In collaboration and with technical support from CDC Vietnam, the Vietnam Administration for HIV/AIDS Control (VAAC) supports the National Strategic Plan for HIV/AIDS in Vietnam with the following objectives:

1. Achieve primary prevention of HIV infection;

2. Improve the care and treatment (C&T) of HIV/AIDS, STIs and related OIs;

3. Strengthen the capacity of Vietnam to collect and use surveillance data and manage national HIV programs;

4. Improve the quality and capacity of laboratory testing associated with HIV and OIs.

VAAC is the national coordinating body for HIV activities, providing coverage at the national, regional and provincial levels. VAAC has direct subcontracts with 28 provinces and 7 national institutes.

Cost efficiencies will be gained through:

-revising the geographic focus based on epidemiological information;

-transitioning out of direct service delivery provision;

-integrating current services into government healthcare facilities; and

-improving linkages/referral to services provided by GVN and other partners.

PEPFARs support to the government of Vietnam (GVN) in program operation and commodities is at the beginning of a transition period in COP 12 to shift to technical assistance. PEPFAR will support integration of VAAC project structure into the GVN Provincial AIDS Committees (PACs), engage regional institutes in provincial-level activities, and provide support for strategies set by authorities at the central and provincial level.

CDC technical teams will work closely with LIFE GAP (LG) and VAAC staff on a monthly basis to provide TA and routine monitoring of activities. Program monitoring will be conducted routinely through program-level data reporting, a robust PEPFAR monitoring system, site visits and program reviews.

In FY 2011, CDC continued to fund and provide technical assistance (TA) to the Ministry of Health (MOH) to provide adult care and support services that include routine clinical care and a minimum package of care (please refer to Care TAN for definitions of service package). Services will be provided at 31 adult outpatient clinics (OPCs) and/or referred to other available HIV support services in 20 provinces.

PEPFAR partners in 24 provinces have received OI drugs and other medications funded through the MOH/Vietnam Administration for HIV/AIDS Control (VAAC) cooperative agreement. As of Aug. 2011, 17,810 clients and 911 HIV-infected people received HIV outpatient services and CHBC services, respectively; 1,456 HIV-affected people received CHBC services; STI services were provided at 1,839 HIV-infected patient visits; and 720 healthcare staff received new and refresher training on HIV clinical care, palliative care, CHBC, STI and program management. In FY 2012 and FY 2013, MOH/VAAC will maintain adult care and support services at 31 OPCs in 20 provinces and CHBC services in 10 provinces, focusing on improved linkages between prevention and care and treatment C&T) services. Collaborating with TB staff, the VAAC will implement isoniazid preventive therapy (IPT) at all adult OPCs and improve referrals of HIV-infected people who are suspected of having TB. A continuum of prevention, care and treatment (C&T) model will be continued in Son La, a northwest province with a high burden of IDUs and HIV. Given the burden of Hepatitis, MOH/VAAC will closely work with experts from the CDC to review existing activities related to HIV and Hepatitis B co-infection and advocate for implementation of the WHO 2010 treatment guidelines. An observational cohort study of HIV, HIV and Hepatitis B and C co-infections in 2 provinces evaluating clinical outcomes and informing program planning will be conducted. Health insurance coverage for HIV diagnosis and treatment and integration of medication supply chain management into the existing healthcare system will be promoted. As an effort of gradual transition of service delivery to the government of Vietnam (GVN), CDC will continue to support MOH/VAAC to develop legal documents, promote health insurance coverage for HIV-infected people, streamline staffing structure, expand quality improvement at HIV OPCs, provide care and support in-reach model to HIV- infected residents of rehabilitation centers and improve service linkages between prevention, C&T. Capacity-building activities for HIV service-providers will be consolidated to avoid overlapping effort and resources between PEPFAR partners and other stakeholder-supported programs. Funds include $458,000 for adult OI and $10,000 for pediatric OI.

