The U.S. Department of Defense (DoD) implements PEPFAR programs by supporting HIV/AIDS prevention, treatment and care, strategic information, human capacity development, and program and policy development in host militaries and civilian communities. These activities are accomplished through direct military-to-military assistance, support to nongovernmental organizations and universities, and in collaboration with other U.S. government agencies in country.

In Vietnam, DoD works with the Vietnam Ministry of Defense (MOD) to: 1) implement military-specific HIV/AIDS prevention programs designed to address the military's unique risk factors; 2) provide care, support and treatment programs for military personnel, their families and civilians in surrounding communities; and 3) strengthen infrastructure, human resources and information systems in the Vietnamese military healthcare delivery system. In Vietnam, 80% of the clients who access military medical services are civilians from surrounding communities.

The comprehensive goals and objectives in DoD PEPFAR's FY 2010 programming reflect breadth across multiple technical areas. In the area of prevention, DoD aims for a Combination Prevention Program, which consists of biomedical and behavioral prevention approaches adapted and prioritized for the Vietnam military. Behavioral interventions are geared toward motivating behavioral change in young military recruits and border guards as in Other Prevention programs that promote peer education of abstinence, be faithful and correct condom use. Biomedical interventions reduce the chances for HIV infections as in Injection Safety and Blood Safety programs. Under care, support and treatment, DoD's breadth across three technical areas: Prevention of Mother-to-Child Transmission (MTCT), TB/HIV (HVTB) and Adult Treatment (HTXS). In FY 2010, DoD aims to intensify on-site coaching/mentoring to reinforce desired behaviors for patient-focused care clinic management practices. Integrated throughout all technical areas, DoD plans to optimize all opportunities for a more efficient system, better quality care and stronger program monitoring.

Linkage to Partnership Framework: In partnering with local nongovernmental organizations and employing local nationals, DoD PEPFAR is directly supporting the PEPFAR Partnership Framework's central strategy of building local capacity to ensure sustainable programming. Prior to FY 2008, DoD PEPFAR was partnering with U.S.-based universities and organizations to implement its programs. In FY 2008, DoD PEPFAR shifted to using Vietnamese NGOs, as well as employing local nationals in the DoD PEPFAR office to execute the DoD program. Forging a strong collaborative effort between Vietnam's military and capable local prime partners to carry out future HIV prevention programming is key to promoting sustainability.

Target Population and Geographical Coverage: The target population for DoD's technical areas includes all patients receiving medical care at military hospitals and all newly inducted male military recruits and mobile border guards (approximately 30,000 young men per year). The target population for counseling and testing, safety injection, blood safety, care and support, treatment, prevention of mother-to-child-transmission and TB/HIV programs includes all clients, civilians or military, receiving services at all PEPFAR-supported locations. The new recruits and border guards have been targeted with this integrated prevention program because they are considered to be at a higher risk of contracting HIV/AIDS due to their young age, high mobility and long periods of time spent in remote areas far away from family support, all of which have been shown to encourage high-risk behaviors, such as drinking alcohol and visiting karaoke bars.

With FY 2010 funding, these comprehensive DoD programs (HVOP, HVCT, HMIN, HMBL, MTCT, HVTB, HTXS, HBHC, HLAB, OHSS, and HVSI) will cover all 63 provinces in all seven military regions and the four military commands (Army, Navy, Air Force and Border Guards), the 16 voluntary counseling and testing/provider-initiated counseling and testing (VCT/PICT) sites, four reference laboratories, five blood safety centers and four outpatient centers. Notably, DoD programs are located in the three "highest HIV prevalence" provinces: Ho Chi Minh City, Hanoi and Can Tho City.

Health System Strengthening: U.S. DoD's key contributions to health system strengthening include: 1) partnering with local NGOs and utilizing local experts, who subsequently will help build the capacity of technical staff for the host government and its partners; 2) mainstreaming injection safety, universal precautions, and infection control into the pre-service training curriculum at military medical and nursing schools; 3) regular technical in-service training for on-site and off-site implementing staff; 4) upgrading staff training by using national training standards; 5) regular on-site management coaching; 6) on-going assessment to promote the retention of the most qualified staff; 7) producing a cadre of trainers who can replicate the same training to others in the future; 8) providing professional staff development through workshops and conferences, when needed, to encourage professional advancement; and 9) periodic assessments for quality improvement of the implementation process.

Cross-cutting Programs and Key Issues: the U.S. DoD covers two cross-cutting programs: 1) Human Resources for Health through using national training standards, on-going in-service training and on-site coaching; and 2) the renovation and upgrading of blood safety centers to meet national standards. Key issues addressed by U.S. DoD include education, TB, mobile populations and military populations.

Program Efficiency: U.S. DoD's strategy is to become more cost efficient over time by: 1) cutting down administrative costs by working directly with the Vietnamese NGOs; 2) using local resources, such as Vietnamese NGOs, to transfer necessary knowledge and skills to the Vietnamese MOD, over time; 3) procuring supplies and services within Vietnam; 4) combining multiple prevention strategies to maximize coverage while reducing administrative costs to the program; 5) adapting the existing national training curriculum to military settings; 6) using existing military-relevant education, information and communication (EIC) materials; 7) optimizing program coordination by having single point-of-contact program officers for consistency and efficiency; and 8) collaborating with other partners in prevention technical areas to optimize the use of standardized educational materials and Vietnam government-supported services .

Monitoring and Evaluation Plans: In FY 2010, with a dedicated Strategic Information Officer for DoD and MOD programs, DoD PEPFAR will further strengthen collaboration with other PEPFAR agencies and partners, i.e., CDC, USAID, the National Blood and Transfusion Institute, CDC Laboratory, other implementing partners to promote the development and use of standardized monitoring and evaluation tools; to plan for interagency quality assurance (QA) activities in clinical areas and HIV testing areas; and to promote interagency visits to implementation sites for QA and training purposes.

This is a continuing activity from FY 2009. In FY 2009, the U.S. Department of Defense (DoD) used only FY 2008 carry-over funds to implement HBHC. Therefore, in FY 2010, this budget code reflects a 20% increase in budget, and thus a budget code narrative is required.

08-HBHC Budget Code Description: In line with PEPFAR's effort to develop human resources to improve healthcare, U.S. DoD will continue to promote increasing the contributions of nurses in the Vietnamese healthcare system. In order to do so, U.S. DoD PEPFAR will collaborate closely with the Vietnam Nurses Association (VNA) to build capacity in the country's nursing forces. In FY 2010, VNA will mainly focus on supporting the implementation sites, training the nursing forces and providing technical assistance (TA) and clinical support to the facilities. At the same time, U.S. DoD will focus on providing technical assistance and operational coaching to nursing and medical leaders in project and program management.

08-HBHC Activity: Technical Assistance and Coaching to Middle- and Higher-Level Nursing and Medical Leaders, $79,500 U.S. DoD will: 1) convene regular meetings with middle- and higher-level nursing and medical leaders to solicit buy-in and discuss ways to improve HIV/AIDS care and support programs; 2) conduct frequent TA using one-on-one or small group methods to promote the adoption of new protocols and guidelines; 3) provide consumables, clinical supplies and testing reagents to four sites; and 4) organize and support experience-sharing workshops for nursing and medical leaders.

08-HBHC Quality Assurance: An important goal for U.S. DoD PEPFAR in FY 2010 is to conduct relevant and/or focused program evaluations, in order to build a high-quality and sustainable program. DoD will coordinate with other PEPFAR agencies to ensure that linkages among all sectors are effective and national standards are met.

This is a continuing activity from FY 2009 when the U.S. Department of Defense (DoD) used FY 2008 carry-over funds to implement strategic information programming for the first time. Therefore, in FY 2010, because this budget code reflects a 20% increase in budget, a budget code narrative is required.

The Strategic Information technical working group (SI TWG) has prioritized creating a culture of data use across the HIV program in Vietnam where programs are increasingly evidence-based. This effort promotes efficiencies and successes, and is coordinated through shared information implementing partners and responsible government of Vietnam agencies. In order to achieve this, it will be critical to build SI capacity in the DOD program and among its implementing partners. Since FY 2008, the U.S. DoD PEPFAR program, like other agencies, has focused its efforts, resources and funding primarily on training and services for care, support, treatment and prevention programs. After substantially expanding its programs, the need for constant SI support became apparent in FY 2008. REDACTED.

While the military health systems in Vietnam are distinct from the civilian health system, similar services are delivered and some of the same populations are served. As a result, strategic information is not only critical for the monitoring and evaluation (M&E) of MOD programs, but also for the integration of these programs into the national HIV strategy and broader health systems for better national program management, improved services across the health systems, and promoting efficiencies through shared resources, methodologies and tools. With the addition of a M&E program officer to the DOD team who will also sit in on the SI technical working group meetings, SI and DOD will be in a better position to address the strategic information needs of the DOD HIV program. They will work across PEPFAR TWGs and national SI TWGs to ensure that DOD partners benefit from the resources and experiences of the teams while contributing to Vietnam's single HIV M&E system.

Funds will support staff and partner capacity development, the assessment of civilian SI strategies and solutions for appropriateness for MOD sites, customization of solutions adhering to national standards and policies, implementation of solutions and on-going monitoring and evaluation. By participating in the SI technical working group, the DOD M&E staff will be able to leverage technical assistance and staff resources to ensure that DOD programs are provided adequate SI support and that DOD SI activities are contributing to the goal of a national culture of data use and integrated into the national HIV M&E system and other systems across health sectors in Vietnam.

In addition to overall SI capacity, there will be two priority activities supported by these funds:

Strengthening MOD's Information Management Capabilities -- The goals of this activity for FY 2010 are: 1) upgrading basic hardware and software to enhance communication among MOD's PEPFAR Steering Committee (MOD-SC), administration offices at four military hospital, and eight implementation sites; 2) training MOD-SC staff and implementation staff on use of standardized national monitoring and reporting requirements; 3) training MOD-SC staff on use of data for program monitoring and evaluation; and 4) providing technical assistance to link MOD's HIV-related services to other partners' implementing sites, according to MOD's policies, in order to increase patient's access to services and better data quality.

Building MOD's Bio-behavioral Survey Capability Funding in FY 2010 will support: 1) training a small MOD core team (3-4 persons) to assist with the implementation of the bio-behavioral survey; 2) producing and/or procuring data collection tools; 3) conducting training and TA on survey methodology and protocols; and 4) providing technical assistance and logistical and operational support to staff of the Military Institute of Hygiene and Epidemiology (MIHE) and the Southern Preventive Medicine Center (SPMC) to complete data collection, entry, analysis and interpretation.

17-HVSI Quality Assurance -- In FY 2010, the DoD SI Program Officer, in collaboration with the PEPFAR SI team, will lead the coordination and implementation of MOD's bio-behavioral survey. Moreover, U.S. DoD will continue to coordinate with other USG implementing agencies and technical groups to ensure that linkages (to training opportunities, experience sharing opportunities, expert resources, etc.) among all sectors are put to best use.

This is a continuing activity from FY 2009. In FY 2009, the U.S. Department of Defense (DoD) used only FY 2008 carry-over funds to implement health system strengthening programs. Therefore, in FY 2010, because this budget code reflects a 20% increase in budget, a budget code narrative is required.

18-OHSS Budget Code Description: In Vietnam, insufficient training has been identified over and over again as a key barrier to improving the current healthcare system (Health System 20/20, USAID, 2008). Having adequate training and a qualified healthcare staff will be even more critical in future years as the Vietnam Ministry of Health moves forward with its 2020 Health Strategy and PEPFAR moves toward the Partnership Framework. Lack of international standard training is even more acutely felt in the Vietnamese military healthcare system because it has only recently accepted outside assistance. A skilled workforce is critical as it affects the overall system performance as well as the feasibility and sustainability of health reforms.

In FY 2010, the U.S. DoD will address the insufficient training through four key activities.

18-OHSS ACTIVITY #1 Strengthening Teaching Infrastructure of the Pre-service Military Medical Institute, $130,000 - Similar to the civilian sector, the Vietnamese military has its own medical and nursing pre-service training academies. One academy is co-located in Hospital 103 where PEPFAR has a full range of supports, including one outpatient clinic, one prevention of mother-to-child transmission (PMTCT) site, one TB/HIV facility, one blood safety center and one voluntary counseling and testing (VCT) site. However, this academy has not received much attention or support in the past. Under this activity, U.S. DoD will: 1) collaborate with the Vietnamese military leadership at the academy to include key curricula, such as infection control, patient-centered care, and quality assurance and quality control, in the pre-service training curriculum at the academy; 2) upgrade the practicum training laboratories at the academy to enhance hands-on practice prior to caring for patients at hospitals; 3) coordinate and support technical assistance on curriculum revision and teaching methods using available experts from other PEPFAR agencies and partners; and 4) coordinate, invite and support military teaching faculty to observe and lecture at civilian medical and nusring schools to share best practices.

18-OHSS ACTIVITY #2 Mainstreaming Infection Control Curriculum Into Pre-Service Military Medical and Nursing Academies, $60,000 Under this activity, DoD will: 1) coordinate and support technical assistance on curriculum adaption and revision and teaching methods using available experts from other PEPFAR agencies, partners, etc.; 2) provide relevant teaching materials, teaching aids and references; 3) support travel expenses for trainers; and 4) explore developing an evaluation tool to assess teaching effectiveness.

18-OHSS ACTIVTY #3 Human Resource Motivational and Retention Activities, $46,000 - Funding will support the following objectives: sharing and recognition of staff's contributions to Vietnam's healthcare system; educating Vietnam Ministry of Defense (MOD) personnel about MOD healthcare staff; introducing a patient-focused care model (being implemented under the HBHC program); engaging MOD policymakers to consider an alternative staff award/promotion model where staff are recognized and rewarded based on a merit system; and introducing a PEPFAR for Excellence award for top performers. U.S. DoD PEPFAR will synchronize these objectives with scheduled and on-going technical workshops and meetings. Under this activity, DoD will also invite several senior military leaders to attend key meetings, such as the annual implementers' meeting, the international or regional AIDS meeting and multilateral medical meetings. The purpose of attending these key meetings is for Vietnam's military leadership to learn best practices and policies from others.

18-OHSS ACTIVTY #4 Program Management Capacity Building, $30,000- In FY 2009, U.S. DoD merged its Total Quality Management (TQM) training program into the CDC TQM training under the Hanoi School of Public Health (HSPH). Under this arrangement, TQM training for middle managers was not only consistent across military and civilian sectors, but also positively encouraged military and civilian managers to work and solve problems together. In FY 2009, CDC through HSPH, provided 30 training slots for MOD medical managers. Travel costs for the TQM training were covered by U.S. DoD. With FY 2010 funding, DoD will continue to support 30 military middle managers to benefit from this TQM training.

18-OHSS Quality Assurance: In FY 2010, the DoD Program Management Specialist will collaborate with other USG implementing agencies and technical groups to ensure linkages (with training and experience-sharing opportunities, educational resources, etc.) across civilian and military sectors are maximized and national standards are met.

This is a continuing activity from FY 2009. In FY 2009, the U.S. Department of Defense (DoD) used only FY 2008 carry-over funds to implement HMBL. Therefore, in FY 2010 this budget code reflects a 20% increase in budget, thus a budget code narrative is required.

04-HMBL Budget Code Description: Main objectives of the U.S. DoD PEPFAR and Vietnam Ministry of Defence (MOD) Blood Safety programs are: 1) to ensure that MOD blood safety practices are in line with national standards in the areas of blood screening, collection preparation and storage; 2) to upgrade the MOD's blood safety basic structure to meet national safety and public health standards; 3) to promote a robust and voluntary donor system; 4) to promote sustainable quality assurance programs across military blood safety centers; and 5) to strengthen and optimize linkages of blood safety, appropriate HIV counselling and testing, and referrals for persons who test positive.

By the end of FY 2009, the Vietnam DoD PEPFAR will be supporting five blood safety centers with HIV screening capacity in Hospital 103 in Hanoi, Hospital 175 in Ho Chi Minh City, Hospital 121 in Can Tho City, Hospital 17 in Da Nang City and Hospital 87 in Nha Trang City. These five blood safety centers will ensure the availability of safe blood products for five co-located hospitals, as well as neighboring civilian hospitals. Additionally, these five blood safety centers also provide provider-initiated testing and counselling (PITC) to all clients using the services. It is important to note that, although military health care facilities are mandated to care for military personnel and their families, approximately 80 percent of the clients are civilians from neighboring towns and provinces.

Blood Safety addresses one of the nine action areas established by the government of Vietnam in the Vietnam National HIV/AIDS Strategy. The Vietnam MOD has consistently supported the Vietnam National HIV/AIDS Strategy by increasing collection and storage of safe blood, and strengthening human capacity in safe blood practices.

04-HMBL Activity #1 Increasing Collection and Storage of Safe Blood, $450,000 With FY 2010 funding, DoD PEPFAR will collaborate with the Vietnam MOD to: 1) increase the collection and storage of blood units from low-risk volunteer donors to 30,000 units per year; 2) increase the number of volunteer donors from 20% to 70% compared to the number of paid donors; and 3) support donor outreach sessions at regional blood transfusion centers for the recruitment of voluntary unpaid blood donors. Without on-going recruitment activities, shortages of safe blood may result in, and may create pressure to use, unsafe blood products that run a higher risk of HIV contamination. In order to ensure this does not happen, DoD PEPFAR will: 1) support clinical and administrative staff implementing blood safety activities; 2) procure necessary consumables, supplies and reagents for increased collection and storage of blood units; 3) procure local equipment maintenance services for five existing blood safety centers; 4) procure additional equipment necessary for processing and storage expansion; and 5) provide technical assistance to MOD on building renovation, equipment selection and testing strategies in adherence with the updated national regulations on blood safety protocol.

04-HMBL Activity #2 Human Capacity Development and Strengthening, $186,500 FY 2010 funding will support: 1) expert blood safety organizations to provide guidance, advice and training to Vietnam's military blood transfusion centers in need of technical assistance; 2) technical assistance to MOD on strategies to develop an organized, high-quality blood transfusion system that will produce an adequate supply of safe blood that adheres to national regulations on blood safety protocol; 3) refresher training of current staff; 4) initial in-depth training with wet lab practice for all new personnel assigned to blood safety centers; 5) training for back-up staff to cover for those on military deployment; (6) piloting biomedical equipment maintenance training to selected staff; and 7) exploring possible collaboration between military and civilian sectors including the Vietnam Red Cross.

04-HMBL Quality Assurance: In FY 2008, a quality assurance and quality improvement (QA/QI) program was initiated at two blood safety centers. In FY 2009, the program was expanded to all five existing blood safety centers. This same QA/QI project will be continued in FY 2010, with more intensive on-site coaching to achieve quality and consistency across all five centers. In FY 2010, the DoD Program Management Specialist will collaborate with other USG implementing agencies and technical groups to ensure that linkages between all sectors are maximized and national standards are met.

04-HMBL Targets:

Percentage of donated blood screened for HIV in a quality-assured manner: 100%

Number of blood safety centers: 5

Number of staff trained on blood safety-related topics: 20

This is a continuing activity from FY 2009. In FY 2009, the U.S. Department of Defense (DoD) used only FY 2008 carry-over funds to implement Injection Safety programs. Therefore, in FY 2010 this budget code reflects a 20% increase in budget, and thus a budget code narrative is required.

05-HMIN Budget Code Description: By the end of FY 2009, the U.S. DoD PEPFAR was supporting four referral laboratories, five blood safety laboratories, four outpatient and inpatient clinics embedded in four infectious disease departments, eight voluntary counseling and testing (VCT) sites, five provider-initiated counseling and testing sites, four prevention of mother-to-child-transmission (PMTCT) sites, and four prevention of tuberculosis and HIV co-infection sites. Requested funds for FY 2010 will support the Vietnam Ministry of Defense (MOD) to continue its participation with other PEPFAR partners in establishing an injection safety program in line with national guidelines. FY 2010, key activities will include injection safety (IS) and waste management (WM).

05-HMIN Injection Safety, $200,000 - With PEPFAR funding in FY 2008 and FY 2009, the IS program for Vietnam was developed through collaborative efforts with the World Health Organization (WHO), the Vietnam Nurses Association (VNA) and Pact Vietnam, an international NGO. A national IS training curriculum has been completed, but has yet to be implemented.

Other PEPFAR civilian partners in Vietnam are currently focusing on three areas: 1) utilizing the national IS training curriculum to produce a cadre of IS trainers using the training of the trainer (ToT) method, 2) designing and distributing teaching materials to clinical areas, and 3) providing sharps containers to clinical areas.

Based upon existing work in Vietnam and funding in FY 2010, DoD PEPFAR will: 1) adopt IS training into pre-service training at military medical and nursing training institutions; 2) organize and train a cadre of 16 military healthcare staff to conduct ToT on injection safety-related topics to include infection control; 3) expand IS training for healthcare workers with a special focus on improving phlebotomy practice and the reduction of needle-stick injuries; 4) advocate for the development of universal precaution guidelines, as well as infection control, to be tested and implemented in military healthcare settings; 5) provide basic and/or locally-produced consumable supplies, such as sharp containers, at selected military hospitals; 6) support trainee travel to training sessions; 7) link post-exposure prophylaxis (PEP) to the counseling and testing program to reduce HIV transmission in medical settings; and 8) provide regular on-site technical assistance to ensure that injection safety principles and practices in the workplace are implemented.

05-HMIN Waste Management, $80,000 In FY 2010, U.S. DoD PEPFAR will expand the Injection Safety program to include Waste Management. In developing countries, such as Vietnam, the collection, storage and disposal of biomedical waste related to HIV/AIDS care is a growing health, safety and environmental problem. In Vietnam, biomedical waste related to HIV/AIDS is produced by establishments such as outpatient centers, VCT sites, laboratories and blood collection/transfusion centers. Biomedical waste poses potential risks to human health and to the environment if not properly disposed. Overall, waste management has received little attention despite the potential environmental hazard and threats to public health. Current options for treating biohazard waste include converting infectious materials to non-infectious waste using processes such as steam sterilizers, autoclaves, and incinerator or microwave technology. Not all these treating options are practiced properly in the Vietnamese military healthcare system. Thus, the Vietnam military has identified waste management as a priority area and has requested PEPFAR technical assistance in order to implement training in biomedical waste management and to formulate guidelines and standards for proper disposal.

With FY 2010 funds, in collaboration with the Vietnam military, DoD PEPFAR will: 1) conduct an initial assessment of waste collection and disposal practices at four healthcare clinics/sites; 2) conduct an assessment of available disposal mechanisms at four locations; 3) identify strengths and weaknesses in current waste management practices; 4) collaborate with the Vietnam military to validate the needs and draft a plan-of-action; and 5) collaborate with the Vietnam military to formulate guidelines and standards of proper disposal. Training of proper disposal methods will be integrated into the injection safety curriculum, where and when appropriate to reduce costs. This activity will be carried out in close collaboration with host nation agencies, USG agencies and other partners, including experts from the World Health Organization. Additionally, lessons learned from other communities and/or countries will be incorporated into the plans-of-action.

05-HMIN Quality Assurance: An important goal for DoD in FY 2010 is to conduct relevant program evaluation, as part of building a high-quality and sustainable injection safety and waste management program. In FY 2010, the DoD Program Management Specialist will collaborate with other USG implementing agencies and technical groups to ensure linkages among all sectors are maximized and national standards are met.

05-HMIN Targets:

Number of sites providing injection safety, including waste management services: 4

Number of staff trained on injection safety, including waste management: 60

This is a continuing activity from FY 2009. In FY 2009, the U.S. Department of Defense (DoD) used only FY 2008 carry-over funds to implement part of the HLAB program. Therefore, in FY 2010, this budget code reflects a 20% increase in budget, and thus a budget code narrative is required.

16-HLAB Budget Code Description: By the end of FY 2009, U.S. DoD PEPFAR supported four referral laboratories with the capacity to perform HIV diagnosis, haematology, biochemistry, CD4 and Polymerase Chain Reaction (PCR), which are conducted to check viral loads in cases of adult treatment failures. These four referral laboratories are: the Military Institute for Health and Epidemiology (MIHE) in Hanoi, the Southern Preventative Medicine Center (SPMC) in Ho Chi Minh City, Hospital 121 in Can Tho City and Hospital 17 in Da Nang City. MIHE and SPMC are designated as regional preventive centers, and serve as centers of excellence for training and research. Two other laboratories (in Hospital 121 and Hospital 17) are provincial referral laboratories embedded within the military regional hospitals. These four referral laboratories support four outpatient/inpatient clinics and eight voluntary counselling and testing (VCT) centers, and five provider-initiated counseling and testing (PICT) sites. All four laboratories are located in PEPFAR-focus provinces. It is important to note that although military health care facilities are mandated to care for military personnel and their families, more than 80% of the clients are civilians.

These four laboratories are staffed by full-time and part-time Vietnamese military laboratory officers and technicians. There are approximately 100 full-time staff working in these sites. Between FY 2006 and FY 2008, U.S. DoD trained a total of 245 laboratory personnel working in PEPFAR and non-PEPFAR-supported laboratories, through partnering with the Armed Forces Research Institute of Medical Sciences (AFRIMS) in Bangkok, Thailand. In FY 2009, DoD began to partner with CDC Laboratory to deliver in-country training in quality improvement for assigned personnel.

Additionally, in FY 2007, U.S. DoD initiated quality assurance and quality control (QA/QC) initiatives at two laboratories. In FY 2008, U.S. DoD expanded the QA/QC program to two more laboratories. The QA/QC program includes: monthly site monitoring, quarterly site visits, standardized assessment tools for monitoring and assessment, quarterly on-site proficiency testing, routine reporting, participation in a national external quality assurance (EQA) program, distant technical assistance, on-site technical assistance, and on-site workshops and training. In FY 2009, U.S. DoD replicated the same QA/QC program at the four PEPFAR-supported blood safety centers in the military system.

In FY 2010 and beyond, U.S. DoD aims to: 1) collaborate closely with the CDC Laboratory technical working group and experts to prepare all four laboratories to be accrediated by the Ministry of Health's Vietnam Administration for HIV/AIDS Control (VAAC); 2) promote greater collaboration between the Vietnamese military, civilian laboratory centers and HIV/AIDS testing, care, support and treatment sites. DoD PEPFAR will continue its collaboration with CDC partners, i.e., LIFE-GAP project to train military laboratory staff on CD4 and opportunistic infection (OI) diagnostics; and VAAC/LIFEGAP to develop a laboratory referral network and specimen transport system within the provinces. DoD will also collaborate with CDC to enable laboratory staff to pilot the Laboratory Information System (LIS) at one military laboratory. In order to achieve these aims, U.S. DoD PEPFAR will implement four activities in FY 2010.

16-HLAB ACTIVITY #1 Increase Military Laboratories' Participation in the National EQA Program, $50,000 U.S. DoD will: 1) coordinate with CDC Laboratory to systematically enroll four military laboratories in the national EQA program; 2) work to encourage military laboratories to be active members in the national EQA program; 3) promote collaboration between MIHE and its counterpart, the National Institute of Hygiene and Epidemiology (NIHE); 4) provide necessary supplies, consumables and reagents for producing proficiency panels for EQA purposes; and 5) provide EQA training through PEPFAR agencies and/or the U.S. DoD component.

16-HLAB ACTIVITY #2 QA/QC Program, $50,000 - The second activity will support on-going QA/QC activities, including two site visits per year in order to monitor and evaluate the implementation progress and maintenance of the QA/QC program. This includes TA on the development of standard operating procedures (SOP's) and a functioning post-exposure prophylaxis (PEP) program. Doing well in the QA/QC program will move the laboratories closer to accreditation status.

16-HLAB Activity #3 Training and Clinical Support, $100,000 - The third activity will support: 1) refresher training for laboratorians and technicians; 2) training in OI diagnostics at military laboratory sites using national and international training packages; 3) practicum training and experience-sharing for laboratorians and technicians at NIHE or another national laboratory; 4) procurement of needed consumables, clinical supplies and reagents; and 5) establishing a local equipment maintenance program for these sites. Well trained laboratorians who carry the training into practice will also move the laboratories closer to accrediation status, as well as contribute to better care. As part of the greater PEPFAR community in Vietnam, U.S DoD coordinates closely with the Supply Chain Management System (SCMC) in the procurement and management of CD4 reagents. Training in this area has greatly enhanced the availability of CD4 reagents while keeping reagent expiration problems to a minimum.

16-HLAB Activity # 4 Renovation of Laboratory Infrastructure, $246,400 The fourth activity will support minor renovations and enhancement of four existing sites to ensure there is adequate work space, storage space, ventilation, hand-washing facilities and appropriate storage areas for reagents and samples. Infrastructure is also a key element in the laboratory accrediation process.

16-HLAB Quality Assurance: See the quality assurance plan above. Additionally, an overall goal for U.S. DoD PEPFAR in FY 2010 is to conduct relevant and/or focused program evaluations, as part of building a high quality and sustainable program. U.S. DoD will coordinate with other PEPFAR agencies to ensure that linkages among all sectors are effective and national standards are met.

16-HLAB Targets:

Number of testing facilities (laboratories) with the capacity to perform clinical laboratory tests: 8