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 activity was carried out in FY08 under HBHC but will be part of MTCT starting this year to better reflect
SCMS technical support to the expanding PMTCT sites. This activity supports the ARV drugs activity in
which SCMS procures medicines for PMTCT sites. $300,000 for technical assistance to support the ARV
drugs logistics is being requested..
SCMS will continue to contribute to the success of the PMTCT program by Activity 1) Providing regular
technical assistance to the PMTCT sites to ensure proper storage and handling of medicines, record
keeping and good dispensing practice. Proper site management feeds directly into the ARV drug activity to
ensure an uninterrupted HIV medicines and commodity supply. Due to the collaboration with VAAC and
CHAI on PMTCT, SCMS supplies ARVs to the pregnant women throughout the country if national
government supplies are not available. Formal training and on the job training is part of this activity. A
second related activity is that SCMS will also support VAAC to improve its ability to manage the supply
chain, including medicines for ARVs
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.01:
In FY08, SCMS procured methadone to support the new Methadone treatment program for six clinics.
Technical support was also provided to the sites. In FY09 SCMS will continue to provide methadone to
support the expansion of the pilot methadone treatment program for recovering injecting drug users in
Vietnam.
METHADONE PROCUREMENT: $650,000
Through close collaboration with the VAAC and PEPFAR partners, SCMS will quantify, procure, import, and
arrange for storage and distribution of methadone.
TECHNICAL ASSISTANCE FOR DRUG MANAGEMENT: $300,000
SCMS staff will also provide technical assistance to FHI, CDC and other implementing partners for the
methadone pilot. This technical assistance will include visiting the sites regularly to monitor inventory,
ensuring proper pharmaceutical management, and providing assistance to ensure the smooth roll-out of the
methadone program. New sites will receive additional support to bring them quickly up to speed.
Developing the capacity of VAAC to provide long-term management for pharmaceuticals will be a priority
area, especially in considering other commodity sources and ensuring commodity security.
Table 3.3.06:
BACKGROUND:
OI medicines continue to require procurement within Vietnam, as most of these medicines are already
registered in Vietnam and thus are not eligible for importation, undeGovernment of Vietnam (GVN) law, as
emergency aid. Since these medicines cannot be purchased by SCMS as a USAID contractor who must
follow USG's FAR rules, an alternate funding mechanism has been chosen through CDC. In COP08, the
plan is to develop local capacity to procure and manage ARVS through the MOH/LIFE-GAP project and
these efforts will continue in COP09.
SCMS will supportIFE-GAP in the management of OI medicines, including selection, procurement technical
assistance, storage and inventory management, reporting, and distribution. SCMS staff will continue to visit
clinical sites and providtechnical assistance (TA) for good stock management, storage and record. SCMS
will provide TA to VAAC and the PACs, in collaboration with PEPFAR, to develop a more sustainable
approach to providing OI medicines. SCMS will continue to provide assistance to the HCMC PAC in its
efforts to manage OI medicines.
USG/Vietnam will also procure and distribute a limited amount of food targeted for clinically malnourished
PLWHA and PMTCT women during pregnancy and lactation. SCMS will assist in delivery of the product(s)
to designated health center clinic sites, and will support the clinic sites on inventory control, storage, and
record keeping (SCMS) are included in other activity narratives.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16264
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16264 16264.08 U.S. Agency for Partnership for 7118 5175.08 $610,000
International Supply Chain
Development Management
Table 3.3.08:
PEPFAR supports SCMS to provide direct technical assistance to pharmacies at adult clinical sites. This
request for $700,000 for technical assistance will provide support for the ARV drugs program area by
ensuring proper supply chain management and reporting. See 15-HTXD for details.
SCMS will continue to contribute to the success of the adult treatment program by providing regular
technical assistance to the adult sites to ensure proper storage and handling of medicines, record keeping
and good dispensing practice. Formal training and on the job training is part of this activity. SCMS will on
occasion provide TA to non PEPFAR sites at VAAC and USG request, to help expand capacity for
monitoring and evaluation. A second related activity is that SCMS will also support VAAC to improve its
ability to manage the supply chain, including medicines for ARVs, in the future.
Nutrition Component: $1,100,000
It is estimated that 15% of adult clients and 30% of HIV infected OVC are either severely or moderately
malnourished (28% and 50% in Kenya and Uganda respectively), which brings the total number of HIV
clients in need of nutrition treatment (within the PEPFAR Vietnam program) as high as 10,500. Using this
figure, the low estimated cost for supplemental and therapeutic foods will be $720,000, logistics not
included. The original amount of $200,000 is not sufficient to ensure adequate malnutrition treatment for
beneficiaries of the PEPFAR program, as such, an additional $500,000 is requested to be added to the
existing amount in order to increase program coverage.
Another $400,000 is requested to set up the food supply system for HIV clients currently integrated into the
national system. PEPFAR will support the Partnership for Supply Chain Management (SCMS) to provide
direct technical assistance to the Vietnam National Institute for Nutrition (NIN). This request for additional
funding for technical assistance will provide support for the FBP program by ensuring proper supply chain
management and reporting.
technical assistance to the adult sites to ensure proper storage and handling of supplemental and
therapeutic foods, record-keeping and good dispensing practice. Formal training and on-the-job training is
part of this activity. SCMS will, on occasion, provide TA to non PEPFAR sites at VAAC and USG request, to
help expand capacity for monitoring and evaluation. SCMS is also expected to support NIN and VAAC to
improve its ability to manage the supply chain in the future.
Continuing Activity: 15342
15342 5832.08 U.S. Agency for Partnership for 7118 5175.08 $1,200,000
9412 5832.07 U.S. Agency for Partnership for 5175 5175.07 Supply Chain $2,434,228
International Supply Chain Management
Development Management System
5832 5832.06 U.S. Agency for Management 3101 3101.06 Rational $196,560
International Sciences for Pharmaceutical
Development Health Management
Plus
Table 3.3.09:
Background: This activity was done in FY08 under HBHC but will be part of PDTX starting this year to better
reflect SCMS technical support to the expanding Pediatric sites. This activity supports the ARV drugs
activity in which SCMS pays for the in-country costs of pediatric medicines which are procured through
CHAI. $300,000 for technical assistance to support the ARV drugs logistics is being requested..
SCMS will continue to contribute to the success of the pediatric program by Activity 1) Providing regular
technical assistance to the pediatric care and treatment sites to ensure proper storage and handling of
medicines, record keeping and good dispensing practice. Proper site management feeds directly into the
ARV drug activity to ensure an uninterrupted HIV medicines and commodity supply. Formal training and on
the job training for clinical site dispensers is part of this activity. Activity 2 , will include SCMS continuing to
work closely with VAAC and CHAI to properly quantify the ARVs for pediatric patients.
Table 3.3.11:
his is a continuing activity from FY 2008.
The Supply Chain Management System (SCMS) will continue activities started in 2006 that center on
ensuring a non-interrupted supply chain for HIV related medicines, commodities and supplies, for up to
34,000 patients by September 2010. There will be increased emphasis on technical assistance to develop
a long range system for GVN to ensure supplies of HIV related medicines and commodities into the future,
post PEPFAR. The need for ARV medicines in COP09 is estimated at $9,000,000 to meet the needs of
adult treatment and PMTCT. Given SCMS currently has an estimated pipeline of $8,000,000 only
$1,000,000 of additional funds are being requested for ARVs and $800,000 for technical assistance to
support the ARV drugs logistics. This area of SCMS activities is closely linked to PMTCT, adult and
pediatric treatment and adult care, as the site level activities feed directly into the ability of SCMS to provide
quantification and logistics. Office expense is distributed across all program areas for which SCMS has
activities. Some medicines may also support patients at the GVN supported clinical sites and may
supplement Global Fund Project sites. SCMS will collaborate with CHAI to ensure the proper quantification
of needed pediatric ARVS which will continue to be procured by CHAI during COP09. PEPFAR will support
SCMS to continue to work closely with CHAI and the PEPFAR care & treatment team to ensure pediatric
medicines are available going into 2011, in anticipation of the end of UNITAID funding. PEPFAR will support
SCMS to continue to manage the storage and distribution of the pediatric supplies to the whole country.
There are two project goals, with activities centered around each goal. For the first goal PEPFAR will
support SCMS to assist the Government of Vietnam to design and implement a more efficient and effective
national system for the distribution of HIV medicines and related commodities by 1)building capacity at
VAAC to quantify needs, manage distribution and storage, and to use information for decision-making; 2)
building capacity of PACs to use information for decision-making and building their capacity to train staff at
new sites; 3) building capacity at sites to store, dispense and collect information for reporting and ordering;
4) collaborating with VAAC to develop a long-range strategy for commodity security, which integrates all
donor commodity resources and helps increase the number of patients on ARVs; 5) collaborating with
VAAC in the design and implementation of a national drug requisition system with roles for site level, PAC
level and National level to be defined; 6)collaborating with VAAC to document and disseminate the standard
operating procedures (SOPs) of the national system according to good pharmaceutical practice (GPP); and,
7) collaborating with VAAC in the design and implementation of a drug management information system
(DMIS) that collects site-level data and makes the information available to VAAC, PACs, sites, and other
stakeholders.
The second goal centers around continuing to improve quantification, procurement, and fund the storage
and distribution of HIV/ AIDS commodities supported through PEPFAR by: 1)stream-lining the quantification
process by moving from morbidity-based forecasting to consumption-based forecasting while continuing to
prepare routine forecasts and supply plans using SCMS tools and methods; 2) procuring PEPFAR-funded
HIV and AIDS commodities using SCMS' procurement system; 3) improving the speed of the importation of
commodities; 4)funding the storage and distribution of HIV and AIDS commodities for PEPFAR and Clinton
HIV/AIDS Initiative (CHAI); 5)continuing to support and monitor the management and dispensing of HIV
and AIDS commodities at ARV sites and CPC#1 to prevent stock-outs or expiration of products, while
transitioning this function to VAAC. Activities will continue to include training of dispensers at adult, pediatric
and PMTCT sites to ensure compliance with storage, handling, and reporting procedures, and to support
dispensers to promote patient adherence to medicine.
Continuing Activity: 15341
15341 9381.08 U.S. Agency for Partnership for 7118 5175.08 $11,650,000
9381 9381.07 U.S. Agency for Partnership for 5175 5175.07 Supply Chain $10,404,000
Program Budget Code: 16 - HLAB Laboratory Infrastructure
Total Planned Funding for Program Budget Code: $6,251,683
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
PROGRAM AREA SETTING
Strengthening Vietnam's laboratory infrastructure, to support sustainable HIV/AIDS related activities, continues to be a priority for
PEPAR. In Vietnam most laboratory support is directed through government institutions such as the Vietnam Administration for
HIV/AIDS Control (VAAC), the national HIV/AIDS coordinating body, and LIFE-GAP, its implementing arm. Support includes
procurement of equipment/commodities, development of quality assurance programs, and human capacity development through
training and technical assistance. In FY09 the PEPFAR laboratory program will also target three major initiatives: development
and implementation of a national laboratory strategic plan, evaluation of HIV rapid tests to serve as the foundation for a national
algorithm and expansion of laboratory information systems (LIS).
PEPFAR Vietnam continues to advocate to the MOH and VAAC, for a tiered, integrated laboratory network which provides
efficient service delivery across various levels of the public health system, as outlined in the 2008 Maputo Declaration and the
resulting report. This goal can best be reached through the development of a national laboratory strategic plan (NLSP). Unlike
most other PEPFAR-supported countries, well-equipped public health laboratories exist in Vietnam, which if appropriately linked
and supported by partners, are well situated to support the country's efforts to prevent and control the most common epidemic
diseases. Numerous international partners are eager to contribute to aspects of Vietnam's laboratory health system. A well-
designed NSLP will maximize resources and coordinate efforts in a setting where there is a shortage of skilled laboratory
personnel. A well-conceived laboratory plan should address national laboratory policy, quality assurance programs, and
standardized training / testing. Successful programs require early establishment and on-going reinforcement of local referral
networks both within and among implementing partners. These local networks provide the support structures for a country's
national network of tiered laboratory services and an efficient mechanism for referral of complex testing and validation of new
technologies or testing algorithms.
The groundwork for a strategic plan was laid in late 2007 when PEPFAR Vietnam and CDC's International Laboratory Branch
collaborated with the Vice Minister of Health and the Vietnam Administration for Medical Services (VAMS) to support the
development of both a steering committee and an international group of donors and technical assistance providers. To date a
steering committee, with a mandate from the Ministry of Health, has been formed. It is chaired by the Vice Minister of Health and
includes representation from appropriate government institutions. With support from PEPFAR and TA from the Association for
Public Health Laboratories (APHL), a draft strategy has been completed; this will be completed and approved in the coming
months. In FY09 PEPFAR will continue to provide resources (funding and TA) for implementation of initiatives outlined in the
strategic plan.
As in other countries affected by HIV, diagnostic testing continues to be the major entry point for care and treatment and relies on
a standardized, quality assured testing program. However, this does not currently exist in Vietnam, as recently acknowledged by a
September 2008 OGAC Adult Treatment TWG TA visit to Vietnam. HIV rapid tests are used throughout Vietnam, however there is
not a single national HIV testing algorithm utilizing simple, rapid HIV tests. In general, WHO strategy III is used with tests
administered in a serial fashion. However, clients visiting VCT, PMTCT and TB facilities do not receive test results during a single
visit (usually, screening tests are conducted at one location, typically a rapid test, and confirmatory testing, usually EIA, is
performed at a second facility). Results are provided back to clients after seven days. Tests within this algorithm are not
standardized, are regularly changed and test product sensitivity and specificity is not considered when selecting a test for
screening or confirmation. Such an environment does not allow for standardized training of laboratorians, adequate time for
laboratorians to develop proficiency in performing tests and development of a quality assurance program. To highlight the critical
importance of this issue WHO (with PEPFAR support) held a regional meeting on HIV testing in Hanoi in August 2008. The
resulting report, Guide to Scaling-up Sustainable Quality HIV Testing in the Western Pacific Region, will be published in early
2009. PEPFAR is also supporting Vietnam in the evaluation of HIV rapid test kits, using internationally accepted guidelines. This
evaluation will be structured to allow for participation from all relevant stakeholders both inside and outside the government of
Vietnam and will serve as a tool for building trust for the use of HIV rapid tests and consensus for a single national algorithm.
During FY08 an evaluation protocol was developed and approved by the government of Vietnam and CDC-IRB; phase I of the
evaluation is due to start in early 2009.
Over the past three years PEPFAR has been engaged in strengthening both paper-based and computerized laboratory
information systems (LIS), in partnership with VAAC, Ho Chi Minh Provincial AIDS Committee (HCMC PAC) and APHL. A solution
was sought that would take advantage of the unique opportunity of strong information technology in Vietnam's private sector and
the rapid uptake of computer technology in general, while at the same time taking into account long term cost, sustainability and
lack of technical and human infrastructure in laboratories. A US-developed, open source LIS package was selected due to its
flexibility. It was locally customized for Vietnam through a collaboration of three state public health laboratories, with assistance
from APHL and a local Vietnamese IT company. A pilot of the resulting LIS package in 2008 at two sites (Hanoi and HCMC) was
successful due to the availability of software expertise in-country, the non-dependence on proprietary tools and the empowerment
and engagement of MOH in the implementation process. In September 2008 PEPFAR Vietnam hosted the Second Global LIS
Meeting. Holding this meeting in Hanoi allowed laboratory staff from various provinces and national institutes to participate in
discussions related to a long term strategy for information systems in laboratory settings in Vietnam and learn how other PEPFAR
programs are working to incorporate information systems into routine laboratory functions. The LIS is currently being rolled out to
4 additional sites.
Additional laboratory accomplishments include support for the enhancement of laboratory capacity at 46 facilities offering HIV
diagnostic and ART monitoring tests (CD4 and/or lymphocyte count). 485 trainings were delivered to laboratory staff working in
these and other health care facilities. Support was provided through PEPFAR to conduct 570,000 laboratory tests related to HIV
diagnosis, care and treatment monitoring (including TB, STI and OI). TA was provided to create guidelines for CD4 determination
and a CD4 quality assurance laboratory network model were developed to improve the accuracy of CD4 testing. Instrumentations
were procured by PEPFAR for placement in six labs. The first external quality assurance program was created at NIHE to support
HIV serology testing in all 64 provinces of Vietnam; to date three rounds have been distributed and customized software is used to
capture / analyze data. To alleviate the scarcity and improve the quality of medical laboratory scientists in Vietnam, PEPFAR
supported initiation of a mentorship program for new medical technologists. The laboratory program also assists host government
partners with identifying and interviewing qualified laboratory staff to oversee national laboratory activities. SCMS continues to be
a strong partner for procurement of laboratory instruments and reagents, particularly for CD4. Their role in Vietnam is different
from that in other countries; they provide TA for instrument placement/training and provide regular site visits to ensure instruments
are correctly used and maintained. PEPFAR continues to strengthen the diagnostic capacity for STIs and TB at supported
laboratories through training. PEPFAR also continues to support Vietnam with TA to fully develop its PCR and sequencing
capacity in Hanoi and HCMC for early infant diagnosis and drug resistance monitoring programs.
While Vietnam does have well equipped laboratories and a functioning specimen transfer system there are numerous challenges.
A MOH policy for HIV testing is lacking, as discussed above. There is not a strong, fully functional laboratory with a clear mandate
from the host government to serve as a National Reference Laboratory. There is no single supervisory body for managing all HIV
associated laboratory practices and standardized implementation of policies. New medication assisted therapy (methadone), for
many HIV positive individuals, has increased the demand for laboratory services. Lead times for laboratory related activities are
often long due to lengthy and complex approval processes within the government of Vietnam. Many laboratories lack sufficient
staff or have staff that is not sufficiently trained. Vietnam is still in the process of transferring HIV diagnostic laboratories at
Preventive Medicine Centers (PMC), within existing health facilities, to newly created Provincial AIDS Centers (PAC) which are
focused specifically on HIV activities. This has resulted in unanticipated expenses for procurement of additional equipment and
provision of training for new personnel. Most laboratories lack Standard Operating Procedures (SOP) resulting in inconsistent
monitoring and evaluating of quality of testing.
The strategy for PEPFAR's laboratory program in COP09 includes support for building a unified, sustainable system, improved
technical capacity and enhanced human capacity. PEPFAR will continue to promote a quality management model for laboratory
programs in Vietnam; this will be clearly outlined in and guided by the finalized NLSP. Though working through government
institutions can be challenging and time consuming, changes in policies and practices at this level will lead to sustainable results.
To alleviate the shortages of qualified laboratorians PEPFAR will continue to adapt and deliver training packages in the areas of
HIV diagnostics and ART monitoring (CD4, biochemistry, hematology, TB, STI and OI). Efforts will also be made to upgrade the
quality of training provided to students studying for medical laboratory degrees (Pre-Service) through new training standards
(outlined in NLSP) and through a curriculum improvement program provided by American Society for Clinical Pathology (ASCP) to
one strategically located university in Vietnam. Training packages for laboratorians currently in service will be updated for AFB
smear microscopy (tuberculosis) using the recently published WHO/CDC generic package and for OI diagnostics through support
from CDC-Thailand and American Society for Microbiology (ASM).
Two facilities in Vietnam are currently conducting TB liquid culture; PEPFAR will support TA, through ASM, to ensure that the
infrastructure of these laboratories and staff training meets internationally recommended standards for safety.
By the end of COP09, the LIS will be operational in approximately 20 sites with both VAAC and HCMC PAC taking responsibility
for defining and implementing the plans for scalability, maintenance, support and training. Recently identified needs will be
addressed; these include standardized laboratory data forms and improved paper-based systems to define minimum data
collection at all laboratories. Laboratory instruments will be interfaced directly with LIS computers to reduce data entry errors and
there will be a focus on systems integration with linkages supported between VCT and HIV care and treatment software and LIS.
Once fully functional, LIS will allow for real-time, accurate monitoring of PEPFAR supported sites nationally. Due to the low cost
associated with open source systems, sites not supported by PEPFAR could possibly adopt it as well.
The PEPFAR laboratory program will continue to function as a cross-cutting technical group, lending support to other technical
groups within PEPFAR including SI, VCT, PMTCT, treatment and TB/HIV. The laboratory program is primarily staffed by four CDC
laboratorians. These consist of the following, with listed responsibilities: one direct hire provides program leadership; one locally
hired staff, with prior experience working within the MOH laboratory program, provides invaluable insight into the functioning of
various government institutions and processes; one contractor, with US-NIH experience, supports quality assurance programs
(example: SOP development/implementation); and a second contractor focused on LIS and laboratory data management. This
PEPFAR laboratory team works in close coordination with the part-time laboratory focal persons from the other USG agencies
(USAID and DOD). An additional CDC locally employed staff based in HCMC provides part-time support for laboratory activities
based in the southern portion of the country.
The National Institute for Hygiene and Epidemiology (NIHE) will continue to be the focus of many HIV related activities; however,
the Pasteur Institute (PI) in HCMC will be brought on as a new PEPFAR laboratory partner and will also provide support for many
of these activities. PEPFAR will also continue to build capacity with other MOH laboratory institutions which already have strong,
unique capacities. Some of these include National Institute for Infectious Tropical Diseases (NIITD) for CD4 EQA, Bach Mai
Hospital for microbiology and OI EQA, National TB Hospital for TB training and QA and National Institute for Dermatology and
Venereology (NIDV) for STI training.
The PEPFAR Vietnam laboratory program will continue to seek opportunities to coordinate with other donor and international
agencies fighting the HIV epidemic in the region. Two current examples of this collaboration include a co-sponsored meeting and
publication on HIV testing with WHO (discussed above) and coordination of CD4 training and DNA test kit donations from Clinton
HIV/AIDS Initiative.
In FY09 laboratory support will be extended to 54 additional laboratories for a total of 100, covering about two third so the
provinces of Vietnam. Training programs will be significantly ramped up (900). An estimated 1,150,000 tests related to HIV
diagnosis, care and treatment monitoring will be supported.
Table 3.3.16:
This is a continuing activity.
The Supply Chain Management System (SCMS) will support procurement of CD4 instruments, test
reagents and maintenance of instruments. SCMS will also conduct regular monitoring visits to sites and
provide technical assistance to staff at all supported sites.
Continuing Activity: 16989
16989 16989.08 U.S. Agency for Partnership for 7118 5175.08 $100,000
