The U.S. Centers for Disease Control and Prevention (CDC) implements PEPFAR programs by supporting HIV/AIDS prevention, treatment and care, strategic information, human resources for health (HRH), and program and policy development through an evidence-based manner. These activities are accomplished through the provision of direct technical assistance, working through a total of 10 cooperative agreements that have been established between the CDC and the government of Vietnam, an international NGO, and a U.S.-based university. All activities are developed in coordination with the government of Vietnam and U.S. Government agencies implementing PEPFAR programs in Vietnam.

The two largest and most comprehensive of the 10 cooperative agreements are with the Vietnam Ministry of Heath's Vietnam Administration for HIV/AIDS Control (VAAC) in Hanoi and the Ho Chi Minh City Provincial AIDS Committee (HCMC PAC). These two cooperative agreements provide direct support to implement a comprehensive strategy on HIV/AIDS through; 1) prevention programming; 2) provision of care, support and treatment programs; and 3) strengthened infrastructure, human resources and information systems. The Hanoi School of Public Health (HSPH) is one of the U.S. Government's oldest and closest partners in Vietnam. Through CDC support to HSPH, critical public health activities are developed in program management, informatics and epidemiology. This represents an important contribution to HRH as increasing numbers of highly qualified public health professionals graduate and enter the public health field. The General Statistics Office receives support to strengthen key cross-cutting capacity in public health evaluation and data analysis.

Another key strategic element for CDC Vietnam is the provision of technical assistance to strengthen the laboratory infrastructure for improved diagnosis of HIV and opportunistic infections (OI) such as tuberculosis. CDC has partnered with three government of Vietnam agencies including the National Institute of Hygiene and Epidemiology (NIHE), the Vietnam Administration for Medical Services (VAMS) and the Pasteur Institute to strengthen laboratory systems and infrastructure. Because the epidemic in Vietnam is driven primarily by intravenous drug use, addressing the epidemic will require a multi-sectoral commitment and a collaborative approach. CDC has a cooperative agreement with the Ministry of Labor, Invalids and Social Affairs that address the addictions issues related to the unique nature of the HIV epidemic in Vietnam. Through partnerships with international organizations, such as Family Health International and the Harvard Medical School AIDS Initiative in Vietnam, HRH and institutional capacity are strengthened through the implementation of clinical mentorship programs.

In addition to the technical, financial and systems strengthening support provided through the cooperative agreements, CDC Vietnam works closely with regional technical staff. Thailand has one of the most developed healthcare systems in Southeast Asia and Thai technical experts are highly respected throughout the region. The CDC Thailand program is well placed to assist in the identification of technical resources within the Thai Ministry of Health to support the PEPFAR Vietnam laboratory program, specifically in the provision of training and technical support to Vietnamese laboratorians in the areas of HIV diagnostics (i.e., regional workshops and post-market surveillance of test kits), external quality assessment program development (in the areas of HIV serology, CD4 and HIV viral load), laboratory auditor programs, OI diagnostics, sexually transmitted infections (STI) diagnostics and equipment calibration (pipette). CDC's Division of Tuberculosis Elimination (DTBE) contributes to the focus and strategy of Vietnam's TB/HIV program, advancing the evidence base for planning and evaluating program, and assists in coordination with the National Tuberculosis Program, the Ministry of Health and VAAC. CDC Vietnam is able to access Atlanta-based expertise, as well as Bangkok-based regional staff from CDC's DTBE. To further support the laboratory programs, CDC Vietnam procures diagnostic test kits (HIV, STI, OI and TB) and laboratory consumables to support CDC-IRB-approved research and surveillance and internal/external quality assurance.

CDC and the PEPFAR Vietnam team are working closely with the government of Vietnam to coordinate activities around a Partnership Framework, which will be developed in the coming year. CDC is committed to building local capacity to ensure sustainable programming through all of its activities and collaborations. CDC Vietnam also recognizes that developing and establishing programs for long term sustainability can only be attained by dedicated and technically driven expertise in country. CDC and PEPFAR Vietnam are therefore committed to strengthening the leadership, management and technical skills of locally employed staff. Technical and management/leadership training opportunities, supporting attendance at conferences, and providing mentorship and skills training are some of the ways in which these goals can be accomplished.

Given the relatively low prevalence of HIV in the general adult population in Vietnam (0.43%), prevention efforts that target most-at-risk populations remain the top priority for CDC and PEPFAR-supported programs. This is central to preventing the further spread of HIV and to identifying individuals with the greatest HIV care and treatment needs.

CDC's key contributions to health systems strengthening include: 1) continued partnerships with the government of Vietnam to build the capacity of its technical staff at the central, provincial and district levels; 2) support to the government of Vietnam to improve the quality of its national health delivery systems, manage technical strategies and health policies; 4) focus on pre- and in-service training and professional staff development opportunities across all program areas; and 5) focus training to strengthen management, harmonization and coordination of health programs.

Program Efficiency: CDC's strategy of working directly and in a bilateral fashion with the government of Vietnam is a strategy intended to build country-based, country-run and country-owned delivery systems. In building the capacity of the government, CDC feels that in the long run, the broader health needs of the country will be met, resulting in efficiencies.

Monitoring and Evaluation (M&E) activities are systematically built into all programming supported by CDC. As the cornerstone of program planning, implementation and improvement, all M&E activities will continue to focus on evidence-driven programming to strengthen quality and efficiency. Through the staffing for results exercise, CDC was designated as the technical working group lead for SI. Working together with the other U.S. Government agencies implementing PEPFAR in Vietnam, CDC promotes the development and use of standardized M&E tools, including surveillance, program monitoring and evaluation, and management information systems.

To support senior epidemiologist seconded from CDC to the HIV and Communicable Disease Surveillance and Response teams of the World Health Organization in Vietnam. Senior epidemiologist will:

Strengthen the capacity of Vietnam in the prevention and response to communicable diseases, particularly cross cutting issues related to HIV, STI and TB by providing technical support in strengthening of surveillance systems including capacity building; conducting ad hoc or special surveys; estimating and projecting disease incidence and prevalence and sizes of high risk populations; as well as, analyzing and utilizing data for program monitoring and evaluation,

Provide technical guidance and support for the development of comprehensive, sustainable communicable disease surveillance systems including special surveys and estimation and projection, especially for HIV, STI and TB in collaboration with international, national, regional, and provincial health officials and partners,

Review, monitor and evaluate communicable disease surveillance and control programs for HIV, STI and TB through field visits, outbreak investigations, laboratory assessments, data collection, surveys and surveillance reports,

Support strengthening of systems and human resource capacity in public health surveillance, monitoring and evaluation and operations research

Participate in responses to outbreaks/epidemics in collaboration with national health officials, WHO, etc.

For short term technical assistance from CDC Atlanta's Sustainable Management Development Program (SMDP) to strengthen the Hanoi School of Public Health (HSPH) and other institutions to improve institutional and management and leadership program capacity. CDC SMDP staff will:

Collaborate with and support PEPFAR Vietnam's national partners to strengthen the Human Resources for Health national strategy and existing and future management and leadership capacity in-country,

Improve national capacity to monitor and evaluate management and leadership-related program activities, specifically those led by the HSPH,

Increase collaboration between national health system leaders, HSPH, and other key partners/stakeholders that will support and sustain management and leadership activities.

For short term technical assistance from the CDC Thailand regional office to PEPFAR Vietnam's TB/HIV activities. Medical Officer/epidemiologist will:

Provide technical support in the development of a PEFPAR TB/HIV strategy that is in harmony with that of the National Tuberculosis Program (NTP),

In collaboration with the NTP participate in planning of TB/HIV activities,

In collaboration with PEPFAR Vietnam and national health officials, compile and disseminate essential information concerning TB/HIV,

Provide support to the development of the national operational research agenda and to participate in the identification and implementation of research activities supportive to the development of evidence-based TB/HIV prevention and control programs,

Support capacity building of national professional officers involved in TB/HIV.