will be scaled up in two existing specialty pediatric clinics at City Pediatric Hospital #1 and
#2, and two existing family-centered clinics.
• An estimated 672 (including 176 new individuals) children will receive ART by September 2009.
• HCMC PAC will coordinate with other donors to: 1) provide technical assistance/quality assurance
(TA/QA) for ART sites through CDC, Vietnam-CDC- Harvard Medical School AIDS Partnership (VCHAP)
follow-on partner TBD experts and other PEPFAR and international donor supported TA providers; 2)
supply adult ARV drugs through the Supply Chain Management System (SCMS) and pediatric medicines
through Clinton Foundation.
• In the context of expansion of PMTCT program, pediatric ART services will enhance linkages to PMTCT
• HCMC PAC will support strong linkages to methadone sites in HCMC.
• HCMC PAC will strengthen capacity for physicians and nurses at Global Fund sites in addition to PEPFAR
sites, and will continue to strengthen the city infectious disease referral hospital to provide tertiary care and
lead the ART network in HCMC.
• Collaborate closely with VCHAP to provide trainings, TA and establish city master trainers. The local
trainers will conduct all relevant trainings with back up from VCHAP follow-on partner TBD.
• In FY07 HCMC PAC continued scaling up ART services at seven existing adult out-patient clinics (OPCs),
two specialty pediatric clinics, and two family-centered clinics. In addition, ARV services were expanded to
two new adult district OPCs. HCMC PAC estimated support for 4,745 adults (1,269 new patients) on ART
across these nine adult sites and 526 children (174 new children) in four pediatric ART sites, including two
specialty pediatric clinics.
FY07 Activity Narrative:
2006 to 7,700 in 2010 (Analysis and Advocacy Project Report, June 2006). As of August 2006, with
PEPFAR support, HCMC PAC has provided direct ARV support to 965 PLWHA (848 adults and 117
children) at nine sites. HCMC PAC has been effective in coordinating multiple donors and international
partners and has developed an aggressive scale-up plan with support from multiple PEPFAR treatment
partners.
In FY07, PEPFAR will continue to support HCMC PAC to advance the following objectives: 1) scale up ARV
Activity Narrative: services; 2) improve quality of services, adherence and the network model especially for vulnerable
By the end of FY07, HCMC PAC will provide ART to 3,600 patients (3,300 adults and 300 children) at
existing and new ARV sites throughout the province. Existing PEPFAR-supported sites that will scale up
treatment include the Tropical Disease Hospital, four district outpatient clinics that will serve as ‘magnet'
sites, Pham Ngoc Thach TB hospital (jointly supported by PEPFAR and Global Fund), two pediatric
hospitals, and Nhi Xuan clinic linked to a government rehabilitation center for drug users (06 center). After
an initial evaluation of lessons learned from early implementation at this clinic, one additional ARV site will
be selected in conjunction with the PEPFAR team to support the PEPFAR plan for expansion of a complete
package of clinic, home and community based services for current and former drug users.
HCMC PAC will recruit and train referral case managers for all adult and pediatric ARV sites. The case
manager will support patients to adhere to treatment, to facilitate transfer of care, to monitor referrals
between ARV services and other medical/support services in the network. These staff will assure women
and families referred from PMTCT services receive ongoing treatment services as needed (key legislative
issues: gender). Case managers will facilitate access to community- and home-based services providing
care and support to adults and OVC in all districts. Case managers will work in teams with peer educators
and support groups to counsel and prevent addiction relapse, help patients access substitution treatment as
it becomes available, and facilitate referral to services for patients released from drug rehabilitation centers.
To facilitate acceptance of PLWHA peer educators into service delivery, training on stigma reduction will be
provided (key legislative issue: stigma).
Vietnam CDC Harvard Medical School AIDS Partnership (VCHAP) staff through training, supportive
supervision, and mentoring of the OPC team. In addition, HCMC PAC is piloting a Treatment Network
Monitoring Unit. Members of this unit will serve as master educators and TA providers to the district-level
sites. Training for new sites and refresher trainings will be provided to update staff on guideline changes
and review lessons learned from previous models. In addition, HCMC PAC will continue organizing monthly
coordination meetings with service providers.
