Goals and ObjectivesFHI360s objective is to support the Government of Vietnam to:- Support the Ministry of Health to establish and coordinate an HIV/AIDS research and evaluation agenda.- Build a sustainable national training system that prepares the current and future health workforce to provide quality medication assisted therapy (MAT) to opioid-dependent persons.- Strengthen MoHs capacity for ethical research oversight through institutional review boards (IRBs) and standard operating procedures.- Improve selected national level laboratories to international standards and capacity of district level labs.

Geographic coverage and target population(s)- FHI360 activities cover the entire country, at both the national and provincial levels- The MMT program covers 12 provinces and cities, with MAT clinicians and drug addiction counselors working in different voluntary, community-based drug treatment settings- For Lab activities, FHI360 works in Hanoi, HCMC, and Hue, where the ISO-supported labs are located.

Cost Effectiveness over TimeCurrently, PEPFAR is providing financial and TA support through FHI to build institutional capacity and start-up activities. To reduce costs and ensure quality cost-effective capacity building, FHI360 will transfer TA from international experts to a local network and Institutionalize training activities into existing health training systems.

Monitoring & EvaluationCDC will work with FHI and will be closely involved with development of all planned activities. FHI360 will work with key stakeholders to develop M&E plans which will include: 1) Clinical mentoring checklists and trip reports; 2) Participant grades after training; 3) Training evaluations by participants.

During COP 12, FHI360 will partner with VAMS, VAAC and PEPFAR partners to enhance and institutionalize health care worker capacity in palliative care (PC), community and home-based care (CHBC), and mental health (MH) for people living with HIV/AIDS. In-service PC training curricula for physicians and nurses will be approved and certified by the MOH. FHI360 will provide TA to local PC trainers and mentors to provide a range of capacity building activities including the following: didactic and on the job PC training for physicians and nurses, mentoring to HIV program staff in PC at HIV OPCs ,and quarterly clinical case discussions in Hanoi, HCMC and Hai Phong.

From October 2011 to September 2012 FHI360 will provide TOT training and coaching to local CHBC trainers and mentors, supporting them to provide CHBC training at the provincial and district level in addition to QA/mentoring of CHBC programs in PEPFAR/CDC supported provinces, in collaboration with other PEPFAR training and TA partners. Mentoring/quality improvement (QI) visits will be made to CHBC sites, in coordination with other PEPFAR partners. A comprehensive QA/QI assessment of GDPFP supported CHBC programs in Nghe An and Nam Dinh will also be conducted. Recommendations will be made to scale up this model for other provinces in a sustainable approach, including those where resources for HIV care and support are limited. FHI360 will support the VAAC to begin the revision of its CHBC curriculum and package of tools and SOPs. FHI360 will begin work with the VAAC and other partners to define a core package of care and support services that will be sustainable once donor support for HIV programs in Vietnam declines.

The focus for COP 12 will be on further institutionalizing capacity building in HIV related PC, MH and CHBC with the ultimate goal of ensuring all training and mentoring work is conducted and funded by local partners and trainers. FHI360 will provide technical assistance and training support to local partners, trainers and mentors in PC, MH and CHBC on an as needed basis. Where possible the costs of providing training and mentoring will be borne by the GVN or through non-PEPFAR donor funded programs. FHI360 will build on work started during COP 11 and work with the VAAC, HAIVN and other partners to integrate training in a core package of HIV care/support services.A limited number of training workshops to build capacity for additional national PC trainers and mentors will be supported in COP 12. FHI360 will collaborate with other partners and/or stakeholders to further develop the national PC network in Vietnam by supporting a virtual PC technical network (list server) for PC providers integrated into other clinical list servers where feasible.FHI360 will work with VAAC and other partners to review and adapt CHBC service provision model to ensure cost efficiency and a delivery service that meets future GVN funding capacity. Furthermore FHI360 will support VAAC to finalize a national CHBC training curriculum that supports the national CHBC service provision model.

FHI360 has been working closely with the CDC Vietnam team and has selected laboratories for implementation of ISO 15189 standards and preparation for ISO 15189 assessment. During the past two years, FHI360 has surveyed a dozen laboratories, eventually selecting 6 (5 national and 1 provincial level) and providing TA, implementation of documents and quality management practices for international accreditation of these 6 laboratories. These laboratories have received numerous trainings on different subjects and they are near the point of applying for accreditation. FHI has also supported the preparation and delivery of lectures on Quality Management trainings organized by LIFE-GAP and VAMS. FHI360 has a proven track record in Southeast Asia for moving laboratories to ISO 15189 accreditation. Over the past year they have hired qualified staff to support this activity.

COP 12 funding will be used to support the following new activities: 1) FHI will develop a program to improve the capability of district laboratories to increase their capability for service delivery and improve the quality of services. This TA focused project in one province will demonstrate to PEPFAR the current conditions of district level labs. Data from VAMS indicates that this is an untapped resource as most clinical lab testing is performed at the provincial level. 2) FHI will implement the SLMTA project, working closely with VAMS. 3) ISO 15189 accreditation: FHI will work with two more laboratories in the South to help them develop the capacity to achieve accreditation.

Institutional and human capacity to conduct and manage research in Vietnam is relatively new. To address this issue, COP12 funds will be used to continue activities to support the establishment and expansion of sites to adequately implement, manage, and oversee high quality research that will be used to inform better program practices and interventions. Building upon COP11 activities and achievement, FHI will provide TA to the MoH to expand the capacity for ethical research oversight through institutional review boards (IRBs) and SOPs at up to 4 institutions that will be identified as Clinical Research Units through an objective review process.

Formal training will also be provided in the areas of protocol development, study design, adverse-events reporting, and research ethics. Curricula for these will be standardized in collaboration with MoH for future application. FHI will also provide direct support to the MoH to define competencies and training programs related to ethical research and will support the integration of this curriculum into the post-graduate university system. Support will also be provided to develop a system to allow the MoH to track in-country human resources for those that have completed research ethics training.

COP12 funds will also be used to continue to support the MoH to establish and coordinate an HIV/AIDS research and evaluation agenda. The objective of this agenda is to define appropriate research needs and to coordinate their implementation by the GVN and other stakeholders. Such coordination and rigorous definition of research needs is currently lacking in Vietnam. It is anticipated that MoH and international funding opportunities will be identified to support the implementation of projects defined in this agenda.

There are an estimated 217,000 IDUs in Vietnam, 90% of whom are concentrated in 30 provinces (EPP 2010). To reduce HIV acquisition and transmission among IDUs, the MoH plans to provide Methadone Maintenance Treatment (MMT) to 80,000 IDUs in 30 provinces by 2015. PEPFAR Vietnam has been committed to building national capacity in MMT and providing technical and financial support to treat 13,000 IDUs at 50 MMT clinics in 15 provinces with high burden of IDU and HIV infections.

In COP 10 and COP11, FHI360 was funded by PEPFAR to support GVN (MoH and MOLISA) in 1) sustainable development of human capacity for provision of MMT and other addiction services; 2) establishment of national systems to provide technical assistance (TA), clinical mentoring and supervision to MMT clinics in Vietnam; and 3) institutionalization of training curricula on MAT/ addiction medicine and addiction treatment counseling into formal training systems in Vietnam including Medical Universities and MOLISAs Universities of Labor and Social Affairs (ULSA). In COP12, we will provide:

1) TA to the Ministry of Health and PEPFAR-supported MMT clinics to ensure quality of services2) support to the ongoing development of local capacity in MMT clinical supervision and mentoring3) TA to MMT master trainers, clinical mentors and supervisors in training new MMT staff4) institutionalization of training curricula on MAT/ addiction medicine into Medical Universities and support pre-services training5) institutionalization of training curricula on addiction treatment counseling into the MOLISA university system (ULSA) and support pre-services training to enable MOLISA to take ownership of this curricula for complementary use in a PEPFAR supported community-based drug treatment pilot

It is projected that FHI360 will support training of 50 MMT doctors, 20 MMT clinical mentors/supervisors, 150 counselors and 200 social work students. Training needs assessments will be conducted to develop training courses. Pre- and post tests will be applied to measure training outcomes. Trainees will be followed over time to evaluate training impact on knowledge and skills. TA visits by local mentors/supervisors will be conducted with support from FHI360 on a regular basis.

In COP 12, FHI360 will support the following activities with available funds:

1) FHI360 will support Hanoi Medical University to review the HIV prevention block curriculum for preventive medicine students and the integrated HIV prevention, care and treatment curriculum for under-graduate medical students based on the facultys experience of implementing the curriculum and teaching program. This may include revising the framework and content of lectures in response to gaps and needs. FHI360 will support the rector of HMU to undertake a number of workshops to advocate for these two curricula to be utilized by all medical universities in Vietnam. Furthermore, during COP 12 FHI360 will support HMU to develop a post graduate curriculum in prevention and clinical HIV care and treatment for post graduate infectious disease students.2) Sub-contract to Pathfinder International to continue its work with Hai Phong Medical University (HPMU) to provide e-learning in HIV using blended learning approaches. PI proposes to:-Support HPMU to finalize and approve the blended learning curricula in: HIV care and treatment, PC and MMT;-Provide technical assistance and support as HPMU implements the 3 revised modules;-Support HPMU to pilot different approaches to market the DL package and recruit;3) Sub-contract with Pathfinder International to enable them to further build on the work to support the institutionalization of HIV-related CME and provider licensing in COP 11 in collaboration with the MoH, PEPFAR and its partner I-TECH. PI proposes to undertake the following activities to further support and institutionalize national CME and licensing for HIV providers.-Support the MoH to review and approve standards for accreditation of HIV/AIDS training institutions as CME providers;-Support MOH to select and accredit 5-10 health facilities as CME providers in HIV/AIDS;-VAAC, MoH, I-TECH and HAIVN will finalize licensing approval.