The Ministry of Health (MOH)/Vietnam Administration for HIV/AIDS Control (VAAC) will maintain support for 4 provinces (Thai Binh, Thanh Hoa, Long An, Thai Nguyen); with a target to support 1,350 OVCs annually. In the next 2 years, VAAC will focus more on supporting project provinces to leverage resources for the program. Activities include building up multi-sectoral partnership among the HIV/AIDS Provincial center, Department of Labor, Invalid and Social welfare (DOLISA), Department of Education and Training, Womens Union, Youth Union, etc.; advocacy for the government of Vietnam (GVN) funding to OVC program through involvement of Peoples Committee, Department of Finance, and Department of Investment and Planning. PEPFAR will fund quarterly meetings, advocacy and strategy development workshops. VAAC will support capacity-building for related systems; the strategy is to build capacity then transfer tasks of coordination and leadership to DOLISA. For staff directly involved in the provision of support for OVC, PEPFAR support will fund training on specialized skills and knowledge areas, such as psychological needs assessment and intervention, and life-skills. PEPFAR also will fund the VAAC to carry out the following activities: -An annual experience sharing and best-practices workshop among 4 provinces and with participation of other PEPFAR partners; -Basic support for OVC under OGAC guidance, but with highest priority given to local or GVN programs; -Project sites will gather information and compile a directory of existing support and the procedures for referrals (to include the National under 5 Malnutrition Control and Prevention program, the degree 67/ND-CP of monthly allowance support for people with hardship conditions, policy of reducing or waiving school fees for pupils with hardship conditions, including orphans). In COP 12, PEPFAR funds and local resources will complement each other to maximize usage and comprehensively cover the needs of OVC.

Core activities include HIV testing and counseling (PITC) for TB patients, intensified TB case finding (ICF), isoniazid preventive therapy (IPT), and TB infection control (IC). All these activities are aligned with national HIV and TB policies and strategies. With COP 12, a transition plan will be made to gradually shift PITC from a project framework to the National TB Program (NTP) as part of the routine standard of care. The Ministry of Health (MOH) will support NTP to improve program quality through technical assistance (TA) models. In accordance with PEPFAR strategy to increase sustainability and government ownership, MOH plans to increase the proportion of TA as the financial contribution for service-delivery is to be increasingly borne by the national budget and other sources. MOH is in the process of developing the National Strategy on HIV/AIDS Prevention and Control for 20102020 with a Vision to 2030. In context of multiple donors and partners working on TB/HIV, VAAC has shown the one national AIDS coordinating body principle to draw other stakeholders into collaborative activities and to coordinate those activities at the national level. Such good coordination minimizes unnecessary duplications. MOH is revising national guidelines on collaborative TB/HIV activities including PITC, ICF, isoniazid preventive therapy (IPT) and IC according to WHO recommendations. This will provide the legal basis to make these activities sustainable. MOH continues to work with NTP to build human capacity through in-country training programs where significant numbers of people are trained locally. TB/HIV indicators are regularly collected and reported by the Vietnam Administration for HIV/AIDS Control (VAAC) and NTP as part of the national HIV and TB M&E systems. These indicators are used mainly for program improvement and planning. In the first three quarters of FY 2010, 92% (24,508/26,521) of TB patients who were registered in 119 PITC sites in 26 provinces have known their HIV status, including 1,078 previously known and 23,430 receiving PITC after TB diagnosis. More than 90% of HIV-infected individuals were screened for TB in HIV care settings, and 810 diagnosed and treated with active TB; 604 HIV-infected patients were started on IPT. A total of 170 healthcare staff were trained in TB/HIV. A low proportion (40%) of HIV-positive TB patients receiving ART and few clients presenting at district PITC sites are big challenges. Potential solutions include strengthening referrals/linkages, advocacy to revise current national ART guidelines according to WHO recommendations to start ART in HIV-positive TB patients irrespective of CD4 cell count, and shutting down PITC sites with very few clients to ensure program cost-effectiveness.

