The goal of the Ho Chi Minh City (HCMC) Provincial AIDS Committee (PAC) is to provide an effective and sustainable response to the HIV epidemic in HCMC and surrounding southern provinces, by making efficient and effective use of limited resources and maximizing coordination of public health service delivery resources. The objectives are to: 1) strengthen the quality of and increase access to HIV services for MARPS and those who are HIV-positive; 2) strengthen public health systems and increase collaboration across programs to provide HIV services; and 3) strengthen the workforce to improve service delivery.

The geographic coverage area is HCMC and surrounding southern provinces. Target populations are HIV-positive individuals, IDUs, female and male sex workers (street- and venue-based), and MSM. Target populations are consistent with the epidemiologic data for populations at highest risk for getting infected, transmitting HIV in HCMC, and in need of HIV care and treatment services. For cost-efficiency the IM plans to combine and decrease service-delivery sites; increase utilization of HCWs and save money by reducing duplication of staff and HCW allowances; combine positions/roles to serve multiple functions; and incrementally transfer PEPAR staff to government of Vietnam (GVN) positions and to other GVN ministries. This is being planned in collaboration with HCMC Peoples Committee.

To transition to the partner government, there will be a gradual, incremental increase in funding from the HCMC Peoples Committee to support streamlined PEPFAR-funded activities and staff. The IM will implement client paid services; increase involvement from the private sector; and use the National Heath Care system to finance HIV drugs when available.

CDC-supported HIV care and support programs promote a package of core services that includes routine clinical care (fungal and OI treatment, ARV-related laboratory monitoring services, and screening for Hepatitis B and C), and care and support (CTX prophylaxis, PITC of HIV and TB, INH prophylaxis and infection control).

HIV/Hepatitis co-infection is a major program concern. The prevalence of Hepatitis B and C among ARV patients in Ho Chi Minh City (HCMC) was 14.4% and 53.3%, respectively, and baseline liver toxicity (ALT>120) is also high (5%). CDC will advocate implementing WHO 2010 Guidelines for early initiation of ART regimens that contain Tenofovir for patients with HIV/HBV co-infection and work with PAC to develop and implement an observational cohort study of HIV and HIV/Hepatitis co-infections to evaluate clinical outcomes and inform program planning.

CDC will continue to support the core adult care service package for PLHIV at 11 outpatient clinics (OPCs), applying a family centered approach that improves linkages between care and treatment (C&T) services and prevention programs, and tracking of referrals. CDC also continues support for mobile clinics that provide services to remote areas in HCMC. HCMC PAC is in the process of decentralizing ARV dispensaries at the community level and will conduct a year-end assessment of this pilot.

Other major challenges are a high percentage of LTFU post-registration at OPCs (40%) and late presentation for ART. CDC, PAC and other stakeholders will develop strategies to increase awareness of HCWs on the benefits of knowing HIV status and early access to and retention in C&T. With consent by the Ministry of Health (MOH), CDC will work with PAC to provide HIV C&T using a rapid test algorithm and to decrease turnaround time. CD4 testing will be provided for patients at their initial visit. Peer educators and PLHIV networks will be mobilized to track referral of VCT clients.

CDC will work with PAC and other stakeholders to strengthen the existing health system and transition a program to the government of Vietnam (GVN) that is more cost-effective. CDC has been working with PAC to transition project staff to GVN employees, and will simplify district service-delivery sites with low caseloads to satellite sites, while maintaining some comprehensive sites. CDC will continue to support linkage and referral between the HIV and other health programs (i.e., TB and MCH) and will work with PAC and HCMC Department of Health (DOH) to conduct a pilot on streamlining facility-based services like ART, methadone maintenance treatment (MMT), and VCT, and integrating them into the existing primary healthcare system.

As designated by the government of Vietnam, Department of Labor, Invalids and Social Affairs (DOLISA) is the core body of the OVC program at the city level. In the past, DOLISA worked closely with PAC in coordinating all OVC players in HCMC and successfully conducted information, education and communications (IEC) activities and raised community awareness of HIV. A major difficulty is lack of skillful human resources in the DOLISA system. A core priority for COP 12 is capacity-building for caregivers, OVC staff and OVC. The HCMC PAC M&E system will supervise and monitor OVC activities. HCMC PAC will work with local partners to improve the quality of OVC services in HCMC, and to ensure comprehensive care and support for OVC is aligned with Decree No. 84 on care and support for children infected/affected by HIV. Technical assistance will be provided to DOLISA to strengthen and mobilize government resources to reach the national strategic goal of ensuring that the needs of most children affected by HIV infection are met by 2020.

Current support for OVC efforts includes mapping by PAC of all OVC support-services, identification of gaps/needs for OVC and gaining feedback from OVC players to improve the quality of the OVC program. In 2010, more than 900 OVC received 1 OVC service supported by CDC. Many capacity-building activities for OVC staff at all levels and OVC were conducted with TA from CDC, PAC and DOLISA.

COP 12 objectives for HCMC PAC OVC activities include improving the quality of OVC services by providing support to 1,000 OVC at 3 OVC sites for food and nutrition, healthcare, education and vocational training, shelter and care, psychological support and protection. Focus will be to reduce direct service-delivery, increase capacity-building, and mobilize alternative resources to fill gaps. Training in care and support, HIV prevention, home-based care, psychological support, and economic improvement of OVC will be provided to OVC providers and caretakers. A second objective is to improve human resource capacity of OVC/DOLISA staff. Activities will include strengthening M&E activities at PAC; training city/district staff on data collection and use for quality improvement; building capacity of government to take over the OVC program; training DOLISA staff at non-PEPFAR sites on the OVC program; and provide TA for service-delivery supported by GVN funding. A third objective is to support the citys OVC program by: providing TA to DOLISA on OVC plan-of-action roll-out; building the coordination mechanism of HCMC OVC program to maximize resources and for resource/experience sharing; and providing TA to DOLISA program management.

Core activities include HIV PITC for TB patients, intensified TB case finding (ICF), isoniazid preventive therapy (IPT), and TB infection control (IC). These activities are aligned with Vietnam national HIV and TB policies and strategies. In COP 12, a transition plan will be made to gradually shift PITC from a project framework to the national TB program. In accordance with the PEPFAR strategy to increase sustainability and government ownership, HCMC PAC plans to increase the proportion of technical assistance (TA) as the financial contribution for service-delivery will be increasingly borne by the national budget and other sources.

HCMC PAC, as the national HIV authority within HCMC, coordinates TB/HIV activities across different donors and partners to maximize partner strengths and resources, minimize duplications and to ensure donor support is aligned with PAC priorities. The HVTB budget allocated for HCMC PAC will support TB/HIV activities in the public sector.

All core TB/HIV activities (e.g., PITC, ICF, and IPT for adult and pediatric patients) implemented in HCMC are part of national TB and HIV policies. Revision of national guidelines for PITC, ICF, IPT and IC to make them more comprehensive and aligned with HIV programs in accordance with WHO recommendations is in progress and will provide the legal basis to make these activities sustainable. Trainings of TB and HIV providers on TB/HIV activities are ensured as part of human capacity development. As part of COP 12 activities, PAC will work with service-delivery sites to reduce staffing costs, provide new and refresher training to government staff in clinics providing routine PITC and ICF, and ensure that targets and core indicators continue to be met.

TB/HIV indicators are regularly collected and reported by HCMC PAC and Pham Ngoc Thach TB and Lung disease Hospital as part of the HIV and TB M&E systems, and used mainly for program improvement and planning. In FY 2010, 97% (13,460/13,916) of registered TB patients in HCMC have known their HIV status including 1,689 previously known and 11,771 receiving PITC after TB diagnosis. More than 95% of HIV-infected individuals were screened for TB, and 1,307 diagnosed and treated with active TB. There were 864 HIV-infected patients started on IPT, and 266 healthcare staff trained in TB/HIV. The low proportion (46%) of HIV-positive TB patients receiving ART is a challenge. Potential solutions include strengthening referrals/linkages and advocacy to revise current national ART guidelines according to WHO recommendations to start ART in HIV-positive TB patients irrespective of CD4 cell count.

The pediatric care and support program started in Ho Chi Minh City (HCMC) in 2005. Today, pediatric OPCs are closely linked to the PMTCT program. The 3 CDC-supported pediatric outpatient clinics (OPCs) provide care and support to HIVinfected and exposed children referred from PMTCT sites. Services include clinical examinations and formula provision for infants 6 weeks through 18 months. Additional services include PCR-DNA testing for early infant diagnosis (EID), CTX prophylaxis, OI and ARV treatment, nutritional supplements, psychosocial support, transportation and hospitalization fee support.

Challenges and priorities for COP 12 include addressing the needs of a growing population of perinatally HIV-infected adolescents, transitioning nutritional and other support services to the government of Vietnam (GVN) and other donors, continuing to address the supervision and quality of pediatric HIV care and support services, and transitioning HIV-infected children to other OPCs. In COP 12, the pediatric care and support program will improve linkages to other health and social welfare programs, and begin planning the transition of adolescents into adult care services.

Currently, there are 1,500 HIV-exposed and infected children receiving CDC-supported care in HCMC and 570 on CTX prophylaxis. In COP 12 a target of 1,620 children will receive care and 600 will be on CTX.In COP 12 HCMC PAC objectives are to: 1) continue providing service-delivery support to HIV-infected and exposed children at 4 pediatric OPCs by gradually transitioning food and nutrition support to other donors; continue providing psychosocial and other support for pediatric clients, organize training courses on Prevention with Positivies (PwP); reproductive health (RH) for adolescents with HIV; establish support groups, provide disclosure counseling to HIV-infected children and psychological support after disclosure; and strengthen linkages with other health and social welfare programs; 2) build capacity of site staff on quality improvement of care and support services including introducing the HIVQUAL model to 2 pediatric OPCs, encourage knowledge and experience sharing between OPC staff; provide technical assistance (TA) to new OPCs to build capacity of site staff on service-delivery and program management ; 3) support OPCs piloting the transition of adolescents into adult services and scale-up the model in the following years; engage the involvement of PLHIV groups and social workers in the transition process.

Ho Chi Minh City (HCMC) Provincial AIDS Committee (PAC) is the main PEPFAR partner providing clinical care and support for PLHIV in HCMC, including treatment monitoring. HCMC PAC continues to expand programs focused on HIV prevention, treatment and care activities, as well as to improve laboratory infrastructure and program M&E, and to provide training to professionals working in numerous health facilities in HCMC.

PEPFAR funds support HCMC PAC to provide training for clinical laboratories and the implementation of a laboratory information system (LIS). When there is sufficient justification (no other local source of funding), we also support procurement of laboratory equipment. HCMC PAC provides laboratory support to all 24 preventive medicine centers (PMC) and 24 district hospitals in HCMC, as well as the HCMC provincial level Preventive Medical Center and several city hospitals, such as Pediatrics #2 and Pham Ngoc Thach. A significant portion of this support has been for training and implementation of the LIS in HIV-testing facilities (PMCs) and hospitals. The electronic LIS is a valuable tool that has improved the quality of laboratory results and data management with barcode technology, electronic exchange of data between instruments, and the LIS software and rapid generation of summary reports. PAC HCMC has deployed the LIS in 8 HIV testing and hospital laboratories, and within the next 12 months will complete installation at 2 district level hospitals. Another activity implemented in HCMC is the deployment of barcode technology at outpatient clinics (OPCs) and PMTCT sites. In the future, OPC sites will have a patient management system (under development), so future emphasis will be given to exchanging data between the patient management system at the OPCs and the LIS at the district-level PMCs. PAC HCMC has provided annual training for district-level laboratories on CD4 testing, biosafety, HIV rapid tests, and internal quality control (IQC).

In COP 12, PEPFAR support to PAC HCMC will continue to strengthen the quality of the laboratory network for HIV-related testing through trainings, onsite monitoring and LIS. PEPFAR will continue to shift away from the purchase of equipment. Focus will be on the institutionalization and sustainability of training and LIS programs, and support for the Center for Standardization and QC in Medical Laboratory of Ho Chi Minh City (CSQL) for the development of EQA software and capacity building.

The Ho Chi Minh City (HCMC) Provincial AIDS Committee (PAC) will continue to provide primary technical oversight for M&E, health management information system (HMIS), and human capacity development (HCD) activities in the province in a number of ways. First, PAC will perform routine program monitoring and reporting for ART, PMTCT, VCT and community outreach activities, focusing on data QA and providing technical assistance (TA) at the service-delivery levels. PEPFAR funds will support contracted staff, training, implementation of QA tools and supervision at all levels across all PEPFAR program areas. PAC also will collaborate with technical local institutions and universities around capacity-building activities to strengthen HIV program management and data collection, management and use. Moreover, PAC will continue an HMIS integration to support centralized client registration for HIV services in 24 districts within the HCMC province. HCMC PAC is receiving technical support from the International Training and Education Center for Health (I-TECH) on integrating information systems supporting HIVS programs in HCMC, including an updated patient index, standardized PMIS systems and a new information system for the PMTCT program. The project will transition to the second phase, where all information systems will be linked to enable data exchange and better referral of HIV patients from entry point-of-service to chronic clinical care and treatment for HIV patients. PAC also plans to roll-out new information systems citywide. HCMC PAC will complete the development of information systems that had been prioritized in 2011. The roll-out will include a series of trainings for end-users, managers and IT support, and possibly daily operational support to ensure appropriate and effective use of the new information systems.

In FY 2011, Ho Chi Minh City (HCMC) Provincial AIDS Committee (PAC) provided VCT to 16,000 individuals (12.7% HIV-positive), and more than 500 couples (22% discordant and 21% concordant positive). All PEPFAR services (2011 SAPR) provided PITC through PMTCT to 202,052 pregnant women (0.3% HIV-positive) and through TB programs to 15,085 TB patients (3.3% HIV-positive).

PEPFAR will build the capacity for PAC to ensure HIV care & treatment (C&T) service provision in select areas across HCMC. Last year, HCMC PAC trained 137 participants on topics related to CHCT, PITC at STI setting, and basic VCT training.After years of continued advocacy, PEPFAR anticipates that rapid testing algorithms would be approved and PAC will implement these in select HCMC sites.

In COP 12, 11 PAC HTC sites will serve 19,000 clients. However, efficiencies in HTC will be explored through potential consolidation of sites based on technical criteria to be developed by PAC, and through possible consolidation of staffing roles. Additionally, opportunities for cross training of counselors (MMT, VCT, ART, etc) will be explored in HCMC.

PAC strategy also will focus on: 1) ensuring a mix of HTC modalities including outreach-based/mobile, community-based, and government health facility-based; 2) partnering more closely with community-level interventions, including outreach workers, and social marketing programs to ensure focused sexual and injecting risk-reduction messages; 3) developing clear bi-directional linkages with methadone maintenance treatment (MMT) clinics to serve IDUs, and their sexual and injecting partners; 4) adding precision risk assessment to increase counseling quality; 5) collaborating in a pilot mens clinic, training HIV C&T providers in MSM sensitization and an advanced understanding of co-occurring risk behaviors; 6) integrating core concepts of Prevention with Positives (PwP) in post-test counseling and in linkage efforts with outreach; 7) promoting CHCT at VCT sites and other HIV-related services.