Estimated amount of funding that is planned for Human Capacity Development $30,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $24,000
Table 3.3.10:
such as prevention of mother-to-child transmission (PMTCT), TB, voluntary counseling and testing, and
home-based care; and 3) improving the capacity of OPC staff through on-site quality assurance and
technical assistance, monthly conferences, and refresher trainings aimed at improving quality of services.
Support will be maintained at two pediatric outpatient clinics and two district OPCs, where services are
provided for HIV-infected children, as well as children born to HIV-infected mothers. Care and treatment
services provided include: clinical examination and monitoring, and related laboratory services, and
community-adherence activities. ARV treatment is provided at four clinics with adherence training offered to
every patient and their caregivers. PEPFAR will support OPCs to provide trainings to improve the capacity
of caregivers to assist with treatment adherence, provide home-based care, and give psychosocial support
to children. In order to improve overall treatment, nutrition and food supplements will be offered at four
pediatric sites to ART patients with severe malnutrition.
Similar to adult OPCs, pediatric OPCs in HCMC also provide antiretroviral therapy (ART) for children from
outside of the city. Patients and families from other southern provinces do not have access to pediatric
services or they are seeking better services in HCMC. They may also fear stigma and discrimination if they
are treated in their localities. In FY08, PEPFAR helped to establish five pediatric OPCs in the south and
many patients now receive care much closer to home. However, there are still unmet needs in those
provinces, due to the lack of some services, such as early infant diagnosis (EID). And not all of the newly
trained health care workers have the necessary supervision they need. Clinics in HCMC will continue to
provide backup services for these newly established clinics.
Monthly pediatric conferences have been organized at Pediatric Hospital No. #1 with participants from
different clinics where pediatric services are provided. This conference provides a forum for doctors to
receive regular clinical updates and discuss difficult management cases. Through this forum a network of
pediatric experts is being built. In FY09, doctors at OPCs in southern provinces will join this growing
network in order to improve the quality of services in provincial OPCs. By providing improved monitoring
and evaluation tools, referral forms, and frequent health care provider meetings, PEPFAR will continue
supporting HCMC PAC to build linkages between PMTCT and pediatric sites to reduce loss to follow-up and
to diagnose infected children as early as possible so they can be enrolled in care and treatment programs.
PEPFAR will also continue funding treatment supporters who play a key role in linkages between the
different clinics, and between clinics and the community. Quarterly meetings of community groups to
support children in the community will continue in FY09.
convenient for families. In FY09, taking lessons learned from the implementation of this clinic, as well as
others in HCMC and surrounding provinces, pediatric services will be expanded to an additional district-
based OPC.
HCMC PAC will continue working collaboratively with the Harvard Medical School AIDS Initiative in
Vietnam's (HAIVN) follow-on partner (TBD) to: 1) provide trainings and technical assistance; and 2)
establish city master trainers on antiretroviral clinical management and on ART adherence so that the local
trainers can conduct all relevant trainings with backup from HAIVN's follow-on partner.
With support from the PEPFAR Strategic Information team and the CDC Care and Treatment team, HCMC
PAC will improve patient monitoring, program monitoring, and quality assurance tools. CDC will continue
supporting HCMC PAC to develop and utilize patient monitoring software at all OPCs in HCMC. In addition,
CDC, in collaboration with VAAC, will support HCMC PAC to establish one HIV drug-resistant monitoring
site in HCMC.
Activity Narrative: two new adult district OPCs. HCMC PAC estimated support for 4,745 adults (1,269 new patients) on ART
partners. In FY07, PEPFAR will continue to support HCMC PAC to advance the following objectives: 1)
scale up ARV services; 2) improve quality of services, adherence and the network model especially for
vulnerable populations such as current and former IDUs; and 3) build local capacity to sustain the HIV/AIDS
response in HCMC.
Estimated amount of funding that is planned for Human Capacity Development $20,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $9,000
Table 3.3.11:
COP09 narrative:
In FY09, activities in Ho Chi Minh City (HCMC) will continue to closely follow those being implemented by
Vietnam's Ministry of Health (MOH) at the national level.
For TB patients, PEPFAR will continue to support provider-initiated HIV testing and counseling (PITC) in all
public TB clinics in HCMC's 24 districts, including the Pham Ngoc Thach TB Hospital. An estimated 14,000
TB patients will receive PITC in FY09 and more than 95% of HIV-infected TB patients will be referred to HIV
care and treatment settings.
PEPFAR will support screenings for TB disease in 10,000 PLHIV, using symptom screenings, physical
examinations, sputum microscopy, and chest radiographies. INH preventive therapy will be expanded to
three additional districts, which will cover 600 PLHIV. PEPFAR will continue to support the Pham Ngoc
Thach TB Hospital in order to provide TB diagnosis, care, and treatment to more than 60 children
hospitalized with TB who are also HIV infected.
PEPFAR will provide antiretroviral therapy (ART) to 350 and care for 800 HIV-infected TB patients through
an HIV/AIDS clinic at the Pham Ngoc Thach TB Hospital. In 2009, the provision of ART will be expanded to
one district TB clinic.
In all districts, PEPFAR will support TB infection control with a focus on administrative control measures in
facilities caring for HIV-infected persons in order to protect the health of staff, patients, and the community
from TB infection. At least 150 persons will be trained in the public and clinical management of TB/HIV to
improve timeliness, competency, and the quality of reporting on TB/HIV collaborative activities.
As part of PEPFAR's support to residents of government centers for injecting drug users ("06 centers"),
more than 1,000 residents will receive both TB and HIV services in 2009.
In order to assess the burden of multi-drug resistant and XDR TB among HIV/TB co-infected people in
HCMC, drug susceptibility testing will be performed on a sample of about 120 well-characterized isolates.
In FY08, PEPFAR supported the HCMC Provincial AIDS Committee (HCMC PAC) to implement routine
PITC for TB patients and referral to HIV services for HIV-infected TB patients, covering 13,000 TB patients
in 24 districts. All PEPFAR-supported districts in HCMC perform active case findings for TB for some 8,000
HIV patients presenting for care and treatment. They adopted modified national TB program registers and
referral forms to better monitor and evaluate HIV services provided to HIV-infected TB patients. Isoniazid
preventive therapy was provided to 600 HIV-infected persons in three districts. In 2008, Pham Ngoc Thach
TB Hospital provided ART for 300 and care for 600 adult HIV-infected TB patients. Also in this hospital,
PEPFAR began to support TB diagnosis, care, and treatment for more than 30 hospitalized HIV-infected TB
children. Collaboration between TB and HIV programs continues to be strengthened with the establishment
of the TB/HIV Coordination Committee. Over 150 Vietnamese nationals have received training in TB/HIV
diagnosis, treatment, and management.
2) COP 08 narrative:
In FY08, activities in Ho Chi Minh City (HCMC) will closely follow those being implemented by the Ministry
of Health (MOH) at the national level.
• In TB patients, PEPFAR will continue to support provider-initiated HIV testing and counseling (PITC) in all
public TB clinics, with an expected target of testing 12,000 TB patients.
• In PLWHA, PEPFAR will support screening for TB disease, using symptom screening, physical
examination, and chest radiography. PEPFAR will support screening of TB disease in 5000 PLWHA and
INH preventive therapy in 400 PLWHA.
• HIV-infected TB patients will receive HIV care and treatment through district-based HIV clinics and through
an HIV clinic at the provincial TB hospital. In the provincial TB hospital, PEPFAR will provide ART for 400
and care for 800 HIV-infected TB patients. A comprehensive plan was developed in FY07 for transitioning
HIV-infected patients from the TB hospital to the current district ART sites; PEPFAR will support effective
implementation of this plan. PEPFAR will also support a new, 100-bed HIV/AIDS department at the
provincial TB hospital.
• At least 150 persons will be trained in the public and clinical management of TB/HIV to improve timeliness,
completeness and quality of reporting about TB/HIV collaborative activities.
