Mitigate the negative effects of HIV disease to individuals, families, and communities by continuing to support a core package of psychosocial and clinical services in out-patient clinics and at home/community that are designed to optimize pre-antiretroviral therapy (ART) care, and facilitate access to long-term treatment.

Support the integration of wrap-around services into Continuum of Care (CoC) sites including family planning, STI, and mental health services, foster referral linkages and mentoring between COC sites and mental health providers.

Provide nutrition screening and comprehensive nutrition assessments to both adults and children where indicated. PLHIV, children, and caregivers will be provided with nutrition education and counseling, and therapeutic food will be provided to those who meet criteria in keeping with OGAC guidance.

Sustain the response by building the capacity of local public, private institutions and CBOs and maintaining a moderate model of services that is acceptable to local government.

Continue to provide OVC services in existing sites and the comprehensive model of care for OVC in Thu Duc district, HCMC.

Continue to develop the psychosocial and protection elements of the OVC program including the identification and response to mental health problems among children.

Continue to support MOLISA to complete national training materials and SOP for OVC program.

Support providing ART at 23 CoC sites to up to 10,000 adult patients, scaling up the integration of comprehensive services into the HIV CoC network.

Continue to support sites to focus on maximizing efficiency of existing sites to offer ART and to focus on client-centered adherence, psychosocial support, and case management to facilitate referral and access to community-based support services.

Established ART sites will function as model training sites for health care workers at new clinics as Vietnam continues to scale up and institutionalize ART within the government system.

Continue to support ARV sites through training, supportive supervision, QA/QI, and clinical mentoring, which will increasingly be done by local mentors using standardized HIV care and treatment clinical mentoring tools.

Sustain the response by building the capacity of local public, private institutions and CBOs and maintaining a moderate model of services that is acceptable to local government.

**These activities build off the activities currently implemented under the FHI-USAID award.

The partner will strive to increase uptake of HTC services by: strengthening existing HTC sites to help them to better serve MARPs; expanding coverage in Dien Bien and Lao Cai to meet rising demand; and through diversified models of HIV counseling and testing services, such as VCT, provider-initiated counseling and testing (PITC), the one-stop-shop model, particularly mobile services, couples counseling, and the mobile placement of HTC in MARP hotspots. The partner will build the capacity of all district health centers and district hospitals to provide HTC services. The partner will strengthen linkage and referral mechanisms between outreach and HTC services, as well as between HTC and other HIV services (including care and treatment, STI, MMT, etc).

Continue to support pediatric care with services linked to HIV counseling and testing to identify and increase access to care for HIV-infected children. 10 of the 23 COC sites will provide clinical services to up to 300 pediatric clients through integrated family-centered care (FCC) outpatient HIV services.

Infants born to infected mothers referred from the PMTCT program will be followed up until their HIV status is identified, and positive children will be provided with on-going care in out patient clinics.

Continue to provide pediatric ART services in 10 of the 23 sites where pediatric treatment is provided in integrated FCC OPC.

Focus on child development and stage-appropriate adherence support, psychosocial support, and case management to families to facilitate referral and access to community-based support.

Scaling up the early infant detection program and supporting clinicians to provide early ART to infants under 12 months of age who are HIV-positive

This is a continuing activity from FY10, and SI activities are on-going. The partner will be supported in FY11 for the PEPFAR Strategic Information priority areas of human capacity development at both national and provincial levels, and data synthesis and use, while continuing to conduct and provide TA on routine program monitoring, QA/QI, DQA for all programs and basic program evaluation of prioritized program areas. These areas include ARV services, basic HIV clinical and community-based care, medication-assisted therapy (MAT), and prevention peer outreach programs.

Data Synthesis and Use: The partner work with the VAAC/MoH and PEPFAR Provincial AIDS Centers (HCMC, Hanoi, Quang Ninh, Hai Phong, Nghe An, Can Tho, An Giang, Dien Bien and Lao Cai) and HPI to: Provide series of trainings on data collection to better understand the local and national HIV epidemic. Conduct the Advocacy and Analysis (A-squared) Project to: 1) providing outcome indicators and coverage information for PEPFAR-supported prevention programming among MARPs in Vietnam; 2) strengthening government staff capacity for data utilization; 3) providing information to explain changes in HIV prevalence, including the impact of PEPFAR-funded prevention programming; 4) providing epidemiologic and behavioral data in specialized formats tailored for advocacy to policymakers; and 5) developing a clear understanding of the HIV/AIDS epidemic in Vietnam so that that effective national policies and appropriately targeted programs can be developed. Other data use activities will include publication and dissemination of the third round of integrated biological and behavioral surveillance (IBBS). For increased understanding of behavioral trends illustrated by quantitative IBBS results, a small scale supplemental survey using qualitative methods, such as focus-group discussions, will be conducted to provide a more complete picture of the issues challenging HIV programs. Continuing to focus on GVN-centered capacity development for SI, the partner will also support epidemiological and program data gathering and participating in analysis and dissemination workshops.

Program monitoring: Reporting: the partner will upgrade the existing prevention peer-outreach program database. This system will help maximize work efficiency at the field level and enable data analysis to assist project partners in continuous quality improvement. In addition, this will be automatically connected to a Geographic Information System (GIS) for better visualization, outreach coordination and decision making. This software will be installed for all partner-supported prevention sites and training will be provided to all software users. DQA and QA/QI Quality of routine monitoring data will continue to be strengthened through the integration of data quality audits (DQA) as part of regular QA/QI visits to project sites. The partner will work with VAAC M&E to develop national standardized guidance for conducting DQA activities for all HIV related programs. In addition the partner will continue a QA/QI activity as routine monitoring and provide its TA to other PEPFAR partners on applying QA/QI tools. MMT: The partner will provide TA to PEPFAR and GVN on the routine M&E activities for national MMT program.

Program Evaluation and operational research: The partner will implement program coverage evaluations of interventions for both prevention, VCT and care and treatment programs and link it with GIS system to provide insightful data for programmers as well as strengthening the data use capacity at program level. The partner will work closely with PEPFAR SI on designing operation research targeting MARPs and bridge populations to provide better understanding on the these populations to guide the programming. The partner will conduct validation research on several methodologies that are used for studying MARPs to identify best practice methodologies for MARPs epidemic surveillance. The partner will create the Small Grant program for HIV research to support for Vietnam local research.

Survey/Surveillance: The partner will work closely with VAAC, NIHE and SI to provide technical assistance and support to the HIV surveillance system in Vietnam including both second generation surveillance (IBBS) and sentinel surveillance (HSS) and promotion of data synthesis, triangulation and use. Technical assistance and training on HIV estimate and projections (including EPP and AEM).

HMIS: Provide support to MoH and VAAC to strengthen the Health Management Information System.

HCD: The partner will share its experience and provide technical assistance in DQA, QA/QI, M&E and GIS for relevant stakeholders working in HIV field in Vietnam including VAAC's, PACs and PEPFAR partners, with the aim to help strengthen a collaborative QA/QI system in the field, and support better HIV program management and coordination of VAAC and PACs. The partner will join to organize and facilitate some basic and advanced training on M&E, HIV surveillance, and data synthesize and use since having solid experiences and expertise on these.

**These activities build off the activities currently implemented under the FHI-USAID award.

The partner will focus on providing intensive risk reduction services for most-at-risk and vulnerable FSWs, particularly those who inject drugs, and those who use condoms inconsistently, and will seek to improve uptake of services, particularly for those FSW who do not utilize health services (such as STI, VCT and RH). These FSW interventions will be particularly emphasized in high-prevalence provinces based on IBBS Round II, such as Hanoi, Hai Phong, HCMC, and Can Tho.

The partner will improve coverage and reach of innovative and evidence-based MSM interventions. They will target MSM, including those who are also MSW and/or IDU, with a comprehensive package of services, and will facilitate access to MSM-friendly VCT, STI services, and HIV treatment.

The partner will build capacity of MSM-led local NGOs and MSM social support groups.

The partner will support reduction of stigma and discrimination in health care settings and in the community through sensitization training on MSM-specific issues and health needs for health care providers, PAC staff and local stakeholders.

**These activities build off the activities currently implemented under the FHI-USAID award.

Scale up MMT service delivery in the most cost efficient manner possible in collaboration with MOH (VAAC and other related departments), provincial People's Committee and provincial health service (PHS). Pilot service provision models and evaluate the effectiveness, cost efficiency and sustainability of each model to prepare for Vietnamese Government to invest in the Methadone treatment service system, including satellite dispensing, co-payment, and integrated in ARV out-patient clinics models. Based on similar QI approaches developed in other prevention, care and treatment interventions develop a tool for improved MMT implementation at the district and provincial levels to add to existing quality improvement tools (QI). Conduct an evaluation of the methadone program in Vietnam to inform programming decision. Findings from the evaluation will support program planning and decision making and will provide evidence in support of effective program elements to Vietnamese policy makers and health authorities.

This evaluation will determine whether and which model of interventions of the scale up of methadone program for Vietnamese IDUs should be replicated nation-wide in expanded settings based on cost effectiveness, observed outcomes on HIV status, adherence to HIV treatment regimens, continued drug injection, sharing of injecting equipment, engagement in criminal activity, and enhanced quality of life, compared with costs of providing methadone treatment. The partner will increase drug users' access to services, as well as to sterile injecting equipment, condoms, and behavior change communication (BCC) aimed at preventing HIV transmission. The partner will encourage and facilitate access for clients to HTC and drug dependence treatment, especially MMT. The partner may procure, and will distribute, clean needles and syringes through a variety of innovative and traditional channels (including outreach, vouchers, pharmacists, tea/snack shops, fixed boxes, fixed sites, and secondary distribution) in accordance with results of an NSP needs assessment to determine procurement and distributions needs throughout the country. In partnership with Chemonics, the TBD partner will provide vocational training with a focus on improving employment opportunities for methadone clients. The partner will incorporate strategies around prevention of sexual transmission among IDUs and their sexual partners.

Continue to support PMTCT services in existing sites where also supports adult and pediatric care and treatment services in a family-centered model, focus on integrating PMTCT services into MCH and RH services and strengthening these services to serve for most-at-risk women.

Improve women's access to PMTCT services by strengthening MCH/RH services and by supporting the development of strong referral links between PMTCT services at the commune and district levels, district pre-natal and pediatric clinics, and district HIV outpatient clinics.

Integrate counseling and testing into pre-natal clinics through the RH and MCH networks, and among mobile teams providing counseling and testing in some hotspot communes in provinces such as Dien Bien and 'hot spot' districts and communes, where the HIV epidemic is generalized.

Sustain the response by building the capacity of local MCH/RH public and private institutions.

Continue to support improved management of HIV-TB co-infection by supporting and funding TB screening and referral, improving coordination of TB and HIV services at the province and district, and, capacity building for TB and HIV clinicians.