The partner will maintain support to the current 20 provinces with 25 outpatient clinics (OPCs) targeting 2,250 infected children and 850 exposed infants referred from PMTCT program. The partner will support project sites and the national program to implement the updated care and treatment (C&T) guidelines. The partner will continue central coordination with the U.S. government, Global Fund (GF), and the government of Vietnam (GVN) institutes and hospitals including NIHE, PI, and pediatric hospitals for early infant diagnosis (EID) aimed at shortening total turnaround time and timely initiation of ART for infected infants. Activities include training for new staff, development of SOPs and onsite technical assistance (TA). In COP 12, service will be expanded to provinces where PMTCT and pediatric programs exist. The Ministry of Health (MOH) continues to support the Health Insurance department to implement the Circular of Health Insurance for HIV/AIDS patient,s which is being planned for development in FY 2012. The Vietnam Administration for HIV/AIDS Control (VAAC) will continue to coordinate TA support with other PEPFAR partners (HAIVN, SCMS, SMART TA) at project sites. With TA from HAIVN, the partner will fund Pediatric Hospital Number 1 in Ho Chi Minh City and the National Pediatric Hospital in Hanoi to build clinical capacity via hands-on training for needed sites/staff of PEPFAR and non-PEPFAR programs.

VAAC will focus more on improved access to children in the country through the following approaches:

-Improve HIV case detection at in-patient wards; -Strengthen infectious diagnosis and treatment of OIs for doctors working at different departments in hospitals; -Support training for general physicians and the improvement of referrals between hospitals and the HIV OPCs; and -Strengthen linkages between PMTCT and pediatric sites. Sites with less than 80% of successful referrals will be reviewed for solutions. VAAC will review staffing structure in regard to workload level, and how to best utilize GVN hospital staff. Cost norms will be reviewed systematically with other program areas. All clinics will be directed to take advantages of health insurance as a resource for OI medicines when appropriate. The partner will provide support for GVN to establish a policy for procurement of formula milk from the GVN budget. In collaboration with the TB/HIV program, the partner will support the implementation of isoniazid preventive therapy (IPT) at HIV clinics in selected provinces. Activities will include development of SOPs, training for healthcare staff, supply of INH, and TA. Funds will mainly come from HVTB. Support for nutrition and transportation will be maintained for children. MOH will implement national nutrition guidelines for HIV patients and collaborate with PEPFAR partners that supply therapeutic foods for severely malnourished children. In provinces with OVC programs (7 PEPFAR focus provinces and Thai Binh), pediatric clinics will improve referral systems to refer infected children to OPCs for clinical care.

LIFE GAP (LG) is PEPFAR Vietnams largest partner for HLAB. Its mandate is to improve the quality and capacity of laboratory testing associated with HIV (and OIs). This includes HIV diagnostic testing, disease staging (CD4) and treatment monitoring (clinical chemistry, hematology and where available viral load). LG also supports a variety of laboratory quality management systems (QMS) activities. Activities supported by LG in the past include: 1) quality management training (identification and training of site quality managers) for lab managers from 28 LG provinces. This introductory quality management training was developed by PEPFAR staff in 2010, and this year was fully handed over to the government of Vietnam (GVN) for continued implementation. 2) Laboratory site monitoring program using the WHO Lab Assessment tool and a cadre of trainers representing various Ministry of Health (MOH) institutions. PEPFAR also supported the creation of a dedicated database for storage and report generation. 3) CD4 training provided to all testing labs in Vietnam (45), using Master Trainers (trained by ASCP). 4) Improvements to the national STI Program (National Hospital of Dermatology and Venereology, NHDV). SOPs development and training for specimen collection. Technical assistance (TA) to update STI training packages (guidelines). Technical training to develop capacity/expertise of NHDV staff. TA for NHDV to create a national STI-EQA program. Support for NHDV to deliver basic STI diagnostic training to provincial labs. 5) Strengthening of the CD4 Testing Network (National Hospital for Tropical Diseases). CD4 EQA Program (panel and report generation), national coordinator for EQA, site monitoring, participation in international/regional CD4 meetings. 6) Support for the largest clinical hospital in northern Vietnam, Bach Mai. Including procurement of EQA panels for microbiology, TA for Bach Mai staff to improve their capacity to train microbiologists at the provincial and district levels, training for physicians for test requests and results interpretation. 7) Laboratory information system, maintenance of system at 8 sites, implementation at 4 new sites, 2 staff at LG, bar-coding at 12 sites, instrument interfacing at 12 sites, and support for data exchange between information systems at 4 sites. 8) National CD4 Conference. 9) Strategic planning, development of a 5-year, national HIV laboratory plan. COP 12 funding will be used to continue all of these long-term activities.

There is support to build capacity and strengthen the monitoring and reporting system of the LIFE GAP (LG) project. LG is also a mechanism through which PEPFAR provides support to the M&E unit at the Vietnam Administration for HIV/AIDS Control (VAAC), the national HIV/AIDS authority. Support to LG M&E provides goes directly to the provincial level and in particular project activities, while support to VAAC goes to the central level providing impact to the overall M&E system at the national level. 1) Support to LG will include: -Support project data management including training and monitoring activities to improve data collection, storage and processing, utilization and maintenance of projects web-based reporting system; -Setup mechanism and support province to province experience exchange; -Improve capacity for M&E project officers at the central and 28 provincial-levels through defined curricula and competencies, onsite mentorship, and routine data-quality assessments and feedback to evaluate and improve M&E system implementation. 2) Support to VAAC will include: -Strengthen surveillance: VAAC works closely with the surveillance TWG to develop a national strategy for sentinel surveillance, update and approve a revised surveillance protocol and its SOPs. Assessment of the HIV case reporting system and its procedures through a defined protocol. -Strengthen HIV information systems: PEPFAR SI has supported development of the national centralized data warehouse and online GIS system. The work enables linkages among multiple databases to allow single access to all existing HIV data. With a web-based GIS interface, the system increases data quality, data utilization and better support program planning at central and provincial levels. PEPFAR SI will support to maintain the system, expand the linkages and database, and scale-up utilization of the system. PEPFAR SI will support VAAC to continue its work toward integrated HIV information. Reporting forms and mechanisms at service-delivery level will be standardized across projects. -Standardize data QA (DQA) tools and processes: PEPFAR has supported VAAC to develop DQA tools. In COP 12, PEPFAR will support standardization of DQAs tools and processes across projects, program areas and administrative levels.

The Vietnam Administration for HIV/AIDs Control (VAAC) will inaugurate its new 5-year cooperative agreement in COP 12and OHSS funds will go toward the implementation of an overarching and strategic HSS program in line with government of Vietnam (GVN) HSS priorities articulated in the National Strategy on HIV. Funding will go toward expanding a pilot on health insurance for PLHIV at the provincial level after assessment and evaluation, as well as using the findings from piloting and assessing an integrated-service delivery model in 2 provinces to revise and contextualize these models in other provinces. In close coordination and collaboration with other CDC and PEPFAR-funded health education programs with the Hanoi Medical University, the Department of Science and Training and the Hanoi School of Public Health, funding will go toward institutionalizing an Ministry of Health (MOH)-approved and accredited HIV curricula in top medical and training universities in the country. Finally, HRH issues remain a key priority for GVNan assessment conducted in COP 11 will provide the roadmap for VAAC to lead activities related to retention and integration of HIV health workers within the national AIDS program and health system.

All prevention services through PEPFAR Vietnam are focused on MARPs. An estimated 60-80% of MARPs have not been tested in Vietnam (IBBS 2009). In 2011, PEPFAR and the Vietnam Administration for HIV/AIDS Control (VAAC) provided VCT to 46,860 individuals (6.8% HIV-positive), and more than 866 couples (12% discordant and 8% concordant positive). All PEPFAR services 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 continue building the capacity for VAAC to ensure HTC technical and services provision. In COP 12, 61 VAAC VCT sites will serve 115,000 clients across 28 provinces. VAAC will increase efforts in testing coverage by: -ensuring a mix of HTC modalities, outreach-based, community-based, and government health facility-based; -finalizing revised national HTC guidelines to include CHCT and PITC; -partnering more closely with community-level interventions, including outreach workers and social marketing programs to ensure focused sexual and injecting risk-reduction messages; -developing clear bi-directional linkages with methadone maintenance treatment (MMT) clinics to serve IDUs, and their sexual and injecting partners; -adding precision risk assessment to increase counseling quality; -training HTC providers in MSM sensitization and an advanced understanding of co-occurring risk behaviors; -integrating core concepts of prevention with positives (PwP) in post-test counseling and in linkage efforts with outreach efforts; -promoting CHCT at VCT sites and other HIV-related services. After years of continued advocacy, PEPFAR anticipates that rapid testing/rapid results algorithms will be approved and VAAC will pilot these in select provinces in 2012. It is estimated that 50-70% of HIV-positive VCT clients nationwide accessed outpatient (OPCs) within 12 months of diagnosis at VCT in 2010. Current tracking efforts are not standardized and include phone calls, paper-based referral forms and log books. In partnership with care and treatment, VAAC HTC will strengthen a bi-directional referral system to facilitate patient enrollment, including a focus on referrals in counseling, knowledge of early treatment benefits, piloting count CD4 testing at select VCT sites, referral to patient support groups, standardizing PwP messages, and routine re-testing messaging. VAAC will institutionalize and build HTC training capacity at the Ministry of Healths (MOHs) regional public health institutes to sustain and transition HTC trainings to the government of Vietnam (GVN). Last year, LIFE GAP trained 219 participants on topics related to CHCT, PITC at STI settings and basic VCT training. VAAC also will continue to enhance the national electronic HTC data base that includes data on PITC, VCT and CHCT. Efficiencies in HTC will be explored through potential consolidation of sites based on technical criteria to be developed by Provincial AIDS Committees (PACs), and through possible consolidation of staffing roles. Additionally, opportunities for cross-training of counselors (MMT, VCT, ART, etc.) will be explored in Ho Chi Minh City.

In FY 2012, PEPFAR will continue to support the Vietnam Administration for HIV/AIDS Control (VAAC) in delivering community-based outreach to promote behavior change among FSWs in areas with high concentration of FSWs in 9 provinces Hanoi, Haiphong, Son La, Thai Nguyen, Quang Ninh, Nghe An, Thanh Hoa, Khanh Hoa and Ba Ria-Vung Tau (size est. 17,000, total 68,000 for Vietnam, EPP 2001). The HIV prevalence in FSWs is 4.1% nationwide, but is greater than 10% in select provinces. FSWs are at increased risk for HIV because of low consistent condom use with clients (<40% of FSW in Hanoi, HCMC and Dong Nai) and drug injection (20-30% in Hanoi and Ho Chi Minh Cith). Less than 50% of FSWs in most provinces know their HIV status(Vietnam IBBS 2009).

Core interventions for FSWs include: 1) community-based outreach, utilizing a case management approach to facilitate behavior change; 2) promotion and distribution of condoms to highly vulnerable FSWs; ensuring access and availability to quality condoms for all FSWs (complementary to the Total Market Approach being adopted in by VAAC in Vietnam); and 3) referring FSW clients to HTC, SW-friendly STI clinics (to be piloted by PEPFAR partners) for routine checkup and treatment, Prevention with Positives (PwP) messages through both prevention and care services, and other relevant clinical services. Drug use-associated risk-reduction messaging is incorporated in the core service package to address multiple risk behaviors prevalent among FSWs, and drug-injecting FSWs will be linked to needles/syringes (N/S) programs and/or methadone maintenance treatment (MMT) services where possible. Approximately 15,000 FSWs will be reached through otherinterventions. In addition, VAAC will collaborate with other partners (i.e., FHI, PSI and HPI) to 1) train/refresh FSW outreach workers and develop innovative approaches to better ensure FSWs access to the core package of services and to better address low levels of risk-perception; 2) advocate for sustainable condoms programming (i.e., social marketing and total market approaches) and expansion of the 100% condom use program (CUP) in selected locations; 3) develop more effective and efficient outreach models by piloting behavior change facilitation through FSW networks. 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 the government of Vietnam (GVN) monitoring systems. Monitoring site visits will be conducted regulalry by VAAC/Provincial AIDS Committee (PAC) staff to assure quality, using standard checklists. Supervisors will be trained on enhanced supervision skills and use of field observation and case conferencing.