In FY07, PEPFAR supported the HCMC Provincial AIDS Committee (HCMC PAC) to implement routine
PITC for TB patients and referral to HIV services for HIV-infected TB patients, covering 12,000 TB patients
in 24 districts annually. All PEPFAR-supported districts in HCMC perform active case finding for TB in HIV
patients presenting for care and treatment, and have implemented modified national TB program registers
to monitor and evaluate HIV services provided to HIV-infected TB patients. In 2007, the provincial TB
hospital provided ART for 300 and care for 600 HIV-infected TB patients and their family members. Over
100 Vietnamese nationals have received training in TB/HIV diagnosis, treatment, and management.
At one provincial TB hospital, PEPFAR will support expansion of RCT in TB settings to 8,000 persons in all
districts in HCMC, provide ART for 200 TB/HIV patients, care for 600 TB/HIV patients, support treatment for
TB disease for 3,000 PLWHA and train 50 persons to provide clinical prophylaxis and/or TB treatment for
PLWHA.
RCT for TB patients and TB screening for HIV patients in HCMC: In FY06, PEPFAR supported HCMC
Activity Narrative: Provincial AIDS Committee (HCMC PAC), a provincial coordination body, to begin RCT in 50% of all
districts. For FY07, PEPFAR will support HCMC PAC to scale-up this model to include all districts with an
additional focus on supporting drug rehabilitation centers, as requested by HCMC PAC and approved by
OGAC, to improve diagnosis and outcomes and to assure adequate screening to facilitate the transition of
clients from the centers to the community. The program monitoring system will also be strengthened
through refinement of paper-based data collection instruments, and routine data analysis and feedback to
sites, to improve timeliness, completeness and quality of reporting about TB/HIV collaborative activities in
HCMC.
HIV Care and ART at Provincial TB Hospitals: An out-patient clinic (OPC) for TB/HIV patients has been
established at Pham Ngoc Thach TB Center in HCMC through a joint effort by the Global Fund (GF),
HHS/CDC and HCMC PAC. As agreed upon with GF, PEPFAR will take over the management of this clinic
in FY07. Funding through PEPFAR palliative basic and ARV services will be used to continue support for co
-trimoxazole, routine laboratory testing, care and when appropriate ART in this clinic (no TB/HIV PEPFAR
funds are requested for this activity). Diagnostic services will continue to be supported through infectious
disease regional funds provided through USAID (non-PEPFAR funds) as part of a targeted evaluation to
establish clinical algorithms to diagnose TB in HIV-infected patients.
Continuing Activity: 15270
15270 5514.08 HHS/Centers for Ho Chi Minh City 7107 3093.08 $300,000
9569 5514.07 HHS/Centers for Ho Chi Minh City 5101 3093.07 HCMC PAC $245,000
5514 5514.06 HHS/Centers for Ho Chi Minh City 3093 3093.06 Cooperative $85,000
Estimated amount of funding that is planned for Human Capacity Development $161,000
Table 3.3.12:
In FY09, PEPFAR will support the Ho Chi Minh City Provincial AIDS Committee (HCMC PAC) to reach out
to 1,500 orphans and vulnerable children, focusing on six basic needs, including health care, shelter,
education, psychosocial support, food and nutrition support, and legal aid and protection.
Because clinics in HCMC are working with large numbers of adult patients, PEPFAR will support HCMC
PAC to make contact with OVC's through the clinics' adult clients and through networks of PLHIV and child
protection programs in the city. Health care workers in the HIV/AIDS system will be trained to conduct
needs assessments on a regular basis, provide support for each particular area of basic needs, and provide
referrals to appropriate services. To protect the family structure, caregivers and household leads will be
trained to provide basic health care to children with HIV/AIDS and psychological support to OVC's. They
also will receive help to ensure the family's livelihood and food security.
In order that the six basic needs of OVC's are met, HCMC PAC will also play the coordination role in the
OVC program, consolidating all OVC efforts in the city. HCMC PAC will hold semi-annual conferences to
share lessons learned, build linkages between partners working on OVC issues in HCMC, and strengthen
OVC programs. HCMC PAC will also mobilize support from other sectors, including HCMC's Department of
Labor, Invalids, and Social Affairs, HCMC's Department of Education and Training, and mass
organizations, such as the Women's Union.
