This is a continuing mechanism that was established in August reprogramming.

Implementing Mechanism: The Institute of Population, Health and Development (PHAD) is a Vietnamese nongovernmental organization. In FY 2007 and FY 2008, PHAD was a sub-partner to an international NGO implementing HIV/AIDS prevention programs. In FY 2008, PHAD became a local prime partner with U.S. DoD PEPFAR, providing technical assistance in voluntary counseling and testing (VCT). By the end of FY 2009, DoD PEPFAR Vietnam supported the Vietnam Ministry of Defense (MOD) to establish VCT and provider-initiated counseling and testing (PICT) programs in eight sites, including five PICT clinics co-located in blood safety centers embedded within military hospitals and three VCT sites integrated within three military preventive medicine centers.

The comprehensive goals and objectives under the award reflect PHAD's breadth across two technical areas: Other Prevention (HVOP) and Counseling and Testing (HVCT).

Linkage to Partnership Framework: In partnering with the Institute of Population, Health and Development, the U.S. DoD is directly supporting the PEPFAR Partnership Framework's central strategy of building local capacity to ensure the program is sustainable. In FY 2007 and FY 2008, PHAD progressively gained greater experience and proved to be a capable implementing partner for HIV prevention programs in several civilian communities. In FY 2008, PHAD became a local prime partner working with DoD. PHAD demonstrated that they can also work with the Vietnamese military in implementing HIV prevention programs in military settings. Forging a strong collaborative effort between the Vietnamese military and a capable local prime partner to carry out future HIV prevention programming is a central goal for DoD in order to promote sustainability.

Target Population and Geographical Coverage: Target population includes all newly-inducted male military recruits and mobile border guards, which will mean comprehensive geographic coverage throughout Vietnam. New recruits and border guards have been targeted with this integrated prevention program because they are considered to be at higher risk due to their age, mobility and the large amount of time spent in remote areas away from family support, all of which can encourage high-risk behaviors, such as increased alcohol consumption and visiting bars and karaoke outlets. With FY 2010 funding, the coverage of this prevention program will be maintained in all 63 provinces and include all seven military regions and four military commands (Army, Navy, Air Force and Border Guards).

Health System Strengthening: Key contributions to health system strengthening include building local capacity by serving as a local prime partner and utilizing local expertise, which helps build up capacity for the government and its partners' technical staff. PHAD is committed to providing qualified and committed human resources in the implementation of these technical areas through: 1) regular in-service training for on-site and off-site implementing staff; 2) regular on-site management coaching for implementing staff; 3) on-going assessment to promote retention of qualified staff; and 4) periodic assessments for quality improvement of the implementation process.

Cross-cutting Programs and Key Issues: PHAD covers two cross-cutting programs: Human Resources for Health by adopting national training standards and offering periodic in-service training, and minor Construction/Renovation of VCT/PICT sites to meet national standards. Key issues addressed by this mechanism include mobile populations and military populations.

Program Efficiency: The implementing mechanism's strategy to become more cost efficient over time is to expand the integrated bio-behavioral surveillance (IBBS) pilot program to additional provinces; utilize existing military-relevant education, information and communication (EIC) materials; synchronize the IBBS with other implementing partners in the civilian sectors; and collaborate with other partners working in VCT technical areas to optimize the use of standardized educational materials.

In addition, the activities (HVOP and HVCT) planned for FY 2010 will further strengthen the collaboration between military and civilian prevention programs. Specifically, the military Peer Education program in the northern border areas will be designed and implemented in close consultation with other PEPFAR partners in order to best address evidence of increased drug use and high-risk sexual behavior in this remote area.

Monitoring and Evaluation Plans: In FY 2010, U.S. DoD PEPFAR will further strengthen collaboration with other PEPFAR agencies and partners, i.e., CDC, USAID, Population Services International (PSI) and Family Health International (FHI) in regard to promotional activities to reach the target population, including development of standard IEC materials used across testing and counseling sites and interagency quality assurance (QA) and monitoring and evaluation (M&E) activities. In addition, DoD PEPFAR in partnership with PHAD will also provide routine observation, supervision and oversight through site visits and on-site coaching and mentoring.

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

08-HVCT Budget Code Description: In FY 2010, DoD aims to strengthen the voluntary counseling and testing/provider-initiated counseling and testing (VCT/PICT) system and VCT/PICT human resources at eight sites: Hospital 103 and the Military Institute of Hygiene and Epidemiology (MIHE) in Hanoi; Hospital 175 and the Southern Preventive Medicine Center (SPMC) in Ho Chi Minh City (HCMC); Hospital 121 and the Military Region 9 Preventive Medicine Center (MR9 PMC) in Can Tho City; Hospital 17 in Da Nang City, and Hospital 87 in Nha Trang City. At these VCT/PICT sites, clients (military and civilians) can receive free-of-charge services such as counseling and HIV testing, counseling on TB and sexually transmitted infections, and referral to on- or off-campus care, etc. It is important to note that although military healthcare facilities are mandated to care for military personnel and their family members, approximately 80% of the clients who access services are civilians from surrounding communities and provinces. Importantly, seven out of eight sites are located in the provinces with the highest HIV prevalence.

08-HVCT Activity #1 Strengthening the VCT/PICT System, $115,000. Under this activity, the Institute of Population, Health and Development (PHAD) will focus on strengthening eight VCT/PICT sites, through: providing frequent technical assistance and on-site mentoring to staff; reviewing and updating service delivery protocols; exploring the potential for deployment of other counseling modes, i.e., couples counseling, counseling at special events or campaigns; strengthening referral networks with other HIV prevention, care and treatment and support services in the civilian sector; promoting meaningful involvement of military VCT/PICT counselors in the national VCT/PICT network, experience sharing and professional exchange activities; expanding VCT outreach activities to remote and hard-to-reach populations in the border areas through military medical community-based initiatives; implementing systematized PICT services in TB and OB/GYN settings; and conducting routine quality assurance activities. PHAD will also provide consumables and clinical supplies to these sites.

08-HVCT Activity #2 Strengthening the VCT/PICT Human Resources, $60,000. Under this activity the Institute of Population, Health and Development will conduct three VCT/PICT training programs: 1) refresher training for selected counselors and laboratory technicians who will provide VCT/PICT services; and 2) in-depth initial training, according to national standardized training, for selected ancillary healthcare workers to serve as new and/or backup counselors when assigned counselors have to be deployed on military missions; and 3) supervisor training.

08-HVCT Quality Assurance. An important goal for the U.S. DoD in FY 2010 is to conduct a useful program evaluation, as part of building a high-quality and sustainable prevention program. In FY 2010, in collaboration with other USG implementing agencies and technical groups, the Prevention Officer and the Strategic Information Officer will assess the effectiveness of referrals and linkages from VCT/PICT sites to HIV/AIDS care, treatment and support, and prevention activities, using standardized referral cards and regular review meetings conducted by relevant services, i.e., VCT sites, outpatient clinics for HIV/AIDS patients, and TB and OB/GYN departments. DoD in-country staff will continue to actively participate in all relevant technical working groups (TWG), including the Prevention TWG, the Strategic Information TWG and the Health System Strengthening TWG, to ensure: interagency coordination in promoting Three Ones; synchronization in reducing duplications; harmonization in enhancing sustainability; and oversight for efficiency and target achievement.

08-HVCT Targets:

Number of individuals who received testing and counseling services for HIV and received their test results: 8,000

Male: 5,000

Female: 3,000

Number of individuals who successfully completed a training program: 50

This is a continuation from FY 2009. In FY 2009, DoD used only FY 2008 carry-over funds to implement HVOP. Therefore, in FY 2010 this budget Code reflects a 20% increase in budget, and thus a budget code narrative is required.

03-HVOP Budget Code Description: To maximize opportunities to prevent new infections, this technical area will continue to support the Vietnam Ministry of Defense's (MoD) HIV integrated prevention program, which consists of two major components.

The first component focuses on training of the trainers (ToT), who will in turn train peer educators, who will in turn train other soldiers at all military command levels (division, company, platoon, etc.) to deliver messages and stress activities to promote safe sex practices, avoid high-risk behaviors and observe the correct and consistent use of condoms. Peer educators will disseminate key messages and demonstrate activities (including abstain and/or be faithful, and as appropriate, correct and consistent use of condoms (ABC), avoiding/reducing alcohol use) to all new young military recruits during their first 18 months of military training.

The second component focuses on assessment and survey of biological and behavioral activties related to HIV prevention, integrated bio-behavioral surveillance (IBBS). In the past years, the ToT and peer educator approach has been seen as one of the most critical prevention strategies for new military recruits in Vietnam. However, limited data has been collected/monitored in order to determine the risk level of this young and mobile population. Such data is needed for achieving effective and efficient prevention programs for this specific population. In FY 2009, in collaboration with the PEPFAR SI team, a small IBBS was piloted in the military population. In FY 2010, the goal is to expand the pilot IBBS program to capture sexual risk and substance use data among a larger proportion of young military personnel.

03-HVOP ACTIVITY #1 Training of the Trainer (ToT) and Peer Educator (PE) Component, $300,000. In direct collaboration with the Vietnamese military, the Institute of Population Health and Development (PHAD) will be responsible for the implementation, monitoring and evaluation of the ToT and PE components, including updating/producing the training curriculum; producing military-relevant education, information and communication (EIC) materials; developing evaluation tools in concert with the PEPFAR SI team; organizing/conducting/supporting workshops at all levels (survey training, ToT training, peer educators training, new recruits communication activities at the lowest military troop level, etc.); providing TA to military sites, military personnel and managers.

03-HVOP ACTIVITY # 2 - Integrated Bio-behavioral Survey (IBBS), $ 100,000. In the second activity, the Institute of Population Health and Development will conduct the IBBS in support of the military prevention program. PHAD will provide technical assistance to military personnel; train military staff for IBBS activities; procure supplies, reagents and test kits; coordinate testing and interviews; coordinate and collect data; manage data (data entry, analysis and reports. This activity will be closely coordinated with other on-going PEPFAR-supported IBBS activities in the civilian sector.

03-HVOP ACTIVITY #3 - Quality Assurance, $30,000. An important goal for the U.S. DoD in FY 2010 is to conduct a useful program evaluation, as part of building a high-quality and sustainable prevention program. In FY 2010, in collaboration with other USG implementing agencies and technical groups, the Prevention Officer and the Strategic Information Officer will assess the effectiveness of referrals and linkages among all sectors. U.S. DoD in-country staff will continue to actively participate in all relevant technical working groups (TWG), including the Prevention TWG, the Strategic Information TWG and the Health System Strengthening TWG. This will help ensure interagency coordination in promoting the Three Ones; synchronization in reducing duplication; harmonization in enhancing sustainability; strengthening Vietnam's military capability for program management and execution; and oversight for efficiency and target achievement.

03-HVOP Targets:

Number of targeted population (young adult men engaging in high-risk behaviors) reached with individual and/or small group level preventive interventions that are primarily focused on abstinence and/or being faithful, and are based on evidence and/or meet the minimum standards required: 50,000 new recruits

Number of individuals who successfully completed a training program: 500