Almost all VCT and outpatient clinic (OPC) sites are co-located, and it is reported that 67% of all HIV-positive VCT clients accessed OPCs in the past 5 years in HCMC. Tracking efforts include a care card that facilitates linkages from VCT to OPC. PAC will strengthen a bi-directional referral system between prevention and C&T to facilitate patient enrollment, including a focus on referrals in counseling, knowledge of early treatment benefits, piloting CD4 testing, referral to patient support groups, standardizing PwP messages, and re-testing messaging.

By September 2013, 8,716 FSWs (and 150 MSM) will be reached with behavior change communication focused on sexual risk reduction and access to preventive commodities (sterile needles/syringes (N/S), condoms) (where applicable, injecting risk-reduction messages will be provided); and 4,355 FSWs (and 75 MSM) will be referred to HTC, STI, HIV care and treatment, and methadone maintenance treatment (MMT) (where applicable).

In COP 12, PAC plans to transition away from PEPFAR support for program operation and commodities to greater technical assistance (TA). The government of Vietnam (GVN) will cover a greater proportion of salaries for staff overtime and train outreach workers using provincial staff with minimum financial support from PEPFAR. Efficiencies will be gained through: 1) revising the geographic focus based on epidemiological information; 2) revising the targets by piloting a network contact approach, focusing on highest risk MARPs and eliminating duplication of efforts by other partners; 3) collaborating with public and private sectors to establish and improve linkages/referral to STI services; 4) coordinating with GVN and other partners in developing BCC messages across care and treatment (C&T), and prevention; 5) expanding outreach workers responsibility to support C&T. Program monitoring will be conducted routinely through program-level data reporting, site visits and program reviews.Core interventions for FSWs include: 1) community-based outreach; 2) promoting/distribution of condoms; and 3) referring FSW clients to HTC, SW-friendly STI clinics (to be piloted by PEPFAR partners) for routine checkup and treatment; 4) Prevention with Positives (PwP) messages through both prevention and care services, and other relevant clinical services; 5) drug use-associated risk-reduction messaging and linkage to N/S and/or MMT services where possible.

PEPFAR supports PAC in its efforts to ensure the same package for MSM. PAC is finalizing a plan for HIV prevention among MSM. PEPFAR will support prevention in MSM through multiple partners (including SMART TA/USAID). Focus will be on using existing outreach workers who may encounter MSM in high-risk areas. PAC also will support referral of MSM (through HIV C&T and outreach efforts across HCMC) to 1-3 pilot male friendly clinics focusing on the sexual health needs unique to MSM.

In COP 12, Ho Chi Minh City (HCMC) Provincial AIDS Committee (PAC) will continue to provide a minimum package of HIV services for IDUs in high-prevalence areas in HCMC. Nationwide, about 90-95% of IDUs are male; 54% were under 30 years of age; 70% had used drugs for 5 years or more; and 36% had been in drug detention centers (IBBS 2009).

Additionally, 16.1% of IDUs are infected with HIV (2010 HIV Sentinel Surveillance), but the prevalence varies significantly by province (7-29%, Sentinel Surveillance 2010). Key HIV risks among IDUs include needles/syringes (N/S) sharing (25% in HCMC, and 7.3-54.1%, varying by province); inconsistent condom use with both SWs and regular partners (from 60-40% in HCMC from 2000-2009); <50% of IDUs know their HIV status, and < 40% received free N/S in the past 6 months (IBBS 2009).

PEPFAR will continue its support to HCMC PAC to establish and ensure provision of a core package of services. Based on varied ecological factors including, size estimation, burden of HIV infection, risk behaviors, and other donor support present, PEPFAR and HCMC PAC will determine specific support for PEPFAR technical assistance (TA) and/or service delivery.

Core interventions include: 1) peer-based outreach to promote behavior change, utilization of case management approach to facilitate risk-reduction, and referral to HTC and relevant clinical services for 3,750 IDUs in selected areas; increased efforts in outreach and linkages will be given to IDUs who report multiple risk behaviors, such as sex work or MSM, or are HIV-positive; 2) procurement and distribution of sterile N/S (in coordination with other donorsthrough outreach and other appropriate modalities; condom promotion and distribution; 3) methadone maintenance treatment (MMT) for 1,000 IDUs in 3 MMT clinics in provinces, in addition to the PEPFAR-supported MMT clinics in HCMC; 4) sustained bi-directional referral systems and linkages among outreach, MMT, HTC, psycho-social support, STI, HIV care and ART treatment services.

Routine program data for outreach programs, including distribution of N/S and condoms, will be used to monitor program performance at provincial and central levels. Efforts will be made to include meaningful, interim behavior change indicators into government of Vietnam (GVN) monitoring systems. Monitoring site visits will be conducted on a regular basis by PAC staff to assure quality using standard checklists. Supervisors will be trained on enhanced supervision skills and use of field observation and case conferencing. HCMC PAC will continue to collaborate with FHI360 to provide training, technical support and clinical supervision to MMT clinics using standard tools.

The PMTCT program supported by CDC-Ho Chi Minh City (HCMC) Provincial AIDS Committee (PAC) covers 56 sites. In 2010, 120,000 pregnant women received HIV care and treatment (HCT) and 620 received ARV prophylaxis. The MTCT rate was reduced from 6.3-4.3% in 2009. PAC has a fully functional M&E system that collects monthly data from PMTCT sites, which is reported to the national M&E data systems. HCMC PAC is responsible for monitoring PMTCT program quality for the province, and will continue to receive TA to do this. PAC is aligned with national PMTCT policies and guidelines, which are prioritizing early HCT and CD4 testing, early ARV initiation for pregnant HIV-positive women, and referral for continuum of care. Key challenges for the PMTCT program include late access of HIV-positive pregnant women to ART and high rates of LTFU of mother-infant pairs after delivery. Targets for COP 12 for HCMC PAC include 120,000 women tested for HIV who receive results, and 650 HIV-positive pregnant women receiving ARV prophylaxis.

COP 12 priorities are continued capacity-building of local government and maintaining PMTCT services in the province. CDC will continue to encourage the use of other resources to support the PMTCT program by increasing the involvement of the health insurance system, encouraging self-pay in covering HIV-testing service fees, and advocating the government of Vietnam (GVN) and/or HCMC to support at least 20% PMTCT staff. The goal will be to increase the number of women who receive early HCT and ARV at ANC by integrating HCT with syphilis and Hepatitis B screening.

In COP 12, PEPFAR will continue to support PAC to: 1) ensure provision of essential services such as HCT, formula and early infant diagnosis (EID), and gradually hand over formula support to GVN; 2)strengthen the referral system; 3) build linkages with other programs to build capacity of community outreach staff and counselors at outpatient clinics (OPCs) and MCH staff on primary prevention; 4) increase uptake of PMTCT services; 5) increase male involvement in PMTCT; and 6) integrate PMTCT information, education and communications (IEC) activities into annual IEC of other programs. Focus also will be on building capacity of staff to ensure that health workers are capable of providing PMTCT services and supervising the program. Training will be provided on routine data collection and using data to monitor and improve service quality. PAC and MCH center will co-lead planning and management of PMTCT program in the city. An online PMTCT data management system will be developed and shared between PAC and MCH system.

In July 2011, 17,436 patients received ART, with 10,614 on active ARV treatment; 1,858 were LTFU and mortality on ARV was 1,662.In COP 12, CDC will provide technical assistance (TA) to PAC for several trainings on various capacity-building topics: 1) HIV clinical management (module 1, 2, 3) for newly recruited doctors and other healthcare providers in Ho Chi Minh City (HCMC) with TA from HAIVN and Tropical Disease Hospital in HCMC; 2) HIVQUAL for OPC staff, including support staff and management, and establishing a committee to increase collaboration between measuring outpatient (OPC) performance and developing a QI plan to improve services; 3) Early warning indicators (EWI) for OPC staff on how to collect and use data to improve treatment adherence and drug-resistance prevention; 4) linkages and referral of ARV patients to HIV services and how to improve treatment adherence for ART support groups; 5) improving skills of HBC groups.

PAC provides supervision to the adult treatment program by mobilizing experienced OPC doctors, HAIVN and tropical disease hospital staff as supervisors who provide clinical mentoring for OPCs monthly using QI tools developed by PAC HCMC. CDC will collaborate with SCMS to improve ARV and OI pharmaceutical management. PAC will organize regular monthly clinical conferences for HIV doctors of ART networks in HCMC to discuss adverse effects and switching patients to second-line regimen.

PAC has developed and implemented standardized core monitoring indicators for paper-based monthly reports for all OPCs that are sent to PAC for analysis. Provincial supervisors use findings from site visits to improve program performance. Due to limited data use at the site level for program improvement, PAC is planning to pilot ARV service QI surveys at 3 pilot sites using HIVQUAL, so that field staff will learn how to measure performance and make QI plans.CDC will provide TA to create a community-based PLHIV network that is able to coordinate all home/community-based care (HCBC) in HCMC. PAC will strengthen facility and HCBC systems supporting care and treatment activities and expand HCBC activities to 10 outlets providing services in clinical management, palliative care and treatment adherence. Pastoral Care will be the network coordinator that is linked to OPCs with oversight from PAC. The network, along with peer educators for MARPs, will assist OPC staff in increasing early access to care and reducing LTFU. PAC will setup support groups for ART patients to improve treatment adherence and organize 4 training workshops for self-help group facilitators to improve their capacity.

The pediatric treatment program in HCMC started in 2005. CDC supports 3 pediatric outpatient clinics (OPCs) that provide services for HIV-infected and exposed children referred from PMTCT sites. HCMC PAC is aligned with national pediatric care and treatment guidelines to provide ART to all positive children <1 year, irrespective of CD4 count. As done nationally, HCMC clinics provide CD4 monitoring bi-annually and VL testing based on CD4 results. Monitoring and supervision is provided by PAC, and results are reported to the national level.

This year, the pediatric treatment program is scaling-up pediatric treatment services, integrating with adult OPCs for family centered care, and adding support for pediatric treatment at existing adult OPCs. In COP 12, the pediatric treatment program will improve linkages with other program services (adult care and treatment, PMTCT, MCH, OVC). Transiting adolescent HIV-infected patients to adult OPC services will be piloted, QI systems will be developed, and adherence support strategies will be strengthened to include PLHIV and community support to patients and families, in addition to support from healthcare providers.

Currently there are more than 900 children on ART. Targets for 2012 include 250 new pediatric patients on ART, for a total of 1,300 pediatric patients continuing to receive ART.

Pediatric treatment priorities for PAC in COP 12 are to: 1) continue supporting service delivery at 4 pediatric OPCs; scale-up the family centered care model; develop and pilot a model for PITC in pediatric patients in high-risk clinical settings; and refine existing services to a minimum package of essential services for HIV-infected children; 2) provide QI of treatment services at OPCs through capacity-building of OPC staff; strengthening the mentoring/supervision system; maintaining training activities at a pediatric tertiary care center for service-providers and students in HCMC and regionally; provide TA to newly established OPCs to build capacity of site staff on service-delivery and program management; apply HIVQUAL at 2 pediatric OPCs in HCMC; and use data for QI; 3) organize regular meetings to strengthen the linkages with adult treatment, PMTCT, and home-based care programs, and establish functional linkages between programs and the community to reduce LTFU and improve long-term outcomes. Specifically, they will engage PLHIV groups and social workers to provide treatment adherence and other psychosocial support, and aid adolescents transition into adult treatment programs.