In FY08 PEPFAR will support Ho Chi Minh City Provincial AIDS Committee (HCMC PAC) to strengthen the
provision of care and support services for OVC and their caregivers. This activity will focus on HIV-positive
children and infants exposed to HIV served by pediatric out-patient clinics (OPCs) at Pediatric Hospital #1
and Pediatric # 2 in HCMC, which serve children from a number of neighboring provinces. Through this
activity initiated in FY07, PEPFAR will keep supporting the provision of a wider range of services, designed
to better meet the developmental needs of each child. OVC services will be mainly provided at both
pediatric hospitals, as well as through referring for more comprehensive services to available sources in the
city. Through this activity, 190 OVC will receive services, and 240 caregivers will be trained to provide
services to their families at home.
The pediatric HIV/AIDS OPCs will provide a core set of OVC services including needs assessment with
OVC and caregivers, counseling and psychosocial support, food/nutrition support (in accordance with
PEPFAR guidelines), provision of formula for PMTCT, support for transportation, and referral to other
services including PMTCT, clinical care for PLWHA caregivers, and social support services for OVC and
caregivers. In coordination with other PEPFAR partners and other donors, case managers will refer patients
of pediatric clinics to other OVC services which are available in the city and to ensure duplication of services
does not happen. Case managers in collaboration with clinic staff will provide trainings on caring for children
at home for caregivers.
PEPFAR will support HCMC PAC to coordinate OVC implementers in HCMC including PEPFAR partners
and other donor agencies through a network with quarterly conferences.
PEPFAR will provide intensive and ongoing capacity-building and technical assistance to ensure consistent
and quality programming, including training courses, mentoring, coaching, and support to bring OVC
partners together to problem-solve, and share experiences and resources. (See HKID TBD 9552).
Continuing Activity: 15271
15271 9535.08 HHS/Centers for Ho Chi Minh City 7107 3093.08 $15,000
9535 9535.07 HHS/Centers for Ho Chi Minh City 5101 3093.07 HCMC PAC $35,000
Estimated amount of funding that is planned for Human Capacity Development $36,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $36,000
Table 3.3.13:
PEPFAR-supported HIV counseling and testing (CT) programs in HCMC target most at-risk populations,
including injecting drug users and their partners, male and female commercial sex workers and their clients,
men who have sex with men, and sex partners of HIV-infected persons.
In FY08, through a cooperative agreement with the Ho Chi Minh City Provincial AIDS Committee (HCMC
PAC), PEPFAR supported eight CT clinics in Districts 1, 2, 4, 10, Binh Chanh, Go Vap, and Tan Binh, and
at the Dermato-Venerology Hospital (DVH). In addition, PEPFAR funded one clinic located in the
government's Nhi Xuan drug rehabilitation center as part of a comprehensive reintegration program for
recovering injecting drug users (IDUs).
During FY08, approximately 17,000 individuals received CT services at these nine clinics. In FY09, with
PEPFAR support, HCMC PAC will continue to strengthen service delivery in these nine established sites
and will expand by adding three outreach teams operating out of current CT sites. These mobile outreach
counseling and testing teams will facilitate access to CT and STI services for hard-to-reach populations,
particularly in areas commonly frequented by CSW. The expansion of same-hour test result notification to
all CT clinics will facilitate more efficient and effective service provision.
The FY08 proposal of PITC activities at two hospitals was not implemented due to capacity concerns; the
funding for this activity will be reallocated in FY09 to the aforementioned outreach teams. In FY09, an
estimated 19,000 individuals will receive CT services and 130 healthcare workers will be trained in
counseling and testing.
