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: 2007 2008 2009
This is a continuing activity from FY08.
This ongoing activity will support the national prevention of mother-to-child transmission (PMTCT) scale-up
strategy to reach 80% geographic coverage, and provide counseling to 90% and testing to 70% of all
pregnant women. It will also provide ARV prophylaxis to 90% of HIV-infected mothers and their infants, and
continuing care and treatment services to 100% of HIV-infected mothers and their babies.
This activity focuses on four main objectives in support of the program area strategy: 1) expanding PMTCT
coverage; 2) strengthening referrals and linkages between PMTCT sites and outpatient clinics (OPCs) and
community-based programs; 3) promoting early HIV testing during antenatal care (ANC); and 4) improving
the quality services.
In FY09, the Ministry of Health's Vietnam Administration for HIV/AIDS Control (VAAC) will retain PMTCT
services in 19 currently-supported provinces and expand to additional district and commune sites in those
same provinces. The goal is to strategically expand both geographic and numeric coverage nationwide so
that the number and proportion of HIV-positive pregnant women tested early, who can then receive
appropriate ARV prophylaxis and/or treatment, is increased.
At the national level, the National OB/GYN Hospital (NHOG) continues to act as the lead to implement the
national PMTCT network. NHOG will provide training and technical assistance and quality assurance
(TA/QA) to provinces and produce information, education, and communication (IEC) materials. Health
workers at all levels will receive new or refresher trainings to improve their knowledge in the provision of
PMTCT services, to update new national PMTCT guidelines and Decision 28, and the new data
management guidance that was recently released by Ministry of Health. PEPFAR will continue to support
capacity building at VAAC through training and TA for new VAAC staff in PMTCT programming.
PMTCT is integrated into routine ANC, and "opt-out" testing will be implemented at all sites. All sites will
provide HIV counseling and testing, aimed at identifying HIV-infected pregnant women early. ARV
prophylaxis will be provided onsite or at a designated adult outpatient clinic closely linked to the PMTCT
site. Clinical staging and evaluation for opportunistic infections (OIs) and TB, and the provision of co-
trimoxazole prophylaxis and treatment during and after pregnancy, will be offered at affiliated OPCs.
In FY08, the sexually transmitted infections (STIs) model was piloted at one PMTCT site. Based on this
model, HIV-positive women referred for STIs screening and provider-initiated counseling will be scaled up
so that women with genital ulcers or urethral discharge will be counseled and provided with HIV testing. In
FY09, with lessons learned from the pilot site, PEPFAR will support the expansion of the STI model to two
more provinces.
The family-centered care model will be applied at all levels if possible, in order that PMTCT and pediatric
and adult care and treatment can be provided in the same location or area, making it more convenient for
family members to access services. New PEPFAR-supported PMTCT sites will be started in areas where
other services, especially adult and pediatric OPCs and home-based care, already exist. PEPFAR will work
closely with other donors such as the Global Fund, the Clinton HIV/AIDS Initiative (CHAI), the World Bank,
and with VAAC to coordinate service expansion for maximum use of resources and to promote the family-
centered care model.
PEPFAR will continue to support VAAC's social marketing activities that are designed to raise the
community's awareness about PMTCT programs and increase the uptake of ANC and HIV testing and
counseling.
PEPFAR will also provide technical support for the development and monitoring of DNA PCR testing using
dried blood spots for early infant diagnosis (EID). PEPFAR will support the National Institute for Hygiene
and Epidemiology (NIHE) and the Pasteur Institute to provide training to health care providers and
laboratory staff on the implementation of dried blood spot testing. They will continue to support the
expansion of EID by adding two regional laboratories, bringing the total number of laboratories providing
DNA PCR for EID to four nationwide in FY09.
COP 08 narrative:
This is a continuing activity from FY07.
This ongoing activity will support the national PMTCT scale-up strategy to reach 80% geographic coverage,
provide counseling to 90% and testing to 60% of pregnant women, provide prophylaxis to 100% of HIV-
positive mothers and their infants, and continuing care and treatment services to 90% of HIV-positive
mothers and their babies.
This activity focuses on five main objectives in support of the program area strategy:
1) expanding PMTCT coverage;
2) strengthening referrals and linkages between PMTCT sites to out-patient clinics (OPCs) and community-
based programs providing counseling, care and treatment and other support services to mothers, children
and family members;
3) promoting early HIV testing during antenatal care (ANC);
4) evaluating the effectiveness of the program; and
5) building capacity to oversee PMTCT programs at the Vietnam Administration for HIV/AIDS Control
(VAAC).
In FY08, VAAC will expand PMTCT services in 13 high-prevalence provinces that currently receive or will
begin to receive PMTCT services in FY07, and will expand services to three additional provinces that do not
have adequate PMTCT coverage, starting at the provincial level. The goal is to increase both geographic
and numeric coverage nationwide to increase the number and proportion of HIV-positive pregnant women
who are tested early and subsequently receive appropriate ARV prophylaxis and/or treatment.
Activity Narrative: At the national level, the National OB/GYN Hospital continues to act as the principal implementer, educator
and technical assistance (TA) and quality assurance (QA) provider, to provide training, implementation
assistance, produce information, education and communication (IEC) materials, provide QA and monitoring
of the provinces and to lead the implementation of the national PMTCT network.
provide HIV counseling and testing, aimed at identifying HIV-positive pregnant women early. ARV
prophylaxis will be provided on-site or at a designated adult OPCs closely linked to the PMTCT site. Clinical
staging and evaluation for OIs, TB, cotrimoxazole prophylaxis and treatment during and after pregnancy for
mothers will be provided at affiliated OPCs. HIV-positive women will be referred for STI screening, and
provider-initiated counseling will be scaled up such that women with genital ulcers or urethral discharge will
be counseled and provided with HIV testing.
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. New PEPFAR-supported PMTCT sites will be started in areas where other
services, especially adult and pediatric OPCs and home-based care already exist. PEPFAR will work
closely with other donors such as Global Fund, Clinton Foundation HIV/AIDS Initiative, World Bank, and
with VAAC to coordinate service expansion for maximum use of resources and to promote the family-
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, including counseling and testing, care and treatment, community- and
home-based care and additional OVC services including a new drop-in center in Hanoi that will provide
psychosocial support through trained case manager and support groups.
Since FY06, PEPFAR has supported the Ministry of Health (MOH) to provide HIV testing free of charge at
the district level and lower, but not at the national and provincial level. However, the cost of HIV testing is
causing some women to delay HIV testing until delivery and program data show that many HIV-positive
pregnant women have received only single dose NVP as a PMTCT prophylaxis option. To promote early
identification of HIV-positive women, starting in FY07 and increasing in FY08, PEPFAR will continue to help
subsidize (full or partially) HIV testing at the provincial level and higher.
In FY08, PEPFAR will support VAAC to begin an assessment of the effectiveness of the national program.
The assessment will help to expose the gaps and weaknesses of the program systematically and provide
recommendations to strengthen the program.
PEPFAR will continue to support capacity building at VAAC through several activities: TA for development
of national guidelines, a national implementation protocol and scale-up plan, training and TA for new VAAC
staff in PMTCT programming and evaluation, and support to develop a national protocol and
implementation for DNA PCR utilizing dried blood spots (refer to Laboratory Infrastructure section).
PEPFAR will continue to advocate for the expansion of PCR for early infant diagnosis (EID) to two
additional regional laboratories, increasing the total number of laboratories providing PCR for EID to four
nationwide in FY08.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15291
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15291 5542.08 HHS/Centers for Ministry of Health, 7114 5170.08 Vietnam $1,840,000
Disease Control & Vietnam Administration
Prevention for HIV/AIDS
Control (VAAC)
9384 5542.07 HHS/Centers for Ministry of Health, 5170 5170.07 Vietnam $1,353,000
Cooperative
agreement
5542 5542.06 HHS/Centers for Ministry of Health, 3092 3092.06 Cooperative $200,000
Disease Control & Vietnam agreement
Prevention
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $300,000
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 $22,000
Economic Strengthening
Education
Water
Table 3.3.01:
PEER OUTREACH FOR COMMERCIAL SEX WORKERS: $339,684
The Vietnam Ministry of Health (MOH), which coordinates donor-funded HIV/AIDS activities, is responsible
for implementing community-based peer outreach programs for injecting drug users (IDU) and commercial
sex workers (CSW). Outreach workers, who are key to these programs, are trained to provide behavior
change communication (BCC) services. They provide health information and help motivate high-risk
individuals to adopt safer sexual and drug use-related behaviors. At-risk individuals receive condoms and
are referred to services, including voluntary counseling and testing (CT), HIV care and treatment, drug and
alcohol abuse treatment programs, family planning, and sexually transmitted infections (STI) services.
