This plus up activity is linked to other PMTCT activities.

In FY 07, PEPFAR will support PSI to develop and launch a new communications initiative to support PMTCT service provision by USG partners in priority provinces. PEPFAR currently supports PMTCT in five high-prevalence provinces: Hanoi, Ho Chi Minh City, Quang Ninh, Hai Phong and An Giang and further expansion as planned. The main objective of the PSI communication program will be to increase proportion of women seeking PMTCT services as part of routine ANC visits in PEPFAR supported provinces. This will be achieved through increased knowledge of PMTCT services and awareness of the availability of the services in select sites. The campaign will also aim to promote benefits of knowing one's HIV status early during pregnancy. PSI will use social marketing approaches, in close collaboration with PEPFAR supported partners providing PMTCT services as well as local government partners, to achieve these objectives. The proposed PMTCT communication initiative will tie in with the PEPFAR supported VCT communication campaign implemented by PSI. In FY 07, PEPFAR will support PSI to continue its communication campaign to promote VCT service in priority provinces. The campaign will aim to increase uptake of CT among target populations, reduce stigma associated with these services and knowing one's HIV status and increase local capacity. As the next phase of the VCT campaign will focus on promoting tangible benefits of knowing one's HIV status, the PMTCT campaign will link directly with the benefits for specific population groups such as pregnant women and couples planning to have a baby. As the current coverage of PMTCT is low and no communication activities have been done to support PMTCT services, PSI will conduct an assessment to better understand the situation on the ground. This will include formative research to estimate current levels of awareness of PMTCT, understand barriers to HIV testing, especially among pregnant women in the general population, and identify potential motivating factors for women to participate in the PMTCT program. The assessment will influence the design and development of the communication campaign. In FY 07, PSI's proposal is to focus on the 2 high prevalence provinces of Hai Phong and Quang Ninh during the first phase of the campaign. During this phase, PSI will train 50 existing care and support personnel to promote PMTCT services among the target population. The program will aim to increase PMTCT uptake among pregnant women in target sites by 15% within the first year.

This activity is linked to HVOP AED (9606), HVOP CARE (9610), HVOP Pathfinder (9621), and HVOP Pact (9623).

PEPFAR will support umbrella organization Pact to provide management and technical support, as well as financial oversight to multiple partners engaged in community-based HIV prevention programs. Pact will support 3 international non-governmental organizations (NGOs) (AED, CARE and Pathfinder), and local partner TBD Local Partner Initiative (LPI), to expand prevention initiatives to include AB components. Overall, 4,235 outreach workers will be trained to provide tailored, AB prevention education to 103,020 individuals, including injection drug users (IDU), men who have sex with men (MSM), mobile workers, migrants, male clients of sex workers and youth. In all activities, efforts will be made to address the social norms that underlie risk behaviors, particularly among young men. Age-appropriate and gender sensitive Behavior Change Communication (BCC) programming will be fostered, along with efforts to reduce stigma and discrimination. Sustainability will be addressed through active partnerships and capacity building provided directly by participating NGOs to agencies of the government of Vietnam, mass organizations, and community-based organizations (CBO).

This activity will be conducted under the guidance of PEPFAR-supported outreach coordinators. Pact will support the coordinators' efforts to ensure linkages among these and other prevention initiatives to enhance effectiveness, coordination and overall coverage. Activities will support the 2006 PEPFAR Prevention technical assistance (TA) visit call for expanded efforts to reach at-risk and lower-risk populations beyond non-traditional settings, and will include efforts to link beneficiaries with the appropriate network model, including CT, HIV/AIDS care and treatment, STI management, and addictions counseling and treatment. Each participating NGO program is summarized here; for further detail, refer to HVOP narratives for each partner.

SMARTWork will work with MOH and the Ministry of Labor, Invalids and Social Affairs (MOLISA) to lead workplace prevention programs, stigma reduction and job placement for People Living With HIV/AIDS (PLWHA), including former residents of 06 centers, government centers for rehabilitating drug users, in the community and in industrial zones. The program will incorporate AB messages as part of a package of behavior change activities for laborers, including PLWHA, migrant workers and individuals released from 06 centers in Ho Chi Minh City (HCMC), Binh Duong, Khanh Hoa, Haiphong, Hanoi, Thai Nguyen, Hai Duong, and Hung Yen. With PEPFAR support, AED will train 4,000 individuals who will reach 85,000 workers. Core components include prevention outreach conducted in and around the workplace via workshops and both written and audio-visual IEC campaigns. AED will also work with participating enterprises to develop in-house communication strategies and activities for prevention and awareness tailored to their particular needs.

CARE will incorporate AB messages in prevention outreach activities conducted via 11 CBOs in Hanoi, HCMC and Quang Ninh. Messages will be specifically tailored to schools and youth in the community, developed in a participatory manner, and disseminated by CBO members and trained peer educators with close community links. Fifteen individuals will be trained, and 500 will be reached with AB messages. CARE will also provide capacity building support to each partner CBO, thereby contributing to the sustainability of AB prevention programming.

Pathfinder will train 170 private providers and pharmacists to provide prevention education, counseling and referrals to 14,520 clients, including Injection Drug Users (IDU), MSM, and the general population who access health care from these sources in HCMC, Can Tho and one TBD province. AB messages will be incorporated into education and counseling as appropriate. Pathfinder will also provide IEC materials to its private sector partners; AB messaging will be integrated into these materials.

LPI prevention activities will train 50 outreach workers to target more than 3,000 women in sexual partnerships with men returning from 06 centers, where HIV prevalence is in excess of 50%. The women, their partners and family members will be encouraged to learn their HIV status and to practice abstinence or faithfulness to a single partner as a primary, effective means of preventing infection. These activities provide vulnerable women with services empowering them to prevent HIV infection, and take into account

the needs of HIV-positive individuals, their partners, and their families. Pact will work with MOH/VAAC to select the appropriate partner.

This activity is linked to HVOP Save US (9604), HVOP Pact (9623), OHPS Pact (9431), and HVAB TBD (9494).

PEPFAR will fund Save US to take the lead working with the Ministry of Education and Training (MOET) on prevention activities targeting in-school and vulnerable youth. These programs will deliver abstinence and be faithful messages and primary drug use prevention activities. PEPFAR will support Save US to train 500 male peer educators to provide HIV/AIDS prevention education, information on healthy lifestyles and related life skills training to 30,000 young men in Quang Ninh, Hanoi and Ho Chi Minh City. This activity will be undertaken under the guidance of the PEPFAR-supported outreach coordinators. It responds to one of the priorities identified by the 2006 PEPFAR Prevention technical assistance (TA) visit by reaching out to young men—a key bridge population.

The activity has 3 behavior change communication (BCC) components which are based on evidence-based best practices for HIV/AIDS BCC targeting youth. The first is to train a cadre of male role models as peer educators to serve as examples for young men and youth to adopt healthy, gender equitable lifestyles. A total of 500 young men will be trained to promote HIV/AIDS prevention through both abstinence and being faithful. Peer educators will be trained to help young men both in and out of school to improve their communication and interpersonal skills and adopt healthy lifestyles that promote HIV/AIDS prevention.

The second component includes outreach and communication skills development. A total of 30,000 young men aged 15-24, including students, street youth, and out-of-school youth, will be targeted. Ten thousand of these men will be reached with specific abstinence messages. Outreach will be conducted via an array of both traditional and non-traditional venues, including schools and vocational training institutions, construction sites, industrial zones, and entertainment establishments such as internet cafes. Young men will be reached by peer educators who will promote behavior change and transfer relevant life skills, broadening the reach of the "Live Like a Real Man Campaign" (see HVAB Pact 9494). A variety of skills will be developed among targeted young men and youth, such as practicing negotiation and dialogue instead of violence and coercion to resolve conflict, practicing a healthy lifestyle, gender awareness and respect for girls, sexual delay, mutual faithfulness and partner reduction. Examples of positive interpersonal communication, abstinence and being faithful will be shared among young men so that they can learn from each other. This activity will also entail outreach to key gatekeepers, such as parents, teachers, business owners and law enforcement officials. Peer educators will also link young men with local service providers (e.g., Counseling and Testing, STI clinics and addictions counseling and treatment services) to ensure young men are able to access needed services.

The third component of this activity is the development and dissemination of Information Education and Communication (IEC) materials to reinforce HIV/AIDS prevention. Existing IEC materials that have proven effective in similar activities will be reproduced. New materials will be designed in collaboration with the target population to ensure they are easy to understand and that they support optimal HIV prevention through both abstinence and being faithful. The materials will be distributed to young men at a range of sites, such as youth clubs, internet cafes, and night clubs. Gatekeepers (e.g., teachers, parents, etc.) will also play a vital role in distributing the materials.

In all components, efforts will be made to ensure complementarity with and reinforcement of the media and peer outreach intervention targeting young male clients and potential clients of sex workers (refer to HVAB Pact 9494). While males targeted by the media and peer intervention are older (ages 18-35) than those targeted by Save US (age 15-24), both projects will conduct outreach in entertainment establishments. In anticipation of potential overlap of target populations and venues, Save US and the selected partner will coordinate IEC and BCC outreach messaging to ensure consistency, maximize resources, and minimize duplication.

Save US will partner with and build the capacity of local organizations to implement this activity, ensuring that local organizations will be able to replicate and/or expand project activities in the future, thereby contributing to the sustainability of the effort. It will also seek to link with other PEPFAR partners and donor initiatives (e.g., Asia Development

Bank's youth prevention program) to ensure efforts are coordinated and additive. Pact will monitor performance and quality of programming through review of quarterly reports, periodic site visits, and technical review of baseline assessment tools and protocols.

This activity is linked to HVOP SHAPC (9622), HVAB Pact (9485), HVOP Pact (9623), and OHPS Pact (9431). In line with the PEPFAR Vietnam 5-Year Strategy, the activity is part of a comprehensive ABC approach to HIV/AIDS prevention.

PEPFAR will fund local NGO STD HIV/AIDS Prevention Center (SHAPC) to take a lead role with MOH/VAAC in interventions targeting university students at a stage when many are becoming sexually active. In partnership with Pact, and building on PEPFAR FY05 and FY06 support, SHAPC will train 160 Youth Union health leaders to promote AB prevention messages and life skills training approaches, and will reach 15,000 university students in Hanoi with AB information and life skills training. Five thousand of these students will receive specific abstinence messages.

A range of prevention approaches will be used to reinforce consistent AB messages, based on formative research related to youth sexual practices and decision-making. This approach is grounded in evidence-based best practices related to HIV/AIDS communications with youth and the PEPFAR Vietnam 5-Year Strategy to promote healthy lifestyles and reinforce existing norms around sexual delay. It will also emphasize mutual faithfulness and partner reduction. The activity will be conducted under the guidance of the PEPFAR-supported Hanoi outreach coordinator, when appointed.

This activity has 3 components. The first involves the revision and distribution of a comprehensive HIV prevention booklet—covering abstinence and being faithful messages—developed with PEPFAR FY05 support. The 15,000 students who will receive the booklet will be encouraged to share it with others in order to increase reach. In addition, HIV/health material desks will be maintained in all 7 targeted universities to provide students with access to in-depth materials on sexual delay, mutual faithfulness, and partner reduction, among other topics.

The second component involves the training of 160 trainers (selected from among Youth Union leaders in the universities) in HIV/AIDS prevention and life skills education. These trained youth union leaders will subsequently educate students, emphasizing accurate HIV/AIDS transmission information and age-appropriate sexual delay, partner reduction, and mutual faithfulness strategies. Trained youth union leaders will also provide students with relevant life skills training to enhance students' ability to adopt behaviors about which they have learned. Instilling HIV/AIDS training capacity in the youth union at each university, along with continuing efforts to ensure high-level buy-in from university leadership, will assist SHAPC in working towards sustained HIV/AIDS prevention education in the university system. Sustainability and program quality will also be enhanced through capacity building and technical support provided to SHAPC by Pact.

The third component of this activity involves using music/knowledge contests and writing competitions to provide and enhance HIV/AIDS knowledge and generate dialogue among the general student body in all 7 universities, an approach that has proven popular and effective in SHAPC's FY05 program and is rooted in best practices in HIV/AIDS communications with youth. The information provided will reinforce messages on sexual delay, mutual fidelity, and partner reduction delivered via both the information booklets and HIV/AIDS education and life skills components described above. Pact will monitor performance and quality of programming through review of quarterly reports, periodic site visits, and technical review of baseline assessment tools and protocols.

PACT (SHAPC) have identified an excess pipeline of $50,000. Accordingly, its budget would be reduced by $50,000. No targets will be changed.

This activity is linked to HVAB Save US (9483), HVAB Pact (9485), and OHPS Pact (9431).

Pact TBD will lead PEPFAR prevention activities with MOH/VAAC and HCMC-PAC targeting current and potential clients of sex workers, an important bridge population. In collaboration with Pact and a partner to be identified in FY06, PEPFAR will support a media campaign and associated community outreach in Haiphong, Hanoi, Ho Chi Minh City, and up to 4 additional provinces, to reduce the acceptability and practice of sex worker visitation. Through this activity, 180 peer educators will be trained to provide AB prevention education and referrals to 180,000 current and potential clients of sex workers.

The initiative is grounded in the PEPFAR Vietnam 5-Year Strategy's recognition of the growing risks of HIV transmission among younger Vietnamese men—and the potential role of this population in contributing to a generalized epidemic. It is based on evidence gathered through PEPFAR-supported formative research illuminating the social norms and decision-making dynamics that underlie men's use of sex workers. The activity aims to modify male norms and behaviors. Specifically, building on strong cultural associations between masculinity and social/family responsibility, and changing prevailing norms associating masculinity with extramarital sex and commercial sex, this activity aims to change norms around sex worker use.

The activity has 2 components. The first is continued development and adaptation of a television, radio, and print media campaign launched by FHI in FY05 and continued, with adaptations in messages and media, by a new partner in FY06. Continuing adaptations of the campaign will be based on ongoing monitoring and evaluation of reach, acceptability, and effectiveness in participating provinces and among targeted male subgroups (e.g., university students, mobile workers) and in new provinces.

The second component involves peer outreach to complement and build on mass media messaging in priority districts of exposed provinces. In new provinces, including previously un-reached areas, entertainment establishments will be mapped in neighborhoods and districts known for commercial sex. Many Vietnamese men gather regularly to socialize with peers and colleagues in a range of entertainment establishments, including karaoke bars, beer halls, and discotheques. It is within these establishments, or following visits to them, that commercial sex is often sought. This activity responds to a key challenge identified by the PEPFAR AB strategy: AB messaging, while culturally appropriate, has historically been limited to such traditional venues as schools and health centers, missing a significant proportion of men at risk.

A group of 180 peer educators will be recruited and trained and/or provided with refresher training. Training sessions will equip peer educators to tailor Behavior Change Communication (BCC) strategies and messages to particular male sub-groups. Peer educators will provide accurate information on HIV/AIDS transmission and prevention, emphasizing the benefits of being faithful to 1 partner and partner reduction and fostering new male norms that popularize abstention from sex worker use. The outreach component will be linked with the media campaign through consistent messaging and distribution of items branded with the media campaign logo (e.g., key chains, discotheque tickets, and informational materials) at outreach sites. Peer educators will also provide referrals to Counseling and Testing (CT), STI management, and addictions counseling and treatment, as needed. The peer outreach component will be coordinated with VAAC and HCMC-PAC peer outreach interventions, and will be conducted under the guidance of the provincial outreach coordinators in Haiphong, Hanoi, Ho Chi Minh City and other selected provinces.

This project will be closely coordinated with Save the Children US' (Save US) prevention/AB work in HCMC, Hanoi, and Quang Ninh (refer to HVAB SaveUS 9483). While males targeted by the media and peer intervention are older (ages 18-35) than those targeted by Save US (15-24), both projects will conduct outreach in entertainment establishments. In anticipation of potential overlap of target populations and venues, IEC and BCC outreach messaging will be coordinated to ensure consistency, maximize resources, and minimize duplication.

This activity is linked to HVAB Save US (9483) and Pact Media Outreach Program (9494), and HVOP TBD-PSI follow-on (9598).

In partnership with the Ministry of Education and Training (MOET) and TBD-PSI follow-on, Save US leads PEPFAR prevention activities targeting vulnerable youth with drug use prevention services. Save US will train 500 peer educators to provide HIV/AIDS prevention education and information on healthy lifestyles and related life skills training to 30,000 vulnerable youth in Quang Ninh, Hanoi and Ho Chi Minh City. This activity will be undertaken under the guidance of the outreach coordinators in targeted provinces. This activity strategically addresses one of the priorities identified in the PEPFAR Vietnam 5-year Strategy by reaching young men - a key bridge population.

This activity is a comprehensive and integrated HIV prevention initiative focused on drug demand reduction. It has three BCC components rooted in evidence-based best practices for BCC targeting youth. In close collaboration with TBD-PSI follow-on, the activity seeks to minimize the spread of HIV through injecting drug use by reaching at-risk populations to promote healthy decision making. Save US' activity will target vulnerable youth who have not yet initiated drug use, while TBD-PSI follow-on will target current injecting drug users (IDU) and commercial sex workers (CSW). Save the Children/UK's research on vulnerable children, conducted in five provinces as part of the PEPFAR-supported OVC assessment, as well as formative research conducted by TBD-PSI follow-on and Save US with PEPFAR support, will be used to help frame the work and identify target groups "hidden in plain view." Ultimately, this work will also serve to inform activities that respond to a key recommendation of the PEPFAR Prevention Technical Assistance visit: integrating drug demand reduction into all prevention activities targeting vulnerable youth.

The first component is to train a cadre of peer educators who can serve as examples for youth to support them to adopt a healthy, drug-free lifestyle. A total of 500 peer educators (350 vulnerable youth also targeted in Save US' prevention/AB program and 150 youth at particular risk of injecting drugs) will be trained to promote HIV/AIDS prevention through behavior change beyond AB. Peer educators will be trained to help young men both in and out of school to improve their communication and interpersonal skills and adopt healthy lifestyles in a manner that promotes HIV/AIDS prevention.

The second component of this activity is outreach and communication skills development. A total of 30,000 individuals ages 15-24, including students, street youth, and out-of-school youth, will be targeted. To increase coverage, outreach will be conducted via an array of both traditional and non-traditional venues, including schools and vocational training institutions, construction sites, industrial parks, and such entertainment establishments as Internet cafes. Young men at these sites will be reached by peer educators who promote behavior change and transfer relevant life skills. A variety of skills will be developed among targeted young men and youth, such as practicing negotiation and dialogue instead of violence and coercion to resolve conflict, practicing a healthy lifestyle, gender awareness, respect for girls, practicing safe sex, and saying no to drugs. This activity will also entail outreach to key gatekeepers, such as parents, teachers, business owners and law enforcement officials. Peer educators will also link young men with local service providers (e.g., CT, STI clinics and addictions counseling and treatment services) to ensure young men are able to access needed services.

The third component of this activity is the development and dissemination of information education communication (IEC) materials on HIV/AIDS prevention. Existing IEC materials that have proven effective in similar activities will be reproduced. New materials will be designed in collaboration with the target population to ensure they are easy to understand and that they support optimal HIV prevention through the full range of behavior change strategies. The materials will be distributed to young men at a range of sites, such as youth clubs, Internet cafes, and night clubs. Gatekeepers (e.g., teachers, parents, etc.) will also play a vital role in distributing the materials.

In all components, efforts will complement and reinforce the Pact media outreach program targeting young male clients and potential clients of sex workers. While males targeted by the media and peer intervention are older (ages 18-35) than those targeted by Save US, both projects will conduct outreach in entertainment establishments. In anticipation of potential overlap of target populations and venues, Save US and the selected partner will

coordinate IEC and BCC outreach messaging to ensure consistency, maximize resources, and minimize duplication.

Save US will partner with and build the capacity of local organizations to implement this activity, ensuring also that local organizations will be able to replicate and/or expand project activities in the future, thereby contributing to the sustainability of the effort. It will also seek to link with other PEPFAR partners and donor initiatives (e.g. Asian Development Bank's youth prevention program) to ensure efforts are coordinated and additive. Pact will monitor performance and quality of programming through review of quarterly reports, periodic site visits, and technical review of baseline assessment tools and protocols.

This activity is linked to OHPS SMARTWork (9432) and HVAB Pact Partners (9482).

PEFAR funds SMARTWork to lead support for MOH and the Ministry of Labor, Invalids and Social Affairs (MOLISA) in workplace prevention programs, with stigma reduction and job placement for PLWHA. This includes former residents of government centers for rehabilitating drug users (06 centers), in the community and in industrial parks. PEPFAR will support SMARTWork to train 4,000 people to promote comprehensive ABC prevention including negotiation skills for safer sex and risk reduction, gender and HIV/AIDS, employment rights, stigma and discrimination, referral to CT services, and support for PLWHA employees. An estimated 215,000 people will be reached with prevention services and linked to CT, care and treatment, and drug addictions treatment services. The comprehensive approach adopted by this initiative is grounded in the PEPFAR Vietnam 5-Year Strategy. This activity will be conducted under the guidance of the PEPFAR-supported outreach coordinators appointed in the 7 PEPFAR focus provinces, and supervised centrally for Hai Duong, Hung Yen, Thai Nguyen, Binh Duong, and Khanh Hoa. Throughout the project, stigma and discrimination will be addressed by training local government and employers to respect PLWHA and their rights in the workplace. Pact will facilitate coordination between SMARTWork's prevention programs, and care and support programs by other PEPFAR partners and relevant government and non-governmental programs.

The SMARTWork program has several components built on FY05/06 activities. First, in partnership with MOLISA, SMARTWork will build the capacity of employer and employee representatives to address HIV/AIDS in the workplace through 16 two-day workshops on ABC prevention methods, gender and HIV/AIDS, employment rights, and stigma and discrimination. A total of 4,000 individuals will be trained.

Second, trainers will teach prevention messages to an estimated 85,000 workers in 52 enterprises where industrial or factory workers may be at risk for drug (including alcohol) abuse and visiting sex workers. These industries are located both in the community and in Ho Chi Minh City (HCMC) Nhi Xuan industrial zone where many former drug users are employed. Participating enterprises will select core employees to participate in HIV/AIDS prevention training according to the proven SMARTWork training model. Trainees subsequently implement workplace outreach for all employees with monitoring and technical support provided by provincial health departments and program staff. A total of 70 courses will be conducted. Printed and audio-visual materials will supplement behavior change messages and referral to CT. At a minimum, these materials will be distributed in the 52 target enterprises in the community and the Nhi Xuan industrial zone, but experience suggests 130,000 upstream targets are expected to read or view the materials.

Third, SMARTWork will provide technical assistance to local partner organizations and enterprises. This will include promoting worker access to CT, development of in-house prevention strategies tailored to the needs of individual enterprises, and provision of employment support for PLWHA. SMARTWork will actively develop relationships with partner industries to advocate employment of PLWHA, including former drug users and 06 center residents. SMARTWork will provide maintenance, counseling and legal services for PLHWA already employed; referral to care and treatment services sponsored by PEPFAR and others; condom vending machines in 52 core enterprises; and information regarding advances in HIV prevention. PEPFAR's FY07 strategy to expand coverage and access for at-risk and vulnerable populations will be met by scaled-up outreach in Baria-Vung Tau, Quang Ninh and Thai Binh.

In FY07 AED SMARTWork will cooperate closely with the Ministry of Labor, Invalids and Social Affairs, HCMC authorities and other partners to develop employment opportunities for former residents of drug rehabilitation centers in HCMC and other locations as possible. This collaboration will replace previously planned efforts to establish workplace prevention programs in the Nhi Xuan Industrial Zone.

This activity is linked to HVCT FHI (9508) and HVAB Pact Partners (9482).

CARE International works with MOH and HCMC-PAC to lead capacity building for local community-based and faith-based organizations (CBOs and FBOs) to prevent HIV transmission. Building on USG support in FY05 and FY06, CARE will train 115 core members of CBOs to conduct community-based HIV/AIDS prevention outreach; these members will subsequently reach 8,000 individuals, principally most-at-risk populations (MARPs) with community outreach HIV/AIDS prevention. CARE's program will continue to work in the FY '06 programming locations (Hanoi, HCMC, Quang Ninh and Can Tho) and will expand to An Giang. This activity is rooted in the comprehensive ABC approach at the heart of the PEPFAR Vietnam 5-year Strategy and responds to the PEPFAR prevention technical assistance visit call for intensified focus on MARPs. In addition, CBOs - many of which are peer- or faith-based—are best placed to identify MARPs who are hardest to reach and most in need. All CBO HIV/AIDS prevention activities will be conducted under the guidance of the outreach coordinator appointed for the province.

CBOs with deep roots in at-risk population communities in Hanoi, HCMC, Can Tho, Quang Ninh and An Giang provinces will conduct HIV/AIDS prevention education and peer outreach. Specific activities include: condom distribution; community-based peer education; communication campaigns in schools and with the broader community; and information exchange in regular meetings of community members. Individuals reached will be referred for further services, including CT, management of sexually transmitted infections (STI), drug and alcohol treatment and counseling, and HIV/AIDS care and treatment as needed. Many of CARE's partner CBOs also engage in community- and home-based care and support services, which will be linked to the prevention initiative. Pact will support CARE in its efforts to link its partner CBOs with the full range of HIV/AIDS-related services available through PEPFAR and other programming.

Specific CBO target populations include PLWHA, injecting drug users (IDU), men having sex with men (MSM), commercial sex workers (CSW) and vulnerable youth, who will be reached at a range of venues including bus stations, bars, karaokes, guest houses and in parks, in line with PEPFAR's strategic goal of expanding coverage at non-traditional venues. Particular vulnerabilities of women and girls will be addressed through CARE-supported prevention programming.

Coordination of peer educators will be facilitated by the PEPFAR sponsored provincial outreach coordinator. Lessons learned from CBOs supported by CARE will be used to inform the Local Partnerships Initiative in selecting partnerships for effective and sustainable prevention programming. Pact will monitor performance and quality of programming through review of quarterly reports, periodic site visits, and technical review of baseline assessment tools and protocols.

This activity is linked to HVAB Pact Partners (9482).

Through the Local Partners Initiative (LPI) Pact/Vietnam will provide small grants to new and/or local partners to design and implement initiatives to extend proven community-based prevention approaches to at-risk populations (e.g., CSWs, IDUs, MSM, vulnerable youth) in PEPFAR's seven priority provinces. These initiatives will address the diversity of individual needs among at-risk populations through a core minimum prevention package, including outreach, behavior change communications, commodities, service referral, and community mobilization. Specific activities will be proposed by potential partners through a competitive process.

Through a separate competitive process Pact/Vietnam will provide a grant to a new and/or current partner to help prevent the spread of HIV/AIDS to female sexual partners of 06 center returnees. This activity is linked to HVAB Pact Partners (9482). In HCMC, the selected partner would target more than 1,500 women, preventing infection by sexual partners recently returned from government centers for rehabilitating drug users (06 centers), in HCMC (linked to 06 center pilot). These activities provide vulnerable women with prevention services that empower them to prevent HIV infection and take into account the needs of HIV-positive individuals, their partners, and their families.

Teams of outreach workers (50 individuals) would be trained to provide relevant motivation and skills needed to adopt safer behaviors. Three months before residents are released from 06 centers, workers would meet with the spouse/regular partner and other family members. Outreach workers would address male and female behavioral norms which dictate men have a right to demand sex from their regular partners while women have no right to refuse sexual relations or to insist on condom use. Outreach workers would stress that spouses/sexual partners of former residents have the right to refuse sexual relationships and that should they decide to engage in sexual activity, correct and consistent condom use is vital. Once residents have returned home from 06 centers, outreach workers would help partners negotiate the adoption of safer sexual practices. Former drug users and family members would be provided with referrals (including booklets) to the full range ofl HIV/AIDS services in HCMC including CT, substance abuse treatment, outpatient clinics, home-based care, PMTCT and care for OVC to ensure potential clients have ready access to the network model.

Pact will work with all selected partners on program design, monitoring, implementation planning, and evaluation. Pact will provide technical support to ensure high-quality effective approaches are well-implemented and will provide capacity building support to local partners. Technical support strategies include site visits, report reviews, and technical review of assessment tools and protocols. Pact will facilitate coordination between Pact partners' prevention and care and support programs and other PEPFAR partners, as well as with relevant government and non-governmental programs.

This activity is linked to HCT MdM France (9512), HBHC MdM France (9577), and HTXS MdM France (9396).

MdM France will target homeless and other at-risk populations through outreach to enlist them in their outpatient clinic (OPC) services in difficult to serve districts in Hanoi and HCMC where MOH and other partner service needs are not met. In partnership with Pact and building on FY05 and 06 activities, MdM France will train 32 social workers and day care center (DCC) staff to provide information on HIV/AIDS prevention to 4,100 individuals, including 2,440 at-risk individuals (1400 injecting drug users - IDU; 900 commercial sex workers - CSW; and 140 men having sex with men - MSM), and 1,660 others, including the homeless, street youth, and current/potential sex worker clients. Activities will take place in HCMC and Hanoi via facility-based and mobile outreach services. This activity is rooted in the comprehensive ABC approach articulated in the PEPFAR Vietnam 5-Year Strategy and responds to the PEPFAR Prevention Technical Assistance visit recommendation for an intensified focus on at-risk populations and provision of an essential package of services. It will be conducted under the guidance of HCMC and Hanoi outreach coordinators.

MdM will support community outreach targeting IDU, CSW, MSM and others. Outreach will be conducted in and near entertainment establishments (e.g., massage parlors, karaoke bars) and other locations where at-risk populations are difficult to reach. Mobile outreach teams include former IDU, sex worker peer educators and physician's assistants. Mobile team members will receive new or refresher training on communication skills, behavior change strategies, and HIV prevention. These will be conducted by MdM and its local partners (e.g., Hanoi Medical University) directly and through collaborative arrangements with PEPFAR supported partner organizations.

The mobile teams will provide at-risk populations with HIV/AIDS prevention information tailored to their particular needs, as well as access to condoms. Male behaviors and norms will be addressed through activities aimed at current or potential clients of sex workers. The vulnerabilities of women and girls - which may be particularly acute in the marginalized communities where MdM's work is focused - will be addressed through activities including condom negotiation skills. Mobile teams will provide clients with referral cards for convenient access to services at MdM-supported clinics. They will have access to sexually transmitted infection (STI) diagnosis and treatment services, CT, and a full range of HIV care and treatment services, including OVC support. MdM will also refer clients to PMTCT and addictions treatment for appropriate candidates.

In HCMC, where mobile teams include physician's assistants, those who are unable to access day care center services will be provided with STI treatment based on syndromic diagnosis. Community-based outreach prevention and facility-based clinical prevention services will be reinforced by IEC and counseling activities on site at each DCC, in rooms dedicated as social gathering and peer support space for IDU, CSW and PLWHA. HIV prevention leaflets and condoms will be available in these rooms, elsewhere in the DCC, and from health care providers. Opportunities for additional prevention education will be provided at both sites by a range of trained staff, including counselors and health educators. Pact will monitor performance and quality of programming through review of quarterly reports, periodic site visits, and technical review of baseline assessment tools and protocols.

This activity is linked to HVAB Pact Partners (9482), and OHPS Pathfinder (9530).

Pathfinder's work with private-sector HIV service providers drives MOH and PEPFAR efforts to build strong public-private partnerships. In FY07, Pathfinder will train 170 private health care providers and pharmacists to provide comprehensive HIV/AIDS prevention counseling, STI treatment and CT referrals for 21,870 clients in Can Tho, Ho Chi Minh City (HCMC) and one TBD province. Beneficiaries will have access to prevention and condom use education, along with PEPFAR-supplied condoms, at 179 condom outlets. Activities will be undertaken with the guidance of appointed outreach coordinators in targeted provinces and will be coordinated with broad-based HIV/AIDS counseling and testing, care, and treatment services in the public sector, including those supported by PEPFAR.

Pathfinder will continue promoting effective linkages between public-sector and private-sector providers to improve the quality and reach of services for those at risk of HIV infection. One of the key challenges identified by the PEPFAR Prevention Technical Assistance visit is the gap in quality and coverage of essential services for at-risk and vulnerable populations. Pathfinder will continue to work with the private sector, where many at-risk and vulnerable populations access health care, to increase private-sector engagement in the HIV/AIDS response and increase capacity to deliver high-quality prevention programs and services, including management of sexually transmitted infections (STI). Major outcomes of this work will include more effective collaboration between the public and private sectors to develop a cohesive and standardized response to the epidemic. Capacity building and training for private health care providers will also contribute to sustainability of the HIV/AIDS prevention response.

The first component of this activity will address prevention of HIV transmission and stigma reduction for private health care providers. Building on Pathfinder's FY06 efforts to build private-sector capacity, local trainers will continue to train private providers who may offer STI services and HIV/AIDS education, counseling and referral to their clients, often at-risk populations. This activity will build private provider capacity, increasing quality of prevention services and expanding the reach to key populations. The project will also employ innovative social marketing strategies to promote those providers offering high-quality STI service. It is estimated the services of 70 private providers and pharmacists will be promoted in this fashion.

A second component includes training sessions to improve pharmacists' and clinicians' knowledge and practical skills for STI diagnosis, case management, education and counseling. Through this component 170 private providers and pharmacists will be trained.

Finally, in conjunction with the provincial outreach coordinators and BCC partners, Pathfinder will replicate informative and targeted educational IEC materials focusing on STI and HIV prevention that will be distributed through private providers and pharmacists to their clients who come in for STI-related services. Fifty thousand copies of IEC materials will be produced and distributed. Pact will monitor Pathfinder performance and quality of programming through review of quarterly reports, periodic site visits, and technical review of baseline assessment tools and protocols.

Pact (Pathfinder) requests additional funding to 1) add second clinical training specialist and second senior program officer 2) Hire international consultant to review strategy and programming 3) Print and distribute standard precautions technical guidance and 4) translate, design and print a summary on two years' program experience and 5) provide full staffing for remaining months of FY06.

This activity is linked to HVAB SHAPC (9484).

Local NGO SHAPC, in conjunction with MOH, plays the lead role in PEPFAR interventions targeting Hanoi university students at a stage when many are becoming sexually active. Building on support provided in FY05 and FY06, SHAPC will train 160 key youth union leaders in seven Hanoi universities on HIV prevention messages and BCC methodologies, and will reach 15, 000 students with messages on HIV and sexually transmitted infection (STI) prevention modalities via a range of approaches, described below.

This activity, focusing on the growing vulnerability of Vietnam's youth to HIV, will provide condoms to sexually active students via 21 condom service outlets, and will be conducted under the guidance of the US sponsored outreach coordinator appointed for Hanoi.

The activity has four components. The first involves the revision and distribution of a comprehensive HIV prevention booklet - covering both safer sex and drug use prevention—developed with PEPFAR support in FY05 based on student input and best practices in youth HIV/AIDS communications. The 15,000 students who receive the booklet will be encouraged to share it with other students, in order to increase reach. In addition, 7 HIV/reproductive health material desks will be established and maintained in all seven targeted universities to provide students with access to more in-depth information on key HIV/AIDS and STI information, including referral information related to STI management, CT, and drug addictions counseling and treatment.

The second component involves the training of 160 trainers (selected from among youth union leaders) in HIV/AIDS prevention and life skills education. These trained youth union leaders will subsequently provide HIV/AIDS education to university student cohorts across the city (totaling 15,000 across all seven universities). Youth union leaders will be trained in, and will subsequently educate students on, HIV, STIs and prevention methods, including safer sex, correct and consistent condom use, the risks of drug and alcohol abuse, along with age-appropriate AB messages. Trained youth union leaders will provide students with relevant life skills training to enhance students' ability to adopt the safer behaviors about which they have learned—including how to discuss sexuality and responsible sexual decision-making with boy/girlfriends, and (for those who are sexually active) how to negotiate condom use. Instilling HIV/AIDS training capacity in the youth union at each university will assist SHAPC in working towards sustained HIV/AIDS prevention education in the Hanoi university system.

The third component of this activity involves using music/knowledge contests and writing competitions to provide and enhance HIV/AIDS knowledge and generate dialogue among the general student body in all seven universities - an approach that has proven very popular in SHAPC's FY05 program, and is rooted in best practices in HIV/AIDS communications with youth. The information provided will reinforce messages delivered via both the information booklets and HIV/AIDS education components described above.

The fourth and final component of this activity involves the maintenance of 21 outlets providing condoms to sexually active university students. In accordance with the PEPFAR Vietnam plan to broaden access to condoms via non-traditional outlets, these will be provided via friendly kiosks and cafes frequented by students, as well as condom boxes hung in convenient locations, in or near university grounds.

This activity is linked to HVOP (9604)

With PEPFAR support, Save the Children USA and Pact/Vietnam supported MOET's development of the National Plan of Action (NPA) for Reproductive Health (RH) and HIV/AIDS Prevention Education for the Secondary School System, which was formally approved in March 2007. The NPA is a critical document that outlines how Vietnamese young people attending lower and upper secondary schools will be provided with access to accurate, high quality information on HIV/AIDS and related prevention modalities and the opportunity to acquire the skills needed to prevent HIV transmission and other reproductive health problems.

As a precursor to NPA development, Save the Children USA supported MOET to systematically assess previous and current school-based HIV/AIDS education programs. This review examined policy documents, curricular studies, extra-curricular activities and teacher training on HIV education for secondary school students in Vietnam and provided recommendations for improvement. The most critical recommendation made, and hence the most important step to operationalizing the now formalized NPA, involves synthesizing currently fractured curricula and activities aimed at secondary students into a cohesive, single program.

Through a competitive process, Pact/Vietnam will identify a partner to support MOET to respond to this key task within the NPA - curriculum synthesis. Technical assistance to MOET will entail: 1) reviewing and assessing previous and current pilot reproductive health and HIV prevention education programs in secondary schools and teacher training colleges/universities and identifying the most effective components for synthesis into unified, comprehensive HIV/AIDS prevention national curricula; 2) designing additional modules to address gaps (e.g., drug use prevention); 3) pilot testing components of a revised curriculum and teacher training materials in one priority province to be identified in collaboration with MOET and PEPFAR; and 4) writing a detailed plan and guideline for school management to implement a unified HIV prevention/reproductive health curriculum in the secondary school system and teacher training colleges/universities nationwide.

Efforts this year will focus on developing, pre-testing, and finalizing the unified curriculum and teacher training materials, which will readily be taken-up in the following year on a broad scale.

This activity is linked to HBHC FHI (9558), HKID Pact (9554), HTXS MOH/VAAC (9529) and HTXS HCMC-PAC (9533).

In FY07, Pact will fund five Vietnamese NGOs to provide palliative care for 1,050 individuals. Pact will build and strengthen NGO capacity to provide basic palliative care to PLWHA and their family members. Pact will ensure palliative care services are in line with the National Palliative Care Guidelines and expanded in line with the PEPFAR Vietnam 5-Year Strategy to extend supportive services through strengthening of civil society. Pastoral Care is a Catholic organization that provides care, support and treatment services to PLWHA in HCMC. PEPFAR will support Pastoral Care's clinics and home care teams with a small grant and technical assistance via Pact, and will provide training and OI drugs. Pathfinder International will be supported to expand a pilot of public private partnership in home and community based care in An Giang province. Pact and Tufts University will collaborate in a qualitative assessment of barriers and facilitators to ART adherence among PLHIV on ART in Ha Noi, with a view to developing concrete recommendations for programming. This assessment will be linked to Pact's ongoing work with its care and treatment partners, which includes a focus on strengthening the adherence support components of their programs.

SHAPC: In FY07, SHAPC will provide home-based care for clients of the Bach Mai outpatient clinic (OPC) living in Hai Ba Trung district in Hanoi and surrounding areas in Hanoi. PEPFAR, Pact, and SHAPC will work together to support home-based care (HBC) teams that implement as a part of the network model in Hanoi, reinforce referral of clients to and from clinical and community settings and ensure effective delivery of services in the home, community and facilities. Both Pact and Family Heath International (FHI) will guide SHAPC to build capacity for HBC service provision.

Mai Hoa: Mai Hoa Center is a small hospice and residence for very poor and homeless PLWHA in Ho Chi Minh City (HCMC), run by a small group of Catholic nuns who are nurses by training. Many PLWHA come to Mai Hoa Center to receive end-of-life care. Though this site remains a hospice and receives patients with terminal disease, the site has also become a longer term residence for patients who have recovered significantly with ART, yet remain homeless or orphaned. In FY05 and FY06, Mai Hoa Center received PEPFAR funding to enhance the quality, comprehensiveness and reach of HIV/ AIDS care, support and treatment for both adults and children. In FY07, PEPFAR will support Mai Hoa to continue providing these services. Along with additional non-USG support, USG will continue to support the Vietnam Harvard Medical School HIV/AIDS Partnership (VCHAP) and a physician from HCMC's Pasteur Institute to provide onsite clinical support.

COHED: The Center for Community Health and Development (COHED) is a Vietnamese CBO engaged in a range of HIV/AIDS response initiatives, including a PEPFAR-supported project to provide care and support services to women living with HIV/AIDS. In FY05 and FY06, PEPFAR supported COHED to open the "Cactus Flower Club", a club for women infected and affected by HIV/AIDS in Quang Ninh Province, which was developed in partnership with the Halong City Health Authority. The club served 250 women through a range of services both on site and through community outreach and home-based care. In FY07 COHED will strengthen and expand palliative care through the Cactus Flower Club, including strengthening relationships and referral links with the provincial level HIV/AIDS outpatient clinic in Quang Ninh to recruit new beneficiaries for palliative care services.

COHED will ensure that services are provided in line with the PEFPAR Vietnam Palliative Care Working group guidance on the basic home-based care package. In addition, COHED will focus on strengthening the capacity of women to care for themselves and their families through economic strengthening activities, including employment referral and employment in collaboration with SMARTWork. COHED will also continue to expand its well-developed program of advocacy and community mobilization to increase awareness of HIV/AIDS including the negative effects of stigma and discrimination.

New Local Partner to Be Identified: In FY07, PEPFAR will select a new local partner to provide H/CBC in 2 districts which have PEPFAR-supported OPCs but do not have HBC services in Quang Ninh Province. This new activity will extend the reach of community-based services in the province, helping to ensure that PLWHA receive essential care and support services in their communities and that they are appropriately linked to

care and treatment services.

Significant funds have become available through cost savings in SCMS through decrease in the cost of ARV. The targets have also been decreased despite expected additional reach through additional funding because Mai Hoa Center will focus on clinical care based at Mai Hoa Center but not community-based care as originally planned (individuals expected to be reached has decreased from 500 to 50).

This activity is linked HBHC FHI (9558), HBHC MOH/VAAC (9529), HBHC HCMC-PAC (9533), and HBHC HPI (9599).

PEPFAR will fund SMARTWork to facilitate job opportunities for PLWHA in 7 focus provinces and place 1,200 PLWHA in employment, helping ensure livelihood security.

This activity builds on previous support in FY05 and FY06. In FY07, SMARTWork will take the lead in assisting PLWHA and residents returning from government rehabilitation centers in obtaining gainful employment (see also Pact/SMARTWork Other Prevention and AB sections). SMARTWork has developed an effective HIV/AIDS workplace prevention and workplace policy development program in collaboration with the Vietnam business sector and the Ministry of Labor Invalids and Social Affairs (MOLISA), the Vietnam Chamber of Commerce and Industry (VCCI), the Vietnam General Confederation of Labor (VGCL), and local PLWHA support groups. In FY07, SMARTWork will work directly with local enterprises in 7 focus provinces to develop PLWHA employment policies and facilitate the hiring and PLWHA for gainful employment. SMARTWork will train select PLWHA to increase awareness among other PLWHA on their employment rights, and will assist them to advocate for employment at industries where SMARTWork has assisted in the development of workplace policies that are PLWHA-friendly. SMARTWork will also implement stigma and fear-reducing training sessions in these same industries to ensure that employees are accepting of PLWHA in the workplace.

In addition, SMARTWork will establish Employment Services Centers in key locations to assist with employment of PLWHA. SMARTWork will work with targeted industries to post information on HIV/AIDS-related services at the workplace and in their community, with references to HIV/AIDS care at MOH/VAAC and other PEPFAR-supported sites, CT services, OVC and PLWHA support in the community. At the same time, SMARTWork will work closely with VAAC and the HCMC-PAC to ensure that PLWHA receiving care are aware of emerging employment opportunities via consultations and posting at clinical care sites and at support organizations including CBOs.

This activity is linked to HBHC FHI (9558), HBHC MOH/VAAC (9529), HBHC HCMC-PAC (9533), and HKID Pact (9540).

Pact will support CARE to strengthen and expand local community and faith based organization (C/FBO) capacity to provide basic health care and support services to 2,500 individuals, training 85 individuals to provide services in 9 service outlets in 5 of the focus provinces.

In FY07 PEPFAR support will expanded to 9 local C/FBOs to provide community and home-based care according to the needs of PLWHA. In line with the PEPFAR Vietnam 5-Year Strategy, Pact partners will expand civil society engagement to meet care targets in communities. Service coverage will be extended to 5 focus provinces. CBOs supported by CARE will include: Bright Futures (Hanoi and Quang Ninh), Dong Cam (Quang Ninh), Tue Tinh Duong (Hanoi), A-for-D (Action for Development) (Hanoi), Network and Pastoral Care - Ho Chi Minh City (HCMC), Xuan Vinh (HCMC), the AIDS Program (HCMC), Green Hope Club (HCMC), Binh Thuy (Can Tho) and a new group to be identified in An Giang Province.

With support and technical guidance from Pact and FHI, CARE will continue to strengthen the capacity of these 9 C/FBO partners to provide basic palliative care to PLWHA in the home and the community. Care provision will be in line with the National Palliative Care Guidelines and O/GAC guidance. Based on FY06 support and feedback from CBOs, training will be modified to include clinic-based training to practice new skills. FHI will partner with CARE to support CBOs to standardize provision of H/CBC, in accordance with the basic care package as defined by PEPFAR Vietnam.

CARE's strong community and home based ARV adherence and literacy activities will work in coordination with PEPFAR-supported clinics to prepare and support PLWHA for treatment provided in out-patient clinics. Psychosocial and spiritual support will be provided to not only PLWHA, but also for their family members, peer educators and caregivers. CARE will also expand activities to strengthen the capacity of local commune health workers to ensure the quality of HIV services and the functioning of the referral system.

In FY07 CARE will support CBOs to provide social support for PLWHA and families members as described in the basic care package. In addition, the project will collaborate with SMARTwork to support FBO/CBOs to strengthen income generation and job assistance activities, working with local businesses, organizations, communities and PLWHA. CARE will continue to support 2 CBOs (Bright Futures and Dong Cam) to implement advocacy activities to reduce stigma and discrimination against PLHWA.

Pact will ensure appropriate referral between all C/FBO programs and clinical services supported by PEPFAR in focus provinces including MOH/VAAC, GF, and HCMC-PAC via provision of a directory of services, referral follow-up, and via liaising with clinical providers supported by PEPFAR.

This activity is linked to HBHC VCHAP (9551), FHI (9558), HTXS Pact (9396), and HKID Pact (9541). Funding is being reprogrammed from previously planned funding for ARV drugs in the setting of reduced drug costs. Using PEPFAR funds, Pact will support Medecins du Monde (MDM) to provide 1,650 individuals with palliative care via two outpatient clinics (Hanoi and Ho Chi Minh City) and 2 home-based care teams for a total of 4 sites. MdM will train 40 individuals to provide palliative care services.

MdM is the lead organization for PEPFAR providing health care for extremely vulnerable populations in two focus provinces, which are often underserved by government sites. PEPFAR will support MdM via Pact to provide palliative services in two district-level outpatient clinics (OPCs) with outreach and home-based care to surrounding districts hardest hit by the HIV/AIDS epidemic. These clinics provide comprehensive HIV/AIDS prevention, care and treatment services, with a focus on serving intravenous drug users (IDU), commercial sex workers (CSW) and very poor and homeless populations. MdM reaches its clientele through services offered at the clinics as well as through mobile outreach services and home-based care teams which operate both daily and nightly.

In FY07, MdM will continue to support clinical palliative care services at these two sites in HCMC and Hanoi. A total of 1,650 PLWHAs will be reached with basic health care and support services, which include: prevention counseling and commodities, regular clinical evaluation and monitoring, opportunistic infection (OI) prophylaxis and treatment of common OIs, screening for TB, related laboratory services; treatment adherence support; referral of complex OIs and TB, symptom management and pain relief, management of HIV/AIDS-related complications. A team composed of doctors, nurses, counselors (including peer counselors), case managers, and a pharmacist will provide treatment literacy well in advance of ART initiation, and provide more intensive treatment preparedness for all their clients, family members, and caregivers when a patient reaches the ARV treatment stage at these clinics. Home-based care (HBC) teams will provide the H/CBC basic care package as defined by PEPFAR and described in the program area context.

In addition, MdM will develop a PLWHA support group to restore social relationships, self confidence and self-esteem, targeting marginalized returnees from government rehabilitation centers. Monthly meetings will be organized for all beneficiaries, including commercial sex workers (CSW), injecting drug users (IDU), PLWHA, ARV patients, and family members/caregivers. The project will also support economic strengthening activities for PLWHA, including vocational training and employment referral in collaboration with the SMARTWork program.

PEPFAR will supply OI drugs, CD4 test and HBC kits directly to these sites. Although MdM will provide direct technical support and oversight, other PEPFAR partners will continue to support the clinics with advanced clinical training courses and on-site coaching. FHI will also support HBC teams to standardize their provision of H/CBC in accordance with the minimum package described in the program area context. PEPFAR will support these clinics to strengthen their linkages with other services in the network.

Additional funding is being granted to MDM through reprogramming from SCMS. This funding will serve to adjust the fiscal year by 3 months to end in September.

Funding will support Soc Son District Preventive Centre, which is 7 km away from two rehabilitation centres, to be the base for a mobile medical mentoring team to provide palliative care & treatment to people entering and leaving these centers.

This activity is linked to HBHC FHI (9558), HBHC HCMC-PAC (9533), HKID Pact (9547), and HTXS MOH/VAAC (9398).

Via the Pact umbrella, PEPFAR will support World Vision to expand the provision of basic health care and support services to 950 PLWHA, train 120 individuals and manage 36 outlets providing HIV-related palliative care in 2 focus provinces.

In FY06, PEPFAR supported World Vision to implement home-based care (HBC) in 3 districts in Ho Chi Minh City (HCMC) and Haiphong provinces. In line with the PEPFAR Vietnam 5-Year Strategy to extend service provision via civil society engagement, and based on lessons learned from FY05 and FY06, PEPFAR will expand HBC service provision to 5 districts (3 in HCMC and 2 in Haiphong). HBC activities will be standardized across all PEPFAR partners and the basic package provided will be based on the needs of individual PLWHA and their families at the community/home level. World Vision will reach new beneficiaries by working in partnership with District Health Centers and Commune Health Centers in each province. PEPFAR, Pact, Family Health International (FHI), and World Vision will work together to support HBC teams engaged in the provision of HBC services as a part of the network model. Specifically, FHI will train HBC teams in the provision of services and will assist with on-going mentoring and supervision until teams demonstrate capacity to operated independently (see FHI Palliative Care).

Pact will ensure appropriate referral between World Vision HBC and clinical services supported by PEPFAR in these focus provinces including MOH/VAAC, GF, and the HCMC-PAC via provision of a directory of services, referral follow-up, and via liaising with clinical providers supported by PEPFAR. Family members will be trained in basic care and support for PLWHA at home, and World Vision will support economic strengthening activities for PLWHA, including vocational training and employment referral in collaboration with the SMARTWork program.

In FY07, PEPFAR will select new partners to provide community-based care in strategic districts in the 7 focus provinces including in 2 districts in Quang Ninh Province and 2 districts in Nghe An Province. Other provinces will be targeted as needed. Selection will be via the Pact's Local Partner's Initiative (LPI) in an attempt to identify and strengthen new local CBO in targeted provinces. This activity will extend the reach of community-based services in provincial and district levels to ensure that PLWHA receive essential care and support services in their community and they are appropriately linked to care and treatment services.

Table 3.3.07: Program Planning Overview Program Area: Palliative Care: TB/HIV Budget Code: HVTB Program Area Code: 07 Total Planned Funding for Program Area: $ 2,378,000.00

Program Area Context:

Program Area Setting Vietnam ranks 13th among the 22 high-burden TB countries with an estimated incidence of 178 cases per 100,000 persons. In 1985, the National TB Program of Vietnam (NTP) introduced Directly-Observed Therapy (DOTS). By 1997, Vietnam reached 100% coverage and was one of 2 high-burden TB countries to achieve WHO-recommended program targets: diagnosing 70% of all new cases and successfully treating 85% of diagnosed cases. Nevertheless, the TB case notification rate has not declined. A 2005 data review concluded that TB rates have not declined due to rapid spread of HIV infection. National HIV prevalence in TB patients is estimated at 4.2%, up from 1.5% in 2000; TB prevalence in high HIV-prevalence areas is 10-20%. Based on 2 limited national surveys, the prevalence of INH-resistant and multi-drug resistance (MDR) strains of TB is 20% and 2%, respectively. There is no national data about TB drug resistance among HIV-infected TB patients. For HIV-infected persons in Vietnam, TB is the primary cause of severe illness and death. Twenty percent of HIV-infected persons have radiographic evidence of TB disease when first screened for TB. Even after TB is apparently ruled out, an estimated 20% of HIV-infected persons develop bacteriological-confirmed TB days to weeks after initiating ART, probably due to either inadequate screening for TB disease or immune reconstitution syndrome. During TB treatment, death rates in HIV-infected TB patients average 20-30% and reach as high as 50% in Ho Chi Minh City, with most deaths occurring in the first 2-3 months after TB diagnosis. Program experience suggests that there are many contributors, including delayed diagnosis of HIV infection and TB and inadequate HIV treatment and care during TB treatment.

Key Accomplishments In the past two years, PEPFAR and MOH have made major progress in responding to the TB/HIV epidemic. PEPFAR has implemented routine HIV counseling and testing (RCT) for TB patients and referral to HIV services for HIV-infected TB patients in 34 districts, 4 provincial-level hospitals and 1 national-level hospital, covering 7,000 TB patients annually (50% coverage). An evaluation of the public health response to HIV-associated TB in one focus province documented the high burden of TB in HIV-infected persons, the survival benefit of co-trimoxazole for HIV-infected TB patients and best practices for implementing TB screening in HIV-infected persons. Other activities include developing national, provincial, and district-level coordinating committees for TB and HIV programs; implementing TB screening of patients known to be HIV-infected in 4 of 6 current focus provinces; assessing the prevalence of drug-resistant TB in HIV-infected patients living in Hanoi, Haiphong, and Quang Ninh; and implementing ART and opportunistic infection (OI) prophylaxis in one provincial clinic. Modified TB registers have been implemented in the 7 PEPFAR focus provinces to monitor and evaluate HIV services provided to HIV-infected TB patients during TB treatment. PEPFAR has identified one locally employed staff member (LES) to serve as the TB/HIV coordinator to promote and monitor PEPFAR TB/HIV activities. Recently, a national TB/HIV Technical Advisory Group has been formed. These efforts will effectively constitute a TB/HIV policy-making entity at the respective levels.

Challenges/Opportunities The Vietnam NTP has incorporated HIV-specific services for adults and children into its national strategy, development plan, training materials and the national AIDS program (the MOH/Vietnam Administration for HIV/AIDS Control, or VAAC) has done the same for TB. However, the TB and HIV programs are generally vertical and poor referral between the two programs has led to delayed diagnosis of TB and delayed entry of TB/HIV patients into the HIV care system. The establishment of a national TB/HIV coordinating committee has been slow due to challenges with technical and administrative management but VAAC recently agreed to the establishment of a national TB/HIV Technical Advisory Group (TAG). There are also difficulties treating smear-negative HIV patients and INH prophylaxis is not approved in Vietnam.

Key Strategy Elements The success of initial PEPFAR TB/HIV collaborative activities provides opportunity for expansion of existing

initiatives and enhancement of services. Consistent with the Vietnam National HIV/AIDS Strategy, and the PEPFAR Vietnam 5-Year Strategy, the highest priorities include implementing RCT across all districts in the 7 focus provinces, developing a successful, evidence-based model for screening HIV patients for TB co-infection, strengthening human resources at the district level, and providing co-trimoxazole, ART, and other services to HIV-infected TB patients. To achieve these goals, PEPFAR has charted specific objectives (described in following paragraphs); each rests on activities that have been planned in coordination with other donors and TA providers included in the MOH NTP five-year development plan, Global Fund (GF) grants for TB and HIV, and VAAC HIV/AIDS planning.

Formal collaboration mechanisms between TB and HIV programs will be established at the national, provincial, and district level in focus provinces. Through PEPFAR support for NTP, focus provinces will convene joint monitoring and evaluation of TB/HIV activities, joint training activities and regular meetings for district-level participants. Technical guidance will come from the NTP, VAAC, PEPFAR and other international partners. All TB patients in focus provinces will receive CT for HIV and referrals to HIV services will be tracked. National policies support HIV testing of any patient in a medical facility at risk of HIV infection. PEPFAR will support VAAC to expand RCT to 14,000 persons in 100% of districts in the 6 current PEPFAR focus provinces, and will discuss with VAAC expanding to a 7th focus province. PEPFAR will support intensive M&E and training by national TB and HIV program staff, as well as PEPFAR staff, to promote patient and provider acceptance of RCT. All HIV-infected TB patients will receive cotrimoxazole preventive therapy, HIV staging, ART (if indicated) and other HIV-related services. PEPFAR will support ART in selected TB settings. Pilot initiatives will document the feasibility and impact of treating latent M. tuberculosis infection and providing TB preventive therapy to 100 PLWHA. Residents of government centers for rehabilitating injection drug user (06 centers) where PEPFAR is providing support will receive equal TB services. Although there is no "fast track" to ART for TB-infected persons, PEPFAR will increase support for ART and OI prophylaxis to 4 provincial TB clinics.

All patients known to be HIV-infected will undergo TB screening at least annually, as well as when showing suspected TB symptoms and before starting ART. Persons diagnosed with TB are registered for TB treatment and PEPFAR will support TB treatment for 7,000 PLWHA at 75 service outlets. At least one facility in each focus province will have sufficient skill and resources for rapid diagnosis and treatment of smear-negative and extra-pulmonary TB in HIV-infected persons. Human resources will be developed to ensure a sustainable TB/HIV care system for the future, including direct technical assistance and training for 450 individuals to provide clinical prophylaxis and/or treatment. PEPFAR-funded HIV care and treatment settings will implement infection control practices to limit TB transmission. PEPFAR has added one country-specific indicator: number of TB patients undergoing HIV counseling and testing (and receiving their results). In accordance with the PEPFAR Strategic Information (SI) plan, information collection for TB/HIV activities will meet national standards ensuring integrated service delivery systems, linkages across providers and programs, routine M&E and support for the National HIV/AIDS M&E System.

Program Area Target: Number of service outlets providing treatment for tuberculosis (TB) to 75 HIV-infected individuals (diagnosed or presumed) in a palliative care setting Number of HIV-infected clients attending HIV care/treatment services that are 7,500 receiving treatment for TB disease Number of HIV-infected clients given TB preventive therapy 100 Number of individuals trained to provide treatment for TB to HIV-infected 450 individuals (diagnosed or presumed)

Table 3.3.07:

This activity is linked to HBHC MdM (9577), HBHC HCMC-PAC (9533), HLAB MOH/VAAC (9505), and HTXS MOH/VAAC (9398).

In 2 Medecins du Monde, France (MdM) supported outpatient clinics (1 in Hanoi and 1 in Ho Chi Minh City), funding will be provided for TB screening for 1,650 HIV-infected persons and referral to TB treatment for 165 PLWHA.

In FY04/05, MdM provided TB screening for PLWHA with suspected symptoms attending 2 PEPFAR-supported outpatient clinics, one in Hanoi and one in HCMC, referring those in need of treatment to the National TB Hospital in Hanoi or the TB Department of the District 6 Hospital in HCMC. In FY06, both clinics will begin screening all PLWHA for TB annually and for suspected symptoms of TB. In FY07, Pact will provide funding and overall program management support to MdM Hanoi and MdM HCMC for HIV/TB-related clinical activities, including screening all HIV-infected persons for TB. The PEPFAR Vietnam 5-Year Strategy includes annual TB screening for all HIV-infected persons, screening as needed for symptoms, and screening before starting ART. In 1 MdM-supported outpatient clinic in HCMC and 1 in Hanoi, funds will be used to provide yearly TB screening of all HIV infected patients, screening for suspected cases and screening prior to starting and during ART as part of the core package of care and treatment services. The complete package of care provided is described in the section HBHC MdM-France (9577).

This activity is linked to HBHC Care (9566) and HKID TBD (9552.)

In FY07, PEPFAR will support CARE to partner with 4 CBOs to increase quality and coverage of OVC programs in three focus provinces. These CBOs include: Bright Futures in Hanoi and Quang Ninh, Dong Cam in Quang Ninh and Xuan Vinh in Ho Chi Min City (HCMC). As in FY06, Pastoral Care in HCMC will also be a partner in capacity building and information sharing. Through home- and community-based care and support services, these CBOs will serve 250 OVC and train 60 professional and family caregivers. These activities will build on work with OVC in FY05 and FY06 to include a wider range of services designed to meet the developmental needs each child served.

Services will be provided in accordance with the PEPFAR basic OVC services package and will include: assessment of needs of OVC and caregivers, counseling and psychosocial support, and service referral, including referral to MOH pediatric outpatient clinics. Direct OVC services will also be offered with a different mix of activities for each partner, developed according to community needs and partner capacity. These will include: food/nutrition support (in accordance with forthcoming PEPFAR guidance), PLWHA and caregivers support groups, and educational activities and play groups for children. The capacity of caregivers will also be strengthened by training in care and support for OVC, as well as through income generation and employment support programs, including collaboration with SMARTWork (See HBHC AED 9564).

In FY07 PEPFAR will continue to support 2 CBOs (Bright Futures and Dong Cam) to implement stigma reduction activities, as well as advocate for the protection and fulfillment of child rights. In this activity, these CBOs will implement advocacy campaigns to change policy for better access for OVC to education. CARE will assist additional CBOs to advocate for changes in policy and practices based on the needs of children in their communities.

PEPFAR will support CARE in strengthening the capacity of these CBOs to offer case-management and OVC services, through training courses and mentoring for staff, and program monitoring and feedback. CARE and CBO staff will also contribute to meetings among implementing partners, to establish consensus on OVC service packages, facilitate exchange of materials and lessons learned, and identify and address gaps in services and referral. Pact will provide Care with project management support and other technical assistance, as required. Pact will facilitate coordination between prevention, care and support programs by other PEPFAR partners and relevant government and non-governmental programs, and CARE and its sub-partners will contribute to service planning and coordination to support the network model.

This activity is linked to HBHC MdM (9577), HTXS Pact (9396), and HKID TBD (9552).

Pact will fund Medecins du Monde France (MdM) to provide care and support services to 450 OVC, as well as train 50 professional and family caregivers in two focus provinces, Hanoi and Ho Chi Minh City (HCMC).

MdM is an international humanitarian aid organization that provides health care for vulnerable populations. In Vietnam, MdM supports 2 government-managed outpatient clinics in the Tay Ho District clinic in Hanoi and An Hoa clinic in District 6, HCMC. These clinics provide comprehensive HIV/AIDS prevention, care and treatment services, with a focus on serving intravenous drug users (IDU), commercial sex workers (CSW) and very poor and homeless populations, including PLWHA. MdM reaches its clientele through services offered at the clinics as well as through mobile outreach services and home-based care teams.

In FY07, MdM will continue to strengthen care and support for OVC and their caregivers through case management and services offered at the clinic as well as through home-based care. Services will be provided in accordance with the PEPFAR core OVC services package and will include: assessment of needs of OVC and caregivers, service referral and the provision of counseling and psychosocial support. MdM Hanoi and HCMC will offer health care services to OVC, food/nutritional support to OVC (in accordance with OGAC guidelines), and PLWHA support groups. MdM will also build the capacity of caregivers, training family members in basic care and support for OVC at home, and offer economic strengthening for poor families through employment referral, small scale income generation projects and short-term, emergency support.

MdM in HCMC has a more established OVC care and support program than MdM in Hanoi, and in FY07 will expand on this core service package to also offer a wider range of direct services to OVC including: health care services, food/nutrition support for children, psychosocial support for children ("talking groups"), play groups and social activities for children. MdM HCMC will continue community mobilization and advocacy activities to reduce stigma and discrimination, including working closely with local schools to help ensure OVC access to education. As appropriate, MdM in HCMC will support MdM Hanoi to strengthen these components of their program.

PEPFAR will enable MdM to develop its capacity for case-management and OVC service delivery, through training courses and mentoring for staff, and program monitoring and feedback. MdM staff will also contribute to meetings among implementing partners to establish consensus on core service packages, facilitate exchange of experiences and materials, and identify/address gaps in services and referrals. Pact will provide MdM with project management support and other technical assistance, as required. MdM will contribute to service planning and coordination to support the network model, including continued participation in a project to map services and beneficiaries in District 6, HCMC. Staff from PEPFAR, Pact, will also support these clinics to strengthen their linkages with other services, including the new AIDS Service Organizations (ASOs) which will provide service assessment and referral as well as a range of prevention, care and support activities for PLWHA. (See HBHC AED 9564).

This activity is linked to HBHC WV (9580) and HKID TBD (9552).

Pact will support World Vision to expand the provision of care and support services to 522 OVC and train 50 professional and lay/family caregivers in two PEPFAR focus provinces.

In FY05 and FY06 PEPFAR supported World Vision to implement home- and community based care, including OVC services in Districts 7 and 8 in HCMC and in Do Son district in Haiphong Province. In FY07, based on lessons learned from previous work, World Vision will expand and strengthen this service package to 5 districts including: Districts 4, 7 and 8 in HCMC, and Do Son and Hai An districts in Haiphong Province. Through OVC services integrated into home-based care, World Vision will provide or ensure access to comprehensive care and support for OVC and training to caregivers, including referral to MOH pediatric outpatient clinics. In addition, World Vision will ensure access to support services for OVC in the community, offered in collaboration with local health authorities and community groups.

Services will be provided in accordance with the PEPFAR OVC services package and will include: assessment of needs of OVC and caregivers, counseling and psychosocial support, and service referral in the community. Direct services will include: provision of basic health care services and referral for health care; food/nutrition support for children (in accordance with OGAC guidelines); and support for education including school fees, uniforms and books; World Vision will offer life-skills education to vulnerable youth, including age-appropriate education to prevent HIV/AIDS and the initiation of drug use, and teach children about their rights including the right to education, health care and to be protected from abuse. Family members will be trained in basic care and support for OVC at home, and the project will include a strong economic strengthening component, including vocation training and small enterprise development using a revolving credit model, implemented in collaboration with the Women's Union.

World Vision will also implement community mobilization and education activities with teachers, students and parents to reduce stigma and discrimination and increase acceptance of OVC in schools. In addition, World Vision will Support a National Children's Forum for OVC, in collaboration with the Vietnam Commission for Population, Families and Children (VNCPFC) and other partners (including Plan International and Save the Children UK).

PEPFAR will enable World Vision to strengthen and expand OVC service delivery by supporting training courses and mentoring for staff in case management and OVC service provision, as well as through program monitoring and feedback. World Vision staff will contribute to meetings among implementing partners, to establish consensus on OVC service packages, facilitate exchange of experiences and materials, and identify and address gaps in services and referrals. Pact will provide World Vision with project management support and other technical assistance, as required. Pact will also monitor the performance and quality of World Vision's OVC activities through review of quarterly reports, periodic site visits, and technical review of baseline assessment tools and protocols.

World Vision will reach new beneficiaries by working in close partnership with District Health Centers and Commune Health Stations of the above mentioned districts. World Vision will collaborate with PEPFAR, Pact and other implementing partners to ensure that home and community based services are integrated into a network model in each district of the two provinces in which they will be active, with functioning referral linkages to facility-based health care as well as other social services.

This activity is linked to HKID TBD (9553) and HKID TBD (9552).

Pact will support World Wide Orphans (WWO) to provide capacity building and direct support for comprehensive treatment, care, support and protection services to OVC living in 2 residential orphan care centers (Tam Binh 2 Orphanage in Ho Chi Minh City and at Ba Vi Social Training Center 2 in Hanoi). Through this activity, 156 children will receive comprehensive services in the centers, and another 50 OVC from other centers and the broader community will participate in educational activities. WWO will also train 45 professional and volunteer caregivers.

Building on work in the 2 centers in FY05 and FY06, WWO will provide technical and financial support to Tam Binh 2 and Ba Vi to ensure quality palliative care and clinical services for orphaned children living in the centers. These activities will include support for ART, regular clinical evaluation and monitoring, OI prophylaxis and treatment of common OIs, screening for TB, referral to related laboratory services; treatment adherence support; referral of complex OIs and TB, symptom management and pain relief, management of HIV/AIDS-related complications. Additional clinical TA and management of side effects and complicated cases will be provided by physicians from MOH Pediatric Hospital 2, also supported by PEPFAR.

From the end of FY05 through FY07, WWO will have hired experienced Vietnamese pediatricians at Pediatric Hospital #2 to provide on-site mentoring for the treatment team at Tam Binh 2. Clinical staff from the 2 centers will also receive advanced training courses and other mentoring and coaching through WWO as well as PEPFAR-supported training partners, including the Vietnam-CDC-Harvard AIDS Partnership (VCHAP). WWO staff will also participate in pediatric HIV/AIDS training and mentoring offered by the Clinton foundation

WWO will continue to provide comprehensive psychosocial services to the children at Ba Vi and Tam Binh, to lessen the developmental and psychological effects of HIV as well as the effects of institutional care, while reducing stigma and discrimination and encouraging the integration of these children into the community. A cornerstone of this work is the early intervention "Auntie" Program. In this program, volunteers from the community are matched with developmentally at-risk children to provide regular one-on-one care and attention.

WWO will ensure that children at Ba Vi and Tam Binh have access to a full range of psychosocial support, educational, medical/ health, and social activities and services to meet their developmental needs. These include full-time educational opportunities in an onsite "classroom setting" onsite, with a trained teacher and play opportunities in the community, while WWO continues to advocate for admission to local community schools. One-on-one and group play activities, tailored to the individual developmental needs of each child, will also be provided.

In addition WWO will work with Ba Vi and Tam Binh to strengthen intake assessment procedures to assess opportunities for returning abandoned children to family-and-kinship based care and collaborate with local authorities and Partner TBD/Reintegration pilot to help families access resources to help ensure long-term support for family-centered care. In addition, WWO will work with Ba Vi and Tam Binh to help ensure more frequent family visits, as appropriate.

PEPFAR will enable WWO to strengthen OVC service delivery by supporting training courses and mentoring for staff in case management and OVC service provision, as well as through program monitoring and feedback. WWO staff will contribute to meetings among implementing partners, to establish consensus on OVC service packages, facilitate exchange of materials and lessons learned, and identify and address gaps in services and referrals. Pact will provide WWO with project management support and other technical assistance, as required. Pact will also monitor the performance and quality of WWO's OVC activities through review of quarterly reports, periodic site visits, and technical review of baseline assessment tools and protocols. WWO will collaborate with PEPFAR, Pact and other implementing partners to ensure strong referral linkages to pediatric treatment and care as well as other social services.

As PEPFAR Vietnam expands the scope and coverage of OVC programming, there is a critical need to support a central OVC capacity building mechanism to strengthen the capacity of all partners to provide appropriate, high-quality care to OVC In FY07, Pact will assist PEPFAR to select a new partner or group of partners to provide responsive capacity-building and technical assistance services to PEPFAR partners who are implementing OVC activities, and as appropriate key partners in government and other agencies including Global Fund (GF). Through this activity, PEPFAR will train 100 professional OVC care providers.

These activities will include: training courses, mentoring, coaching, and convening and facilitating fora to bring partners together to establish consensus on the PEPFAR OVC core service package, facilitate exchange of materials and lessons learned, and identify and address gaps in services and referral. Partner TBD will also create and/or distribute resources and tools to support effective service delivery including supervision and QA tools.

Core skills and knowledge for all OVC service providers will include: child development basics, basic counseling skills, case management skills for assessing and addressing the psychosocial, educational and health care needs of OVC, as well as risk assessment for neglect/abuse. Specialized training and TA will be provided to OVC Comprehensive Service sites as well as to residential and institutional care. Training will build on the core case-management training provided to all treatment, care and support sites through Palliative Care in FY07.

This activity is linked to HKID WWO (9550) and HKID TBD (9552).

The USG will support the development and implementation of a new community reintegration program for OVC who are living outside of family care, including those living in institutions. The program will serve 150 OVC at 3-4 program sites, and 50 caregivers will be trained to provide quality care and support.

In collaboration with Pact, USAID will use a competitive process to select an appropriate implementation partner. This partner will have strong experience in providing care, support and protection to vulnerable children and OVC, including in family-like residential and foster care settings.

One goal of this activity is to develop and implement community-based alternatives to institutional care, which can serve as models that can be brought to scale through government programs as well as by other partners. The program will be developed in consultation with the Ministry of Labor, Invalids and Social Affairs (MOLISA) and Vietnam Commission for Population, Families and Children (VNCPFC) and aligned with national plans for community-based alternative care for vulnerable children, as articulated in the forthcoming National Child Protection Strategy and National Action Plan on Children and HIV/AIDS. Throughout program development and implementation, lessons learned will be documented and shared with Government of Vietnam (GVN) and partners. The program will be developed with a clear exit strategy with transfer to local NGO and/or VNCPFC and MOLISA.

The program will include a strong de-institutionalization component, facilitating the transition of OVC from institutional care settings into community-based care. Where family or kinship care is not a viable option, the program will support the provision of care through family-like alternatives care settings such as group homes, foster care, and "shared" family/kinship care (in which care is provided jointly by family members and non-family care providers). Partner TBD will also collaborate with orphanages and child protection centers to help prevent institutionalization, including strengthening intake assessment procedures to assess opportunities for returning abandoned children to family-and-kinship based care, providing short-term emergency financial and social support to families, and leveraging additional resources to help ensure long-term support for family-centered care. Partner TBD will build the capacity of staff and family caregivers to provide comprehensive care and support to OVC, including developing individualized service plans to meet the unique needs of each child. The program will also include strong child protection monitoring mechanisms in both alternative care as well as kinship care.

In the first phase of the project, partner TBD will conduct situation assessments in the PEPFAR focus provinces to determine the appropriate locations and mix of care models to support, based on need as well as support from local communities and orphanages, which will be critical partners in the project. Partner TBD will explore opportunities to locate at least 2 of centers in Hanoi and Ho Chi Minh City (HCMC), in order to serve children currently living in institutional care at Ba Vi 05 Social Rehabilitation Center and Tam Binh 2 Orphan Care Center. These 2 sites serve a large proportion of all the HIV positive children who have been institutionalized in Vietnam, and receive PEPFAR support through the World Wide Orphans Foundation (See HKID WWO 9550).

This activity is linked to HBHC Pact (9563) and HKID TBD (9552).

With support from PEPFAR, Pact will provide financial oversight and technical and management support to one Vietnamese NGO (COHED) and one local FBO (the Mai Hoa Center) to implement a package of OVC services, enabling them to serve 70 OVC with care and support services, and to train 30 professional caregivers and family care providers.

The Center for Community Health and Development (COHED) is a Vietnamese NGO engaged in a range of HIV/AIDS response initiatives, including a PEPFAR-supported project to provide care and support services to women living with HIV/AIDS. In FY05 and FY06, PEPFAR supported COHED's initiation of a club ("The Cactus Flower Club") for women living with HIV/AIDS in Quang Ninh Province, which was developed in partnership with the Halong City Health Authority. The club offers a range of services both on-site and through community outreach and home-based care. In FY07, COHED will assist the Cactus Flower club to expand its services by integrating OVC services into its home and community based activities. In FY07, COHED will strengthen relationships and referral links with Hon Gai HIV/AIDS outpatient clinic, including the recruitment of new beneficiaries for both palliative care and OVC services.

COHED will ensure that services are provided in accordance with the PEPFAR basic OVC services package, including: assessment of needs of OVC and caregivers, counseling and psychosocial support, and service referral in the community, including to MOH pediatric outpatient clinics. Direct services will include: basic health care services, food/nutrition support for children (in accordance with OGAC guidelines), educational activities and play groups for children, and adherence support for women and children on ART. In addition, COHED will focus on strengthening the capacity of women to care for themselves and their families through training in care and support for OVC at home, and through economic strengthening and income generation activities, including employment referral in collaboration with SMARTWork. COHED will also continue to expand its well-developed program of advocacy and community mobilization to increase awareness of HIV/AIDS including the negative effects of stigma and discrimination.

Mai Hoa Center is a small hospice and residence for very poor and homeless PLWHA in HCMC, run by a small group of Catholic nuns who are nurses by training. Many PLWHA come to Mai Hoa Center to receive end of life care, sometimes bringing their children with them. Other children are referred to Mai Hoa Center from hospitals and social service programs, when they have no options for kinship-based care. Children living in the center receive comprehensive care, support and educational services in a family-like environment.

In FY05 and FY06, Mai Hoa Center received PEPFAR funding to enhance the quality, comprehensiveness and reach of HIV/ AIDS care, support and treatment for both adults and children. In FY07, Mai Hoa Center proposes to continue with program areas launched in FY05 and being implemented in FY06, including OVC, Palliative Care and Antiretroviral Therapy.

Pact and PEPFAR will continue to support Mai Hoa Center to ensure that children living in the center have access to a full range of services including: psychosocial support, educational, medical/ health, and social activities to meet their developmental needs. Mai Hoa Center will receive clinical support for ART service delivery and referral from physicians at the Ho Chi Min City Pasteur Institute, the Vietnam-CDC-Harvard AIDS Partnership (VCHAP), and the University of California/San Francisco, who will also facilitate referral to MOH pediatric outpatient clinics as appropriate. Mai Hoa Center will provide basic health care services to 10 child residents, including treatment of opportunistic infections based on up-to-date treatment guidelines. Full-time educational opportunities are offered in a "classroom setting" onsite, with trained teachers, while the Center continues to advocate for admission to the local community school. Children will also have access to play activities and weekend social and sporting activities outside the center.

PEPFAR will enable COHED and Mai Hoa Center to strengthen their capacity for quality OVC service delivery, through training courses and mentoring for staff, and program monitoring and feedback. COHED and Mai Hoa Center staff will contribute to meetings among implementing partners, to establish consensus on the OVC service packages, facilitate exchange of experiences and materials, and identify and address gaps in services

and referrals. COHED and Mai Hoa Center will also contribute to service planning and coordination in their districts, with support from PEPFAR and Pact. Pact will also provide and broker technical support to enable both organizations to achieve and report results, and will provide oversight to ensure effective coordination both among Pact partner programs, and between these programs and those implemented by other PEPFAR partners as well as other relevant government and non-governmental programs and partners.

With support from PEPFAR, Pact will provide financial oversight and technical and management support to one Vietnamese NGO (COHED) and two local FBOs (Mai Hoa Center and Pastoral Care) to implement a package of OVC services, enabling them to serve 100 OVC with care and support services, and to train 30 professional caregivers and family care providers.

Pastoral Care is a Catholic organization that provides care, support and treatment services to PLHIV and OVC in HCMC. Through Pact, PEPFAR will support Pastoral Care in its care for OVC in a home for abandoned women and children (Mai Tam Center) and in the community. Support will focus primarily on shelter and care, nutrition, education, and either links to or direct provision of clinical services as needed.

This activity is linked to HKID TBD/Reintegration (9553) and HKID TBD/Training (9552).

In FY06, in collaboration with UNICEF, Save the Children Alliance, FHI, WHO, and other key partners, PEPFAR technical staff will provide technical support and assistance to the Vietnam Commission for Population, Families and Children (VNCPFC) as they serve as the focal point for the development of a multisectoral National Action Plan for Children and HIV/AIDS. This support will include technical meeting costs, as well as support for local consultants and international OVC experts to facilitate and guide the development process at key junctures. In FY07, the PEPFAR team, offering both technical support and financial assistance, will work with this community of partners to support VNCPFC put the National Plan of Action on Children and HIV/AIDS into operation. Key priorities include: developing and disseminating guidelines for the care and protection of OVC; clear delineation of the roles and responsibilities of key government ministries for the implementation of these activities, including addressing stigma and discrimination and ensuring equitable access to services; support for the development of capacity-building plans and systems to ensure an adequate workforce, including capacity building and monitoring structures at village and commune level; support for the development and expansion of community-based alternatives to institutional care for children; and helping ensure access to and increased resource allocation for government social support for OVC.

This activity is linked to HLAB NIHE(9506), HTXS REACH (9396), and HVCT TBD-PSI Follow-on (9513). Funding is being reprogrammed from previously planned funding for ARV drugs in the setting of reduced drug costs.

Through Pact and sub-partner Medecins du Monde (MdM), PEPFAR will continue support of CT services at 2 clinics in 2 focus provinces, Tay Ho district (Hanoi) and District 6 (HCMC), with a goal of reaching 2,650 clients. PEPFAR will support strengthening of referral services and provision of CT training to 14 individuals.

MdM will strengthen referral to CT services through mobile teams targeting injecting drug users (IDU), commercial sex workers (CSW) and men who have sex with men (MSM). Mobile teams will promote CT seeking behaviors among these groups and refer them to CT services. Home care teams providing home-based care to people living with HIV/AIDS (PLWHA) will be trained to refer spouses/sexual partners and/or children of PLWHA to CT services. In addition, Pact, together with other PEPFAR partners, will initiate couples counseling using HHS/CDC and OGAC approved curricula.

MdM will provide CT services to 2,650 individuals at Tay Ho clinic, Hanoi and at An Hoa clinic in District 6, HCMC. These clinics perform HIV rapid test and send blood samples that are positive to higher level labs for confirmatory testing. Those who test positive will be referred directly to care and treatment services in the same clinic. Those who reside far from the clinic will be referred to other HIV clinics in Hanoi and HCMC. Pregnant women who test HIV positive will be referred to hospitals providing PMTCT services. Pact will support coordination of CT activities between MdM and MOH programs.

To ensure quality of both the referral and the CT services, MdM will support on-the-job mentoring and training for mobile team and home care team members and CT counselors.

Funding will support Soc Son District Preventive Centre, which is 7 km away from two rehabilitation centres, to be the base for a mobile medical mentoring team to provide counseling and testing to people entering and leaving these centers

This activity is linked to HTXS FHI (9415) and HTXS VCHAP (9394). Funding is being reprogrammed from previously planned funding for ARV drugs in the setting of reduced drug costs.

PEPFAR will support Pact for provision of management and technical support, as well as financial oversight, to three NGOs engaged in the delivery of ART at five treatment sites. In FY07, these sites will provide treatment to 830 adults and 102 children. Pact will continue to work with NGOs on program design, implementation planning, and activity-based budgeting; efficient grants management and administration; will provide financial management support and monitoring. Pact will monitor the performance and quality of its partners' ARV programming through review of quarterly reports, periodic site visits, and technical review of baseline assessment tools and protocols. Pact will facilitate coordination between Pact partners' ARV programs, and prevention, care and support programs by other PEPFAR partners and relevant government and non-governmental programs.

ARV services activities supported through Pact will include provision of ART to both adults and children through 2 magnet district outpatient clinics in Hanoi and Ho Chi Minh City (HCMC) (see Medecins du Monde, below); through orphanage facilities in HCMC and Ha Tay province (see Worldwide Orphans, below); and in a residence for adults and children living with HIV in HCMC (see Mai Hoa Center, below).

In FY07, Mai Hoa Center will provide antiretroviral treatment to adult and child residents who initiated PEPFAR-supported treatment in FY05/FY06 or are newly eligible in FY07, for a total expected number of 30 adults and 10 children. Along with additional non-USG support, PEPFAR will continue to support Vietnam CDC Harvard Medical School AIDS Partnership (VCHAP) and a physician from HCMC's Pasteur Institute to provide onsite clinical support (see HTXS VCHAP 9394).

Worldwide Orphans (WWO) will support ART at 2 orphanages, Tam Binh 2 in HCMC and Ba Vi in Ha Tay Province. Clinton Foundation will provide pediatric ARV solutions and didactic training for the sites. WWO will continue to support lab monitoring, mentoring of a local physician and onsite monitoring at Tam Binh 2 which will serve as a full service treatment site supporting 48 patients. Providers and WWO staff will attend trainings provided by the Clinton Foundation and VCHAP, as appropriate. Additional clinical TA and management of side effects and complicated cases will be provided by physicians from Pediatric Hospital 2, also supported by PEPFAR. In Hanoi, 24 patients at Ba Vi will receive treatment. WWO will support initial screening, transport and ongoing monitoring. WWO will facilitate receipt of services for complicated cases as needed at this site.

Through a model of integrated prevention, treatment, care and support and building upon Medecins du Monde's (MdM) successful model in District 6 of HCMC and Tay Ho District in Hanoi, PEPFAR will continue to support and scale up MdM's provision of ART to eligible PLWHA in both of these clinics to serve as full-service magnet sites. An estimated 207 people will initiate treatment during FY06, and an additional 350 people (including 10 children) will begin treatment in FY07, for a total of 820 patients. District 6 will also continue providing eligible children with ART on site through a family centered approach (key legislative issue: gender). Services will include onsite adherence counselors, case management and referral to other programs, home-based care, peer support, close links with community based groups. This community involvement will increase uptake into services and decrease stigma (key legislative issue: stigma). PEPFAR will support provision of hospital fees and transport for those in need as well as nutrition support for malnourished pediatric and adult ART patients, micronutrient support, and income generation activities. New and refresher didactic training will be supported by Harvard Medical School (clinical), FHI (adherence and home based care) and through the MOH/VAAC national training curriculum. Onsite clinical mentorship will be provided by VCHAP.

Additional funding is being granted to MDM through reprogramming from SCMS. This funding will serve to adjust the fiscal year by 3 months to end in September.

Funding will support Soc Son District Preventive Centre, which is 7 km away from two rehabilitation centres, to be the base for a mobile medical mentoring team to provide

palliative care & treatment to people entering and leaving these centers.

This activity is linked to HVOP Pact/SMARTWork (9606), HBHC Pact/SMARTWork (9564) and HVAB Pact/SMARTWork (9482).

Pact will provide funding, strategic management and oversight for the SMARTWork program to develop a model workplace-based HIV/AIDS policy with the Ministry of Labor, Invalids and Social Affairs (MOLISA). This policy model will be used to advocate with other line ministries to improve their HIV/AIDS workplace policies. It will also be directly applied in 52 enterprises where SMARTWork will support employment for PLWHA and former drug users. Target enterprises will be located in the 7 focus provinces as well as 5 other provinces where SMARTWork has been implemented. Enterprises located in Ho Chi Minh City and other major urban centers with industrial parks will be encouraged to employ former drug users via referral from MOLISA social workers. Additionally, 2000 local officials will be trained on HIV/AIDS workplace policy recommendations via 25 one-day workshops in focus provinces.

The model policy will help to reduce stigma and discrimination in the workplace (key legislative issue) and provide for an enabling environment for PLWHA and former drug users to seek gainful employment. The focus on former IDU will enhance prevention efforts by keeping IDU away from injecting peers once they have returned from rehabilitation centers.

This activity is in line with the PEPFAR Vietnam 5-Year Strategy in seeking to reduce HIV transmission (via job placement for IDU) and care for PLWHA via job placement and reduction of stigma and discrimination.

This activity is linked to OHPS HPI (9428) and OHPS UNDP (9536).

Building on the curriculum development and training conducting in FY05 and FY06, the Harvard Kennedy School will partner with Health Policy Initiative (HPI) and the Ho Chi Minh National Political Academy (NPA) to deliver 2 regional trainings on HIV/AIDS public policy to 200 new national and provincial-level government cadres from 16 provinces.

The objective of this program is to engage newly appointed Communist Party leaders taking office by improving their knowledge and strengthening their capacity to organize, direct and coordinate HIV/AIDS prevention and control activities in Vietnam. The NPA provides training to all new political appointees taking various mid- to high-level offices nationwide. All new government cohorts must pass through central or regional training centers before taking office. Harvard faculty will update the current training materials in conjunction with the NPA and will finalize training for 15 core trainer faculty of the NPA. These trainers will work closely with the Harvard faculty to train 200 newly appointed policy makers from 16 provinces (the 7 focus provinces plus 9 additional) on the determinants and impacts of HIV/AIDS, best practices in prevention, treatment and impact mitigation, and how to coordinate rights-based, evidence-based and multi-sectoral responses at the provincial level.

The curriculum also covers a range of public policy issues related to HIV/AIDS, including economic and social impacts, gender issues (key legislative issue), law and rights, stigma and discrimination (key legislative issue), leadership, and the role of businesses in responding to the HIV epidemic. Policy makers include key representatives from the provincial Departments of Health, Public Security, Labor, Invalids and Social Affairs, Education, Planning and Investment, the Party Commission on Culture and Ideology, Women's and Youth Unions and provincial People's Committees.

It is expected that this is the last year of funding for Harvard as NPA trainers will obtain the capacity to update the curriculum and train independently. Once institutionalized, the training will continue for all new government cadres. It is estimated that over 200 new cadres will be trained each year in subsequent years, without any additional funding from PEPFAR. This program complements the UNAIDS policy training workshops, which train existing high-level Communist Party and GVN cadres who would not otherwise attend the Harvard-supported trainings given they already hold office.

This activity will help PEPFAR reach the vision outlined in the PEPFAR Vietnam 5-Year Strategy by building local capacity through training of local leaders on impact mitigation, and on ways to coordinate rights-based, evidence-based and multi-sectoral HIV/AIDS responses at the provincial level.

This activity is linked to HVOP Pathfinder (9621).

This activity will build on work initiated by Pathfinder International (Pathfinder) in FY06 to promote strategic linkages between public and private providers (pharmacists and STI doctors) and to develop public-sector capacity to regulate private-sector practices around prevention, care and treatment of HIV/AIDS in 7 focus provinces. Specifically, Pathfinder will develop the capacity of 7 Provincial Health Departments to train 78 providers on national policy on HIV prevention and referral to CT, in addition to stigma and discrimination reduction (also see Pact/Pathfinder Other Prevention).

In FY06, PEPFAR supported Pathfinder to promote strategic linkages between the public sector and private sector in Quang Ninh province, and to expand its work to 2 additional PEPFAR priority provinces (An Giang and Ho Chi Minh City). Results from FY06 demonstrate an improvement in the quality and reach of services for PLWHA and those most at risk of HIV infection by increasing the engagement of private sector providers in the HIV/AIDS response and their capacity to deliver high quality services.

However, the Pathfinder assessment also noted diverse practices and understanding of national policies on STI treatment, referral and CT services. Pathfinder will use the supportive supervision methodology to train 7 Provincial Health Departments (1 in each focus province) to apply the standardized supportive supervision methodology with 78 private providers (pharmacists, nurses and doctors) who have been trained to improve STI diagnosis and treatment for at-risk populations, and stigma reduction according to national policy. Pathfinder will provide coaching and support to the trainer teams on a monthly basis.

In conjunction with the development of public-sector capacity to supervise private-sector practices at the site level, Pathfinder will develop and pilot an approach for the government to recognize and promote quality service delivery among private-sector providers. Specific activities will include the dissemination of names and addresses of private providers who offer high quality services (as evidenced through training follow up), certification of private-sector training by Provincial Departments of Health, specific events of recognition and appreciation (e.g. on Doctor's Day) and partnership with MOH/VAAC on the development and promotion of a logo indicating VAAC support for providers offering high-quality services. Based on lessons learned, Pathfinder will develop recommendations for guidance on public-sector regulation of private-sector practices, and will disseminate this guidance at a national workshop in partnership with VAAC.

Pathfinder will also provide a small grant to support provincial professional medical associations to enhance their capacity and legitimacy as bodies representing private-sector interests. Specifically, grants will be provided to assist 2 provincial medical associations (to-be-determined) to understand the needs of their membership, and to meet to discuss the role/mandate of the association in relation to its membership and to the government. In addition, the grants may cover special events designed to increase the visibility of the association. These special events could include seminars or special lectures given by experienced national or international experts on themes relevant to HIV/AIDS.

This activity will help PEPFAR reach the vision outlined the PEPFAR Vietnam 5-Year Strategy by enhancing the referral network for comprehensive HIV/AIDS prevention, care and support and treatment services.

This activity is related to HTXS VAAC (9398), HKID VAAC (9531), MTCT VAAC (9384), and HBHC VCHAP (9551).

Pact will support TBD-CBO to implement a stigma reduction training program for healthcare workers at HIV/AIDS service provision sites in the 7 focus provinces, and to support PEPFAR clinical implementing partners to integrate model anti-stigma components in their interventions. TBD-CBO will train 90 healthcare staff from 30 PEPFAR-supported service provision sites with a proven stigma-reduction intervention, and will work with 4 clinical training implementing partners to ensure that trainings incorporate effective anti-stigma components (training 20 program staff). TBD-CBO will also work with a local media agency to produce a short series of public service announcement to raise community awareness on HIV stigma and to reduce discrimination against PLWHA.

A recent study on HIV/AIDS-related stigma in Vietnam found that stigma is relatively high in the healthcare setting. PEPFAR will support TBD-CBO to conduct a desk review of stigma-related research in Vietnam in order to develop a training program specifically designed to reduce or eliminate stigma and discrimination in the healthcare setting. PEPFAR will support TBD-CBO to implement the model intervention in all 7 focus provinces for public-sector healthcare staff working in PEPFAR-supported clinical sites via training of 90 healthcare staff and additional healthcare and Provincial Health Department staff (resources permitting).

TBD-CBO will also work with PEPFAR clinical care and treatment implementing partners to incorporate an anti-stigma component in training modules and materials to ensure sustainability of anti-discrimination messaging in future trainings and as an element of program supervision. Mainstreaming of anti-stigma components will be supported via a training workshop for 20 clinical trainers and program monitoring staff and materials provision.

To expand anti-stigma messaging via multi-media, TBD-CBO will partner with a local media agency to develop a series of public service announcements to target communities with HIV/AIDS awareness-raising messages with a focus on reduction of stigma and discrimination for PLWHA. Messages will be shown regularly on national television via donated air time from the national network.

Pact will use PEPFAR funding to provide financial support to, and build the capacity of 3 community-based AIDS Service Organizations (ASOs) in 3 focus provinces (TBD) to provide referral services to PLWHA and their families to satisfy their full range of needs. Specifically, TBD will train 15 staff to manage and operate 3 ASOs.

This activity will increase local organization capacity to respond to the HIV/AIDS epidemic and will help develop community linkages and referral as a part of the network model. TBD will identify potential ASOs via a competitive process and will provide financial support for the establishment of functional offices, staffing, communications tools, and community engagement to ensure that PLWHA and their families in 3 select provinces have access to a range of services.

PEPFAR will ensure that ASOs are designed to be safe/comfortable multipurpose venues used for a range of prevention (including prevention for positives) programs, care and support activities (including addiction services for drug users and referral to job employment for IDU and PLWHA, PLWHA support, referral to vulnerable youth interventions, Women's Union Empathy Clubs, and related clinical care and support programs).

ASO capacity building and expansion will be based on lessons learned from the FY06 ASO Pilot development supported by Health Policy Initiative (HPI), and expansion will include support for the one existing pilot and development of two additional ASOs. Training for 15 ASO staff will be adapted from the ASO Pilot and capacity will be built via 3 one-week training sessions focusing on program planning and management, service referral, and engagement of policy-makers for program and PLWHA advocacy. Ongoing supervision via TBD program staff will ensure that ASOs have access to support and assistance in improving services and problem solving.