PEPFAR will fund HCMC PAC to continue to improve the quality of service delivery by providing training
and innovative quality assurance and quality control (QA/QC) measures, including: introducing client exit
interviews; linking CT information systems to laboratory information systems; providing advanced
counseling skills to healthcare workers; integrating couples counseling protocols into existing CT clinics
based on the HHS/CDC and OGAC Technical Working Group curricula; and enhancing existing referral
systems between HIV prevention and care services through hired provincial referral coordinators and
monthly referral coordination meetings for partners working within the HIV prevention and care network. The
PEPFAR-supported counseling and testing program will maintain close cooperation and enhance
coordination with World Bank and Global Fund CT programs through the provision of technical assistance
and forums for information and experience-sharing discussion.
In collaboration with a TBD partner who will implement a social marketing program, HCMC PAC will
continue to strengthen the CT social marketing program in HCMC to maximize service uptake and to link
HIV-positive individuals to care and treatment. HCMC PAC will continue outreach communication through
CT counselors who, in collaboration with outreach programs, PLWHA groups, and Women's and Youth
Unions, will provide CT education to target populations. This CT education activity, in conjunction with the
social marketing program, will encourage people to seek counseling and testing, help eliminate stigma and
discrimination, and facilitate recruitment of families and couples into the HIV prevention and care network.
This collaboration will also support HCMC PAC's counseling and testing program in encouraging test result
disclosure and notification, especially for discordant couples, and in ensuring that HIV-negative partners do
not seroconvert.
Recognizing the importance of service accessibility to recovering IDU, PEPFAR will collaborate closely with
peer outreach programs, case manager teams, and outpatient clinics to ensure the continuation of care,
treatment, and support to residents after being released from government rehabilitation centers. In addition
to the continuation of CT service delivery at Nhi Xuan drug rehabilitation center, FY09 funds will be used to
support HCMC PAC to provide either mobile CT services to residents of three other government
rehabilitation centers or technical assistance to improve already existing in-center CT services as part of an
innovative mobile services package to center residents.
Number of service outlets providing counseling and testing according to national and international
standards: 9
Number of individuals who received counseling and testing for HIV and received their test results (excluding
TB): 19,000.
Continuing Activity: 15272
15272 9509.08 HHS/Centers for Ho Chi Minh City 7107 3093.08 $520,000
Estimated amount of funding that is planned for Human Capacity Development $241,000
Table 3.3.14:
The course of the HIV epidemic in Ho Chi Minh City (HCMC) has changed in the last few years with a
dramatic rise in HIV prevalence among injecting drug users and female sex workers. According to published
projections, the total number of people living with HIV/AIDS in HCMC is expected to rise from 72,400 in
2006 to 89,900 in 2010 and 105,800 in 2020. The Ho Chi Minh City Provincial AIDS Committee (HCMC
PAC) is the main PEPFAR partner providing clinical care and support for PLHIV in HCMC, including
treatment monitoring. HCMC PAC continues to expand programs focused on HIV prevention, treatment and
care activities, as well as by improving laboratory infrastructure, program monitoring/evaluation and by
providing training to the professionals working in numerous health facilities in HCMC.
PEPFAR funds support HCMC PAC to procure equipment, provide training for clinical laboratories, and
expanded implementation of Laboratory Information system (LIS). An electronic LIS is an important tool for
improving the quality of laboratory results and managing information accurately and efficiently. Since 2006,
PEPFAR has been supporting the implementation of LIS in several sites in Hanoi and HCMC. These
systems are relevant, in light of the growing number of laboratory tests being conducted that are related to
HIV care and treatment. In FY08, PEPFAR will support HCMC PAC to install LIS software at six counseling
and testing centers and six prevention of mother-to-child transmission (PMTCT) treatment sites. By the end
of FY09, all PEPFAR supported counseling and testing sites in HCMC will be linked to the LIS at HCMC
PMC. This will allow for data related to the specimens and patients to be submitted electronically to the
Provincial Medical Centers and results to be received electronically, reducing wait times and eliminating
errors common with manual transcription.
Based on needs assessments, the electronic system will be expanded to four more laboratories in HCMC
bringing the total LIS sites supported by HCMC PAC to nine by the end of FY09. All sites will be able to
send aggregate data electronically to HCMC PAC, allowing for a central data repository that will be used for
the management and evaluation of the laboratory tests.
Another activity planned for FY09 involves the implementation of barcode technology at the outpatient
clinics (OPC's). Specimens submitted to laboratories will be labeled with a patient identifier developed by
OPC/PAC and a corresponding barcode. This will allow the laboratories to easily access past results and
link the laboratory test results over time to an individual patient. This is particularly important at sites that
currently do not have a patient management/antiretroviral system. Emphasis will be given to exchanging
data with patient management/antiretroviral systems.
In FY08, linkage is planned between the LIS and the patient management system at two sites. For FY09,
this effort will be expanded though the data exchanging capability and will depend on the standards being
followed by other systems. Focus will also be placed on interfacing equipment for new LIS sites.
PEPFAR has also allocated funds for procurement of equipment to support the expansion of diagnosis and
treatment monitoring programs (FACS Count, centrifuges, ELISA washers and readers) based on recent
needs assessments. PEPFAR will continue to strengthen the quality of the laboratory network for HIV-
related testing through refresher trainings, LIS training, on-site monitoring visits, and the formation of a HIV
laboratory working group. PEPFAR funds allow HCMC to support 24 laboratories (performing HIV diagnosis
and treatment monitoring) with 48 trainings and reagents to perform 350,000 tests in FY09.
Continuing Activity: 15274
15274 9503.08 HHS/Centers for Ho Chi Minh City 7107 3093.08 $270,000
9503 9503.07 HHS/Centers for Ho Chi Minh City 5101 3093.07 HCMC PAC $199,830
Estimated amount of funding that is planned for Human Capacity Development $67,000
Table 3.3.16:
The Ho Chi Minh City Provincial AIDS Committee (HCMC PAC), a provincial coordination body, provides
oversight to all HIV/AIDS activities in HCMC. Achievements to date include the standardization of routine
program monitoring and reporting for ART, PMTCT, VCT, Peer Education and rehabilitation center
activities; and HMIS activities supporting centralized client registration for HIV/AIDS services in HCMC.
HCMC PAC proposes to use FY 2009 funds to maintain high functionality of these information systems
through systems assessment, staffing capacity, and hardware and software maintenance and upgrades.
HCMC PAC will continue to provide primary technical oversight for M&E, focusing on continued human
capacity development and data quality assurance and data use activities. In collaboration with FHI, HCMC
PAC will conduct the second round of Advocacy and Analysis, which will provide a clear understanding of
the HIV/AIDS epidemic in HCMC, explain changes in HIV prevalence, including the impact of PEPFAR-
funded prevention programming, and inform advocacy for policy change and resource allocation. With
regards to specific human capacity development activities, through partnerships with the Pham Ngoc Thach
Medical University and the School of Public Health in the University of Medicine and Pharmacy in HCMC,
HCMC PAC will provide continued training to M&E staff and service providers across all PEPFAR programs
on HIV program management and data management using curricula piloted in FY 2008 and new curricula
as needed. These universities will also be supporting longitudinal patient monitoring activities in selected
PEPFAR-supported clinics in HCMC and be responsible for the abstraction, entry and analysis of data from
either electronic or paper-based patient medical records. Furthermore, to ensure integration of HCMC PAC
M&E system with the national system, HCMC PAC will continue to participate on the national M&E technical
working group and contribute to data triangulation, GIS, and advocacy activities. Services provided to the
GVN Transition Program where IDU 06-center residents are returned to their communities, will expand to 5
new districts, or up to 9 catchment districts. As the program shifts, the costs of the transition program will
shift away from program evaluation and toward basic program monitoring. Tools developed by Abt
Associates, Inc. for process evaluation will become part of routine program monitoring.
Continuing Activity: 15275
15275 5692.08 HHS/Centers for Ho Chi Minh City 7107 3093.08 $625,000
9243 5692.07 HHS/Centers for Ho Chi Minh City 5101 3093.07 HCMC PAC $530,000
5692 5692.06 HHS/Centers for Ho Chi Minh City 3093 3093.06 Cooperative $127,710
Estimated amount of funding that is planned for Human Capacity Development $315,000
Table 3.3.17:
