Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 5164
Country/Region: Vietnam
Year: 2007
Main Partner: FHI 360
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $6,539,000

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $255,000

This activity is linked to HVOP FHI (10207) and consists of five main components.

PEPFAR will support FHI to train health educators and peer educators to deliver effective AB messages to appropriate most-at-risk populations (MARPs) in the 6 current and 1 planned focus provinces, reaching 48,000 people. Outreach teams will incorporate AB messaging in daily contacts with drug users, Men who have Sex with Men (MSM) and, where possible, with peers and family members of MARPs, stressing abstinence as the only 100% certain way of avoiding sexual transmission and mutual faithfulness as a critical means to reduce risk of exposure. Outreach workers will be trained in peer counseling skills to help clients develop strategies to reduce risk of HIV transmission. Behavior Change Communication (BCC) materials stressing abstinence and faithfulness will be distributed to key populations through outreach activities and at drop-in centers where clients can receive additional counseling, HIV counseling and testing, and other services.

FHI will receive funding from PEPFAR to address male cultural and social norms to stress marital fidelity among current or potential clients of female sex workers (FSW) in all focus provinces. The intervention is based on FY05 and 06 research among FSW clients that identified situational factors—such as drinking with co-workers and peer pressure—that often lead to sex worker visits. Health promoters will employ intensive outreach to target 70,000 high-risk men in entertainment establishments, such as beer bars, karaoke, hotels and other locations identified through mapping. One hundred health promoters will be trained to convey abstinence and be faithful messages to men.

FHI will cooperate with Health Policy Initiative to promote greater involvement of People Living With HIV/AIDS (PLWHA) in abstinence and faithfulness approaches, building PLWHA skills to counsel clients on the importance of fidelity to 1 partner as part of a comprehensive prevention strategy (refer to HVOP FHI 10207). PEPFAR will support training for 50 service providers and 100 PLWHA peers who will counsel clients at out-patient clinics, PLWHA support group meetings and home-based care visits. Twenty-five hundred positive PLWHA will be reached through peer counseling sessions that stress fidelity as a primary means to prevent infection or cross-infection.

FHI will provide a sub-grant and technical assistance to support Vietnam-based NGO Consultation of Investment in Health Promotion's (CIHP) internet-based counseling and HIV/AIDS education program, which aims to reach MSM nationwide, and will include discussions on being faithful and partner reduction as part of its comprehensive prevention approach. Counseling will be provided in a manner that enables MSM accessing on-line service to strategize appropriate ways to reduce risk of HIV transmission. Forty five MSM peer educators will be trained to provide on-line counseling, and an estimated 2,400 individuals will be reached. FHI will work closely with CIHP to build overall capacity and sustainability.

FHI will expand the scope and scale of substance abuse treatment options initiated in FY05 and FY06 by FHI to enable Vietnam to attain and retain an adequate number of health workers needed to address drug addiction sufficiently in focus provinces, and to accomplish PEPFAR goals. Training sessions will be developed and delivered as a series of coordinated, strategic interventions that address the lack of community based treatment options and absence of experienced substance abuse counselors. Both pre-service and long term training will assist development of a skilled cadre of substance abuse counselors through recruitment of new staff and leveraging existing resources by training government and other donors' workforces. A comprehensive array of substance abuse treatment options supports the PEPFAR Vietnam 5-Year Strategy to bolster Vietnam's national drug control policy. These activities will result in more than 300 individuals trained in substance abuse treatment and more than 6,000 reached with prevention messaging based on abstinence from drug use (see HVOP FHI 10207) and abstinence and being faithful as an essential means of preventing HIV transmission (6,000 person target).

FHI will expand a nationwide network of case managers, drug counselors, and social workers for inpatient and community substance abuse programs. This activity began with FY05 and FY06 FHI training of addictions counselors and case managers in Haiphong and Ho Chi Minh City. In 2007, PEPFAR will support FHI to train more than 30 new counselors and will integrate a Training Of Trainers (TOT) for 12 of the most qualified counselors. All trainees will be taught to employ a prioritized AB message in conjunction with abstinence

from drug use. Developing a nationwide core of counselors and case managers will help "legitimize" the profession of addiction counseling and ensure sustainability without continued reliance on expensive foreign technical assistance.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $1,850,000

This activity is linked to HVCT FHI (9508), palliative care: basic health care support (#9558), ARV (#9415), HVAB FHI (9480), and HVOP HPI (9626).

PEPFAR supports Family Health International (FHI) to take the lead NGO role working with MOH to promote health education outreach for high risk clients. FHI plays a strong role in prevention for commercial sex worker (CSW) clients (with new Pact TBD partner 9494) and PLWHA (through cooperation with HPI). This activity will reach the following most at-risk populations with effective ABC behavior change communication; 14,000 IDU, 22,000 FSW, 70,000 current or potential clients of sex workers, 14,400 MSM; and will train 100 peers in discordant couple counseling skills. Interventions will incorporate OGAC technical guidance on ABC and IDU prevention programming, and the PEPFAR Vietnam 5-year Strategy to avert HIV infections. FHI will implement high quality HIV prevention services targeting key populations and geographic areas where Vietnam's epidemic is most severe.

All BCC outreach activities are coordinated with the PEPFAR-supported provincial outreach coordinators to ensure coverage is efficient. FHI will support HIV prevention in the 7 focus provinces, addressing unique needs of male and female injectors, in conjunction with MOH outreach (complementing districts with unmet needs). Health educators and peers will contact intravenous drug users (IDU), stressing the importance of learning HIV status to protect one's health and the health of their family. This interpersonal approach will encourage drug users to access the network model, including drop-in centers, where IDU have access to CT, care and treatment, and an array of drug and alcohol abuse treatment options. A methadone treatment program will be piloted in 3 focus provinces. For IDU who are unable to stop using, clients will be encouraged to avoid sharing injecting equipment and reduce other risky behaviors.

Building on FY05 and FY06 outreach and drop-in center activities, services will be expanded to Lang Son and Khanh Hoa provinces where significant IDU populations are found. FHI will develop the provinces of Quang Ninh, Haiphong, Ho Chi Minh City (HCMC), and Lang Son as learning sites to build capacity of government agencies and other donors. In-country study tours will foster local capacity, leverage other resources and build sustained national capacity to address local HIV prevention needs.

FHI will scale up targeted behavior change interventions for female sex workers (FSW) in Can Tho, HCMC, Hanoi, Haiphong, and three new provinces. Services for FSW include STI diagnosis and treatment, condom negotiation skills to ensure vulnerable women are empowered to prevent HIV infection, links to vocational training for women who wish to leave sex work, and comprehensive network services. To facilitate women's equal access to HIV/AIDS services, "one-stop shop" model women's health clubs will be enhanced to offer CT and STI treatment as well as referral for OI prophylaxis, PMTCT and ART treatment. Women who desire to leave prostitution will be referred to vocational training and job placement. Women who require assistance with substance abuse problems will have access to an increasing array of treatment options to include counseling and, potentially, medication assisted therapy.

FHI will target clients and potential clients of sex workers to change male norms, reducing transactional sex and multiple partners in the 7 focus provinces, in conjunction with the Pact/TBD "Live Like a Real Man" program, and coordinated by the outreach coordinator to maximize coverage. FY07 efforts will expand interpersonal outreach as teams of trained educators explain the risks to health, family, and employment associated with visiting sex workers. For men who are unable to remain faithful to one partner, outreach workers will promote partner reduction and correct, consistent condom use.

FHI will employ a range of activities to address issues of discrimination and the double stigma attached to MSM. Current programs advocate a comprehensive ABC approach to HIV prevention with interactive outreach programs and drop-in centers where MSM can access an integrated network model. Programs will be scaled up in Ho Chi Minh City (HCMC), Hanoi, Can Tho, Khanh Hoa and a new site in Ha Long. FHI will expand outreach in MSM hotspots identified through mapping of bars, dance clubs, cafes, sauna-massage locations and public "cruising" areas. MSM learning centers will be established with help from staff of local NGO SHAPC in Hanoi, and HCMC-PAC will provide technical assistance (TA) for scale-up of interventions at new MSM intervention sites. Additionally, FHI will

provide a sub-grant and technical assistance to the local non-governmental organization (NGO) Center of Investment for Health Promotion (CIHP) to develop internet-based efforts to reach men having sex with men (MSM). FHI will assist CIHP in training 45 MSM peer educators to provide prevention education, counseling, and referrals to 2,400 MSM through a website-based service. CIHP will develop a website with updated information on HIV/AIDS programs and services targeting MSM, including referral for CT, MSM drop-in centers offering peer support, MSM outreach programs/support clubs offering access to condoms and additional information and education.

Increasing incidence of HIV among partners of drug users necessitates effective interventions among discordant couples, to empower women to refuse unsafe sexual practices, and encourage correct and consistent condom use. FHI will leverage existing structures, supporting PLWHA groups to use peer counseling and group meetings in districts in 10 PEPFAR focus provinces. FHI will create links and stronger referral between OPCs and treatment services for discordant couples. Condoms will be provided and promoted intensively during outreach opportunities and at all drop-in-centers for FSW, MSM and IDU, and outpatient centers (OPCs). Plus up funds will be used to support and expand two peer education and outreach activities. 1. Family Health International and its local partners will train 100 non-using peer educators who will provide support to an estimated 2,500 recovering drug users who are in the process of transitioning from rehabilitation centers to their communities. These peers will provide a critical role in helping recovering drug users to stabilize their lives, specifically in the area of drug use relapse prevention and accessing drug treatment services, VCT, and, if HIV+, care and treatment services. They will work in existing PEPFAR focus provinces of Ho Chi Minh City, An Giang, Can Tho, Hanoi, Hai Phong, and Quang Ninh. Existing peer educators who have remained off of drugs will assist in training new peers. In collaboration with case managers, non-using peer educators will lead support groups for recovering drug users and assist them to stay off of drugs. 2. Family Health International will work with its local partners to train 200 peer educators who will provide HIV risk reduction information and motivation support to an estimated 2,000 female sex workers (FSW), 1,500 injection drug users (IDU), and 1,000 men who have sex with men (MSM). These peers will be drawn from areas within the PEPFAR focus provinces of Ho Chi Minh City, An Giang, Can Tho, Hanoi, Hai PHong, and Quang Ninh that lack sufficient coverage. Urban areas in 2-3 non-focus provinces will be selected in discussion with the PEPFAR Vietnam Team. These will be areas where there are large concentrations of former drug users who are leaving rehabilitation centers and moving back to their communities. Mappings of high concentrations of FSW, IDU, and MSM will be used to plan which areas are in need of peer programming.

FHI staff together with trained peers will scale up these interventions.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $100,000

This activity also relates to activities in Counseling & Testing (#9508), palliative care: basic health care support (#9558), and anti-retroviral services (#9415).

Family Health International will train 50 individuals who are trained in addictions counseling and case management to provide approximately 1,000 recovering drug users with services and strategies that promote drug use relapse prevention, drug treatment, including methadone, and HIV prevention. Case managers will also help HIV+ drug users with ARV drug adherence. They will be stationed in existing outreach centers for drug users or outpatient care (OPC) clinics in the existing PEPFAR focus provinces of Ho Chi Minh City, An Giang, Can Tho, Hanoi, Hai Phong, and Quang Ninh. Metropolitan areas of other provinces will be added where an expressed need is identified in collaboration with PEPFAR partners.

This cadre of case managers will build off of the experience from work started in the previous year in Ho Chi Minh City under the 06 center pilot for recovering drug users leaving rehabilitation centers. More experienced case managers from Ho Chi Minh City who have undergone a training-of-trainers program will serve as trainers for new recruits in other provinces. They will provide training in helping recovering drug users understand and negotiate solutions to their drug cravings, relapse triggers, and family and social support issues. They will also help them to set up local non-drug using peer support groups. When methadone becomes available in new provinces, these case managers will be ready to prepare drug users for this treatment. Finally, case managers will remain up-to-date on the building array of services available in localities and ensure that their clients are actively taking advantage of these services.

Release of these funds will be contingent upon a PEPFAR prevention technical working group assessment of current addiction counselor and case manager functions.

Funding for Care: Adult Care and Support (HBHC): $1,551,000

This activity is linked to HTXS FHI (9415), HKID FHI (9537), HBHC VCHAP (9551), HBHC Pact (9563) and (9566).

Family Health International (FHI) takes the lead in supporting MOH/VAAC and HCMC-PAC in providing technical assistance for the provision of palliative care and support services at the district and commune levels, complementing districts that are not covered comprehensively by VAAC and GF. FHI also takes the lead in developing and training PEPFAR partners including VAAC on home- and community-based care and support. In collaboration with VAAC, GF, HCMC-PAC, Catholic Relief Services (CRS) focus province Provincial AIDS Committees, and additional F/CBOs, FHI will support 7,900 PLWHAs in 21 sites in 7 focus provinces.

The PEPFAR-supported care network consists of provincial level tertiary care with the full range of clinical services, district level secondary care with outpatient and in-patient care (with the exception of treatment of complex OIs and HIV-related complications), TB/HIV referral, ART, and commune level home-based and community based care (H/CBC) with support to orphans and vulnerable children (OVC). In FY07 FHI will scale up district and commune-level services to include: (1) urban care sites in HCMC and Hanoi, (2) rural care sites in An Giang, Can Tho, and Quang Ninh, and 3) integrated prevention and medication-assisted therapy in select focus provinces for injecting drug users (IDU).

FY07 district care sites will be managed by current and newly trained provincial management and district care provider staff composed of PLWHA, Communist Party officials, health care workers, religious leaders, and CBO personnel. These staff will improve referral systems by coordinating with PEPFAR partners to utilize uniform referral forms and standard operating procedures at care sites. FHI will also work with PEPFAR partners to develop HIV care and prevention service guides for PLWHA and providers, which will be provided to all PEPFAR and GF-supported sites.

Coverage will be increased to additional sites via care provider training, and onsite mentoring and supportive supervision. District outpatient services will be integrated into existing district health centers (DHCs). Outpatient clinics (OPCs) will be linked with inpatient care at DHCs, and, in addition to Home and Community Based Care (H/CBC), will continue to provide prevention counseling and commodities, assessment of psychosocial situation and OVC needs, regular clinical evaluation and monitoring, OI prophylaxis and treatment of common OIs, screening for TB, related laboratory services; treatment literacy and intensive treatment preparedness; referral of complex OIs and TB, management of symptoms, pain, and HIV/AIDS-related complications, nutrition and emotional support. To facilitate rapid care scale-up, Binh Thanh, Thu Duc and Cam Pha districts (from Ho Chi Minh City and Quang Ninh provinces - one southern and one northern) will be used as HIV care and support learning centers.

All outpatient clinic services are linked with home-based care (HBC) teams to ensure seamless follow-up between home care and hospital care. HBC teams play a critical role in providing palliative care to PLWHA and families providing pain relief, symptom management, adherence counseling support, nutrition and livelihood assistance, emotional counseling, links to spiritual care, end-of-life care and planning and care for OVC. Home care and PLWHA groups will work with health center staff to promote ART and methadone adherence (for those sites providing methadone to drug users). Referrals to tertiary care for PLWHA clients will be managed by the district health center staff and home care teams. H/CBC services will be linked with services implemented by other PEPFAR partners.

IDU access to a full range of prevention, treatment, and care interventions will be increased through case management in all districts, but with emphasis on those released from government rehabilitation centers and involved in the methadone pilot. Case managers and former-IDU peers for drug users and former drug users (supported by HCMC-PAC) will ensure that all residents released from government rehabilitation centers have access to relapse prevention counseling, family supportive counseling, and other risk-reduction. In Haiphong and Quang Ninh, IDU who are HIV positive will be able to enroll in medication-assisted therapy (MAT) co-administered with ART where clinically eligible, provided the Government of Vietnam (GVN) approves the pilot protocol. Clinicians, adherence counselors, case managers, and HBC teams will receive comprehensive training in addiction, ART, methadone co-therapy, and ART adherence support for IDU. Providers

in Ho Chi Minh City (HCMC) and Haiphong will be trained as mentors for future IDU care training sessions.

At the national level, technical support and capacity building will be provided to PEPFAR H/CBC partners, GF and VAAC to develop guidelines, standard operating procedures, and training packages. FHI will also assist in the review and revision of national opioid policies (see FHI Policy System Strengthening 9430).

FHI will support implementatation of three methadone clinics linked to HIV service delivery in existing outpatient clinics. Methadone will be procured in collaboration with other international partners and MOH.

Additional funding will support five activities: 1) Assessment and development of existing Vietnam nutrition guidelines, incorporation of international recommendations and development of procedures for implementation in all PEPFAR funded palliative care sites; 2) Additional provincial level advocacy will be provided in the 7 focus provinces to increase awareness of the national palliative care guidelines and boost support for the national palliative care fellowship program. 3) Funding for the Department of Therapy to produce and disseminate National Home based care guidelines; 4) Implementation of enhanced STI diagnostics and treatment into selected outpatient clinics; 5) Expansion of training for staff in PEPFAR and other funded OPCS in providing psychosocial assessment, support and appropriate referrals. Funding will improve quality of current services and plans, but will not add to targets.

Funding for Care: TB/HIV (HVTB): $74,000

This activity is linked to HBHC FHI (9558), HBHC VAAC (9529), HLAB VAAC (9505) and HTXS FHI (9415).

Funding will provide TB screening and appropriate referral for 7,900 HIV-infected persons in 21 outpatient clinics in the 7 focus provinces, referral to TB treatment for 790 PLWHA, train 250 individuals to provide clinical prophylaxis and/or treatment for TB to PLWHA and will support TB/HIV coordination activities at the district level.

Family Health International (FHI) will support HIV outpatient clinics in 21 districts in the 7 focus provinces where clients receive care, support, counseling and ART services. Funding will support training sessions for HIV and TB physicians and staff time. As with all PEPFAR-supported clinics, clients will receive TB screening once per year and additional screening as needed for symptoms and prior to commencement of ART. All patients with suspected or confirmed TB will be referred to the adjoining district TB clinic for further management. A PEPFAR strategic goal is increasing the collaboration and linkages between the TB and HIV programs at the district, provincial and national levels. Funding will be provided to strengthen the district TB and HIV coordination activities implemented through VAAC through several targeted activities, including annual technical meetings between TB and HIV clinicians, development of Standard Operating Procedures (SOP), quarterly network model coordination meetings, regular monthly case conferences between TB and HIV clinicians at clinical sites and quarterly supportive supervision visits.

Funding for Care: Orphans and Vulnerable Children (HKID): $390,000

This activity is linked to HBHC FHI (9558), HTXS FHI (9415), and HKID TBD (9552).

FHI will provide family centered care for OVC and caregivers through outpatient clinics, home and community based and support care services in the PEPFAR focus provinces. This activity will help ensure that children's developmental needs are met through a range of services, as appropriate to meet the unique needs of each child. FHI will help ensure quality of care by building the capacity of OVC care providers and expand coverage OVC care services through partnerships with home-based care teams, local NGOs, the Women's Union, the Ministry of Labor, Invalids and Social Affairs (MOLISA) and the Vietnam Commission for Population, Families and Children (VNCPFC). Through this activity, 1,030 OVC will receive services, and 350 professional and family caregivers will be trained.

OVC services will be provided through case-management services at eight district outpatient HIV/AIDS clinics (OPCs) which provide comprehensive health care services, including pediatric ART. OVC services will also be provided through home-based care services that extend the reach of these clinics to the community.

OVC services will be provided in accordance with the PEPFAR core OVC services package, and will include: comprehensive needs assessment, counseling and psychosocial support, development of a service plan to assist OVC and their caregivers in meeting prioritized needs and service referral in the community. Direct services will also be provides including: health care services, adherence support, food/nutrition support for children (in accordance with OGAC guidelines), and referral to other social and health care services including referral to MOH pediatric hospitals and links to Integrated Management of Childhood Illnesses services (C-IMCI) offered through commune health stations. FHI will train families to provide care and support at home, including adherence support for pediatric ART and other medications. The project will support school enrollment and provide educational activities/therapeutic play groups with children. FHI will also support PLWHA and caregiver support groups, link parents and OVC caregivers to income generation services and employment referral services, and provide succession planning, including preparing wills and identifying stand-by caregivers.

Through this activity, OVC services will also be offered through partnerships with community based organizations in Haiphong (Nordic Assistance to Vietnam [NAV]) and Hanoi (Hien Quang Pagoda). OVC services will be delivered in a way that supports family-centered care, partnering with and building the capacity of caregivers' to address their children's needs.

In addition, FHI will collaborate with UNICEF, Save the Children, PEPFAR and other stakeholders to provide technical support and assistance for the development of OVC care and protection guidelines, including the development of the Vietnam National HIV/AIDS Strategy.

FHI staff will continuously strengthen their capacity for OVC service delivery, through training, mentoring, and program monitoring and feedback from PEPFAR and FHI management. FHI will contribute to meetings among implementing partners, to establish consensus on core service packages, facilitate exchange of materials and lessons learned, and identify and address gaps in services and referrals. FHI will also provide capacity-building and technical assistance to other PEPFAR partners in implementing OVC (especially in the context of home- and community-based care).

Funding for Testing: HIV Testing and Counseling (HVCT): $800,000

This activity is linked to HLAB NIHE (9506), HVTB FHI (9565), HVCT TBD (9518), HVCT TBD-PSI Follow-on (9513), and HVCT UNDP (9516).

In FY07, PEPFAR will support FHI to train 200 counselors and provide counseling and testing (CT) services for 16,500 clients at 12 VCT sites in 7 PEPFAR focus provinces.

FHI will expand and strengthen CT services in the Network model, strengthen the absorptive capacity of 8 existing CT sites in Hanoi, Haiphong, Quang Ninh and Ho Chi Minh City (HCMC) and develop 4 new CT sites in HIV hotspots in Hanoi, Can Tho, An Giang and the seventh PEPFAR focus province. All sites will be fully integrated into district care outpatient clinics (OPC) and PEPFAR funded drop-in centers (DIC) and will have strong referral links to all Network model prevention and care and treatment services. CT counselors will function as case managers, providing client-centered initial and follow-up counseling services to negative and positive clients, and facilitating client referral to relevant services. Training and TA will be provided to existing CT sites to restructure counselor workload and to increase their efficiency and absorptive capacity, particularly in HCMC where thousands of residents from 06 centers, government centers for rehabilitating drug users (06 centers), will be released by the end of FY07.

FHI will also promote CT among most at-risk populations (MARP). MARP outreach workers and PLWHA will encourage testing among networks of injecting drug users (IDU), commercial sex workers (CSW) and their clients, and MSM to prevent infection and to interrupt rapid transmission patterns among the newly infected, linking them to CT offered in local DICs. CT social marketing and MARP-focused outreach to reduce stigma and discrimination will increase the awareness of CT benefits while decreasing barriers to seeking testing.

FHI will work with HCMC-PAC to strengthen the referral system between 06 centers, CT, Care and Treatment, and PMTCT by training healthcare workers and developing clear referral guidance and tools for peer educators (PE), counselors, and case managers.

FHI will form a national cadre of CT counselors. The Anonymous Testing Sites (ATS) and Bach Mai VCT Centers will provide technical assistance (TA) to developing CT services supported by other PEPFAR partners. TA services will include study tours, 1 to 2 weeks of in-service practicum, supportive supervision visits to newer VCT sites, and basic and advanced HIV counseling training. Both sites will lead case consultation meetings for CT counselors.

FHI will also focus on strengthening the national CT program with a view to sustainability. FHI will work with MOH/VAAC and other partners to develop a national CT training curriculum based on HHS/CDC guidance and other resources. In addition, FHI will contribute to the finalization of national CT guidelines and the development of CT SOPs and QA/QC tools to establish national standards of quality CT services. Capacity building of health providers in CT will contribute to sustainability of future CT service provision. TA for the development of national counseling and testing standards will also strengthen national capacity in CT.

With the additional funding of $US 400,000 FHI will support the establishment and operations of eight VCT sites more in PEPFAR focus provinces, with a focus on provider-initiated testing and counseling (PITC) model, integrated with existing health facilities, such as STI, TB, reproductive health services, where most-at risk populations (MARPs) substantially access to. FHI will adapt the current training curriculum to train for VCT counselors and testing staff to make it relevant for these settings. The existing quality assurance and quality improvement (QA/QI), data management software and monitoring system will be used for these sites. Networking with current USAID/FHI-supported VCT sites and other USG-supported VCT sites is our priority to build the capacity and share experiences among VCT counselor networks. FHI will incoporate recommendations from OGAC Counseling and Testing Technical Assistance trip in May 2007 and revise program as necessary to address priority needs identified in this TA trip.

Funding for Treatment: Adult Treatment (HTXS): $939,000

This activity is linked to HBHC FHI (9555), HKID FHI (9537), and HTXS VCHAP (9394).

This activity will focus on 4 main objectives: coverage and access, quality, support for IDUs, and capacity building. In FY07, PEPFAR will fund FHI to provide treatment for a total of 3,690 adult and pediatric patients (including 1,900 new patients).

ARV therapy will be provided to adults and children through community-based ART sites providing a comprehensive package of integrated care, treatment and prevention services. In support of the PEPFAR strategy of improving support for vulnerable populations, particularly current and past injecting drug users (IDU), the strategy will focus on client-centered adherence, additional psychosocial and addiction counseling and case management support to facilitate access to services in the community (key legislative issue: stigma). Family centered districts will increase access to treatment services for HIV infected mothers and children (key legislative issue: gender). As of August, 2006, FHI is supporting 710 patients on ART in 6 treatment sites in 3 provinces and, in accordance with the PEPFAR geographic scale up and coverage plan, will expand to 20 sites in 7 focus provinces. All new sites will function as district magnet sites covering surrounding districts linked to community and home-based care (C/HBC) services in each of the districts. Each site will be selected in conjunction with the MOH/VAAC and the PEPFAR care and treatment technical working group (TWG).

ARV sites will be supported through training, supportive supervision, and mentoring of a multidisciplinary outpatient clinic (OPC) team responsible for providing treatment services as well as care and support and prevention with positives services. Sites will support sustainability by functioning as model training sites for health care workers at new clinics as Vietnam continues to scale up. In accordance with the PEPFAR SI plan for monitoring and evaluation, outcomes of the ARV program will be evaluated in some sites, including clinical outcomes, psychosocial well-being, adherence and patient retention. Program lessons learned will guide future programming.

In Ho Chi Minh City (HCMC), all FHI-supported ART sites will be linked to 06 centers, government centers for rehabilitating drug users. Case management support and discharge planning will be provided to 06 center residents, and adherence preparation supported for the sub-set of residents eligible for ART. FHI will continue to equip case mangers, OPC and HBC teams, peer educators, and PLHA groups in Binh Thanh District, District 8, Thu Duc District and Hoc Mon District, to provide appropriate referral, coordinated care, and intensive adherence support for all clients to be re-integrated into the community.

FHI will begin implementation of a medication-assisted therapy program in a joint ARV/methadone substitution therapy program (pending development of VAAC implementation guidelines and approval) in 2 provinces. Intensive adherence and psychosocial support will be provided to IDU clients through a directly assisted therapy program of methadone and ARV therapy with intensive support from OPC adherence counselors, PLWHA groups, family, and HBC teams where appropriate. FHI will work with Vietnam CDC Harvard Medical School AIDS Partnership to develop didactic training on ARV-methadone therapy and will provide ongoing mentorship from experienced providers. This program will be evaluated and results disseminated as an advocacy tool and to improve methadone/HIV programming both within Vietnam and across the region.

As a part of PEPFAR/Global Fund (GF) collaboration, FHI will provide intensive mentoring, infrastructure development and lab monitoring support at 2 district-based clinics jointly supported by GF. These sites will be scaled up as "magnet" sites and then taken over by GVN with support of GF Round 6 funding. If Round 6 funding is not approved, FHI will support ongoing services at these 2 sites.

FHI will continue to provide capacity-building in ART adherence support to VAAC and other PEPFAR partners for the development of adherence counseling systems to prepare and support PLWHA on ART. FHI will support VAAC to develop an adherence toolkit for adults and children containing training for adherence counselors, job aids for counselors, and client information and training in use of the toolkit. PLWHA support groups will be equipped with the skills and materials necessary to provide treatment adherence support to members and their families; and provide HBC teams with lay adherence counseling


Funding for Strategic Information (HVSI): $520,000

This activity is linked to HVOP FHI (10207), HVTB FHI (9565), HKID FHI (9537), HVCT FHI (9508), HTXS FHI (9415), HLAB HCMC-PAC (9503), HLAB HSPH (9504), HLAB MOH/VAAC (9505), and HLAB APHL (9499).

In the first component of this activity PEPFAR will partner with FHI to collect biologic and behavioral data among MARPs for appropriate program planning and policy development. In FY 2005, PEPFAR supported the MOH to implement an additional round of 2nd generation, integrated biologic and behavioral surveillance (IBBS) among MARPs in the 6 current PEPFAR focus provinces (Hanoi, Haiphong, Quang Ninh, HCMC, Can Tho, and An Giang) and Danang. The survey was implemented by FHI and NIHE, in collaboration with Provincial Preventive Medicine Centers (PMC) and HCMC Provincial AIDS Committee (PAC), a provincial coordination body. Findings from the survey are being finalized.

In FY 2007, PEPFAR will support another round of IBBS in previous survey provinces and 1 new focus province to be selected in collaboration with MOH. These data will be linked to previous IBBS surveys and will provide information on impact and outcomes for prevention programs and provide an updated state of Vietnam's epidemic for focused program planning. The information will also be used to support advocacy and policy activities. The survey activity will be linked to routine surveillance activities through GVN partners to ensure continued development of surveillance information systems, methodologies, and skills of public health personnel. FHI will partner with NIHE to develop a more sustainable behavioral sero-surveillance program in Vietnam.

FHI will provide technical support for the survey and partner with NIHE (for the north) and HCMC Pasteur Institute (for the south), which will serve as implementing agencies in collaboration with provincial public health personnel.

In the second component of this activity PEPFAR will support FHI to provide oversight to surveillance of the clients of CSWs. FHI will partner with NIHE to conduct this activity. This is a particularly hard to identify at-risk population where little information is available on their risk and estimation of population size. FHI will provide TA to NIHE to develop methodology that will be incorporated into other routine sentinel surveillance activities and assist with capacity building at NIHE to conduct this surveillance independently in the future.

In the third component of this activity FHI will continue to implement the Analysis and Advocacy (A2) project funded by PEPFAR from FY 2005 to produce quality data analysis and synthesis and work in collaboration with Health Policy Initiative (HPI) (related activity HVSI 9369) to advocate for appropriate responses to the Vietnam HIV/AIDS epidemic. In FY07, FHI will: continue national and provincial-level data collection so that implication of surveillance, survey, targeted evaluation, and program assessment results and other data are fully utilized for modeling the HIV/AIDS epidemic, policy implications and interventions; conduct workshops in collaboration with HPI on the use of data; provide concrete programmatic implications to the PEPFAR team as well as PEPFAR partners; collaborate with other international and local partners to continue supporting VAAC in integrated and advocacy under the framework of A2 - this project will utilize the strengths of both VAAC and PEPFAR for the appropriate use of data in policy-making and intervention development; and apply the A2 framework to implement advocacy activities in other focus provinces including Hanoi, Quang Ninh, Can Tho and An Giang.

The ultimate goals of this activity are to: 1) provide outcome indicators and coverage information for PEPFAR-supported prevention programming among MARPs in Vietnam; 2) strengthen the capacity of government staff on data utilization; 3) provide information to explain changes in HIV prevalence, including the impact of PEPFAR-funded prevention programming; 4) provide epidemiologic and behavioral data in specialized formats tailored for advocacy to policymakers; and 5) to develop a clear understanding of the HIV/AIDS epidemic in Vietnam so that that effective national policies and appropriately targeted programs can be developed.

Finally, FHI will continue to partner with the University Training Center for Health Care Professionals-HCMC and HCMC-PAC in conducting enhanced patient monitoring and quality improvement. The abstraction of these data from either electronic or hard-copy patient medical records in 4 outpatient clinics in HCMC will provide information beyond

routine patient monitoring important for program planning and continuous quality improvement. The activities will be coordinated with related activities described under the HCMC-PAC activity narrative (HVSI 9243).

Funding for Health Systems Strengthening (OHSS): $60,000

This activity is linked to HVOP FHI (10207), HBHC FHI (9558), and HTXS FHI (9415).

PEPFAR will partner with FHI to support the MOH/VAAC in strengthening palliative care policy and implementation at the central and provincial levels. To ensure quality provision of palliative care (to include pain care) at government sites, PEPFAR will support FHI to develop and implement a training program for 300 key hospital managers, central and provincial leaders on the National Palliative Care Guidelines, PLWHA rights to pain management, and policies around the use of opioids for pain management at the central level and in focus provinces.

Palliative care services in Vietnam are relatively new to most providers and local-level policy makers, and strict drug laws have incurred reluctance for provincial health programs to use opioid pain killers to relieve pain. Building on FHI support to VAAC in FY06 to develop National Palliative Care Guidelines, FHI will train 300 key hospital managers and local policy makers to understand the new Guidelines and how they will affect provision of care and treatment at the site level. They will also incorporate a stigma and discrimination reduction component, to reduce care provider fear and increase compassion in the provision of palliative care. This and all other palliative care related components will be implemented through a partnership with the MOH Department of Therapy (MOH/DOT), Vietnam-CDC Harvard Medical School AIDS Partnership (VCHAP), and the Health Policy Initiative. The FHI-supervised training will build the capacity of MOH staff, hospital administrators and representatives from the pharmaceutical industry who are represented at USG-supported sites in the 7 focus provinces.

In conjunction with training on the National Palliative Care Guidelines, FHI will work with MOH and VCHAP to revise the current opioid control policies (which in some cases contradict the Guidelines) to negotiate for easier access to opioids for patients in need of palliative care. PEPFAR support will enable VAAC and the Ministry of Public Security to prepare revised annual opioid use estimates to be reported to the International Narcotics Board (INCB). With this information, care sites will be able to draw down from central resources to ensure adequate supply for palliative care beneficiaries. Technical assistance will also be provided to the Drug Management Administration to explore local production of codeine and long-acting oral morphine.

Subpartners Total: $1,428,000
National Institute for Hygiene and Epidemiology - Vietnam: $104,000
STDs, HIV And AIDS Prevention Center: $62,000
Ho Chi Minh City Provincial AIDS Committee: $525,000
Haiphong Provincial Health Service: $212,000
Campha District Health Center: $84,000
Hanoi Women's Union: $49,000
An Giang Preventive Medicine Center: $77,000
Bach Mai Hospital: $41,000
Can Tho Provincial Health Service: $190,000
Van Don District Health Center: $84,000