In COP 12, the Vietnam Administration for HIV/AIDS Control (VAAC) will continue to provide a minimum package of HIV services for IDUs in high-prevalence areas in 28 provinces (size estimate 130,000; total 217,500 for Vietnam, EPP 2010). 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). Nationwide, 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 (7.3- 54.1%, varying by province); inconsistent condom use with both SWs and regular partners (20-40%); <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 VAAC to establish and ensure provision of a core package of services in all provinces. Based on varied ecological factors including, size estimation, burden of HIV infection, risk behaviors and other donor support present, PEPFAR and VAAC will determine specific support for PEPFAR 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 ~35,000 IDUs in selected districts of 24 provinces. 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 donors, including World Bank/Global Fund ATM) through outreach and other appropriate modalities; condom promotion and distribution; 3) Methadone maintenance treatment (MMT) for 4,500 IDUs through 17 MMT clinics in provinces (Hanoi, Thai Nguyen, Hai Duong, Quang Ninh, Nam Dinh, Danang and one TBD); 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 VAAC and Provincial AIDS Committee (PAC) staff to assure quality using standard checklists. Supervisors will be trained on enhanced supervision skills, and use of field observation and case conferencing. VAAC 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-Ministry of Health (MOH) covers 230 sites providing PMTCT services. In 2010, 130,000 pregnant women received HTC; and 560 received ARV prophylaxis. LIFE GAP (LG)-MOH is aligned with national PMTCT policies and guidelines that prioritize early HTC, CD4 testing and early ARVs for pregnant HIV-positive women, and referral for continuum of care (CoC). 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 LG-MOH include 120,000 women tested for HIV with receipt of results, and 650 HIV-positive pregnant women receiving ARV prophylaxis. COP 12 priorities will be to: 1) Continue reducing direct-service delivery support: Scale down the coverage of the PMTCT program by halting support for inefficiently implemented sites. Support the government of Vietnam (GVN) to develop financial strategies to support the PMTCT program light of declining PEPFAR funding, such as involving the health insurance system or self-pay for HIV testing service fees. Reduce unit cost by reducing the cost norms of many PMTCT services, including staffing, training and management costs, reducing support for HIV testing gradually but ensuring essential services such as HIV testing, ARV and early infant diagnosis are provided. With health insurance and self-pay, PEPFAR supports free HIV tests for 60% of pregnant women at antenatal clinics ANCs, providing ARV for HIV mothers and their exposed children. 2) Build capacity for MCH/PMTCT staff at the provincial level: Organize training on PMTCT and related programs for provincial staff. Provincial Project Management Units PPMU will hold some training courses for PMTCT staff at the district level, support VAAC to provide technical assistance (TA) and onsite training for the national PMTCT program, build capacity of PMTCT staff at the site level on data collection, analysis and using data for QI. Work with the Vietnam Administration for HIV/AIDS Control (VAAC) and MCH to standardize training curricula, TA/QA tools and SOPs using the national PMTCT program. The National Hospital for Obstetrics and Gynecology (NHOG) and Tu Du Hospital will be the TA bodies for the PMTCT program in providing training, mentoring, coaching. 3) Integrate PMTCT into the existing health system, such as nutrition, MCH, vaccination programs: Collaborate with the MCH department in planning and monitoring the PMTCT program, support MCH in rolling out the integrated MCH-PMTCT reporting system, and integrate IEC activities into annual IEC of the health programs such as reproductive health program, population and family planning, nutrition and vaccination programs. 4) Strengthen linkages with other programs to increase PMTCT uptake, reduce LTFU and promote CoC: Strengthen referrals and linkages between PMTCT sites and MCH services, outpatient clinics (OPCs), STI, VCT, and community-based programs by consolidating training, collaborating in implementing activities, and regular meetings.

As of July 2011, with support from PEPFAR, the Ministry of Health (MOH)/LIFE GAP (LG) provided care and treatment (C&T) services for 17,205 adult HIV-infected people, including 11,199 patients on active ART at 30 outpatient clinics (OPCs) in 20 provinces. In COP 12, the Vietnam Administration for HIV/AIDS Control (VAAC) will not open new ART sites but maximize capacity of existing ART sites and apply creative models to increase patient uptake and ensure patients equitable access to treatment. VAAC will expand a mobile care and treatment model to provide HIV treatment for difficult-to-reach populations in mountain areas and rehabilitation centers. An additional model is to use existing OPCs to provide ART for eligible patients living in neighboring non-HIV clinic districts and provinces. LGs anticipated adult ART target by the end of Sept. 2013 will be 20,000 adult patients. To improve quality and sustain the treatment program, MOH will work with PEPFAR and other donors to develop a national capacity-building plan for the HIV health system and implement it in the next COP with clear function for each relevant partner to maximize their technical assistance (TA) but reduce overlap with others. The standardization of national ART training curricula and using national TA team to mentor for OPCs with steadily replacing external TA will be continued in COP 12. In addition, MOH will use its hospital-based clinics, mostly at the provincial level, to mentor district OPCs. MOH tracks clinical outcomes and ART sites performance through ART program evaluations and routine reports as well as HIV drug resistance (HIVDR) surveys including EWI, threshold and monitoring surveys in selected sites. Their results from ART evaluation and an EWI survey in 2010 indicated that the majority of patients started ART at low CD4 count, but their immunological response improved and an average first-line retention rate was greater than 80% after 12 months of ART. Clinical performance was changed but still needs to be improved. MOH will select some of these tracking activities to continue in COP 12. Moreover, with technical and financial support from PEPFAR, MOH will expand quality improvement activities to other adult clinics based on the results of a HIVQUAL pilot in COP 11. MOH will continue performing viral load tests for ART patients with suspected treatment failure by applying national viral load guidelines to ensure patients are being switched correctly to ARV second-line regimens. Transition of treatment from PEPFAR to the government of Vietnam (GVN) was started in COP 11 and remains a priority in COP 12 and beyond. MOH has set national targets of 82,800 and 105,000 patients receiving ART by 2013 and 2015. In the absence of definitive financial support from GVN or other sources, it is difficult to achieve these targets. Therefore, MOH will work closely with PEPFAR and the Global Fund (GF) to develop transition strategies for human resourcse through the increase of GVN staffs involvement and capacity, integration of HIV treatment into existing health system and primary care, financial and technical coordination among donors, drugs and commodities procurement, social mobilization and health insurances participation, etc., to pursue goals of program sustainability and country ownership.

VAAC will maintain support to 21 treatment sites in 20 provinces, contributing to the achievement of national pediatric treatment targets. It is expected that 300 and 250 infected children will newly enroll in the treatment program, increasing the number of children receiving ARV treatment to 1,750 and 2,000 by the end of Sept. 2013 and Sept. 2014, respectively.

Continuing toward the integration of HIV services into the existing general healthcare system, the Vietnam Administration for HIV/AIDS Control (VAAC) will continue supporting capacity building for pediatric doctors and nurses who provide HIV treatment to children. The National Pediatric Hospital in Hanoi and Pediatric Hospital Number 1 in Ho Chi Minh City (HCMC) are supported as the 2 leading hospitals on Pediatric HIV in the country. VAAC will continue working with PEPFAR partner HAIVN to facilitate hands-on training, clinical mentoring and case conferencing in these hospitals. MOH will use experienced local experts to provide technical assistance(TA) to national program sites.

MOH will no longer plan to organize clinical training but will coordinate with HAIVN for these courses. In COP 12and COP 13, MOH will support training on the revised patient charts, log books, and forms that are under development.

VAAC will work with stakeholders to expand HIVQUAL to selected pediatric sites to improve quality. Supervision to clinics will be delegated more from the central level to province level to increase provincial ownership.

In collaboration with the adult treatment program, the partner will continue implementation of viral load (VL) testing of children with suspected treatment failure in 50-70% of project provinces. The partner will consider supporting the implementation of national guidelines for VL testing.

Based on the results of national pediatric ARV evaluation, MOH will work with related partners and donors to find solutions for improvements. The results will be disseminated in national care and treatment (C&T) conference, as well to provinces for their actions.

To accelerate early treatment for children, activities will include training on updated treatment guideline for doctors; utilize TA from PEPFAR partners (HAIVN) for onsite TA; and make sure early infant diagnosis (EID) is offered on time with acceptable turnaround time. The partner will review the existing referral SOPs from PMTCT and TB programs for efficiency.