Outreach workers also refer clients to peer support groups, drop-in centers, vocational skills training, job
placement, and micro credit/microfinance programs.
With PEPFAR support, MOH's outreach services are now provided in 29 provinces with high HIV
prevalence. From October 1, 2007 to July 1, 2008, 30,994 at-risk individuals were reached with BCC
services and 9,719 (31%) received CT through MOH-supported outreach workers. With FY07 funds, MOH
successfully organized two regional outreach workshops that involved hundreds of peer outreach workers,
local government officials, representatives from both the Ministry and the Departments of Labor, Invalids
and Social Affairs (MOLISA/DOLISA), and local and international NGOs. The workshops promoted best
practices in: providing outreach services to high-risk populations; using data to improve program planning
and service quality; and promoting the important role of peer outreach workers in HIV prevention.
In FY08, PEPFAR is supporting MOH to train 176 peer outreach workers to work with CSW in 11 provinces
(Hanoi, Hai Phong, Quant Ninth, Nghe An, An Giang, Son La, Thai Nguyen, Binh Duong, Da Nang, Khanh
Hoa, and Ba Ria-Vung Tau). FY09 funds will be used to maintain CSW-focused outreach activities in these
geographic areas and improve the quality of services. PEPFAR-supported provincial outreach coordinators
will be responsible for coordinating BCC interventions. As MOH outreach services are provided to CSW in
multiple provinces where outreach programs are funded by other partners and donors, interventions will be
planned in cooperation with provincial outreach coordinators to avoid overlapping in target districts. Staff
training, "hot-spot" mapping, and quality assurance/quality improvement activities will be coordinated to
ensure effective utilization of available resources. MOH will also develop strategies to improve referrals to
CT, HIV and STI care and treatment, and other social support services.
Targeted strategies to better address the diverse needs of CSW will be developed based on the results of
the FY08-funded Transactional Sex Assessment. The goal will be to increase contact with hard-to-reach
groups of sex workers, including establishment-based CSW (with participation of bar and hotel owners), cell
phone-based or scooter-based CSW, and to ensure equitable access to HIV/AIDS services for drug-using
CSW (based on CSW/IDU needs assessment results). The program will place particular emphasis on
reaching and meeting the needs of CSW who also face HIV risks associated with drug use.
FY09 funds will continue to support MOH's HIV/AIDS community centers in five provinces (Hai Phong,
Quang Ninh Thai Nguyen, Nghe An, and Hanoi). These centers will offer space for group meetings,
refresher-training courses, and for clients to learn risk-reduction skills. Outreach coordinators will host
coordination meetings and training sessions in these centers, facilitating networking among different
outreach groups and other service providers. This work complements other peer outreach efforts conducted
by the MOH and supported in the IDUP section.
Number of individuals reached through community outreach that promotes HIV/AIDS prevention through
behavior change other than abstinence and/or being faithful: 12,000
Number of individuals trained to promote HIV/AIDS prevention through behavior change other than
abstinence and/or being faithful: 176
Continuing Activity: 15292
15292 5810.08 HHS/Centers for Ministry of Health, 7114 5170.08 Vietnam $1,350,000
9627 5810.07 HHS/Centers for Ministry of Health, 5170 5170.07 Vietnam $900,000
5810 5810.06 HHS/Centers for Ministry of Health, 3092 3092.06 Cooperative $675,000
Gender
* Increasing gender equity in HIV/AIDS programs
* Increasing women's access to income and productive resources
Estimated amount of funding that is planned for Human Capacity Development $295,000
Table 3.3.03:
PEER OUTREACH FOR INJECTING DRUG USERS: $900,000
are referred to services including voluntary counseling and testing (CT), HIV care and treatment, drug and
alcohol abuse treatment programs, and sexually transmitted infections (STI) services. Outreach workers
also refer clients to peer support groups, drop-in centers, vocational skills training, job placement, and micro
credit/microfinance programs.
In FY08, PEPFAR is supporting MOH to train 584 peer outreach workers to work with drug-using
populations in 27 provinces. FY09 funds will be used to maintain outreach activities in these geographic
areas and improve the quality of services. PEPFAR-supported provincial outreach coordinators will be
responsible for coordinating BCC interventions. As MOH outreach services are provided to IDUs in multiple
provinces where outreach programs are funded by other partners and donors, interventions will be planned
in cooperation with provincial outreach coordinators to avoid redundancy in target districts. Efforts with
regards to training, "hot-spot" mapping, and quality assurance/quality improvement activities will be
coordinated to ensure effective utilization of available resources. MOH will also develop strategies to
improve referrals to CT, HIV care and treatment, drug addiction, and other social support services.
Targeted strategies to better address the needs of CSW who use drugs will be developed based on an
assessment conducted with FY08 funds. In FY 09 the program will seek to expand access to HIV/AIDS
services for drug-using CSW, drug-using men who have sex with men, recovering IDUs (particularly those
released from government 06 rehabilitation centers), and non-injecting drug (e.g., stimulants) users.
Quang Ninh, Thai Nguyen, Nghe An, and Hanoi). These centers will offer space for group meetings,
outreach groups and other service providers. The centers will also provide HIV prevention and drug
addiction counseling services to clients. This work complements other peer outreach efforts conducted by
the MOH and supported in the HVOP section.
prevention of drug use: 21,000
Number of individuals trained to promote HIV/AIDS prevention through prevention of drug use: 584
METHADONE: $464,052
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, PEPFAR is supporting MOH to establish MMT programs in four pilot district sites in Hanoi. When
all MMT sites are operational they will serve approximately 1,000 IDUs in districts with a high prevalence of
IDU and HIV (Hai Ba Trung, Long Bien, Tu Liem, and Ha Dong). Patients on MMT will be linked with
medical and social support services such as CT and HIV care and treatment. They will also be referred to
support groups, vocational skills training, job placement, and micro credit/microfinance programs. The FY09
funds will be used to maintain services at these four pilot sites and expand to three additional sites (location
TBD). The expansion will bring the total number of patients on MMT at the MOH-supported sites to
approximately 1,750.
In addition, the FY09 funds ($100,000) will support the procurement of urine test kits for all MMT pilot sites
through the MOH mechanism.
prevention of drug use: 1,750
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $952,000
Table 3.3.06:
In FY08, PEPFAR supported Vietnam's Ministry of Health (MOH) through a cooperative agreement with
Vietnam Administration for HIV/AIDS Control/LIFE-GAP (VAAC/LG) to provide clinical care and support for
PLWHIV at the provincial and district levels in 20 PEPFAR provinces in coordination with MOH- and Global
Fund-supported programs. The PEPFAR Vietnam 2008 Annual Program Results (APR) reported that there
were 14,754 adult outpatients being provided direct care and support services at 33 adult outpatient clinics;
and 120 healthcare providers attended refresher trainings on HIV/AIDS care and the national outpatient
clinic operational protocol.
In FY09, VAAC will continue its partnership with PEPFAR to boost local capacity in order to care for HIV-
infected individuals in clinical settings, with strong linkages to community- and home-based care.
Based upon the National Palliative Care Guidelines and OGAC guidance, VAAC/LG will support
comprehensive clinical palliative care services in six provinces with high HIV prevalence as well as in
selected additional high prevalence provinces VAAC/LG has partnered with the Global Fund to ensure that
resources are not duplicated, and that geographic coverage is maximized. In addition, with PEPFAR
support, VAAC/LG will maintain basic clinical care services at provincial outpatient clinics in other 23
PEPFAR provinces (see uploaded Geographic Coverage document). The package of services provided is
described in the Adult Care and Treatment program narrative. VAAC/LG will support the National Institute
for Dermatology and Venereology (NIDV) to enhance sexually transmitted infections (STI) diagnosis and
treatment for outpatients. This will be achieved by providing training and technical assistance to outpatient
clinic (OPC) and STI clinicians, improving referrals to STI clinics and enhancing laboratory capacity at those
clinics. In addition, VAAC/LG will continue to work with other PEPFAR partners to provide nutrition support
for PLHIV and their family members.
With PEPFAR support, VAAC/LG will strengthen its role in coordination, supply, and distribution of
opportunistic infections drugs, laboratory supplies, and other commodities to OPCs. Due to high HIV
prevalence, and the need for care and support services for PLHIV residing in government-run drug
rehabilitation ("06") centers (which house injecting drug users), VAAC/LG will continue to work closely with
the Ministry of Labor, Invalids and Social Affairs (MOLISA) and the Ministry of Public Security (MOPS) to
ensure quality care as patients move between the centers and the community. VAAC/LG-supported
outpatients will also be provided quality counseling via treatment supporters. They will referred to prevention
of mother-to-child transmission programs, TB/HIV care, drug addiction treatment counseling, and
psychological and social support services in their communities through PLHIV support groups and the
employment program supported by PACT partners.
MOH's Department of Population and Family Planning, Family Health International (FHI), and a number of
community- and faith-based organizations supported by PEPFAR, will fund home- and community-based
care and support for PLHIV receiving care at VAAC/LG sites. In collaboration with PEPFAR partners, the
Harvard Medical School AIDS Initiative in Vietnam (HAIVN) and FHI, VAAC/LG will promote standardizing
the national training curricula to provide initial and refresher training on stigma reduction in health care
settings, clinic operational procedures, counseling and laboratory procedures for healthcare providers at
different levels, and training on antiretroviral therapy readiness and adherence for patients and caregivers.
With support from the PEPFAR Strategic Information and Care and Treatment teams, VAAC/LG will
improve patient care monitoring and program monitoring and quality assurance tools, in support of the
national M&E system.
2) COP 08 narrative
PEPFAR supports the Ministry of Health/Vietnam Administration for HIV/AIDS Control (MOH/VAAC)
through a cooperative agreement to provide clinical care and support for PLWHA at the provincial level in
the PEPFAR focus provinces, and provides palliative care services in selected districts and additional
provinces in coordination with Global Fund (GF)-supported programs.
In line with the PEPFAR Vietnam 5-Year Strategy to increase care and support services to 110,000 PLWHA
through FY08, VAAC 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 supported
by other PEPFAR partners. In FY07, VAAC handed over provincial out-patient clinics to GF in a phased
approach in order to maximize coverage and quality in higher-prevalence provinces. The PEPFAR Vietnam
2007 Semi-annual Progress Report (SAPR) reported that there were 14,754 adult and pediatric outpatients
provided palliative care services at 45 out-patient clinics; and 120 healthcare providers attended refresher
trainings on HIV/AIDS care and the national out-patient clinic operational protocol.
Based upon the National Palliative Care Guidelines and OGAC guidance, VAAC will support
comprehensive clinical palliative care services in focus provinces and in selected additional high-prevalence
provinces (see uploaded Geographic Coverage document). VAAC has partnered with the GF to ensure that
support, VAAC will maintain basic clinical palliative care services at provincial out-patient clinics in other
PEPFAR non-focus provinces. The package of services provided is described in the Palliative Care Basic
program narrative. VAAC will enhance STI diagnosis and treatment for outpatients through improvement of
referrals to STI clinics and enhancement of lab capacity at those clinics. 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 PEPFAR support, VAAC will strengthen its role in coordination, supply and distribution of OI drugs, lab
supplies and other commodities to out-patient clinics.
Activity Narrative: Due to the high HIV prevalence and need for palliative care services for PLWHA residents in government-
run drug rehabilitation ("06") centers where many injecting drug users reside, VAAC will continue to work
closely with the Ministry of Labor, Invalids and Social Affairs (MOLISA), and the Ministry of Public Security
(MOPS) to ensure quality care as patients move between the centers and the community. VAAC-supported
outpatients will also be provided quality counseling via case managers and referrals to PMTCT, TB/HIV
care, drug addiction treatment, and psychosocial and social support services in their communities through
PLWHA support groups and the SMARTWork employment program.
Family Health International and a number of community- and faith-based organizations (C/FBOs) supported
by PEPFAR will support home- and community-based care and support for PLWHA receiving care at VAAC
sites. In collaboration with PEPFAR partners, VAAC will continue standardizing the national training
curricula to provide initial and refresher training on stigma reduction in the health care settings, clinic
operational procedures, counseling and laboratory procedures for healthcare providers at different levels,
training on ART readiness and adherence for patients and caregivers, and training on methadone therapy
for healthcare providers in accordance with the National Methadone Guidelines. PEPFAR will work closely
with the government of Vietnam, including VAAC, to advocate to expand the methadone program to
additional patients, and additional sites, in order to increase access to these services for as many persons
as possible.
With support from the PEPFAR Strategic Information and Care and Treatment teams, VAAC will improve
patient care monitoring, and program monitoring and quality assurance tools, in support of the national
monitoring and evaluation system.
Continuing Activity: 15293
15293 5517.08 HHS/Centers for Ministry of Health, 7114 5170.08 Vietnam $3,400,000
9529 5517.07 HHS/Centers for Ministry of Health, 5170 5170.07 Vietnam $1,686,029
5517 5517.06 HHS/Centers for Ministry of Health, 3092 3092.06 Cooperative $1,375,000
Estimated amount of funding that is planned for Human Capacity Development $567,500
Table 3.3.08:
1) COP09 narrative:
In FY09, the quality of adult treatment services will be improved to maximize the capacity of existing
antiretroviral therapy (ART) sites. Even though the Ministry of Health's Vietnam Administration for HIV/AIDS
Control (VAAC) may not open new ART sites in FY09, they will increase treatment patient uptake through
scaling up therapy at 26 adult existing ART sites in 17 provinces, including an outpatient clinic (OPC) in the
Hanoi Tuberculosis Hospital. Some ART sites serve as family-centered clinics, providing medications for
both adults and children. PEPFAR's treatment target is to provide ART for 8,840 adult patients by the end of
September 2010.
With support from PEPFAR and other donors, VAAC will strengthen activities and improve the quality of
ART programs by developing the skills and knowledge of national and provincial master trainers as well as
development and application of national quality assurance guidelines for all ART sites across country. Two
sets of national training curricula for health providers at the provincial and district levels will be completed in
FY08, led by VAAC's Department of Training and External Collaboration, with technical support from
experts from CDC, WHO, the Harvard Medical School AIDS Initiative (HAIVN), and the Global Fund. Master
trainers will use those curricula as standard material for their training courses.
VAAC will pilot a model that shifts tasks from doctors to nurses in two selected ART sites in the anticipation
of greater patient uptake while maintaining service quality. Due to a shortage of doctors, trained nurses
under the supervision of experienced physicians will be able to prescribe ART regimens and provide direct
follow-up of patients who have stable clinical status.
In order to assess the impact of treatment programs and provide the evidence needed to improve the
quality of services, routine programmatic evaluations will be conducted annually in well-established ART
sites in five focus provinces, and possibly expanded to other sites.
In addition to providing second-line drugs, PEPFAR will continue supporting viral load testing for patients
with suspected treatment failure in six focus provinces in order to give patients earlier access to ARV drugs.
As VAAC requested, this service will be expanded to cover additional Global Fund and national HIV/AIDS
program sites in six provinces: Quang Ninh, Hai Phong, Hanoi, Can Tho, Nghe An, and An Giang.
Through close support from PEPFAR, the World Health Organization, and the World Bank, VAAC will work
with the Ministry of Labor, Invalids, and Social Affairs (MOLISA) to develop and release an inter-ministry
circular focused on how to provide ARV services for HIV-infected people who reside in government
rehabilitation ("06") centers or are receiving ARV drugs at community-based OPCs but brought to "06"
centers. This circular will help prevent treatment interruptions and provide the necessary treatment for "06"
residents.
FY09 funding will support patients to receive comprehensive care and treatment packages, including
medicines, HIV counseling and testing, nutritional supplements, adherence and social-psychological
support, etc. In order to improve overall treatment, nutrition and food supplements will be offered at 26 adult
sites to ART patients with severe malnutrition. VAAC/LIFE-GAP will expand the Quang Ninh collaboration
model between clinics and home- and community-based care to additional provinces. They will also
continue working to improve linkages with methadone maintenance clinics in three provinces. Counselors,
case managers, PLHIV peer educators, support groups, and volunteer treatment supporters will stress
adherence, and side-effects monitoring. They will also facilitate referrals to and from services such as
hospitalization, family planning, counseling and testing, sexually transmitted infections, PMTCT, and TB
diagnosis and treatment facilities, and link patients to community-based care services.
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 Vietnam Administration for HIV/AIDS Control (VAAC) will scale up ARV services in eight focus
provinces and expand services to nine non-focus provinces. ARV services will be in place at 25 adult ART
clinics with a total of 6,969 adults (including 3,179 newly initiating adults) on ART.
Pediatric ART will be scaled up at 12 specialty pediatric clinics and seven family-centered clinics across 17
provinces. VAAC will provide treatment to a total of 787 children (including 307 new children) by September
2009.
VAAC will start providing ART in one to two tuberculosis hospitals to increase the access of TB-infected HIV
patients to ART.
In FY08 VAAC will coordinate with other donors (Global Fund (GF), PEPFAR, Clinton HIV/AIDS Initiative) to
increase treatment coverage effectively. VAAC will work closely with Vietnam CDC Harvard Medical School
AIDS Partnership (VCHAP) to provide on-site technical assistance (TA) for GF sites and non-PEPFAR
provinces, especially on second-line regimens that were supplied by PEPFAR.
In FY08 VAAC will disseminate ART program-related outcomes and lessons learned from the Enhanced
Evaluation (link with SI). VAAC will take the lead in coordination of drug resistance program with support of
PEPFAR and the World Health Organization (WHO). National trainer teams will be set up and take the lead
on updating training curricula and implementing a treatment strategy to support national scale up of ART
with technical support from international experts.
• To date, VAAC has established 11 national and provincial and one district level ART sites. With PEPFAR
support, VAAC has provided ART for 2,075 patients, including 1,890 adults and 185 children. Using FY07
funding, VAAC is currently expanding ARV services in a total of 24 ART sites to support 3,790 adults and
480 children on ART across 15 adult ART sites, nine specialty pediatric clinics and one family-centered
clinic.
Activity Narrative: FY07 Activity Narrative:
In FY05 and FY06, the Ministry of Health (MOH)/VAAC scaled up ART services to 1,135 adult and pediatric
patients at six adult out-patient clinics (OPCs) and four pediatric specialty clinics in five PEPFAR focus
provinces. In FY07, VAAC will expand treatment to provide direct support for 4,320 (existing and new)
patients at 18 provincial and district-level clinics in six focus provinces (clinics in Ho Chi Minh City, the
seventh province, are supported by the Ho Chi Minh City Provincial AIDS Committee). VAAC will provide a
limited package of support to provincial-level ART clinics in 12 non-focus provinces. VAAC will focus on
achieving four main objectives in FY07: expanding services at the provincial and district levels to support
initiation and monitoring of ART; enhancing services at the provincial level (via adult, TB, and pediatric
specialty clinics) to support secondary and tertiary level care; improving quality of services; and building
national and local capacity to ensure sustainability of ART service provision throughout Vietnam.
In each of the focus provinces, VAAC will support one provincial-level adult ART OPC and one pediatric
specialty clinic. These clinics are responsible for providing initial prescription of ARV as well as managing
referrals from district-level sites for management of side effects and second-line therapy. VAAC will also
support provincial-level ART clinics at TB hospitals in focus provinces where there is a 10-20% HIV sero-
prevalence rate. Primary service delivery of ART in Vietnam is being decentralized to the district level so
that provincial-level sites can increasingly focus on tertiary care. In FY06, VAAC supported one district-level
ART clinic with PEPFAR funding. In FY07, VAAC will expand this clinic into a magnet clinic supporting ART
and home-based care (HBC) services for three surrounding districts, and will launch two new district-level
ART clinics targeting current and former injecting drug users (IDU). In addition to its work in the focus
provinces, VAAC will provide a limited package of support to provincial-level ART clinics in 12 non-focus
provinces with PEPFAR funding. This support package includes staffing, supervision and lab monitoring
and will be phased out over the next two years (refer to uploaded Geographic Coverage document).
VAAC will support a referral case manager in all clinics in the focus provinces to facilitate referrals to
TB/HIV and STI services as well as to home- and community-based care services provided by PEPFAR
and other partners. These staff will assure women and families referred from PMTCT services receive
ongoing treatment services as needed (key legislative issues: gender). Case managers at provincial-level
pediatric clinics will closely link with community-based OVC services and work part-time in PEPFAR
supported resource centers to be established in three provinces providing psychosocial assessments and
links to other social supports. At each of the sites a network of peer educators and volunteers will be trained
to provide treatment support and establish support groups. These networks will provide additional
adherence support and also facilitate access to care and treatment services. To facilitate acceptance of
these groups into service delivery, training on stigma reduction will be emphasized (key legislative issue:
stigma). Case managers will work in teams with peer educators and support groups to prevent addiction
relapse, help patients access to substitution treatment as it becomes available; and facilitate referral to
services for patients released from drug rehabilitation centers.
Finally, in collaboration with the Vietnam CDC Harvard Medical School AIDS Partnership (VCHAP), Family
Health International (FHI) and HHS/CDC, funds will support VAAC to continue leading the national ARV
training program using the national treatment protocol and other standardized curricula. HHS/CDC care and
treatment staff will work closely with new VAAC staff to build capacity on ART, patient monitoring, and use
of standardized quality assurance tools for ARV program implementation, management and monitoring.
Collection of information for implementing, monitoring, and evaluating activities will be in line with the
PEPFAR SI strategy and meet national standards ensuring integrated service delivery systems, linkages
across providers and programs, routine monitoring and evaluation, and support for the national HIV/AIDS
Continuing Activity: 15297
15297 9398.08 HHS/Centers for Ministry of Health, 7114 5170.08 Vietnam $2,387,000
Estimated amount of funding that is planned for Human Capacity Development $250,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $123,120
Table 3.3.09:
1) COP 09 narrative
In FY09, activities will focus on: 1) maintaining 18 pediatric outpatient clinics (OPCs); 2) building linkages
between pediatric OPCs and other services, such as prevention of mother-to-child transmission, TB,
counseling and testing, and home-based care; and 3) improving the capacity of OPC staff through onsite
quality assurance and technical assistance, workshops, and refresher trainings aimed at improving the
quality of services.
PEPFAR support will maintain 18 pediatric outpatient clinics, which provide services for HIV-infected and -
exposed children born to HIV-infected mothers and 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-DNA testing for early diagnosis;
testing and treatment of opportunistic infections; providing general medication and co-trimoxazole (CTX)
prophylaxis; providing transportation, food, hospitalization, and psychosocial support to children; and
referring infected and exposed children to available services in the community, if needed.
Training will be provided to order to improve the capacity of caregivers on treatment adherence, and how to
take care and provide psychosocial support to children, etc. Health care providers will be provided new and
refresher trainings to enhance their skills in providing care and support services to their patients and on dry
blood spots for early infant diagnosis.
PEPFAR will continue to expand the family-centered care model so that adult OPCs, PMTCT sites, and
pediatric OPCs are located in a setting for patients' convenience. When parents and their children receiving
services in clinics near each other this reduces traveling costs for families and reduces loss to follow-up.
Funding will also continue for treatment supporters, who play a key role in linkages between clinics and
between clinics and the community. These counselors will assess the six basic needs of orphans and
vulnerable children and refer them to additional support systems, if needed.
VAAC will be supported in order to improve linkages between PMTCT and pediatric OPC sites, in order to
reduce loss to follow-up and to provide early diagnosis to identify infected children who will be enrolled in
care and treatment. PEPFAR will focus on supporting the annual national experience sharing workshops;
monthly conferences between PMTCT and pediatric OPC staff for problem solving to strengthen linkages;
and funding case-managers at the community-level to support mother-child pairs.
With PEPFAR support, VAAC will strengthen its role in coordination, supply, and distribution of opportunistic
infection drugs, laboratory supplies, and other commodities to outpatient clinics (OPCs). PEPFAR will
coordinate with the Clinton HIV/AIDS Initiative (CHAI) to support VAAC's development of a national protocol
and implementation plan for DNA PCR, and utilizing dried blood spots (refer to the Laboratory Infrastructure
section). They will also support the National Institute of Hygiene and Epidemiology and the Pasteur Institute
in order to provide free DNA PCR testing to exposed infants.
With support from the PEPFAR Strategic Information team and the Care and Treatment team, VAAC will
improve patient care monitoring, and program monitoring and quality assurance tools, in support of the
national monitoring and evaluation system.
• In FY08, the Vietnam Administration for HIV/AIDS Control (VAAC) will scale up ARV services in eight
focus provinces and expand services to nine non-focus provinces. ARV services will be in place at 25 adult
ART clinics with a total of 6,969 adults (including 3,179 newly initiating adults) on ART.
• Pediatric ART will be scaled up at 12 specialty pediatric clinics and seven family-centered clinics across 17
• VAAC will start providing ART in one to two tuberculosis hospitals to increase the access of TB-infected
HIV patients to ART.
• In FY08 VAAC will coordinate with other donors (Global Fund (GF), PEPFAR, Clinton HIV/AIDS Initiative)
to increase treatment coverage effectively.
• VAAC will work closely with Vietnam CDC Harvard Medical School AIDS Partnership (VCHAP) to provide
on-site technical assistance (TA) for GF sites and non-PEPFAR provinces, especially on second-line
regimens that were supplied by PEPFAR.
• In FY08 VAAC will disseminate ART program-related outcomes and lessons learned from the Enhanced
Evaluation (link with SI).
• VAAC will take the lead in coordination of drug resistance program with support of PEPFAR and the World
Health Organization (WHO).
• National trainer teams will be set up and take the lead on updating training curricula and implementing a
treatment strategy to support national scale up of ART with technical support from international experts.
support, VAAC has provided ART for 2,075 patients, including 1,890 adults and 185 children.
• Using FY07 funding, VAAC is currently expanding ARV services in a total of 24 ART sites to support 3,790
adults and 480 children on ART across 15 adult ART sites, nine specialty pediatric clinics and one family-
centered clinic.
FY07 Activity Narrative:
Activity Narrative: provinces. In FY07, VAAC will expand treatment to provide direct support for 4,320 (existing and new)
ART clinic with PEPFAR funding.
In FY07, VAAC will expand this clinic into a magnet clinic supporting ART and home-based care (HBC)
services for three surrounding districts, and will launch two new district-level ART clinics targeting current
and former injecting drug users (IDU). In addition to its work in the focus provinces, VAAC will provide a
limited package of support to provincial-level ART clinics in 12 non-focus provinces with PEPFAR funding.
This support package includes staffing, supervision and lab monitoring and will be phased out over the next
two years (refer to uploaded Geographic Coverage document).
Estimated amount of funding that is planned for Human Capacity Development $80,000
Table 3.3.10:
In FY09, activities will focus on: 1) maintaining 10 specialty pediatric outpatient clinics (OPCs) and eight
pediatric sites based in adult OPCs; 2) building linkages between pediatric OPCs and other services such
as prevention of mother-to-child transmission (PMTCT), TB, counseling and testing, and home-based care;
3) improving the capacity of OPC staff and the quality of services through onsite quality assurance (QA),
technical assistance and refresher training; and 4) supporting the Ministry of Health's Vietnam
Administration for HIV/AIDS Control (VAAC) to conduct better data management of infected children
throughout the country.
antiretroviral medicines, adherence training, monitoring and testing, and food and nutritional support. In
order to improve overall treatment, nutrition and food supplements will be offered at 18 pediatric sites for
antiretroviral therapy (ART) patients with severe malnutrition. Treatment supporters, who play a key role in
linking different clinics, as well as linking clinics and the community, will continue to be funded.
PEPFAR will continue to support capacity building at VAAC through several activities: providing technical
assistance for revising national guidelines on pediatric ARV treatment; developing a national
implementation protocol and scale-up plan; and providing quality assurance tools. PEPFAR will coordinate
with the World Health Organization, the United Nations Children's Fund, and the Clinton HIV/AIDS Initiative
(CHAI) to support VAAC to develop training curriculum on pediatric antiretroviral care and treatment. With
support from PEPFAR and other donors, VAAC will strengthen activities and improve the quality of ART
programs by developing the skills of national master trainers. These master trainers will then join with
outside experts to provide trainings and help supervise OPC staff across the country.
PEPFAR will support VAAC to institute better counseling and testing of family members and reporting
procedures at PMTCT, TB, and counseling and testing settings in order to locate and enroll more infected
children in antiretroviral programs at a younger age, helping to ensure better treatment outcomes.
with suspected treatment failure in six focus provinces in order to give patients earlier access to second-line
ARV drugs
In order to develop data-driven interventions, routine program monitoring and evaluations will be
implemented annually in ART sites in six focus provinces
In FY09, VAAC will expand treatment to provide direct support for 1,019 (new and existing) patients at 18
provincial- and district-level clinics in 18 provinces.
Activity Narrative: national and local capacity to ensure sustainability of ART service provision throughout Vietnam.
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $16,440
and Service Delivery
Table 3.3.11:
COP09 narrative:
In FY09, PEPFAR will continue to support the Ministry of Health's (MOH) successful scale-up of TB/HIV
activities, with expansion from 17 to 19 provinces. Six provinces will continue to provide the comprehensive
package of services. The remaining 13 will offer a basic package of services. Activities will include:
-- Collaboration mechanisms between TB and HIV programs will be strengthened at all levels by applying
national collaboration protocol for diagnosis, treatment, and management of HIV-infected TB patients using
referral forms and establishing a Coordination Committee to provide operational guidance. Joint monitoring
and evaluation of TB/HIV activities at the provincial level, and joint training activities and regular meetings
for district-level participants, will be continued and strengthened.
-- Human resource development will include direct technical assistance (TA) and training for 350 individuals
to strengthen TB/HIV clinical management and program monitoring.
-- 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 (M&E) and support for the National HIV/AIDS M&E system. In
addition, PEPFAR will support the World Health Organization to recruit one Vietnamese national program
officer to help improve the national system for TB/HIV M&E activities and refine the national guidelines for
TB/HIV, based on evidence collected from program implementation. They will also help strengthen
relationships between PEPFAR and other donor-supported TB/HIV activities such as those of the Global
Fund.
-- An estimated 26,000 TB patients will receive provider-initiated testing and counseling (PITC) in TB clinics.
-- More than 80% of patients who are found to be HIV-infected will be referred for HIV clinical services.
Referrals will be tracked on TB and HIV program forms.
-- PEPFAR will support TB disease screening in PLHIV attending HIV clinics and those who are living in the
community. An estimated 12,000 HIV-infected persons in 19 provinces will be screened for TB.
-- HIV-infected TB patients will receive co-trimoxazole preventive therapy, HIV staging, and antiretroviral
therapy (ART), if indicated. The Ministry of Health will expand ART from one to three provincial TB
hospitals.
-- PEPFAR will expand INH preventive therapy to two provinces to help prevent TB in 400 patients.
-- Laboratory capacity will be expanded from six to eight provinces. The goal is to have one facility in each
selected province with sufficient skills and resources for rapid diagnosis and treatment of all forms of TB,
including smear-negative and drug-resistant TB that is sometimes seen in HIV-infected patients. Additional
support for this activity has been provided to the KNCV Tuberculosis Foundation (see KNCV activity
narrative).
-- TB infection control will be expanded from 14 to 20 provinces. MOH will strengthen work practice and
administrative control measures within facilities caring for HIV-infected persons through national and
regional trainings. PEPFAR will support minor renovations and simple equipment upgrades to improve
airflow and environmental controls. Additional support for this activity has been provided to KNCV (see
KNCV activity narrative).
-- Support for public-private partnerships intervention has been provided to MOH through PATH Vietnam in
two provinces (see PATH activity narrative).
In FY08, PEPFAR provided either basic package or comprehensive package of TB/HIV services in 17
provinces. The basic package included PITC of TB patients, TB screening of HIV patients, co-trimoxazole
prophylaxis, training of health staff, and monitoring of TB services provided to HIV patients and HIV services
offered to TB patients. In six focus provinces, the basic package was complemented by additional services
(the "comprehensive package"), including, improving TB laboratory capacity, offering ART for HIV-infected
TB patients and implementing TB infection control measures in HIV clinical settings. In addition to this
package of services, PEPFAR also supported pilot initiatives in selected provinces, including the provision
of HIV care and treatment at one provincial TB hospital, molecular-based methods for rapid TB drug
susceptibility testing in five provinces, collaboration with private pharmacies and clinics in two provinces,
and the provision of INH-preventive therapy to 600 HIV-infected persons in two provinces. At the national
level, PEPFAR supported the creation of a national TB/HIV Technical Working Group that wrote a national
TB/HIV policy and developed training materials for healthcare staff. In FY08, nearly 24,000 TB patients and
10,000 HIV patients across 17 provinces received TB/HIV services through PEPFAR, and over 330
Vietnamese nationals were trained in TB/HIV diagnosis and treatment.
2) COP 08 narrative:
In FY08, PEPFAR will continue to support the Ministry of Health's (MOH) successful scale-up of TB/HIV
activities. The comprehensive package of services will be expanded from six provinces to eight provinces;
eight other provinces will continue to receive the basic package of services. Activities will include:
• Mechanisms of collaboration. Collaboration mechanisms between TB and HIV programs will be
strengthened at all levels. Provinces will convene joint monitoring and evaluation of TB/HIV activities, joint
training activities and regular meetings for district-level participants.
• Human resource development. Including direct technical assistance (TA) and training for 300 individuals to
Activity Narrative: strengthen TB/HIV clinical management and program monitoring.
• Monitoring and evaluation (M&E). 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 M&E and support for the National HIV/AIDS M&E System.
• Provider-initiated HIV testing and counseling (PITC). An estimated 28,000 TB patients will receive PITC in
TB clinics. Patients who are found to be HIV-infected are referred for HIV clinical services, and successful
referral is tracked on TB and HIV program forms.
• TB screening. PEPFAR will support TB disease screening in PLWHA that are attending HIV clinics and
are living in the community. PEPFAR will support TB screening for 10,000 PLWHA in 15 provinces.
• Clinical services for HIV-infected TB patients. HIV-infected TB patients will receive co-trimoxazole
preventive therapy, HIV staging, ART (if indicated) and other services. MOH will expand ART to three
provincial TB hospitals.
• INH preventive therapy. PEPFAR will support this service for 600 patients in two current provinces.
• TB lab capacity. Lab capacity will be expanded in an additional two provinces. The goal is to have at least
one facility in each focus province with sufficient skill and resources for rapid diagnosis and treatment of all
forms of TB, including smear-negative and drug-resistant, in HIV-infected patients.
• Infection control. MOH will receive support for ongoing assessments and implementation of administrative
controls and, where necessary, physical renovations. Additional support for this activity has been provided
to FHI and KNCV (see FHI and KNCV activity narratives).
• Public-private partnerships. Support for this intervention has been provided to the MOH through PATH
(see PATH activity narrative).
In FY07, PEPFAR provided both a basic and comprehensive package of TB/HIV services in selected
Vietnamese provinces. The basic package included PITC of TB patients, TB screening of HIV patients, co-
trimoxazole prophylaxis, training of health staff, and monitoring of TB services provided to HIV patients and
HIV services provided to TB patients. In focus provinces (six in FY07; refer to Geographic Coverage
document for clarification), the basic package was complemented by additional services, including
development of TB lab capacity, ART for HIV-infected TB patients and implementation of TB infection
control measures in HIV clinical settings. In addition to this package of services, PEPFAR also supported
pilot initiatives in selected provinces, including provision of HIV care and treatment at provincial TB
hospitals, molecular-based methods for rapid TB drug susceptibility testing, collaboration with private sector
HIV and TB providers, and provision of INH preventive therapy to PLWHA. At the national level, PEPFAR
supported creation of a national TB/HIV Technical Advisory Group that wrote a national TB/HIV policy and
developed training materials for healthcare staff. In FY07, over 18,000 TB patients and 7000 HIV patients
across 15 provinces received TB/HIV services through PEPFAR, and over 350 Vietnamese nationals were
trained in TB/HIV diagnosis and treatment.
Continuing Activity: 15294
15294 5513.08 HHS/Centers for Ministry of Health, 7114 5170.08 Vietnam $1,370,677
9570 5513.07 HHS/Centers for Ministry of Health, 5170 5170.07 Vietnam $933,971
5513 5513.06 HHS/Centers for Ministry of Health, 3092 3092.06 Cooperative $129,000
Health-related Wraparound Programs
* TB
Estimated amount of funding that is planned for Human Capacity Development $500,000
Table 3.3.12:
In FY08, LIFE-GAP piloted the orphans and other vulnerable children (OVC) program in Thai Binh province
in order to mobilize and build capacity for HIV health care workers at the provincial and district levels to
manage the OVC program and provide support to children in the six basic needs, in line with OGAC's OVC
guidance. This activity successfully coordinated OVC efforts from various sectors in the province,
particularly the Department of Labor, Invalids, and Social Affairs and the Department of Education and
Training.
In FY09, with lessons learned from the pilot in Thai Binh, PEPFAR will support LIFE-GAP to expand the
OVC program to two additional TBD provinces, maximizing the use of current government resources,
including state health care workers, in order to sustain the services. Health care workers in the HIV/AIDS
program system will be trained to conduct needs assessments on a regular basis, provide support for each
particular area of basic need, and provide referrals. Privacy and confidentiality will be emphasized in all
trainings, in the protocols, and during quality assurance and quality improvement visits. To protect the family
structure, caregivers and household leads will be trained to provide health care for children with HIV/AIDS
at home. They also will receive support to ensure the livelihood and food security of the family.
In each province, regular workshops will be held to review the process in order to make adjustments, share
experiences, and consolidate commitment from various sectors to strengthen OVC programs in that
province.
2) COP 09 narrative
In FY08, PEPFAR will support the Ministry of Health/Vietnam Administration for HIV/AIDS Control
(MOH/VAAC) pediatric program to continuously strengthen the provision of care and support services for
OVC and their caregivers in six focus provinces and other provinces where the pediatric program will be
extended. As planned in FY07, OVC services were added in pediatric clinics and at a drop-in center for
OVC and their caregivers which was established in Hanoi. In FY08, PEPFAR will continuously support the
provision of this wider range of services, designed to better meet the developmental needs of each child.
344 OVC will receive services, and 30 caregivers will be trained to provide services to OVC and their
families. Case managers at newly established clinics will be trained to provide OVC services at clinic
settings.
The 11 pediatric HIV/AIDS out-patient clinics (OPCs) will keep providing a core set of OVC services,
including needs assessment with OVC and caregivers; counseling and psychosocial support, food/nutrition
support (in accordance with PEPFAR guidance), 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.
PEPFAR will also support the provision of OVC services through the drop-in center. OVC and their
caregivers will be referred to the center from National Pediatric Hospital and Saint Paul Hospital, as well as
through other health care and community-based support services. The drop-in center will provide the same
assessment, referral and psychosocial support services offered through the pediatric OPCs. In addition, the
drop-in center will offer more comprehensive services to OVC and caregivers, including caregiver support
groups, educational activities and advocacy/support for enrollment of OVC in community schools,
therapeutic play groups for OVC, training of family caregivers in basic care and support for children, age
appropriate life-skills education for OVC including primary prevention of HIV/AIDS and primary prevention of
drug use, and on-going support to families at risk of institutionalizing children.
PEPFAR will keep providing intensive and ongoing capacity-building and technical assistance to ensure
consistent and quality programming, including training courses, mentoring, coaching, and support for a to
bring OVC partners together to problem-solve, and share experiences and resources.
Activity Narrative: groups, educational activities and advocacy/support for enrollment of OVC in community schools,
consistent and quality programming, including training courses, mentoring, coaching, and support for fora to
Continuing Activity: 15295
15295 9531.08 HHS/Centers for Ministry of Health, 7114 5170.08 Vietnam $30,000
Estimated amount of funding that is planned for Human Capacity Development $30,000
Table 3.3.13:
COUNSELING AND TESTING: $1,900,000
The Ministry of Health/Vietnam Administration for HIV/AIDS Control (MOH/VAAC) leads government
initiatives to develop counseling and testing (CT) policies and guidelines, and to implement CT
programming in Vietnam. In FY09, PEPFAR will support VAAC to strengthen HIV counseling and testing
(CT) coverage in 28 high prevalence provinces. The services will target most at-risk populations (MARPs)
including injecting drug users (IDU), commercial sex workers (CSW), men who have sex with men (MSM),
sexual partners of HIV-infected persons, and clients of sex workers. VAAC will provide counseling and
testing services for 68,000 clients at 54 CT clinics in these provinces.
In FY08, the VAAC has developed the use of same-hour test result notification. With FY09 funding, the
VAAC will expand same-hour test result notification, establishing the practice in all provinces to encourage
increased service uptake. Based on the use of rapid testing, VAAC will expand the Hai Phong outreach CT
model to all PEPFAR focus provinces, establishing 10 outreach CT teams based at existing counseling and
testing sites to improve coverage of most at-risk populations.
In line with PEPFAR counseling and testing strategies, VAAC will enhance provider-initiated testing and
counseling (PITC) services at sexually transmitted infections (STI) clinics in all PEPFAR focus provinces
and develop PITC at TB clinics to 19 provinces with the highest TB prevalence. In addition, VAAC will
continue to integrate CT into drop-in centers for IDU in all focus provinces, and to ensure that CT services
are routinely offered to clients at methadone sites. Couples counseling will also be integrated into current
CT services to better reach regular sexual partners of IDU, sex workers and other high-risk groups.
PEPFAR funds will be used to improve services offered at all sites by training 200 health care workers in
advanced counseling and couples counseling using HHS/CDC and OGAC technical working group-
approved curricula, and employing internal and external quality assurance/quality control (QA/QC)
measures. VAAC will also strengthen the current CT information system and link it to the laboratory
information system to ensure the smooth service functioning. With PEPFAR support, VAAC will continue to
provide technical assistance to Global Fund and World Bank counseling and testing programs through
refresher trainings, QA to improve service provision, standardized data collection, monitoring and
evaluation, and the coordination of a national HIV counseling and testing reporting system.
Through FY09 funding, PEPFAR will support VAAC collaboration with the World Health Organization
(WHO) and UNICEF to ensure that counseling and testing is available for children and adolescents, and to
guarantee approval of guardians and non-discrimination against minors. Training on safeguarding the
welfare of children will be provided to health care workers through health information networks, training, and
legislative regulations.
In collaboration with the UN, WHO, other major donors (Global Fund, AusAID, and World Bank), and
international NGOs (Family Health International and Population Services International), PEPFAR will assist
VAAC in disseminating national guidelines for counseling and testing as well as national guidelines for
PITC. PEPFAR will coordinate with referral officers to enhance existing referral systems between HIV
prevention and care services through the implementation of a referral card tracking system. PEPFAR will
also continue its support of VAAC monthly coordination meetings at the provincial level.
VAAC will work closely with PEPFAR social marketing partner PSI to increase the number of people who
access counseling and testing services. To strengthen linkages with outreach programs, VAAC and
PEPFAR will coordinate activities with PLHIV groups, peer outreach programs, and organizations such the
Vietnam Women's Union and Youth Union to encourage test result disclosure, service utilization by families,
and to prevent HIV-negative partners of PLHIV from becoming infected. These activities will facilitate
normalization of HIV test-seeking behavior and reduction of stigma and discrimination.
Number of service outlets providing counseling and testing according to national and international
standards: 54
Number of individuals who received counseling and testing for HIV and received their test results (excluding
TB): 68,000
Continuing Activity: 15296
15296 5325.08 HHS/Centers for Ministry of Health, 7114 5170.08 Vietnam $1,900,000
9511 5325.07 HHS/Centers for Ministry of Health, 5170 5170.07 Vietnam $1,455,000
5325 5325.06 HHS/Centers for Ministry of Health, 3092 3092.06 Cooperative $670,000
Estimated amount of funding that is planned for Human Capacity Development $770,000
Table 3.3.14:
In Vietnam, most laboratory infrastructure development funding goes to government institutions. PEPFAR
supports the Ministry of Health's (MOH) Vietnam Administration for HIV/AIDS Control (VAAC) to build the
capacity and sustainability of the laboratory infrastructure through memorandums of understanding with the
following institutions: 1) the National Institute of Dermatology and Venereology (NIDV) for diagnosis of
sexually transmitted infections (STI); 2) the National TB Hospital to build capacity for TB diagnosis; 3) the
National Institute for Infectious Tropical Diseases (NIITD) for improved CD4 testing; 4) the Hanoi Medical
School to improve testing associated with HIV antiretroviral monitoring; and 5) Bach Mai Hospital for
development of opportunistic infections (OI) external quality (EQA) programs. These last two institutions
have only recently been identified to receive PEPFAR support through VAAC. Support from PEPFAR funds
salaries for two staff who are focused solely on laboratory activities, technical assistance (TA) for guideline
updates, EQA programs, training in HIV diagnosis and treatment monitoring, strengthening of laboratory
data management, coordination meetings (VAAC subcommittees and donor agencies), and equipment
procurement and maintenance. VAAC will also work closely with the Vietnam Administration for Medical
Services for implementation of the National Laboratory Strategic Plan.
VAAC's renewed focus on laboratory EQA schemes for clinical testing, including hematology, biochemistry,
microbiology, TB, STI and OI is in keeping with laboratory quality management principles. VAAC will take a
leadership role in EQA program planning and will assist in the selection of a national coordinating institution
for each program. Once assigned, the institution will receive PEPFAR support for procurement and/or
production of EQA panels, TA visits from laboratory coalition partners, and data management and analysis.
PEPFAR will also support conferences and workshops so participating laboratories can become conversant
with the program, share experiences, and solve problems.
To expand HIV antiretroviral therapy (ART) monitoring, Bach Mai Hospital will work closely with the
American Society for Microbiology (ASM) to develop and deliver training to laboratory staff in PEPFAR
focus provinces in order to diagnosis the most common OIs. Training will include proper specimen collection
and transport. Laboratory reagents and equipment (biological safety cabinets and microscopes) will be
procured.
Due to the critical importance of regular and accurate CD4 cell counts in HIV-infected clients (both those
recently diagnosed and those on drug therapy) PEPFAR has placed emphasis on developing capacity
across Vietnam over the past five years. Efforts have been focused on equipment procurement and training.
This will continue in FY09, but additional focus will be placed on developing referral networks for CD4
testing to maximize the capacity of currently available testing sites. Contracts will be signed to ensure that
all of these machines will be maintained regularly. Trainings will concentrate on improving quality
management at CD4 laboratories. In addition, PEPFAR will support expansion of existing EQA programs
coordinated by NIITD so that all CD4 laboratories in the country can participate. PEPFAR will coordinate
support to VAAC from the Supply Chain Management System (SCMS), which currently provides quarterly
monitoring visits to CD4 laboratories and ASCP, as well as providing TA to improve the current training
curriculum.
To improve the accuracy and capacity of TB diagnosis, the National TB Hospital will take the lead in
improving the existing AFB quality assurance (QA) program, updating the current AFB smear microscopy
training package using CDC/WHO generic package as a reference, and providing trainings to staff in TB
laboratories nationwide. PEPFAR will provide funds and TA in support of these activities. Where necessary,
equipment will be provided. The National TB Hospital, and Pham Ngoc Thach Hospital in Ho Chi Minh City,
currently perform TB liquid culture. TA will be provided by APHL to both facilities to ensure that liquid culture
is performed according to internationally-accepted safety standards.
VAAC is currently working closely with the National Institute of Dermatology and Venereology (NIDV) to
upgrade STI diagnostic capacity, specifically for syphilis, gonorrhea, and chlamydia. PEPFAR will continue
to provide support to NIDV to develop and distribute standard operation procedures for laboratory testing
and provide hands-on training to strengthen the proficiency of STI laboratory technicians. PEPFAR will
support TA from ASM to update STI training curriculum and disease specific guidelines. PEPFAR will also
support enrollment of NIDV into an EQA program and development of a national STI EQA program based at
NIDV.
Hanoi Medical School (HMS) continues to coordinate an internship training course on HIV/AIDS laboratory
testing (clinical microbiology). Plans are underway to expand this course in FY09 to cover other fields of
laboratory testing related to HIV/AIDS patient management. HMS has also been called upon to develop a
system to monitor the quality of biochemistry and hematology laboratory results generated by the clinical
network. In FY09, funding will be provided for the development of a biochemistry and hematology EQA
program. HMS will implement this program in focus provinces.
In FY08, three counseling and testing sites were provided with bar coding capacity and are being linked to
the library information system (LIS). The software at the site will exchange data with the LIS at the testing
laboratory to allow for an integrated system. In FY09, all PEPFAR-supported counseling and testing sites
will either be linked to a LIS or provided with bar coding capacity for the improved data management of
results. This linkage will allow data (specimen, patient, and results) to be transmitted electronically. Two
benefits of this system are reduced wait times and the reduction of errors from manual transcription. Similar
efforts to develop bar coding capacity and linkages will be undertaken for selected prevention of mother-to-
child transmission (PMTCT) treatment sites. Support will be provided to allow outpatient clinics (OPCs) to
employ bar coding technology. Specimens submitted to laboratories will be labeled with a patient identifier
developed by the OPC or PAC and a corresponding barcode. This will allow laboratories to easily link
individual patient laboratory results generated over time.
Based on recent needs assessments, VAAC will support the following site staff: either one or two LIS
supervisors, based on the size of the facility, a quality manager to oversee data use and reporting from the
Activity Narrative: LIS and QA laboratory activities, and IT staff to provide assistance with hardware. It is hoped that these
personnel will ensure that LIS activities are part of routine work flow. LIS will be expanded to four more
sites, bringing the total number supported by VAAC to 11. All sites will have the capacity to send aggregate
data electronically to VAAC, creating a central data repository that will be used for more efficient monitoring
and evaluation of laboratory tests.
Interfacing LIS directly to testing instruments will also be supported to reduce manual data entry.
In FY08, emphasis was placed designing systems that would allow for exchange of data between LIS and
patient management/ARV systems. These efforts will be expanded in FY09; however, data exchange
between the two different systems will require technical adjustments to both.
Continuing Activity: 15298
15298 9505.08 HHS/Centers for Ministry of Health, 7114 5170.08 Vietnam $1,224,500
9505 9505.07 HHS/Centers for Ministry of Health, 5170 5170.07 Vietnam $493,928
Estimated amount of funding that is planned for Human Capacity Development $360,500
Table 3.3.16:
VAAC M&E Unit: $605,000
LIFE-GAP M&E Team: $180,000
The VAAC M&E Unit and the LIFE-GAP project M&E Team are main implementing partners for SI activities
under the PEPFAR cooperative agreement with MOH. VAAC M&E Unit activities will focus on the support of
the National M&E Framework, MOH Decision 28 mandated reporting, and on-going M&E, HMIS and GIS
technical working groups. LIFE-GAP activities will focus on the development of LIFE-GAP SI human
resources to ensure that programs are continuously more evidence-based, efficient and sustainable.
VAAC is responsible for the oversight and management of all national HIV program M&E and leads the
national M&E technical working group (TWG). By partnering with other agencies in the Ministry of Health
(MOH), donors, UN, and implementing partners, VAAC is charged with ensuring these programs are
coordinated through a single M&E system for national program management. PEPFAR funds to VAAC will
continue to support:
•Routine service delivery systems through the development of national standards for data structures and
information system design for adult and pediatrics care and treatment, PMTCT, TB/HIV, VCT and
prevention and community-based activities. Also, TWG-led consensus building activities around data
standardization and harmonization will take place.
•A national HMIS drawing data from routine service delivery information systems, surveillance activities,
surveys, and program management databases, including program coverage and quality data. The single
national system will be achieved through the guidance of a national HMIS TWG led by VAAC and with
broad participation from UN, donors, and implementing partners.
•M&E capacity development through trainings focusing on data analysis, quality assurance and use at the
national level across programs and among provincial AIDS control centers throughout Vietnam. VAAC and
the provincial AIDS control centers will also benefit from in-service epidemiology training to be conducted by
the schools of public health.
•Program activity mapping for better coordination of service provision across donors and programs. The
activity will generate a database of basic characteristics of prevention, care and treatment services in
Vietnam.
•Obtain results for the National M&E Framework's core indicators for which data sources are not readily
available, such as facility survey assessing health service provision.
•Contracted services for M&E with a focus on data quality assurance, particularly for Decision 28 reported
data, and for coordinating data sharing across all stakeholders.
•Data triangulation, which is an analytical approach to synthesizing quantitative and qualitative studies,
along with data from HIV prevention, care and treatment programs, and making use of expert judgment in
order to evaluate interventions and assess population-level outcomes. VAAC will receive technical
assistance from other PEPFAR partners to be determined.
•Participation in geographical information systems (GIS) applications. VAAC will coordinate and contribute
government and multiple donor data to the application to produce nationally applicable information for
program monitoring and management.
The LIFE-GAP project M&E Team supports data collection and management of prevention, care and
treatment services in PEPFAR provinces. Funds will continue to support LIFE-GAP's program monitoring
activities, including service data quality assurance, reporting and feedback. Funds will also be used for
establishing information systems for managing programs and for hardware and software maintenance and
upgrades. Human capacity development activities include contractual M&E staffing at LIFE-GAP and
provincial AIDS control centers and ongoing training, including attendance at M&E short-courses and VAAC
-organized M&E trainings and organizing data management training at service delivery points.
Continuing Activity: 15299
15299 9376.08 HHS/Centers for Ministry of Health, 7114 5170.08 Vietnam $1,100,000
9376 9376.07 HHS/Centers for Ministry of Health, 5170 5170.07 Vietnam $430,000
Estimated amount of funding that is planned for Human Capacity Development $320,000
Table 3.3.17:
The Ministry of Health (MOH)/Vietnam Administration for HIV/AIDS Control (VAAC) was established in
August 2005 and is responsible for overseeing and coordinating HIV/AIDS programs in all 64 provinces.
PEPFAR's success in Vietnam depends in part on sustainable national program management solutions as
VAAC expands its mandate to coordinate HIV/AIDS activities nationwide. VAAC is mandated to oversee all
major donor assistance programs including PEPFAR, Global Fund, World Bank, and the Asian
Development Bank. PEPFAR funding currently supports activities in 30 provinces.
Since 2007, PEPFAR has scaled up support to VAAC to support capacity building in technical areas by
providing funds for 30 contract staff at the central level and partial support (temporary contract, overtime,
incentive bonuses) for provincial and district level staff. This staff has played a critical role in supporting the
MOH/VAAC to coordinate donor supported activities across administrative and technical areas. In 2008,
PEPFAR supported VAAC to begin developing a comprehensive national plan for geographic coverage of
HIV/AIDS programs, in collaboration with other donors including GFATM and World Bank. This includes
developing a tiered approach for PEPFAR support in the eight focus provinces, expanded targeted
programmatic area technical support in carefully selected provinces, and maintenance of existing services
in a total of 32 provinces. PEPFAR will provide continuing support in this project with planned completion in
Several donors have come together to support the government of Vietnam (GVN) in its response to the
HIV/AIDS epidemic, including PEPFAR, Global Fund (GF), World Bank, and the Asian Development Bank.
With PEPFAR support, VAAC has strengthened its capability to serve as the coordinating agency by
conducting regular coordination meetings with PEPFAR partners, Vietnamese government officials and
other donor agencies. These meetings serve as a forum for dialogue on program progress, overlap and
duplication, and will address key issues for strengthening the national program. In addition, VAAC sponsors
technical workshops on prevention, care and treatment, and strategic information to disseminate lessons
learned, program results, as well as highlight innovative programs and ideas.
In 2009, PEPFAR funds to VAAC will continue to support human capacity through temporary contract
technical and administrative staff at VAAC, whose principle role will be to coordinate donor programs at the
central and provincial levels. At the national level, key temporary technical contract staff will continue to
work in prevention, care and treatment, and program administration. At the provincial level, PEPFAR will
continue to support temporary contract VAAC staff in each of the seven PEPFAR focus provinces, and will
support additional temporary contract staff in the eighth focus province. These individuals will serve as
primary liaisons for VAAC and other donor-funded activities, supporting the coordination and
communication between national and provincial programs. All PEPFAR-funded staff participate in the Total
Quality Management (TQM) course offered in partnership with the Hanoi School of Public Health (HSPH)
(see OHSS HSPH activity narrative). Through a memorandum of understanding between VAAC and
HSPH, HSPH will continue to provide management technical assistance and training to national and
provincial staff. PEPFAR will increase support for the development of provincial AIDS centers (provincial
VAAC) through material support, carefully selected infrastructure and renovation support, and coordination
activities in eight focus provinces plus at least two additional provinces in which PEPFAR will provide
expanded technical support. Also at the provincial level, VAAC will continue to support a network of
regional program managers that will link HIV/AIDS programs and provide a forum for discussions on
implementation, key issues, challenges and solutions. This network will also provide a mechanism for the
dissemination of successful programmatic innovation. The network will meet on a regular cycle to bring
together provincial governments, PLHIV, local organizations and international donors, within the provinces
to foster a connected relationship between all sectors involved in HIV/AIDS programs.
PEPFAR is currently working with VAAC to develop a sustainable Human Capacity Development strategy
(HCD), with information from the Health Systems 20/20 Assessment, as well as the forthcoming HCD
Assessment from the Capacity Project. Currently critical staffing gaps are filled through provision of funds
to hire temporary workers on behalf of the MOH or other government bodies. It is anticipated that the HCD
strategy will address key issues in human capacity to enable a more effective response to the epidemic in
Continuing Activity: 15300
15300 9414.08 HHS/Centers for Ministry of Health, 7114 5170.08 Vietnam $874,000
Estimated amount of funding that is planned for Human Capacity Development $645,275
Table 3.3.18:
