PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
ABT ASSOCIATES 100% CUP GUIDANCE AND CURRICULUM DEVELOPMENT; 100% CUP
IMPLEMENTATION IN AN GIANG: $100,000
The 100% Condom Use Programs (100% CUP) piloted in Vietnam have been largely project-based, with
major challenges achieving the principle of "no condom, no sex". While guidelines for the Vietnam "National
Condom Promotion Program" will be launched in 2008, these emphasize general outreach and
communication for HIV prevention at entertainment establishments (EE) including karaoke shops, massage
parlors and saunas. Following guideline development, practical guidance materials and a training
curriculum for 100% CUP targeting EE is essential to support correct and consistent condom use among
sex workers and their clients. Through this activity, Abt Associates will assist the MOH to develop national
guidance and a training curriculum for HIV prevention through implementation of the 100% Condom Use
Program. Abt will provide technical assistance to VAAC, relevant ministries and institutions to review
existing initiatives in Vietnam and other countries, to draft national guidance and a training curriculum for the
100% CUP targeting EE, and to field test them. The activity contains three components:
1. Abt will support VAAC to review existing 100% CUP initiatives at EE to identify models for
implementation. Abt will support sharing of experiences among stakeholders to raise their awareness on
100% CUP implementation. Concerned ministries such as MOPS and MOLISA as well as other
stakeholders will be involved.
2. Abt will facilitate a VAAC lead working group to draft national guidance on implementation of the 100%
CUP targeting EE (including supervision and monitoring tools) and a training curriculum. They will provide
technical assistance for this and to accelerate implementation of national condom promotion guidelines
launched in 2008. The development of tools for supervision and monitoring of the 100% CUP
implementation will be an integral part of this process.
3. Abt will field test the draft guidance materials and training curriculum in selected provinces, particularly in
An Giang where PEPFAR supports a 100% CUP pilot. Draft national guidance and a training curriculum will
be completed through COP 09 support. Abt will also guide field testing in conjunction with EE owners, law
enforcement and health program implementers. Following field testing, Abt will lead revision of the
materials, incorporating supervision and monitoring tools.
The 100% CUP is an integral part of the PEPFAR Vietnam 5-Year Strategy and comprehensive ABC HIV
prevention programs. Whereas many outreach programs target either sex workers or potential clients, the
100% CUP is uniquely positioned to join these facets together with the explicit cooperation of law
enforcement, health authorities, and other stakeholders. This collaboration assists the PEPFAR team to
reach planned FY 09 targets not only through outreach, but by reducing the fear or arrest and stigmatization
that causes sex workers and clients to avoid health seeking behaviors.
While supporting development of 100% CUP guidance and curriculum, Abt Associates will maintain and
expand operation of a PEPFAR pilot 100% Condom Use Program in An Giang, targeting vulnerable groups
with emphasis on direct sex workers and potential clients. The 100% CUP will be implemented through a
provincial partnership among police, health and local authorities, establishment owners and sex workers; it
will be linked to ongoing HIV and STI services. In An Giang the program is founded on: a) an MOU for
100% condom use signed by partner agencies; b) establishment of a provincial management unit including
the Provincial TB and HIV Center and law enforcement; c) elaboration of a strategic plan with
responsibilities, targets, and M&E components; and d) a regular reporting schedule.
Populations targeted include sex workers and their clients, traditionally marginalized by law enforcement
and social standards. To effectively reach these often hidden populations, Abt Associates will develop a list
of venues to ensure adequate coverage. Teams of community representatives and police will be trained to
liaise with target venues and will be responsible for monitoring and ensuring the compliance with the
program. Stakeholders will receive training on condom use and 100% program guidelines and provisions.
Review of existing condom distribution networks and establishment of additional distribution networks will
be coordinated with the PEPFAR condom social marketing partner, PSI. IEC activities for clients and sex
workers will promote use of condoms in commercial sex and use of condoms with non-commercial sex
partners. Finally, incorporation of STI services into the program will highlight the role of STI workers and
physical examinations for sex workers and—if appropriate—contact tracing to ascertain the sources of the
infection and provide information to direct prevention efforts.
Number of targeted condom service outlets: 30
Number of individuals reached through community outreach that promotes HIV/AIDS prevention through
behavior change other than abstinence and/or being faithful: 3,000
Number of Individuals trained to promote HIV/AIDS prevention through behavior change other than
Abstinence and/or being faithful: 200
ABT ASSOCIATES POSITIVE PREVENTION: $224,265
Abt Associates will lead ongoing PEPFAR support for MOH positive prevention programming in Vietnam.
FY09 funding will support continued refinement of the current positive prevention training module developed
by Constella Futures, and to support a core of 200 PLWHA trainers employing positive prevention
messages. Training will be provided to 3,500 people to promote HIV prevention messages and 8,000
PLWHA will be reached.
In collaboration with PLWHA groups, 200 PLWHA trainers will refine the existing positive prevention training
module to promote behavior change communication (BCC) through skills-building to adopt safer behaviors
employing a range of prevention methods including correct, consistent condom use. The module teaches
life skills, counseling (including referral for addiction treatment), and will address difficulties faced by
women, and male norms and behaviors. Specific interventions will address HIV re-infection and provide
support for PLWHA by providing clear referrals to the network model in PEPFAR focus provinces.
The module will be used by the core group of 200 PLWHA prevention trainers. Drawn from existing PLWHA
Activity Narrative: groups, including Bright Futures, trainers will conduct workshops to build capacity among members of
multiple PLWHA groups from each of the original 7 PEPFAR focus provinces. This will also boost local
organizational capacity as well as development of networks, linkages and referral systems. Trainers will
establish relationships with other service providers, including VCT and outpatient clinic (OPC) sites, to
enable mutual referral among trainers and service providers. The 200 PLWHA prevention trainers will hold
workshops for PLWHA groups and other service providers in intervention provinces. Three workshops in
each province (total 21) will train 3,500 participants to teach PLWHA abstinence or faithfulness or correct
and consistent condom use as appropriate, establish condom outlets, and mobilize communities to promote
safer behaviors. Condoms will be provided to groups and individuals as a component of the training on a
regular basis. A component of this activity will link with other PEPFAR prevention activities to ensure that
PLWHA groups are provided with regular and adequate supplies of condoms.
Number of targeted condom service outlets: 60
behavior change other than abstinence and/or being faithful: 8,000
Abstinence and/or being faithful: 3,500
ABT ASSOCIATES 06 PARTNERS: $108,000
This is a continuing activity, however the program has been removed from the Pact scope of work, and
added to this mechanism to reduce overhead costs. The program is split funded between HVOP and IDUP.
FY 09 funding will support the third year of program implementation, improvement and refinement of
program activities.
Abt Associates will continue to prevent the spread of HIV/AIDS to female and male sexual partners of drug
rehabilitation center (06 center) returnees in 4 Hanoi districts. Abt developed the program in Hanoi, working
with partners ISDS, the Hanoi Women's Union, DOLISA, the Hanoi Provincial AIDS Center, police and
others. Recruiting a project coordinator and four district coordinators, Abt trained peer educators and
engaged participants in Hanoi's Long Bien, Hai Ba Trung, Dong Da, and Hoang Mai districts. Participants
(primary sexual partners of returnees from and residents of rehabilitation centers and prisons) were invited
to individual confidential interviews and have blood drawn for HIV rapid test. HIV positive participants have
been referred to free HIV care and treatment services.
With FY 09 funding Abt will ensure that all program participants, regardless of HIV status, will benefit from
peer outreach, focus groups, psychological counseling and behavior change communication that provide
individuals and their sexual partners with comprehensive ABC messaging and the motivation, skills, and
commodities needed to adopt safer behaviors. Through the program, outreach workers will continue to
address male and female behavioral norms and stress messages that spouses/sexual partners of former 06
center residents have the right to refuse sexual relationships and that should they decide to engage in
sexual activity, correct and consistent condom use is vital. Using individual- and couple-oriented
approaches, outreach workers help partners negotiate the adoption of safer sexual practices, and provide
drug use prevention and risk-reduction education. Center releasees, their primary partners (who may also
be current/former drug users), and family members will continue be provided with referrals to the full range
of HIV/AIDS services in Hanoi, including counseling and testing, substance abuse treatment, HIV/AIDS care
and treatment, PMTCT, and care and support services for infected/affected children.
Number of targeted condom service outlets: N/A
behavior change other than abstinence and/or being faithful: 1,500
Abstinence and/or being faithful: 50
New/Continuing Activity: Continuing Activity
Continuing Activity: 19469
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
19469 19469.08 U.S. Agency for Abt Associates 8674 8674.08 HPI - Vietnam $250,000
International
Development
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $200,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.03:
06 PARTNERS: $100,000
This is a continuing activity, however in FY09 the program has been relocated from a sub agreement under
the Pact scope of work, and added to this new direct mechanism with Abt to reduce overhead costs. The
program is split-funded between HVOP and IDUP. FY09 funding will support the third year of program
implementation, improvement and refinement of program activities.
Abt will continue to prevent the spread of HIV/AIDS to female and male sexual partners of drug
rehabilitation center (06 center) returnees in 4 Hanoi districts. Abt originally developed the program in
Hanoi, working with partners ISDS, the Hanoi Women's Union, DOLISA, the Hanoi Provincial AIDS Center,
police and others. Recruiting a project coordinator and four district coordinators, Abt trained peer educators
and engaged participants in Hanoi's Long Bien, Hai Ba Trung, Dong Da, and Hoang Mai districts.
Participants (primary sexual partners of returnees from and residents of rehabilitation centers and prisons)
were invited to individual confidential interviews and have blood drawn for HIV rapid test. HIV positive
participants have been referred to free HIV care and treatment services.
With FY09 funding Abt will ensure that all program participants, regardless of HIV status, will benefit from
prevention of drug use: 1,500
Number of individuals trained to promote HIV/AIDS prevention through prevention of drug use: 50
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $40,000
Table 3.3.06:
Health Policy Initiatives was re-competed in 2008. The awardee will begin to develop the work plan in
October 2008 after which more precision will be know regarding the following planned activities.
PEPFAR will support the Health Policy Initiative Vietnam program to implement four activities in this
program area: continue support to the HIV/AIDS legal centers that were set up in 2005-2008; strive to
improve consistency between the HIV/AIDS-related laws and policies and their implementation through out
the country; continue to build the capacity PLHA groups and other CSOs; and monitor the implementation of
the HIV/AIDS-related laws in provincial plans.
Activity 1: Bring consistency to HIV/AIDS-related laws and policies and their translation into comprehensive
programs throughout the country.
The 2008 revision of Vietnam's drug law decriminalized drug addiction, but did not fully legitimize the risk-
reduction measures called for in the HIV/AIDS law. This inconsistency represents a significant obstacle to
scaling up these interventions. HPI will conduct a review of remaining inconsistencies between the 2008
revision of the drug control law and HIV/AIDS laws, decrees, and plans, a review that will identify specific
examples of problems posed for program implementers. The team will ensure that the implications of the
inconsistencies are understood by means of media interviews, public meetings, and targeted awareness-
raising sessions aimed at influential individuals. The HPI team will work closely with partners in GVN and
CSOs, to draft a model law and/or proposed revision language to achieve consistency across these
instruments (e.g., by incorporating appropriate attention to community-based strategies and reducing
reliance on 05/06 centers). The line-by-line comparison analysis and model, or proposed revised language
will be shared with all relevant government agencies (e.g., VAAC, MOLISA, MPS, as well as the National
Assembly, Party bodies, and other stakeholders [e.g., CSOs, UNODC, UNAIDS]). HPI will convene a high-
level meeting to review the proposed revisions. The team will also ensure that the Ho Chi Minh National
Political Academy training includes discussion of the inconsistencies and their implications, and will share
legal and other remedies for correcting them. The expected result of this activity is to improve the
consistency among the drug control law and the HIV/AIDS law, implementing decree, VAAC risk-reduction
plan, and provincial HIV/AIDS plans. The expected results of this activity will be greater consistency among
the drug control law and the HIV/AIDS law, implementing decree, VAAC risk-reduction plan, and provincial
HIV/AIDS plans.
Activity 2: Build the capacity of PLHA groups and other CSOs.
The network of PLHA groups in Vietnam is expanding and gaining in influence, with about 60 such groups,
representing more than 4,000 members. Bright Futures has 6 core groups in 18 provinces and 1,000
members; the COHED-supported Hope Network has 20 groups in 10 provinces and also 1,000 total
members. These groups provide support to PLHA, disseminate information and referrals for treatment, and
engage in advocacy to reduce stigma and discrimination. To help PLHA groups build their leadership ranks
and gain their full potential will require (1) improving the process for gaining official recognition; and (2)
developing groups' capacity to conform to this process and establish themselves as full-fledged
organizations. As one of the leading CSOs serving PLHA, HPI partner COHED is especially well placed to
convene on behalf of the team a high level meeting with MOLISA, the Ministry of Home Affairs, VAAC, the
National Assembly, Communist Party entities, leaders of PLHA groups, and the HIV/AIDS Vietnam Action
Group (HAVAG, a coalition of CSOs), to review registration procedures and solicit specific suggestions for
their revision. The meeting would be a vital first step toward convening a drafting group to develop a
detailed policy. Through weekly meetings of the working group and consultations with government officials
the HPI team will have facilitated the drafting of a proposed policy specifying revised registration
procedures. The Abt team will then hold a national training session to present registration requirements
(summarized in an easy-to-read "Ready Reference") and outline their implementation requirements. To
expedite registration, the team will prepare template application and supporting materials for PLHA and
other groups. HPI will provide technical assistance (TA) to organizations seeking to gain registration.
Only once PLHA and other groups are "made visible" by gaining legal recognition can capacity building
efforts have significant and enduring impact. HPI will build the capacity of PLHA groups, encouraging their
expansion into underserved locations, and helping them establish their presence and services there. Many
MARPs (IDUs, sex workers, and men who have sex with men [MSM]) neither access health care nor
participate in advocacy efforts for fear of being identified and mistreated. Drawing on its experience and
contacts working with MARPs on HIV prevention, the HPI team will reach these groups and engage them in
services and encourage and assist them to form advocacy organizations of their own. MARP-based NGOs
could become effective advocates for HIV/AIDS-related services and powerful forces against stigma and
discrimination. HPI will develop tailored strategies for organization of MARPs groups, drawing on examples
of effective NGOs in other countries founded by IDUs, sex workers, and MSM. HPI will work with the
founders of the MSM listserv recently established in Hanoi to assess their potential to become the basis of
an MSM NGO. Through its ongoing work, HPI is approaching and helping to organize groups of sexual
partners of IDUs now in 06 centers and prisons in Hanoi and recently released from them, and we will
expand these efforts to other locations. In addition to assisting MARPs-based NGOs (as well as PLHA
groups) in obtaining government registration, the project will offer small seed grants (e.g., $2,000) to such
organizations, helping them apply for registration and build their management capacity. By designing and
providing regional training sessions for PLHA and other groups to develop personnel, management,
budgeting, and accounting procedures, the project will equip nascent NGOs to operate independently. It will
provide customized training in proposal preparation and fundraising, so that PLHA and MARPs groups are
able to solicit and respond to available funding opportunities. This activity will work towards establishing a
simplified and codified registration policy for NGOs and registering and launching at least one IDU, SW or
MSM NGO. HPI will also train key staff of all PLHA groups in fundraising.
Activity 3: Offer quality legal aid to adults and children facing stigma and discrimination.
HIV/AIDS related stigma and discrimination act as barriers to prevention, treatment, and impact mitigation
services. HIV/AIDS-affected children face special difficulties in accessing education and health care. HPI
will focus on expanding the staff and capacity of existing HIV/AIDS legal clinics (adding attorneys and
advocacy case managers, with preference for PLHA), increasing responsiveness, enhancing case-finding
Activity Narrative: and raising awareness about legal clinics and hotlines through leaflets, targeted media, and encouragement
of referrals by VCT centers. These activities are designed to ensure that parents, teachers, and other adults
know how to recognize discrimination against children and whom to contact for assistance. The HPI team
will further build capacity for legal assistance by working with the Vietnam Lawyers' Association, American
Bar Association (ABA) Rule of Law Initiative, law schools, and other stakeholders to provide training and
clinical placements for lawyers, law students, advocacy case managers, and judges. HPI will provide
training on international human rights law affecting PLHA and all staff will be trained to ensure that all
contacts with clients and all client records remain confidential.
Activity 4: Monitor implementation of the HIV/AIDS law and provincial plans.
Until now, the multisectoral coordinating bodies for HIV/AIDS established by national and provincial
governments have not monitored the implementation of laws and provincial plans. To strengthen local
monitoring capacity, the HPI team will work to develop and field auditing tools to assess implementation of
the national HIV/AIDS law and implementing decree, as well as provincial HIV/AIDS plans. We will target
the HCMC PA's network of 500 provincial leaders, interviewed for the evaluation of the HCMNPA training in
2007, to serve as respondents for proposed surveys on implementation of HIV/AIDS law and provincial
plans. These data will provide the basis for "report cards" on the progress of implementation and the
performance of multisectoral coordinating bodies. Report cards will summarize the volume of key activities
(condom promotion, peer outreach/education, and other interventions for MARPs) and services provided
(number of persons receiving ART), and levels of funding from different sources to gauge the extent of
reliance on international donors and/or sustainable funding). These report cards will illuminate the progress
of work being conducted under the auspices of the multisectoral coordinating bodies and spur the
committees to action by holding them publicly accountable. HPI will work with individual provinces to identify
strategies for improving coordination and will develop six-month remediation plans. An important policy
advance will be to empower multisectoral bodies to make binding decisions on budget and staff allocations.
Annual report cards will be produced and disseminated on implementation of provisions in national
HIV/AIDS law and provincial plans.
Continuing Activity: 19473
19473 19473.08 U.S. Agency for Abt Associates 8674 8674.08 HPI - Vietnam $420,000
Table 3.3.08:
October 2008 after which more will be known regarding the following planned activity.
IMPROVING STRATEGIC PLANNING FOR OVC
PEPFAR will support the Health Policy Initiative Vietnam program to implement one activity in this program
area. One of the biggest challenges in addressing the issue of OVC related to child welfare and adoption in
Vietnam is that no one knows how many children are currently in orphanages, how many of these children
are orphans (double or single, as opposed to children left in care), how many have special needs (HIV+ or
disabled), etc. MOLISA will be supported to obtain this basic data and to update records leading to more
effective planning and policy related to child welfare and appropriate action for OVC. To achieve this, there
have been preliminary discussions regarding on regular data collection potentially to be conducted through
sub-award with IOM in the orphanages. IOM would send a monitoring form to each orphanage, and then
follow up by telephone to verify and compile the data. The work plan will formalize the project description
for this activity.
Given that HIV in Vietnam is concentrated among highly marginalized populations (IDU, MSM, FSW) ,
stigma and discrimination associated with the epidemic impacts both the lives of the PLWHA as well as their
children. The HPI team will lead strategic information activities on stigma and discrimination against
PLWHA and their children and AIDS orphans. The team will develop data collection tools for monitoring
trends in HIV-infected and -affected children including tracking incidents and characteristics of HIV/AIDS-
related discrimination against adults and children in Vietnam, and associated numbers of cases receiving
legal assistance. Data will be collected from legal assistance clinics, as well as from provincial AIDS
centers, PLHA groups, and other NGOs. Findings will be aggregated into summary reports, which will be
disseminated by the project to legal assistance teams, government, donors, and CSOs and the project will
facilitate their use in program planning and monitoring of progress in this critical area.
Continuing Activity: 19474
19474 19474.08 U.S. Agency for Abt Associates 8674 8674.08 HPI - Vietnam $70,000
Program Budget Code: 14 - HVCT Prevention: Counseling and Testing
Total Planned Funding for Program Budget Code: $5,341,267
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
PROGRAM AREA SETTING
The concentration of HIV infection in marginalized and hard-to-reach populations in Vietnam calls for a targeted approach to bring
HIV counseling and testing services to high-risk individuals without enhancing stigma and discrimination. An epidemic of injecting
drug use continues to be the primary driver of the HIV epidemic in Vietnam, and the Ministry of Health (MOH) estimates that more
than 60% of all HIV infections are among injecting drug users (IDU). PEPFAR-supported behavioral and biological surveillance
(IBBS) has documented HIV prevalence rates as high as 65% among IDU in at least one PEPFAR focus province (Hai Phong-see
uploaded Geographic Coverage document), and has revealed that injecting drug use is likely the most important driver of new
infections among sex workers and other high-risk populations. For example, sex workers who report injecting are three to 30 times
more likely to be infected with HIV than those who do not, and the prevalence of injecting among sex workers is a strong predictor
of overall HIV prevalence in this population. Although UNAIDS estimates that HIV prevalence in the general adult population is
0.5%, an estimated 20% of IDU and 4% of commercial sex workers (CSW) are infected with HIV. Reliable national HIV
prevalence estimates are not currently available for men who have sex with men (MSM) in Vietnam, but PEPFAR-supported
behavioral surveillance has documented HIV prevalence rates of 9% among MSM in Hanoi and 5% in Ho Chi Minh City. The next
round of this surveillance will be expanded to include MSM in other provinces. Other populations facing elevated infection risks
include clients of sex workers, sex partners of HIV-positive persons, and street and vulnerable youth.
Concerns about stigma and discrimination amongst members of most at-risk populations (MARPs) in Vietnam have been further
amplified in recent years by large-scale government campaigns to curb drug use and sex work. As a result, members of high-risk
populations have become increasingly hard to reach, and report a common reluctance to seek needed services out of fear that
they will face stigma and discrimination from health care and other service providers.
In the initial "emergency" phase of USG support to address HIV/AIDS in Vietnam, PEPFAR has established 81 service sites and
trained more than 2,000 healthcare workers to provide HIV counseling and testing (CT) services. The fact that HIV prevalence is
higher than 20% among the 250,000 individuals who have received counseling and their HIV test results through PEPFAR
support suggests that the program may have had some success in targeting MARPs. However, it is also likely that this high
prevalence reflects the fact that many individuals do not seek services until they suspect they are infected and need HIV care and
treatment. A review of routine program data demonstrates that only a small percentage of the individuals reached through
PEPFAR-supported peer outreach programming have actually received CT services. In addition, based on existing MARPs size
estimates in Vietnam, it is unlikely that more than 15% of those individuals most likely to be infected with HIV in Vietnam have
ever benefited from CT services.
Recognizing the essential role that targeted HIV counseling and testing can play both in reinforcing the adoption of safer
behaviors in high-risk groups, and as an essential gateway to HIV care and treatment services among those individuals with the
greatest needs, the government of Vietnam has made CT a priority and a key component of its national HIV/AIDS strategy. In
partnership with PEPFAR, the Global Fund, Marie Stopes International, and the World Bank, Vietnam has established CT
activities in 50 of its 64 provinces, with much of its focus on high-prevalence settings. A half-million people across Vietnam are
tested for HIV/AIDS each year, including those who are tested as part of sentinel surveillance efforts. In January 2007, Vietnam
issued national guidelines to standardize and govern CT practices across the country, and provider-initiated testing and
counseling (PITC) guidelines, specifically addressing CT practices at health care settings, are being developed with PEPFAR
support. A national CT training curriculum was approved in 2008 and is used in all CT training courses. Both anonymous and
confidential CT services are provided to target populations in all settings, and PEPFAR technical support for guidelines, training,
quality assurance, and quality improvement plays an important role in ensuring that these services are delivered with the three
"Cs" - consent, confidentiality, and client-centered counseling.
One of the most frequently cited barriers to bringing CT services more directly to high-risk and hard-to-reach populations in
Vietnam is the fact that the government of Vietnam has not yet adopted testing algorithms that allow the use of rapid tests for the
confirmation of positive HIV test results. Although an estimated 90% of clients return for their test results at PEPFAR-supported
sites, the continued reliance on laboratory testing results in a three- to seven-day waiting period, a potential barrier to the
development of outreach-based approaches that use rapid tests to bring CT services to MARPs and their partners and family
members in the community, in intervention hotspots, and before individuals enter late-stage infection.
However, the Vietnam team has developed and is currently piloting an innovative outreach approach using rapid tests that
provides immediate confirmation to individuals with sero-negative test results, and provisional findings and linkages to lab testing
and care and treatment services for individuals with sero-positive test results. This approach should result in dramatically
increased integration of CT into peer outreach-based programming for MARPs, with little additional investment in testing center
infrastructure. This model is being evaluated in FY08 and will be refined and expanded to other focus provinces where injection
drug use or commercial sex work is prevalent in FY09. In addition, the PEPFAR Vietnam team continues to work with the MOH
and the World Health Organization (WHO) to support the adoption of algorithms that provide for the use of rapid tests for the
purposes of confirming HIV infection. This includes high-level advocacy, hosting international experts and meetings in Vietnam,
technical advocacy, and support for an evaluation of rapid tests in Vietnam, which began in the 4th quarter of 2008. PEPFAR will
provide TA to conduct trainings on the roll-out of rapid testing. This past summer, PEPFAR and WHO co-hosted a regional
meeting on HIV testing in Vietnam during which the validation and adoption of rapid testing algorithms that do not require
laboratory-based confirmation was identified as a key regional priority.
Another key priority in ensuring access to CT services among MARPs in Vietnam is improving the linkages between these
services and targeted community-based prevention and care programs. The findings from Boston University's (BU) recently
completed evaluation of PEPFAR-supported peer outreach programs suggest that knowledge of the benefits of CT services and
HIV care and treatment services remains low among peer outreach workers. To improve the ability of these individuals to
persuasively influence their peers to seek CT services and to improve referrals, PEPFAR will work in conjunction with the MOH
and other donors to improve and harmonize peer educator training in this and other areas in FY09. Furthermore, outreach
workers will be trained to encourage MARPs to bring their injecting and sexual partners for CT, and the recent integration of
training for couples HIV counseling and testing (CHCT) into PEPFAR-supported CT services in all sites should support voluntary
disclosure of test results with partners and family members. Both the routine counseling training and the couples counseling
training in FY09 will be refined to provide improved risk-reduction counseling pertaining to both drug-related and sexual risks, and
to ensure referrals to both drug treatment and HIV services. PEPFAR will also strengthen the existing referral system at the
provincial level by refreshing the training of referral coordinators in PEPFAR focus provinces and creating opportunities for them
to share approaches and "best practices" through regular meetings.
Rather than attempting to expand to new provinces in FY09 in the face of fewer resources and rising costs, PEPFAR will focus on
improving coverage and quality of CT services in current PEPFAR focus provinces, as HIV prevalence is highest in these areas.
In addition to expanding the application of outreach-based approaches, priority will be given to integrating CT services in existing
MARP-friendly drop-in centers, including integration of prevention counseling, couples HIV testing and counseling, and support for
test result disclosure to sex partners and needle sharing partners, to improve uptake of CT and promote behavior change among
these key populations.
The expansion of access to provider-initiated testing and counseling (PITC) in key clinical settings is another local priority for
enhancing access to HIV prevention, care and treatment services among MARPs. With PEPFAR support, access to PITC has
been dramatically expanded in sexually transmitted infection (STI) and tuberculosis (TB) clinics, and will be integrated into
medication-assisted therapy (methadone) sites. Each of these settings serve clients who are more likely to be infected with HIV
than members of the general population, and the HIV prevalence among recovering IDU participating in the pilot methadone
program in Vietnam may be as high as 50%. Implementation of PITC at TB clinics began in 2006 and provides services to 40,000
patients annually. Implementation of PITC at STI clinics was initiated in five PEPFAR "focus" provinces in FY08 and is expanding
to two other focus provinces in FY09.
Addressing the concentration of HIV in the IDU and CSW populations is further complicated by the GVN's continued practice of
placing drug users and sex workers in custodial rehabilitation centers for periods of 18 months to four or more years. Currently, an
estimated 60,000 IDU reside in more than 84 centers nationwide; reliable data is lacking on HIV prevalence among center
residents but has been estimated as high as 70%. The further concentration of high-risk individuals in rehabilitation centers makes
these settings a high priority for service delivery, particularly given that the vast majority of centers only offer detoxification and
labor programs, with no formal drug treatment or HIV programming. Human rights concerns about the fact that many residents are
placed in centers with no judicial process, concerns about the risks of treatment interruption among individuals who may be
started on antiretroviral medications in centers but who will return to communities all across the country upon release, and
concerns about the sustainability of building infrastructure in centers that should rightly give way to more efficient and evidence-
based drug treatment models, have all presented the team with difficult and important challenges regarding expanded support.
PEPFAR is currently supporting a pilot program that provides HIV-related services to current and former residents of the Nhi Xuan
rehabilitation center. A formal evaluation of the program is underway, but it is clear from review of routine program data that in-
center HIV counseling and testing and OPC services are underutilized, and are not conveniently located to accommodate the
ongoing needs of clients post-release. With this in mind, PEPFAR has put mechanisms in place through prior reprogramming and
through the FY09 COP to support training and in-reach models using existing community-based OPC staff to bring much-needed
pre-release services - including CT services - to residents of five more centers without building additional center infrastructure,
and facilitating the continuity of care in the community upon release.
PEPFAR-supported CT social marketing programs have been expanded since their inception in 2005, with the aim of reducing
stigma related to testing and increasing demand for CT services among MARPs. In FY09 PEPFAR will continue to market CT
services to MARPs, their sexual and injecting partners, and clients of sex workers in coordination with organizations such as the
Vietnam Women's Union, the Vietnam Youth Union, and faith-based organizations. These recruitment strategies will help to
identify and provide opportunities for prevention in discordant couples. PEPFAR will work with PLWHA groups and will strengthen
linkages between CT and peer outreach programs through routine coordination meetings, sharing information to support
strategies to ensure HIV-negative partners do not seroconvert. Following national testing campaigns in FY07 and FY08, PEPFAR
will support Vietnam to promote a national testing month in 2009 to help reduce the stigma of HIV testing and encourage more
high risk individuals to seek CT.
With PEPFAR support, a standardized, Ministry of Health (MOH)-approved, computerized CT information system was adopted by
all CT providers. In FY09, PEPFAR will strengthen the current CT information system and link it to the laboratory information
system to ensure the smooth functioning of services and accurate reporting. For example, smart card or fingerprint recognition
technology will be used to facilitate entry into and movement between HIV service centers and to track referrals. Collection of
information for implementing, monitoring, and evaluating CT activities will meet national standards, ensuring that there are
integrated delivery systems, linkages across providers and programs, and routine information systems that support the national
monitoring and evaluation system. To support these efforts, PEPFAR will introduce external quality assurance (QA) training and
supervision for healthcare workers managing CT programs, will standardize training curricula and QA and quality control toolkits,
and will expand the use of client exit interviews in CT clinics in all focus provinces.
The PEPFAR CT team will also collaborate with the PEPFAR PMTCT team to incorporate care and treatment and PMTCT
services into antenatal sites, and with the laboratory team to improve the quality of laboratory training by and provide internal and
external laboratory QA and QC.
Recognizing the importance of providing CT to blood donors, the DOD will work with the Vietnam Ministry of Defense (MOD) to
integrate CT into the existing blood safety program. This program will serve not only military but also civilian population to
standardize CT at blood bank centers, and ensure that donors receive both their test results and appropriate counseling.
Table 3.3.14:
This is a continuing activity from FY08 with a new prime partner through the HPI mechanism.
A-Squared - Advocacy: $75,000
Triangulation Technical Assistance: $25,000
Human Capacity Development - SI Technical staff: $25,000
Data Use Workshop: $25,000
In FY09, Health Policy Initiative (HPI) will continue the Analysis and Advocacy (A2) project funded in FY05
to advocate for the use of available data to formulate appropriate responses to the Vietnam HIV/AIDS
epidemic. Using Ho Chi Minh City (HCMC) and Hai Phong as case studies, a model will be developed for
the use of information to inform HIV/AIDS policy development and resource allocation. With experience and
lessons learned from FY05, HPI aims to: 1) complete the development of the Goals Model and Asia
Epidemic Model interface and complete resource allocation analysis for Vietnam; 2) in collaboration with
Family Health International (FHI), present major outcome results by the end of FY06; 3) conduct workshops
in collaboration with FHI on the use of data from the integrated biologic and behavioral surveillance which
will provide updated findings on prevalence, behavior and coverage of the minimum package of services for
injection drug users, commercial sex workers, and men who have sex with men in the seven focus
provinces; 4) provide concrete programmatic implications to the USG team as well as to USG partners; 5)
collaborate with other international and local partners to continue supporting the Ministry of Health/Vietnam
Administration for HIV/AIDS Control (MOH/VAAC) in advocacy under the framework of A2 (this project will
utilize the strengths of both organizations for the appropriate use of data in policy-making and intervention
development); and 6) apply the A2 framework to advocacy activities in other focus provinces including
Hanoi, Quang Ninh, Can Tho and An Giang. The ultimate goal of this activity is to inform policy makers in
focus provinces and at the national level on the situation of the epidemic and resources needed to respond
appropriately and effectively to HIV/AIDS in Vietnam.
PEPFAR will support HPI Vietnam to ensure timely and accurate data used for evidence-based decision
making. The HPI team brings unique capabilities in using data to translate policy into action through
HIV/AIDS policy planning, budgeting, and program implementation.
In FY 09, PEPFAR will support HPI to continue Analysis and Advocacy (A2) project activities by focusing on
translating the results of studies and model applications into real policies, programs, and resource
allocations. Also, expanding the data resources to inform HIV/AIDS decision making. HPI will coordinate
with other PEPFAR efforts to address stigma and discrimination, develop/enhance existing tool kits to
include a gender assessment, activities and monitoring to support all partners in their ability to review their
programs through the gender prism, and to use resultant data and information to improve access to
services, especially for MARPs and PLHA.
Abt will aim to:
1) Expand the use of A2 (a tool for HIV/AIDS epidemic modeling and evidence-based policy advocacy) and
the GOALS model (for HIV/AIDS resource allocation) to other PEPFAR provinces beyond HCMC, to inform
planning and resource use based on numbers of infections averted and cost per infection averted.
2) Applying HAPSAT, which simulates national and provincial scenarios of breadth and depth of service
delivery coverage, to complements A2 and GOALS.
3) Develop more extensive modules on both A2 and GOALS to be added to the HCM National Political
Academy training curriculum to expand the potential reach of the tools to officials in the provinces.
4) Collect and create a comprehensive data repository to inform policy advocacy and recommendations for
program expansion and redeployment of resources. Summarize and distribute data in easy-to-use formats
to aid decision making.
5) Provide technical assistance to support province-level application of these enhanced strategic
information tools. The first priority will be 7 PEPFAR focus provinces.
6) Measuring Stigma and Monitoring Changes related to Stigma: Abt will establish a data collection system
for monitoring stigma reduction, focused on stigma faced by different
MARP groups, including gender-based stigma.gram.
Continuing Activity: 19475
19475 19475.08 U.S. Agency for Abt Associates 8674 8674.08 HPI - Vietnam $25,000
Table 3.3.17:
PEPFAR re-competed Health Policy Initiatives locally in 2008. The awardee will begin to develop the work
plan in October 2008 after which more precision will be know regarding the planned activities.
ACTIVITY 1: PEPFAR will support HPI to provide national and provincial leaders with skills to design
HIV/AIDS policies and programs. National capacity for developing and implementing HIV/AIDS policy has
increased significantly in recent years as a result of a highly successful training program run jointly by
Boston University and Ho Chi Minh National Political Academy (HCMNPA). Over the course of the first half
of the HPI Vietnam project, the training program is to be fully transitioned to the HCMNPA. The international
and HCMNPA faculty will team teach three-day workshops on HIV/AIDS policy and planning in focus
provinces. HPI provide uninterrupted on-the-ground support to the HCMNPA trainers, to strengthen their
capacity for an eventual transition away from external technical assistance. A policy and planning sessions
will be offered this year. Training will take place in provinces chosen in consultation with USAID, drawing
participants from People's Committees, multiple government sectors, Communist Party, and People's
Councils. Alumni of previous trainings will be invited to participate to discuss ways in which they have used
the training in their work. Shorter training sessions will be offered to high-level policy makers, including
officials of ministries, party bodies, and the National Assembly. In addition, HCMNPA will independently
conduct two three-day HIV/AIDS public policy training sessions. HPI will provide ongoing financial support
to the Academy to continue the training, once BU assistance ends, with technical support from the onsite
HPI team as needed. Expected results: Graduates of the policy training program incorporate analysis of
epidemiological data, current state of programs and cross-cutting themes of gender, GIPA, human rights,
and multisectoral response into their provincial HIV/AIDS plans. The BU/HCMNPA policy training program
will be successfully transferred to HCMNPA.
ACTIVITY 2: PEPFAR will support HPI to train journalists to report on HIV/AIDS accurately and fairly.
Building public literacy about HIV/AIDS requires that media professionals themselves have such literacy.
The HPI team will present journalist training to cover epidemiology, transmission, prevention, treatment, and
impact mitigation, with a focus on accurate media coverage and ending stigma and discrimination.
Internews, an expert media services specializing in training journalists on matters related to HIV/AIDS
stigma and discrimination, will develop and conduct the course which will help journalists understand the
effects of the "social evils" formulation and make the case for a policy shift toward community-based
substance abuse treatment and HIV prevention. The Abt team will also invite media representatives to
participate in the HCMNPA HIV/AIDS public policy training programs to improve their understanding of
appropriate and non-stigmatizing policies and programs
ACTIVITY 3: PEPFAR will support HPI to assist in certification for private providers to provide HIV/AIDS
care. An effective response to HIV/AIDS requires mobilizing all qualified professionals and facilities. Yet,
without defined standards and proper oversight, effective therapies may be misused, thus worsening the
epidemic. Stigma and discrimination within the healthcare system—including private providers—are also
major barriers to an effective HIV/AIDS response. The Abt team will work with the Ministry of Health and
health provider organizations to define minimum standards for private HIV/AIDS providers. Once agreed on,
these minimum standards will be captured in a survey that we will use to assess providers' readiness to
achieve certification and provide a full range of HIV/AIDS services, including antiretroviral therapy (ART).
For private providers to satisfy minimum requirements, however, they will need access to clinical training
covering current treatment protocols. The Abt team will help private providers access this training and
negotiate access to subsidized HIV drugs and other services. The certification process will require private
providers to participate in training on reducing HIV/AIDS-related stigma and discrimination issues affecting
care and treatment. The project will produce "Ready References" summarizing certification requirements for
private providers interested in providing HIV/AIDS care. The expected result is that certification criteria,
including stigma and discrimination training, for private providers to dispense ART will be defined, agreed to
and implemented.
Continuing Activity: 19476
19476 19476.08 U.S. Agency for Abt Associates 8674 8674.08 HPI - Vietnam $555,000
Table 3.3.18:
