PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
Pact sub-partner: Ministry of Education and Training (MOET)
This is a continuing activity from FY07 that was previously funded entirely under the Condoms and Other
Prevention section of the COP. The narrative provided below is unchanged from FY07. Major updates to
this activity since approval in FY07 are:
• The activity is now being funded across both the AB and Condoms and Other Prevention sections of the
COP to facilitate the delivery of comprehensive prevention programming in compliance with PEPFAR
technical considerations and guidance.
• In FY08, technical assistance provided to MOET will support the regional adaptation and national
integration of the revised national reproductive health and HIV prevention curriculum for secondary
students.
FY07 Activity Narrative:
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.
Pact sub-partner: Local Partners Initiative (LPI)
This is a continuing activity from FY07. Because this activity was embedded in a larger Pact narrative in
FY07, a new narrative for FY08 is provided below.
In FY08, Pact will continue to provide small grants to local partners to design and implement community-
based prevention approaches for most-at-risk populations in PEPFAR's focus provinces. This LPI will
support outreach, behavior change communications, commodities, service referral, and community
mobilization. The selected partners in FY07 will continue to receive funding for a second year and an
additional set of new partners will be supported in FY08.
Pact will work with all selected partners on program design, monitoring, implementation planning, and
evaluation. Technical support strategies will include site visits, report reviews, and technical review of
assessment tools and protocols. Pact will facilitate coordination with other prevention, care and treatment
programs supported by PEPFAR, other donors, and the government of Vietnam (GVN).
Through the LPI program, 100 outreach workers will be trained and 3,000 individuals will be reached with
programming to prevent the sexual transmission of HIV and to address the HIV risks associated with drug
use.
Pact sub-partner: CARE
This is a continuing activity from FY07. In the AB section of the FY07 COP CARE's activities were
embedded in the Pact narrative, so a new AB narrative is being provided for FY08.
In Vietnam, most-at-risk populations (MARPs) are often hidden in the community due to official campaigns
or to stigma and discrimination. CARE International works with provincial AIDS centers (PACs) to build
capacity for local community-based and faith-based organization (CBOs and FBOs) HIV prevention
programs to reach vulnerable and frequently hidden groups. With technical support from Pact Vietnam,
CARE activities comprise a key element in the PEPFAR strategy for HIV prevention. Both AB and Other
Prevention funding streams will assist CARE to train core CBO and FBO members in Hanoi, Ho Chi Minh
City (HCMC), Quang Ninh, Can Tho, and An Giang. In FY08 CARE will establish activities in Hai Phong
and Nghe An, training a total of 130 people to provide comprehensive HIV prevention messaging to 10,000
members of high risk groups through sustained personal interaction.
Consistent with the PEPFAR Vietnam 5-Year Strategy and a refined focus on high risk populations, CARE
will improve outreach workers' skills through six training of trainer (TOT) courses for 130 peer educators
(PE). Two courses will train new PE while four others will facilitate existing workers' professional
development in behavior change communication (BCC), counseling skills, techniques for reaching hidden
MARPs, and improved counseling and testing (CT) referral. Following TOT completion, CARE will provide
information, education and communication (IEC) materials and a manual to guide and assist CBOs in their
work. Monthly information sharing meetings will allow outreach workers to share insights, improve skills
and develop new ideas on a regular basis. In FY08, CARE-sponsored competitions for CBO teams will
facilitate brainstorming on case studies and skill sharing, while invited media will spotlight the importance of
CBO activities to the wider community. All skills will develop outreach workers' ability to stress abstinence
or faithfulness to a single partner as the single most effective way to prevent HIV infection.
CARE International community-based HIV prevention programs form an integral part of the expressed
PEPFAR prevention strategy, reaching critical and hidden populations in the community, improving referral
to counseling and testing, and introducing HIV+ clients to care and treatment services sponsored by
PEPFAR and by other donors. CT referral will be guided by PEPFAR CT social marketing partner (TBD
pending competition). CARE outreach will be closely linked to other partners' work through PEPFAR-
supported outreach coordinators to ensure maximum coverage of at-risk clients while minimizing overlap
with other partners and donors. Pact will support coordinators' efforts to ensure linkages among prevention
initiatives to enhance effectiveness and coordination, and ensure access to a comprehensive continuum of
HIV care and treatment.
Primary clients of CARE supported CBOs/FBOs include injecting drug users (IDU), commercial sex workers
(CSW), men who have sex with men (MSM), and PLWHA already marginalized by law, by their HIV status,
and by society. To reach vulnerable and often hidden populations, CARE supports CBO members and peer
educators—often members of target groups—to reach others in their networks and provide accurate
information on reducing HIV risk, encouragement to learn their HIV status, and links to free HIV care and
treatment. Prevention messages are tailored to the risk behaviors for each target group and are developed
in a participatory manner through 11 current CBOs in Hanoi, Hai Phong and Quang Ninh. Messaging for
IDU will stress the importance of refraining from sharing injecting equipment and will provide referrals to
addiction counseling currently being scaled up by PEPFAR partner FHI. Sex worker outreach will focus on
correct, consistent condom use with referral to CT and addiction counseling as needed. MSM outreach will
convey the need for partner reduction as well as for safer practices. In FY08, CARE will continue to
strengthen and expand its peer educator network to increase access to vulnerable populations.
CARE support for CBO/FBO activities addresses critical gender issues, particularly male norms and
behaviors that contribute to HIV transmission in Vietnam. Through outreach to primarily male IDU, outreach
workers seek to reduce risky behaviors estimated to be the root cause of most HIV infections throughout the
country.
Pact Direct
This is a continuing activity from FY07.
In Vietnam, Pact serves as an umbrella organization providing grants, technical assistance and oversight,
and program management support to multiple partners engaged in community-based HIV prevention
programs. Pact will assist PEPFAR with the implementation of its AB prevention strategy by supporting sub-
partners' efforts to stress abstinence and faithfulness as a critical element of all programs. In concordance
with the Five-Year PEPFAR/Vietnam strategy, programs are designed and implemented in the context of a
comprehensive ABC prevention approach, with appropriate AB targeting by beneficiary group. Prevention
activities will be undertaken with the guidance of the USG outreach coordinator in each focus province.
Pact's activity consists of three components:
The first is to provide an effective and transparent award and administration system for provision of grants
to STI/HIV/AIDS Prevention Center (SHAPC), CARE, Vietnam's Ministry of Education and Training (MOET),
and multiple organizations TBD, including new partners. This system will facilitate rapid launch,
implementation, and/or expansion of AB prevention programming in all priority provinces. Local partners in
particular will continue to receive capacity building support through assistance with program design,
implementation, planning, and activity-based budgeting. Pact will maintain a system for rapid disbursement
of funds; monitor financial management; and, among Vietnamese NGOs, will support development of
compliant sub-agreements with local government, mass organizations, and community-based organization
(CBO) partners. Capacity building support related to organizational development will be provided to local
NGO partners in an effort to increase the reach, impact, and sustainability of civil society engagement in the
national HIV/AIDS response.
The second component is to provide partner programs with high-quality technical support to assist in
achieving and reporting results. Pact will monitor the performance and quality of its partners' AB prevention
programming through review of quarterly reports and periodic site visits. Pact will also conduct technical
review of baseline/formative assessment tools, prevention messages/materials, and training curricula, with
a focus on local NGO partners and drawing on expertise offered by other PEPFAR partners. All sub-
grantees will be encouraged to account for the complex linkages between gender and HIV vulnerability in all
prevention programming and to design programs conducive to reducing stigma and discrimination against
PLWHA. Pact will continue to support development of rigorous monitoring and evaluation frameworks and
data collection systems among all partners to ensure complete and accurate reporting against PEPFAR
targets, including AB targets, and the effective use of data for decision-making.
The third component is to ensure effective coordination among Pact partner AB programs, and between
these programs and those implemented by other PEPFAR partners and relevant government and non-
governmental programs. Particular efforts will be made to coordinate with PEPFAR-supported Ministry of
Health peer outreach activities. Pact will promote linkages among partner prevention programs and other
services beneficiaries may require, including prevention/other behavior change programming; counseling
and testing; STI diagnosis and treatment; addictions counseling and treatment; and HIV care and treatment,
as necessary.
For FY08, the budget for this activity reflects Pact's management and operational costs for building the
technical and management capacity of its sub-partners with a focus on local NGOs and CBOs. Separate
activity narratives have been developed for Pact sub-partners, and the budgets for these activities are
exclusive of the additional contributions Pact makes to these programs in terms of technical and
management capacity building.
Pact sub-partner: STD HIV/AIDS Prevention Center (SHAPC)
This is a continuing activity from FY07. The narrative below is unchanged from the FY07 COP. Major
updates to this activity since approval in the FY07 COP are:
• In FY08, the program will sharpen its focus on meeting the HIV prevention needs of higher risk university
students, based on the findings of a rapid assessment conducted with technical support from Pact in FY07.
• With expanded funding in FY08, SHAPC will train 240 peers to reach 10,400 students with comprehensive
ABC HIV prevention education that also addresses the HIV risks associated with drug and alcohol use.
• Targets for FY08 have been revised to reflect the fact that the program will only count individuals reached
through interactive one-on-one or small group approaches towards direct targets.
• As of July 2007, 71 peer educators have been trained and have provided HIV prevention education to
2,200 students in Hanoi universities.
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 the
Ministry of Health/Vietnam Administration for HIV/AIDS Control (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
prevention messages and life skills training approaches, and will reach 15,000 university students in Hanoi.
A range of programming approaches will be used to reinforce consistent prevention 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 the adoption of protective practices. The activity will be
conducted under the guidance of the PEPFAR-supported Hanoi outreach coordinator, when appointed. This
activity has three components. The first involves the revision and distribution of a comprehensive HIV
prevention booklet—including 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 seven 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 prevention 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
seven 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.
Pact sub-partner: Integrated Behavior Change Communication (iBCC) Consortium
• Following a fair and open RFA competition executed by Pact Vietnam, a consortium of partners led by
Population Services International (PSI) was awarded the portfolio of activities targeting current and potential
clients of sex workers. The successful application is entitled "integrated Behavior Change Communication"
or iBCC. The consortium consists of PSI, Save the Children US, Hanoi Medical University, and the AIDS
Program in Ho Chi Minh City (HCMC). PSI outreach activities focus on mobile men and men in
entertainment establishments such as karaokes and beer halls, while Save US outreach will focus on young
men in university areas.
• Whereas FY07 support for the male client intervention was funded solely through the AB funding stream,
FY08 support for client outreach will be split funded between AB and Condoms and Other Prevention in
accordance with the FY08 Country Operational Plan Guidance. This provides for a more appropriate and
comprehensive ABC approach in line with the PEPFAR Vietnam 5-Year Strategy.
• The iBCC program will increase capacity at the provincial level through additional staffing (interpersonal
communicators) within provincial AIDS centers (PACs). Consortium members will expand coverage of
‘surround media', through mass and mid-media activities and engage the target audience through
innovative media (websites and text messaging).
• FY07 funding provided for implementation in Hanoi, HCMC, Hai Phong and Can Tho. With FY08 support,
the iBCC program will be expanded to two additional provinces, An Giang and Quang Ninh, and two
additional HCMC districts. In total, 200 individuals will be trained to promote HIV prevention through
abstinence and/or being faithful, reaching 168,000 potential clients.
Pact TBD will lead PEPFAR prevention activities with the Ministry of Health/Vietnam Administration for
HIV/AIDS Control (MOH/VAAC) and Ho Chi Minh City Provincial AIDS Committee (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 two components. The first is continued development and adaptation of a television, radio,
and print media campaign launched by Family Health International (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 one partner, 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, HCMC 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.
Activity Narrative: Pact sub-partner: Integrated Behavior Change Communication (iBCC) Consortium
PEPFAR, with management oversight from Pact Vietnam, will help Vietnam's Ministry of Health's (MOH)
Nursing Division to develop a national training curriculum on injection safety. The training materials currently
available in Vietnam will be collected and reviewed, and used to develop a safety manual that can be used
by health professionals across the country. Technical assistance (TA) will be provided by in-country and
international experts, including the World Health Organization (WHO), working in collaboration with an MOH
technical working group. PEPFAR funds will be used to design and print the national training manual.
In order to strengthen nursing knowledge and skills in injection safety, PEPFAR will support the Nursing
Division and the Vietnam Nursing Association to coordinate and implement a series of three baseline
training programs in the eight PEPFAR focus provinces. Three training-of-trainers (TOT) courses will be
held for 90 nurses who will subsequently coordinate and carry out training programs for their nursing
colleagues. There will also be three refresher training courses for the 120 nurses who attended the injection
safety TOT sessions in 2007.
To provide adequate information to nurses involved in the practice of infection safety at clinics, the Nursing
Division and the Vietnam Nursing Association will design, develop, and distribute brochures and leaflets on
injection safety to PEPFAR-supported national, provincial and district level hospitals in the eight focus
PEPFAR will provide approximately 7,000 sharps containers for 26 national, provincial and district hospitals
in the current seven PEPFAR focus provinces. In FY08, when an eighth focus province is added, PEPFAR
will provide sharps containers to nine additional hospitals, bringing the total to 35.
PEPFAR will support development and dissemination of national injection safety guidelines, and
procurement of sharps disposal equipment for the six current and one new PEPFAR focus provinces.
WHO will work in partnership with the MOH/Vietnam Administration for HIV/AIDS Control (VAAC) Nursing
Division, the Vietnam Nursing Association, the Nursing Department of Hanoi Medical University, and the
HHS/National Institute of Occupational and Environmental Health to strengthen the government of
Vietnam's (GVN) medical transmission/injection safety program. This will be accomplished through the
following activities:
National guidelines on injection safety will be developed and training programs designed and implemented:
WHO has, in the past, supported the GVN in the design and implementation of surveys to review practices
on injection safety among health care workers. With support from PEPFAR, the results of these surveys
along with other information will be used to develop a draft of national guidelines and a training manual on
safe injection practices. Specifically, PEPFAR will support the establishment of a technical working group
(TWG) which will collect comments from experts and finalize a set of national guidelines on injection safety.
PEPFAR funding will also be used to design and print national guidelines.
Nursing skills among 120 nurses will be strengthened: PEPFAR funds will be used to establish a TWG
within the VAAC Nursing Division that will review existing material and information to develop a training
document designed to address safe injection practices among nurses in Vietnam. Funding will also be used
to coordinate and implement a series of four training programs that specifically address the issues of
injection safety among the nursing profession. Four TOT programs will be held for 120 nurses in the seven
PEPFAR focus provinces, who will subsequently coordinate and carry out training programs for their
nursing colleagues within these provinces. It is expected that the TOTs will be completed in FY07, while the
subsequent training activities will take place in FY08.
Sharps containers will be provided for 26 provincial and district hospitals in the seven focus provinces: With
the exception of a limited number of out-patient clinics that are currently supported with PEPFAR funding,
hospitals in Vietnam use their own budgets to buy sharps containers for proper disposal of needles. Budget
constraints preclude many hospitals, particularly those at the district level, from purchasing these
containers, and they are therefore unable to adhere to universal precautions with regard to proper disposal
of needles. Under this activity, PEPFAR funds will be used to expand current coverage to 26 provincial and
district hospitals in the seven focus provinces. Specifically, funding will be used to procure an estimated
3,300 sharps containers, and to support VAAC for distribution of the containers. The provision of other
injection safety commodities will be considered in FY08.
In Vietnam, Pact serves as an umbrella organization providing awards, technical guidance and oversight,
programs. In FY08, PEPFAR will support other prevention messaging in accordance with the Five-Year
Strategy for Vietnam. Programs will be designed and implemented in the context of comprehensive ABC
messaging, with age-appropriate targeting by beneficiary group. Based on the recommendations from
previous USG prevention assessments, Pact will also support sub-partners in the integration of drug
demand reduction activities into youth HIV prevention programming. Prevention activities will be undertaken
with the guidance of the USG-supported outreach coordinator in each focus province. Pact's activity
consists of three components:
The first component will provide an effective and transparent award and administration system for the
provision of grants to STI/HIV/AIDS Prevention Center (SHAPC), CARE, Vietnam's Ministry of Education
and Training (MOET), Medecines de Monde (MdM) France, Pathfinder International, Population Services
International (PSI), and multiple organizations TBD, including new partners. This system will facilitate the
rapid launch, ongoing implementation, and/or expansion of prevention programming in priority provinces.
Local partners in particular will continue to receive capacity building support through assistance with
program design, implementation, planning, and activity-based budgeting. Pact will maintain a system for
rapid disbursement of funds; monitor financial management, and, among Vietnamese organizations,
support the development of compliant sub-agreements with local government, mass organizations, and
community-based organization (CBO) partners.
The second component will provide partner programs with access to high-quality technical support to assist
in achieving and reporting results. Pact will monitor the performance and quality of its partners' prevention
programming through review of quarterly reports, periodic site visits, and technical review of
baseline/formative assessment tools, prevention messages/materials, and training curricula. Technical
assistance for the development of these tools will be provided with a focus on local NGO partners and
drawing on expertise offered by other PEPFAR partners. All sub-grantees will be encouraged to account for
the complex linkages between gender and HIV vulnerability in all prevention programming, and to design
programs conducive to reducing stigma and discrimination against PLWHA. To facilitate effective reporting,
Pact will support the development of rigorous monitoring and evaluation frameworks and data collection
systems to ensure complete and accurate reporting against PEPFAR targets, including prevention/other
behavior change targets, and the effective use of data for decision making.
The third component is to ensure effective coordination both among Pact partner programs, and between
Health (MOH) peer outreach activities. Pact will promote linkages between partner prevention programs and
other services that beneficiaries may require, including prevention/other behavior change programming,
counseling and testing; STI diagnosis and treatment; addictions counseling and treatment; and HIV care
and treatment, as necessary. Pact's long-term engagement in PEPFAR-supported initiatives will facilitate
these linkages, nurtured both informally and through existing and new coordination mechanisms.
Pact sub-partner: 06 Returnees Program
Through a competitive process, Pact/Vietnam provides a grant to a partner to help prevent the spread of
HIV/AIDS to female sexual partners of injecting drug user (IDU) rehabilitation center (06 center) returnees in
Ho Chi Minh City (HCMC). FY08 funding will support the second year of program implementation.
Using a gender-based approach, the program will provide vulnerable women with prevention services that
empower them to prevent HIV infection. It will target women, both individually and along with their sexual
partner, to provide the motivation, skills, and commodities needed to adopt safer behaviors. Outreach
workers will address male and female behavioral norms and stress messages that spouses/sexual partners
of former 06 center 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. Using individual- and couple-oriented
approaches, outreach workers will help partners negotiate the adoption of safer sexual practices, and
provide drug use prevention and risk-reduction education. Center releasees, their primary partners (who
may also be current/former drug users), and family members will also be provided with referrals to the full
range of HIV/AIDS services in HCMC, including counseling and testing, substance abuse treatment,
HIV/AIDS care and treatment, PMTCT, and care and support services for infected/affected children.
Pact will work with the selected partners on program design, monitoring, implementation planning, and
evaluation. Pact will provide technical and capacity-building support to ensure effective implementation.
Technical support strategies will include site visits, report reviews, and technical review of assessment tools
and protocols. Pact will facilitate linkages with other prevention, care and treatment programs.
or iBCC. The consortium consists of PSI, Save the Children US, the Hanoi Medical University, and the AIDS
Program in HCMC. PSI outreach activities focus on mobile men and men in entertainment establishments
such as karaokes and beer halls while Save US outreach will focus on young men in university areas.
accordance with the FY08 COP Guidance. This provides for a more appropriate and comprehensive ABC
approach in line with the PEPFAR Vietnam Five-Year Strategy.
• Enhanced efforts will ensure comprehensive HIV prevention efforts targeted at male clients of sex workers
by promoting correct and consistent condom use and increasing uptake of VCT services. Consortium
members will partner with the TBD condom and VCT social marketing partner to promote safer practices
and counseling and testing.
• FY07 funding provided for implementation in Hanoi, Ho Chi Minh City (HCMC), Hai Phong and Can Tho.
With FY08 support the iBCC program will be expanded to two additional provinces, An Giang and Quang
Ninh, and two additional HCMC districts will be selected for program implementation. In total, 200
individuals will be trained to promote HIV prevention through means beyond abstinence and/or being
faithful, reaching 168,000 potential clients.
HIV/AIDS Control (MOH/VAAC) and HCMC Provincial AIDS Committee (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 four additional provinces, to reduce the acceptability and
practice of sex worker visitation. Through this activity, 180 peer educators will be trained to provide AB
The initiative is grounded in the PEPFAR Vietnam Five-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
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.
transmission and prevention, emphasizing the benefits of being faithful to 1 partner and partner reduction
Activity Narrative: intervention are older (ages 18-35) than those targeted by Save US (15-24), both projects will conduct
venues, information, education and communication (IEC) materials and behavior change communication
(BCC) outreach messaging will be coordinated to ensure consistency, maximize resources, and minimize
duplication.
Pact sub-partner: Ministry of Education and Training
• In FY08, technical assistance provided to Ministry of Education and Training (MOET) will support the
regional adaptation and national integration of the revised national reproductive health and HIV prevention
curriculum for secondary students.
• To support the sharpened PEPFAR prevention focus on high risk populations, CARE will assist community
-based organizations (CBOs) to tailor prevention messages to specific risk behaviors. Messaging for
injecting drug users (IDUs) will stress the importance of not sharing injecting equipment, and use of
addiction counseling currently being scaled up by PEPFAR partner Family Health International (FHI). Sex
worker outreach will focus on correct, consistent condom use and addiction counseling as needed. Men
who have sex with men (MSM) outreach will convey the need for partner reduction as well as for safer
practices. In FY08, CARE will continue to strengthen and expand its peer educator (PE) network to
increase access to vulnerable populations.
• Monthly information sharing meetings will allow outreach workers to share insights, improve skills and
develop new ideas on a regular basis. In FY08, CARE-sponsored competitions for CBO teams will facilitate
brainstorming on case studies and skill sharing. Local media will be invited to spotlight the importance of
CBO activities to the wider community.
• In FY08 CARE will expand its reach, developing partner CBOs in Nghe An and strengthening those in
Quang Ninh. Six prevention training of trainers (TOT) courses will be conducted for 130 PE who will offer
structured communication on HIV prevention for 10,000 individuals. Two of the TOT courses will train new
PE while four will sharpen skills of those trained in FY07 to improve behavior change communication (BCC),
condom use promotion, access to hidden populations, and CT referrals in conjunction with the TBD
PEPFAR CT social marketer.
• During the FY07 semi-annual reporting period, CARE CBO/faith-based organization partners reached
more than 3,000 PLWHA and most-at-risk population members through community outreach in four focus
provinces. Buddhist and Catholic organizations, PLWHA networks and others coordinated focused
prevention efforts with IDU, commercial sex workers (CSW), MSM and other groups at risk for HIV
transmission.
CARE International works with Vietnam's Ministry of Health (MOH) and Ho Chi Minh City Provincial AIDS
Committee (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 FY06 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 Five-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, karaoke bars, 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
Pact sub-partner: Local Partners Initiative
based prevention approaches for most-at-risk populations in PEPFAR's focus provinces. This Local
Partners Initiative (LPI) will support outreach, behavior change communications, commodities, service
referral, and community mobilization. The selected partners in FY07 will continue to receive funding for a
second year and an additional set of new partners will be supported in FY08.
programs supported by PEPFAR, other donors, and the government of Vietnam.
Pact sub-partner: Medecins du Monde France
• Through FY08 funding, Medecins du Monde France (MdM) will expand its HIV prevention outreach
program to District 9 in Ho Chi Minh City (HCMC).
• Building on FY07 experience, and in accordance with the PEPFAR Vietnam 5-Year Strategy and a refined
focus on prevention, MdM will intensify outreach for high risk individuals focusing on effective interpersonal
behavior change communication, and strengthening referral to counseling and testing (CT) and to
comprehensive prevention, care, and treatment services provided by MdM and other partners.
MdM France will target homeless and other at-risk populations through outreach to enlist them in their out-
patient clinic (OPC) services in difficult to serve districts in Hanoi and HCMC where the Ministry of Health
(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 centre (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 parlours, 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, behaviour 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 behaviours 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
centre 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 information,
education and communication (IEC) materials and counselling 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 counsellors 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.
Pact sub-partner: STD/HIV/AIDS Prevention Center (SHAPC)
• With expanded funding in FY08, SHAPC will support 18 condom outlets and train 240 peers to reach
10,400 students with comprehensive ABC HIV prevention education that also addresses the HIV risks
associated with drug and alcohol use.
Local NGO SHAPC, in conjunction with the Ministry of Health (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, seven 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.
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.
Pact sub-partner: Population Services International (PSI)
• PSI was selected to implement this activity in FY07 as a Pact sub-partner and will complete the pilot
intervention in FY08. Lessons learned from the pilot will be shared with other existing outreach programs to
inform program improvement.
The funds for this activity will support a targeted program for commercial sex workers (CSWs) who are
injecting drug users (IDUs), including a needs assessment and development of an innovative outreach
model targeting this high-risk group. The goal of the activity is to provide equitable access to HIV prevention
programs and meet the needs of this group of vulnerable women. The overall objective of the outreach
activity will be to reach CSWs who are at double jeopardy of HIV infection through commercial sex work and
injecting drug use.
Recent anecdotal and observational evidence suggests that CSW/IDUs (CSW who also inject) are an
increasing concern. Greater numbers of sex workers are also IDUs, and injecting drug use may serve as a
catalyst for initiation of sex work. In some cases women use drugs because they have IDU boyfriends or
partners. Others enter sex work to pay for drug habits, and some start drug use after entering into sex work.
Based on recommendations from a 2006 PEPFAR Prevention Technical Assistance visit, PSI will conduct a
needs assessment in both Hai Phong and Ho Chi Minh City (HCMC) to better understand factors that lead
to injecting drug use among this target population and identify gaps within current programs to design and
develop an innovative outreach model. Following the assessment and development of an evidence-based
model, PSI will train 15-20 outreach workers to pilot the model in Hai Phong. These outreach workers will
reach 250 women during the program year.
In this initial phase, PSI will conduct a needs assessment: reviewing existing evidence and gathering field
data in two key focus provinces where the epidemic is most severe. The assessment will employ
confidential individual and group interviews. Detailed information will be collected on the numbers of
CSW/IDUs, their risky behaviors, and their current knowledge of and access to risk reduction products and
services. This will include formative research with IDUs and CSWs and will explore specific factors
influencing initiation into injecting drug use. This will be closely coordinated with a planned 2006 Ministry of
Health/Vietnam Administration for HIV/AIDS Control (MOH/VAAC) assessment of nationwide risk reduction
HIV prevention activities.
Based on the needs assessment, PSI will develop an innovative intervention model targeting CSW/IDUs.
The model may include special forms of outreach for CSW/IDUs to increase access to and knowledge of
prevention options (including male & female condoms), promote safer sexual practices and safe injecting
practices through behavior change communication (BCC), and promote uptake of VCT. The program will
ensure linkages to other services for substance counseling, STI treatment, and care & support. PSI will
provide concrete advice on key elements and strategies for CSW/IDU interventions, and suggestions for
improving referrals. The PEPFAR provincial outreach coordinators will work with PSI to ensure
recommendations are included in new and innovative program activities.
Pact sub-partner: Pathfinder
• Through FY07 funding, Pathfinder will expand the implementation of its comprehensive curriculum for HIV
prevention -- including substance abuse prevention and treatment -- beyond the Hai Phong Medical
University (HPMU) to the Hai Phong Secondary Medical School (HPSMS). This will provide training not only
for physicians, but also nursing staff who frequently contact clients at risk of HIV infection through
substance abuse or other risky behaviors.
• FY08 funds will be used to implement the curriculum developed through FY07 support. Pathfinder will
conduct updates in substance abuse prevention and counseling and active teaching methods at HPMU and
HPSMS. Classroom and practicum teaching will be monitored and feedback provided. The medical pre-
service program will collaborate with PEPFAR and other donor-supported programs in Hai Phong, including
Family Health International's (FHI) training initiative for addiction counselors and case managers, and the
newly approved methadone pilot program, both of which provide an opportunity for field-based practicum for
medical students and nurses. With FY08 funds, a total of 630 individuals will be trained to promote
HIV/AIDS prevention. Pact Vietnam will work closely with the Pathfinder team to provide technical and
financial management assistance for all program activities.
• Pathfinder staff and Hai Phong medical personnel will share the curriculum and project experiences with a
technical support working group consisting of representatives of all eight Vietnamese medical universities,
the Ministry of Health (MOH) and the Ministry of Education and Training (MOET). This will include
representation of selected secondary medical schools in PEPFAR focus provinces.
Building on experience working with Vietnam's medical education system, the Ministry of Health and
Ministry of Education and Training, Pathfinder International will introduce HIV prevention training into the six
-year undergraduate medical program in Vietnam.
Through a pilot initiative, Pathfinder will develop a framework for integrating a comprehensive, skill-oriented
curriculum for HIV prevention, including substance abuse prevention and treatment, at Hai Phong Medical
School and one other medical school to be selected in discussion with the Ministry of Health, Ministry of
Education and Training, the Vietnam PEPFAR team and others. Working closely with the dean board and
relevant departments, Pathfinder will provide technical assistance to conduct a needs assessment, identify
gaps in the current curriculum, propose new or updated topics to be taught, develop a clinical rotation plan,
and provide selective HIV prevention technical updates to faculty members and staff.
The project will begin in Hai Phong Medical School, a current partner of Pathfinder's reproductive health
medical education project. Pathfinder will collaborate with PEPFAR-supported programs operating in Hai
Phong, including FHI's training initiative for addiction counselors and case managers, and the newly
approved methadone pilot program, both of which provide an opportunity for field-based practicum for
medical students. Technical inputs, particularly related to substance abuse prevention and counseling, will
be provided from UCSF experts with experience working in Vietnam.
Pathfinder will ensure strong engagement of other medical and secondary medical schools in the project,
which will facilitate the application of the new prevention curriculum within other medical schools and
adapted for use in the secondary medical schools and in university-level nursing and pharmacy programs.
Efforts this year will focus on developing the framework for integrating an HIV prevention curriculum,
conducting a needs assessment, and providing select technical updates to faculty and staff of Hai Phong
Medical School, all of which will readily be taken-up in the following year on a broader scale.
Pact sub-partner: Save the Children US
This is a continuing activity from FY 07. The narrative below is unchanged from the FY 07 COP. Major
updates to this activity since approval in the 2007 COP are:
•The program will expand to an additional province - Hai Phong - with a large population of both high-risk
youth and IDU.
•The program will expand to address the specific prevention needs of both male and female out-of-school
and high-risk youth.
•The TBD partner will adapt and apply components of the evidence-based Program H intervention to
address male norms of sexual and drug using behavior that contribute to the spread of HIV.
•The program will develop a system to identify and recognize "model" youth clubs and to support the
sharing of lessons learned between these and newly formed clubs.
•To help young men in the program better understand and appreciate women's perspectives on gender
roles and HIV risk, some innovative program components will be developed to foster positive
communication between male club members and female peers.
•The program will establish a partnership with a local NGO to train motorcycle taxi drivers to distribute
condoms, counsel and support young men to use condoms, and provide referrals to other services when
giving rides to/from places of work and entertainment establishments, or while waiting outside such
locations.
•At least 50 condom service outlets will be established in strategic locations in FY 08. These condom
service outlets will be supplied through the TBD condom social marketing program, and will provide
supplementary risk reduction education through linkages to this program.
•The program will expand to double the number of individuals trained (1,000) and reached (60,000) through
interactive one-on-one or small group peer education activities in FY 08.
FY 07 Activity Narrative:
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
Activity Narrative: 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.
act sub-partner: Save the Children US
Pact sub-partner: TBD (Gender)
• By the end of FY08, partner TBD (to be selected in November 2007) will be able to provide programmatic
tools for reaching women infected and affected by HIV/AIDS.
• By FY08, TBD partner will provide detailed operational recommendations, including guidelines, training
curricula, and other deliverables, to facilitate improved responsiveness to the particular needs of women
living with HIV/AIDS among all relevant PEPFAR Vietnam implementers. Screening skills and referrals
services related to gender-based violence will also be available.
• In FY08, programming tools will be made available to all PEPFAR partners and other organizations
involved with providing care and support programs for PLWHA women. Organizations are expected to
integrate recommended activities into on-going programs in order to provide more relevant services for
women.
• In September 2007, the RFA will be finalized in consultation with the USAID care and treatment advisor. A
two-year award (FY07 and FY08 funding) to an appropriate recipient will be issued by Pact to allow for an
iterative assessment/intervention methodology. This methodology will make it possible to link assessment
findings with improvements in HIV/AIDS and other service access for women living with HIV/AIDS, who are
subject to significant stigma and discrimination, including gender-based violence, as a result of their positive
status. Program activities will occur in Hanoi, Ho Chi Minh City (HCMC) and two other priority provinces
TBD.
Through a competitive process, Pact will provide financial and technical support to a local partner or local-
international NGO partnership TBD to assess the extent, nature, and consequences of gender-based
violence (GBV) among women living with HIV, with a particular focus on the two-way relationship between
GBV and HIV/AIDS service use/effectiveness. Partner TBD will also assess the current GBV screening and
counseling practices of select service providers across the continuum of care; map the availability of GBV
services and support networks; and develop intervention models for later uptake by PEPFAR and
government of Vietnam (GVN) prevention, care, and treatment partners. The assessment will be conducted
in up to four priority provinces.
According to Ministry of Health (MOH) estimates, an estimated 86,000 women in Vietnam were living with
HIV in 2005. While the epidemic remains predominantly male, the gender gap has narrowed - from 70%
male compared to 30% female in 2003, to an estimated 67% male to 33% female in 2005 - and is projected
to narrow further. Sentinel surveillance data indicate that prevalence among pregnant women increased
from 0.02% in 1994 to 0.37% in 2005, and had reached 1% in high-prevalence provinces by 2005.
As in other countries, Vietnamese women living with HIV are more likely to experience HIV-related stigma
and discrimination within their families and communities, as well as in health and social services. When HIV
surfaces in a family, women are more likely to be blamed, regardless of which partner was first infected.
The forms of stigma and discrimination women face tend to be more severe than is the case for men: data
show that they are significantly more likely to have experienced physical assault, threats of violence,
spousal or family abandonment, and seizure of property as a result of their HIV status. Fear of these
consequences reduces use of existing HIV/AIDS prevention, care, and treatment services, with profound
effects on the effectiveness of these services and on transmission.
A 2001 study by Vietnam Women's Union found that 60% of women in Vietnam had experienced emotional
or physical spousal abuse. The study also found widespread tolerance of this abuse. Women living with HIV
are likely to be at higher risk of abuse - and tolerance of the abuse they experience is likely greater. Drug
use and sex work - often but not always precursors to HIV among women in Vietnam - are strongly judged
as "social evils" and are not tolerated; HIV status is considered evidence of such behaviors. Particular
difficulties may be faced by women exiting Vietnam's network of rehabilitation centers for sex workers and
drug users.
Although PEPFAR has supported small-scale initiatives that respond to the particular needs of women living
with HIV in Vietnam, these have limited reach and scalability. A more systematic response is needed, based
on a careful assessment of women's experience and needs, and on possible responses to these needs
from both within and outside the HIV/AIDS continuum of care system. Partner TBD's assessment will
employ qualitative and quantitative methods and will target women living with HIV, family and community
members, HIV/AIDS and other service providers, and support agencies (local NGOs, community-based
organizations, government agencies, and mass organizations) who are currently engaged in serving HIV-
positive female clients, or who have the potential to do so.
In combination with a rigorous mapping of support services (e.g., shelters/safe houses, support groups,
hotlines, legal support mechanisms) and the gaps in these services, the assessment will enable partner
TBD to develop detailed, evidence-based operational recommendations in support of improved,
engendered practice among HIV/AIDS service providers. Synergistic wraparound programming with a range
of agencies and sectors engaged in the fight against GBV in Vietnam will also be recommended. This
initiative will lead to concrete responses not only to urgent needs in Vietnam but also to global priorities as
identified by the Gender Technical Working Group by reducing the prevalence of adverse consequences for
women resulting from disclosure of status and participation in HIV care and treatment programs.
Pact sub-partner: Medecins du Monde (MdM) France
• Pact supports MdM, which provides comprehensive services in two treatment sites reaching 1,130
PLWHA.
• In FY08, Pact will support MdM to continue comprehensive care and support in the two current sites and
expand to two new sites: District 9 in Ho Chi Minh City (HCMC) and TBD district in Hai Phong. MdM aims to
provide palliative care to 5,000 PLWHA and family members, including 2,000 in Hanoi and Hai Phong and
3,000 in HCMC.
• MdM will work to increase the quality of their services to PLWHA and find better ways to ensure that
injecting drug users (IDUs) adhere to ART. MdM will also facilitate reintegration of IDUs after they return
from rehabilitation centers by registering them for health care and engaging them in social activities at the
drop-in clinics.
• By April 2007, MdM provided 214 patients in Hanoi with clinic-based services including OI prophylaxis,
adherence training, counseling, nutrition training and meals; its home-based care team provided 135 of
these patients with hygiene counseling, ART adherence, symptom management, psychological support,
funeral support and transportation costs. In the same period 916 patients in HCMC received disease
monitoring and OI prophylaxis and treatment (508), vaccination for HBV (141), referral for TB (69) and
treatment of complications of non-TB OIs (35).
• By April 2007, MdM in HCMC in collaboration with Health Policy Initiative provided orientation to patients
on legal issues and legal services to PLWHA and clinic staff. Now MdM staff are able to guide patients
through some of the related procedures.
• Challenges: Staff changes in Hanoi slowed down services temporarily; some patients relapse or come late
for CD4 testing; some do not adhere to treatment because of using drugs; one home care team member
relapsed and was sent home to recover. MdM is constantly addressing these on-going challenges.
Using PEPFAR funds, Pact will support Medecins du Monde (MDM) to provide 1,650 individuals with
palliative care via two out-patient clinics (OPCs) (Hanoi and Ho Chi Minh City) and two home-based care
teams for a total of four 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 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 the Supply Chain Management
System (SCMS). This funding will serve to adjust the fiscal year by three months to end in September.
Pact sub-partner: World Vision International
• Pact supports World Vision International, which works in five communes in two districts in Ho Chi Minh
City (HCMC) and one district in Hai Phong providing community-based care to PLWHA.
• In FY08, Pact will support World Vision to expand its services further to one island district in Hai Phong
and increase the total number of individuals reached to 1,320.
• In FY08, World Vision will continue to support the caregivers' team approach and the successful economic
strengthening activities, which World Vision started last year in partnership with district and commune health
centers, and in collaboration with other PEPFAR partners.
• By April 2007, World Vision provided palliative care services to 538 individuals. Under its COP07 program,
World Vision expanded to one more district in Hai Phong and one more in HCMC, reaching an estimated
950 individuals.
• By April 2007, 75 PLWHA in Hai Phong were provided with health monitoring, health care support, self-
care advice, and counseling. A training session was held for 50 caregivers on proper nutrition and cooking
procedures, and 30 PLWHA from very poor families received rice and cooking oil. World Vision sponsored a
community event to reduce stigma and discrimination; 186 residents attended. In collaboration with the
district health center, World Vision succeeded in advocating for district-level ART access for its clients and
related training for physicians, which is provided by the provincial hospital along with management of more
complex cases.
• In collaboration with the local Women's Union, World Vision established a small business initiative for
PLWHA caregivers; 30 were given loans and simple tools to start their businesses.
• By April 2007 in HCMC, 17 home-based care teams provided services to 463 PLWHA including
psychosocial support, health monitoring, support with health care access, nutritional support and food
supplements in severe cases, end of life care and funeral support. PLWHA were referred to hospitals for OI
treatment and ART diagnosis and treatment. PLWHA family clubs met monthly to share and learn from
others. In the area of economic strengthening, a training course was conducted for 30 Women's Union
representatives as a first step in assisting them with management of a credit and savings scheme for
• Challenges include difficulties recruiting and retaining qualified program officers for the program, and
ongoing capacity building needs for these staff once recruited. Care providers have no way to track
referrals. Pact is supporting World Vision to address these challenges.
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 two focus provinces.
In FY06, PEPFAR supported World Vision to implement home-based care (HBC) in three 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 five districts (three in HCMC and two 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 the Ministry of Health/Vietnam Administration for HIV/AIDS Control
(MOH/VAAC), Global Fund (GF), and the Ho Chi Minh City Provincial AIDS Committee (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.
Pact sub-partner: Five local NGOs
• In FY08, Pact will continue to support five local organizations' work in palliative care: Center for
Community Health and Development (COHED) with $100,000 to serve 650 PLWHA and train 50 providers;
the STI/HIV/AIDS Prevention Center (SHAPC) with $50,000 to serve 350 PLWHA and train 30 providers; a
new Quang Ninh partner to be identified by December 2007 with $70,000 to serve 500 PLWHA and train 70
providers; Mai Hoa Center with $10,000 to serve 50 PLWHA and train 5 providers; Pastoral Care with
$20,000 to serve 100 PLWHA and train 20 providers.
• In FY08 a new component to support broader local organizations' engagement in palliative care for
PLWHA will be added. Using an RFA mechanism, Pact will identify at least six additional local organizations
who will receive small grants; $250,000 will be available to provide care for 1,450 PLWHA and train 180
care providers. These services will be located strategically to facilitate enhanced linkages to treatment
services, particularly CDC-LIFEGAP treatment sites.
• By April 2007, COHED provided services to 370 PLWHA (psychosocial support, symptom care, regular
health checks, referral for OI treatment and ART). In the same period Mai Hoa Center served 100 PLWHA
(OI treatment, pain relief, psychosocial support, end of life counseling, shelter, recreation).
• Pastoral Care, SHAPC and partner TBD in Quang Ninh (all mentioned above) will start their work in
palliative care in the last quarter of calendar 2007.
• By April 2007, Pact provided training in the basic care services package for home-based care providers;
on-site and through coaching, developed a set of tools for home-based care including cure cards, client
forms and a team log book; and collaborated with FHI to bring together partners to share lessons learned.
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 Ho Chi Minh City (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 PLWHA on ART in Hanoi, 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 out-patient 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-PEPFAR support, PEPFAR 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 community-based
organization (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
HBC. 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 OPC 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 HBC 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
two 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 the Supply Chain Management System
(SCMS) through a decrease in the cost of ARV. The targets have also been decreased despite expected
Activity Narrative: 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).
• Pact supports CARE International (CARE), which works with eight local organizations (including five
community-based organizations (CBOs), two faith-based organizations (FBOs) and one local NGO)
providing services to 2,294 PLWHA in four provinces.
• In FY08, Pact will continue supporting CARE and its sub-grantees at a slight increase over FY07; 12
grantees in five provinces will provide care and support to 2,750 PLWHA and train 200 care providers.
• In FY08, CARE will continue providing organizational capacity building to these organizations, and with
technical support from Pact, will continue to train providers in the provision of quality palliative care services,
using the national service package as guidance.
• By April 2007, CARE supported eight local groups with training on developing proposals, budgets and
workplans, how to reach clients and how to provide specific services, and reporting on service delivery.
• CARE's partners attended a March 2007 workshops where they networked and shared experiences.
• CARE and Pact also provided CARE partners with guidance using these fora. Pact oriented CARE
partners on community-based care (CBC) service packages, reporting requirements, and data collection
methods.
• Challenges: Programs vary greatly and partners are at different levels of competency; some programs are
just starting up.
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 nine service outlets in five of the focus provinces.
In FY07 PEPFAR support will expanded to nine local C/FBOs to provide community- and home-based care
(H/CBC)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 five focus provinces. CBOs supported by CARE will include: Bright Futures (Hanoi and Quang
Ninh), Dong Cam (Quang Ninh), Tue Tinh Duong (Hanoi), Action for Development (A-for-D) (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 Family Health International (FHI), CARE will continue to
strengthen the capacity of these nine 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 OGAC
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
(OPCs). 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 two 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 the Ministry of Health/Vietnam Administration for HIV/AIDS Control
(MOH/VAAC), Global Fund (GF), and Ho Chi Minh City Provincial AIDS Committee (HCMC PAC) via
PEPFAR.
Pact sub-partner: AIDS Health Foundation
This is a new activity in FY08.
Pact will support AIDS Health Foundation (AHF) to implement two HIV clinics in Thuy Nguyen district (Hai
Phong province) and Dong Trieu district (Quang Ninh province). The clinics will enroll PLWHA from these
and neighboring districts. Patients will be provided with HIV/AIDS counseling related to care and treatment;
will receive regular health checks and monitoring of HIV infection; and will be provided with OI prophylaxis
and treatment as appropriate. Essential laboratory tests will be made available to ensure quality care.
Physicians will be trained according to national and PEPFAR training standards. AHF will foster linkages
between the two clinics and more mature district-level sites, as well as provincial sites, to facilitate
exchange of clinical experience and provision of clinical backstopping. In addition, clinical technical
assistance (TA) will be provided by AHF's technical team, based in Los Angeles, which provides technical
guidance to AHF-supported clinics around the world. The clinics will adopt practical standard operating
procedures (SOPs) based on national guidelines and drawing from those developed by PEPFAR Vietnam
implementers (including CDC, Family Health International (FHI), Medecines du Monde (MdM)).
The clinics will be linked to VCT services in Hai Phong and Quang Ninh, to facilitate access to the clinic
among PLWHA, and access to VCT among clinic patients' sexual/injecting partners. To ensure the
continuum of care, clinical services in AHF clinics will also be linked to community-based care services
provided by other organizations, including PLWHA self-help groups, new care and support projects to be
rolled out through Pact's small grant program, and other programs supported by the government of
Vietnam, Global Fund and other donors in Hai Phong and Quang Ning. These linkages will ensure that AHF
clinics are connected well to the provincial service network and community groups are informed of available
AHF services to refer PLHWA, while the clinics will refer patients and their children to community-based
programs for adherence, social and other support. Children of patients will be referred to CDC- or FHI-
supported clinics that provide pediatric testing and treatment services.
AIDS Healthcare Foundation (AHF) is a US NGO working on HIV/AIDS medical care domestically and
internationally. Internationally, AHF Global brings lifesaving anti-retroviral therapy to developing and
resource-poor countries including: Cambodia, China, Ethiopia, Guatemala, Haiti, India, Mexico, Russian
Federation, Rwanda, South Africa, Swaziland, Uganda, Ukraine, Zambia, and Vietnam.
In Vietnam, AHF made contacts with the Ministry of Health (MOH)/Vietnam Administration for HIV/AIDS
Control (VAAC) and offered its experience in addressing identified barriers in access to care. AHF Asia's
Pacific Bureau Chief, Dr.Chinkholal Thangsing, had made a presentation about AHF to MOH, the UN
agencies, the World Health Organization (WHO) and various national and international HIV/AIDS care and
support providers, members of the technical working group on treatment, care and support in Vietnam. The
Chief of Medicine, Dr. Charles Farthing, had also visited Vietnam and met with various government officials
sharing about AHF's activities to them.
By February 2006, PACCOM Vietnam granted AHF with its legal status to work in two the provinces of
Vietnam which were Hai Phong and Quang Ninh. AHF then visited Hai Phong and Quang Ninh provinces,
had official meeting with the provincial AIDS authorities and PLWHA groups to discuss its work plan. The
proposed centers include the ART Center of Excellence at the Thuy Nguyen District Hospital in Hai Phong
and an out-patient clinic in Dong Trieu in Quang Ninh. AHF will collaborate with Hai Phong and Quang Ninh
AIDS Authorities to operate these two treatment facilities and provide VCT services. AHF is committed to
assist in supporting ARV drugs for 50 patients and OI medications for each clinic, and to build and
strengthen the capacity and skills of physicians, nurses, healthcare workers by conducting technical training
and clinical preceptorship at the ‘Center of Excellence'.
Pact sub-partner: World Wide Orphans Foundation
This is a new activity in FY08 which adds a palliative care (HBHC) component to a current partner.
Pact has supported World Wide Orphan Foundation (WWO) as a sub-partner in OVC and ART services
since FY05. Pact provides capacity building and direct support to WWO for providing comprehensive
treatment, care, support and protection services to OVC living in two residential orphan care centers (Tam
Binh #2 Orphanage in Ho Chi Minh City and Ba Vi Social Training Center #2 in Hanoi).
This new activity will support broader palliative care for both clinical and community-based services related
to continuing treatment services and complementing on-going OVC services. Building on their previous
work in the two centers, 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 regular clinical evaluation and monitoring, screening for TB, referral to
related laboratory services, treatment adherence support, symptom management and pain relief, and
management of HIV/AIDS-related complications.
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.
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.
Pact will enable WWO to strengthen palliative care service delivery by supporting training courses and
mentoring for staff in case management and children on ART, as well as through program monitoring and
feedback.
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 palliative care activities through review of quarterly
reports, periodic site visits, and technical review of baseline assessment tools and protocols. WWO will
collaborate with other implementing partners to ensure strong referral linkages to pediatric treatment and
care as well as other social services.
This is a continuing activity from FY07. In FY07, Pact's direct activities and costs were integrated into its
partners' narratives. This year, these activities are identified below in this narrative along with associated
costs.
• In Vietnam, Pact serves as an umbrella organization providing grants, technical guidance and capacity
building, project monitoring, and oversight for overall consistency with PEPFAR goals for partners engaged
in palliative care.
• In FY08, Pact will support up to 19 palliative care partners: eight sub-partners, five local community-based
organizations (CBOs) and up to six new local CBOs.
• In FY08, Pact will promote effective coordination between Pact partner community-based care initiatives
and relevant programs being implemented by other partners across the continuum of prevention, care, and
treatment, to promote cross-learning and coordination.
• Pact will maintain an effective and transparent award and administration system for the provision of grants
to both Vietnamese and international NGO sub-partners. Workshop-based training along with ongoing
virtual and one-on-one mentoring will be provided to these organizations to ensure compliance with USAID
rules and regulations. Local partners in particular will also receive capacity building support through
assistance with detailed project design, implementation planning, activity-based budgeting, financial
management, and the development of essential institutional policies and procedures.
• Pact will monitor the performance and quality of palliative care programming through review of quarterly
reports and periodic site visits. Based on PEPFAR palliative care guidance and on Pact's palliative care
programming experience in and outside of Vietnam, and drawing from the experience of other organizations
(e.g. Family Health International (FHI)), Pact will also provide technical capacity building support to partners
to ensure provision of the community-based care service package and improve the quality of each service
component.
• In FY08, Pact will provide training and training capacity building to partners in technical areas related to
care and support for PLWHA. Potential themes include strengthening treatment adherence support, drawing
from the results of an assessment of adherence barriers and facilitators to be conducted with Tufts
University in FY07; and providing targeted support for special groups of PLWHA, including women and
those with drug use histories. Themes will be identified by Pact and partners in collaboration. Pact activities
to address these themes may include curriculum development, training of trainers, and cross-partner
information sharing workshops. Pact will also facilitate Pact partner engagement in other relevant training
and/or capacity building opportunities offered by other organizations to address needs identified during
project implementation. ($127,224 dedicated to this effort)
• Pact, with input from the PEPFAR Care and Treatment technical working group, will determine an
intervention program to train private sector physicians in targeted high prevalence areas with information on
HIV/AIDS care and treatment as well as in treatment adherence and referrals to ART sites. TBD partner(s)
will be selected by Pact.
• To facilitate effective reporting of results, Pact will continue to support the development of rigorous
monitoring systems, with the objective of ensuring complete and accurate reporting against targets and the
effective use of data for decision-making. Pact will continue to undertake this work through workshop-based
training, as well as one-on-one coaching and review of partner monitoring and evaluation (M&E) systems
and tools. Pact will support partners to implement a client information and service monitoring system, which
was developed by Pact in collaboration with partners in the FY06 implementing year, and will be tested in
the FY07 implementing year.
• In FY08, Pact will increase its effort at providing local partner organizations with technical assistance for
HIV-related institutional capacity building. Pact's organizational development program will focus on
governance, strategic planning, financial management, human resources development and management,
advocacy, gender and equality issues, information systems, and external relations.
• By April 2007, PACT supported five palliative care sub-partners with the expectation of supporting nine
sub-partners by the end of FY07.
In FY08, in two Medecins du Monde, France (MdM)-supported out-patient clinics (one in Hanoi and one in
Ho Chi Minh City (HCMC)), funding will be provided for TB screening for 1,700 HIV-infected persons and
referral to TB treatment for 170 PLWHA.
This fund will also be used to support implementation of the recommendations of an FY07 PEPFAR-funded
assessment of infection control practices for TB and other airborne diseases in HIV care and treatment
settings.
In FY07, Pact provided 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. In one MdM-
supported out-patient clinic in HCMC and one in Hanoi, funds were 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.
In two Medecins du Monde, France (MdM)-supported out-patient clinics (one in Hanoi and one in Ho Chi
Minh City (HCMC)), 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 two PEPFAR-
supported out-patient 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 one MdM-supported outpatient clinic in HCMC and one 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 is a continuing activity from FY07:
• Pact's sub-partner CARE International (CARE), works with three local groups (community-based
organizations - CBOs) providing services to 547 OVC in two provinces.
• In FY08, CARE will add one new CBO (plus one in FY07) for a total of five CBOs and will continue to
provide start-up training, institutional strengthening support, and regular monitoring. Pact will support CARE
and its sub-grantees at $150,000 and will continue providing technical assistance to CARE in support of
quality service delivery across all sub-partners. The CBOs are expected to provide care to 700 OVC and
train 70 providers.
• As of March 2007, CARE's CBO partners had provided OVC with school fees, referrals for ARV and OI
treatment, recreational events, nutrition support (milk), etc. They also carried out advocacy activities,
resulting in the Commission for Population, Family and Children (CPFC) providing financial support to OVC,
and businesses in Quang Ninh offering jobs and some direct financial support to parents.
• With FY07 funding, CARE will introduce the basic package for OVC and implement a child information and
service monitoring system in consultation with Pact. CARE also intends to adapt the ‘Start Your Business'
model for financially-strained HIV-affected families.
• Challenges: OVC are scattered over a wide area and difficult to reach; funding is minimal for
comprehensive care.
In FY07, PEPFAR will support CARE to partner with four 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 Minh 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 Ministry of Health (MOH) pediatric out-patient 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 two 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.
Pact sub-partner: Medecins du Monde
• Pact supports Medecins du Monde France (MdM), which provides OVC services in two treatment sites
and their surrounding communities, serving 35 OVC in Ha Noi and 386 OVC (22 are on ART) in HCMC.
• In FY08, MdM will continue comprehensive care and support in the two current sites and expand coverage
in one new site, District 9 in HCMC, reaching a total of 600 OVC
• MdM will establish case management system for assessing and tracking children; Pact will train new MdM
staff in the six basic services for OVC; in Hanoi, MdM plans to test or assess the status of children of
PLWHA in one site.
• By March 2007, MdM provided core services to OVC including nutritional support (nutrition training for
caregivers, simple meals, milk for 30 malnourished OVC), school fees and school supplies, and
psychosocial support.
• MdM also established a small play room in one clinic for families to play with children while parents are
receiving medical care. Both clinics organized social activities for children, including celebration of Full
Moon and Lunar New Year.
FY07 Activity Narrative (Approved):
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 two government-managed out-patient 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).
Pact sub-partner: World Vision
• Pact supports World Vision (WV) which works with OVC in one district in Hai Phong province and two
districts in Ho Chi Minh City (HCMC), reaching a total of 180 OVC. Under its COP07 program, WV program
will expand to one more district in Hai Phong and one more in HCMC, reaching an estimated 522 OVC, and
will introduce the basic package for OVC.
• In FY08, Pact will support WV to expand its services further to one island district in Hai Phong and
increase the total number of OVC reached in both provinces to 1,150 OVC.
• WV will continue to improve the quality of care for OVC through a case management approach which will
assess the needs of children and monitor services acquired.
• WV plans to pursue advocating for the rights of infected and affected children to be admitted to public
school and will initiate vocational opportunities for older children.
• By April 2007, WV provided care to 120 OVC (including 14 who are HIV+) in Hai Phong and 60 OVC
(including 26 who are HIV+) in HCMC. WV provided nutritional support (milk, vitamins and rice) and school
fees for needy children, and referred HIV+ children to pediatric HIV outpatient clinics. WV also held three
training courses for 84 caregivers on care and nutrition during this period.
• In Hai Phong 30 children, including 10 OVC participated in a Nov 2006 TV program to reduce stigma and
discrimination against children living with and affected by HIV/AIDS; the show also included government
officials from the national AIDS coordination office, the Commission on Population, Family and Children and
heads of International NGOs.
• In the same period, three caregiver clubs (65 members) in HCMC met monthly to share information and
experiences in caring for OVC, especially HIV+ children. WV provides them with information on children's
rights, nutrition and basic health care.
• In FY07, World Vision will implement a child information and service monitoring system, in consultation
with Pact.
Pact will support World Vision (WV) 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 five 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
Ministry of Health (MOH) pediatric out-patient 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.
Pact sub-partner: Worldwide Orphans Foundation
• Pact funds Worldwide Orphans Foundation (WWO) to support orphans and vulnerable children in two
residential centers providing services for 130 children.
• In FY08, Pact will continue to support WWO's work in the two orphanages, including psychosocial support,
education and social activities to meet the developmental needs of 310 children; improving and maintaining
quality of care will remain a priority.
• In FY08, WWO will continue to support the reintegration of select children to family and kinship providers.
To date, one child has been united with his family.
• By April 2007, WWO had successfully adapted an "Auntie" program at Tam Binh Center #2 (HCMC),
matching community volunteers with residents in need to interact through play activities, books, stories,
weekend excursions, etc.
• At Ba Vi Center #2 (Ha Tay), WWO provided training to volunteers in child development and developed
their skills to improve their interacting with the children. WWO funded a teacher to provide first grade
education and plans to continue until the children are allowed to attend public school.
• By April 2007, two assessments were carried out: one to assess psychological needs of residents and the
other to assess barriers in integrating children into community schools. The findings of the latter
assessment will assist WWO in reducing school and community based stigma and discrimination, a
continuing priority in both FY07 and FY08.
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 two 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 two 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 the Ministry of Health (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 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 a "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.
opportunities for returning abandoned children to family-and-kinship based care and collaborate with local
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
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
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.
Pact sub-partner: TBD (OVC pilot)
• Pact is currently in the process of competing this activity from COP07. Activities are expected to begin by
December 2007.
• In FY08, funds will allow the continuation of this activity which will be well underway. With FY08 funding,
Pact will be able to provide a two year award which will allow for piloting of alternative care settings which
keep OVC closer to family and kinship groups and in communities. Reintegration of institutional residents
will continue if the success rates are viable.
• FY08 funding will be $250,000, for scale-up of service provision to 500 OVC and training of 100 providers.
PEPFAR 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).
Pact sub-partner: Center for Community Health and Development, Mai Hoa Center, Pastoral Care
• In FY08, Pact will continue to support one local NGO and two faith-based organizations (FBOs): Center for
Community Health and Development (COHED) with $50,000 to provide care for 150 OVC and train 40
providers; Mai Hoa Center with $5,000 to provide care for 15 OVC; and Pastoral Care with $20,000 to
provide care for 100 OVC and train 10 providers.
• A new component for FY08 will identify up to six additional local organizations via a $200,000 RFA to
provide care to 500 OVC and training for 150 care providers. These services will be located strategically to
facilitate linkages to treatment services, particularly CDC-LIFEGAP treatment sites.
• Two other local organizations new to OVC support will be the STI/HIV/AIDS Prevention Center (SHAPC)
and a partner to be determined in the last quarter of calendar 2007 in Quang Ninh province. These two
organizations, providing adult-focused care and support services with FY07 funds, will integrate OVC care
into their HBHC programs. These organizations will receive $20,000 and $30,000 respectively to serve 100
OVC and train 25 providers each.
• By April 2007, the Mai Hoa Center was able to provide intensive care to 14 OVC - setting up primary
education class rooms and separate living quarters for boys and girls, conducting recreational activities, and
providing psychological counseling for children facing puberty.
• By April 2007, COHED, without specific OVC funding, provided necessary care to 40 OVC reached
through its adult-focused care and support project. Both COHED and Pastoral Care will initiate systematic
OVC care activities in Oct-Nov 2007 with FY07 funds.
• Current Challenges: Quality of services across local organizations vary greatly.
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 out-patient 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 Ministry of Health (MOH) pediatric out-patient 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 out-patient 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
Activity Narrative: implemented by other PEPFAR partners as well as other relevant government and non-governmental
programs and partners.
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 PLWHA 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.
in care and support for OVC (HKID).
• In FY08, Pact will support up to 16 partners who engage in care and support services for OVC: five sub-
partners, three local CBOs and up to eight new local CBOs.
• In FY08, Pact will promote effective coordination between Pact partner OVC initiatives and relevant
programs being implemented by other partners across the continuum of prevention, care, and treatment, to
promote cross-learning and coordination.
• In FY08, Pact will maintain an effective and transparent award and administration system for the provision
of grants to both Vietnamese and international NGO sub-partners. Workshop-based training along with
ongoing virtual and one-on-one mentoring will be provided to these organizations to ensure compliance with
USAID rules and regulations. Local partners in particular will also receive capacity building support through
• In FY08, Pact will monitor the performance and quality of OVC programming through review of quarterly
reports and periodic site visits. Based on PEPFAR OVC guidance and on Pact's global OVC programming
experience, and drawing from the experience of other organizations and experts (e.g., FHI, UNICEF, Save
the Children), Pact will also provide technical capacity building support to partners, guiding them in child
identification, assessment, and approaches to providing needs-based support.
• Pact will provide training and training capacity building to partners in technical areas related to OVC care.
Potential themes include priority areas of psychosocial support, e.g., support for children facing
discrimination or loss due to HIV/AIDS, disclosure of child HIV status to children, and adherence support for
teenage children. Themes will be identified by Pact and partners in collaboration. Pact activities to address
these themes may include curriculum development, training of trainers, and cross-partner information
sharing workshops. Pact will also facilitate Pact partner engagement in other relevant training and/or
capacity building opportunities offered by other organizations to address needs identified during project
implementation. ($35,042 dedicated to this effort.)
effective use of data for decision-making. Pact will continue to undertake this work through workshop-
based training, as well as one-on-one coaching and review of partner M&E systems and tools. Pact will
support partners to implement a child information and service monitoring system, which will have been
developed and tested in collaboration with partners in FY07.
• In FY08, Pact will increase its effort at providing local organizations with technical assistance for HIV-
related institutional capacity building. Pact's organizational development program will focus on governance,
strategic planning, financial management, human resources development and management, advocacy,
gender and equality issues, information systems, and external relations.
• Pact will continue its work to support the policy environment for the emerging civil society OVC response,
in which Pact sub-recipients play a lead role. In the FY06 implementing year, at USAID's request and on
behalf of an international partnership group on Children and HIV/AIDS, Pact initiated support to the
Government of Vietnam's development of a National Plan of Action (NPA) on Children and HIV/AIDS, via
engagement of international and national consultants to provide technical and policy development
assistance to the Vietnam Commission of Population, Families and Children (VCPFC). VCPFC, which had
been charged with developing the NPA by the Prime Minister, was dissolved in August 2007. Responsibility
for the NPA was then passed to the Ministry of Labor, Invalids, and Social Affairs (MOLISA). Prior to
VCPFC's dissolution, significant progress towards drafting the NPA was achieved, including support to
review and analysis of available data and other information on vulnerable, infected, and affected children,
and expanded engagement of other line ministries essential to NPA implementation. Pact and the
international Partnership Group (including USAID) are working closely with MOLISA leadership to keep the
process on track, and expect the NPA to be issued in early or mid-2008.
Pact will provide awards, technical guidance, oversight, and program management support to Medicines du
Monde (MdM) France in counseling and testing programs. Pact will provide an effective and transparent
award and administration system for the provision of grants to the partner, facilitating their rapid launch,
ongoing implementation, and/or expansion in priority provinces. Pact will continue to work with these sub-
grantees on program design, implementation planning, and activity-based budgeting; maintain a system for
rapid disbursement of funds; and provide financial management support and monitoring.
Pact will monitor the performance and quality of counseling and testing programming through review of
quarterly reports and periodic site visits, and will provide technical assistance and advisory services. VCT
sub-grantees will be encouraged to apply the OGAC VCT technical assistance visit recommendations (e.g.,
promote linkages between counseling and testing programs and other programming that beneficiaries may
require), strengthen the prevention component of VCT programming (e.g., promoting return visits for those
who test negative but still practice risk behaviors), and ensure positive clients are linked to care and
treatment. Pact will also support the rapid test pilot being undertaken by the Ministry of Health/Vietnam
Administration of HIV/AIDS Control (MOH/VAAC) and PEPFAR, particularly in the MdM sites. To facilitate
effective reporting, Pact will support the development of rigorous monitoring and evaluation frameworks and
data collection systems to ensure complete and accurate reporting of PEPFAR counseling and testing
targets.
Pact will also ensure effective coordination - and reduce duplication - both among Pact partner programs,
and between these programs and those implemented by other PEPFAR partners and relevant government
and non-governmental programs. Particular efforts will be made to coordinate with peer outreach and
social marketing activities to promote VCT services. Pact's long-term engagement in PEPFAR-supported
initiatives will facilitate these linkages, nurtured both informally and through existing and new coordination
mechanisms.
Pact sub-partner: Medecins du Monde (MdM)
changes to this activity since approval in the FY07 COP are:
• This integrated VCT model will be replicated in a new site in Ho Chi Minh City (HCMC) in HCMC District 9,
in collaboration with the prevention, care, and treatment technical working groups.
Through Pact and sub-partner Medecins du Monde (MdM), PEPFAR will continue support of CT services at
two clinics in two 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 Ministry of Health 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.
Pact sub-partner: AIDS Healthcare Foundation (AHF), Medecins du Monde (MdM) France, Mai Hoa Center,
and Worldwide Orphans (WWO)
• In FY08, Pact will support one additional organization - AIDS Healthcare Foundation (AHF) - to provide
ART services. AHF's two HIV clinics in Thuy Nguyen district (Hai Phong) and Dong Trieu district (Quang
Ninh) will provide ART to 300 people living with HIV.
• MdM France will continue providing ART at its two current clinics in Tay Ho district (Hanoi) and District 6
(Ho Chi Minh City (HCMC)), and will set up two additional ART clinics in one district in Hai Phong (TBD) and
in District 9 (HCMC). MdM will provide ART to 1,330 people living with HIV (including 30 children in HCMC).
• Mai Hoa Center's and WWO's ART targets will increase to 35 people living with HIV (including 15 children)
and 110 children, respectively.
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 these NGOs on: program
design, implementation planning, and activity-based budgeting; efficient grants management and
administration; providing 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 two magnet district out-patient 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 two 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 ten 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 Ministry of Health/Vietnam Administration of HIV/AIDS Control
national training curriculum. Onsite clinical mentorship will be provided by VCHAP.
partners' narratives. In FY08, these activities are identified below in this narrative along with associated
Pact Vietnam serves as an umbrella organization providing grants, technical guidance, project monitoring,
and oversight for overall consistency with PEPFAR goals for partners engaged in other policy/systems
strengthening (OHPS) initiatives, including one Vietnamese NGO. Pact will promote effective coordination
between Pact partner policy/systems strengthening initiatives and relevant programs being implemented by
other partners across the continuum of prevention, care, and treatment activities to promote cross-learning
and responsiveness of policy to program developments.
Pact will maintain an effective and transparent award and administration system for the provision of grants
to both Vietnamese and international NGO sub-partners. Workshop-based training, along with ongoing
virtual and one-on-one mentoring, will be provided to these organizations to ensure compliance with USAID
rules and regulations. Local partners in particular will receive support with program design, implementation
planning, activity-based budgeting, and financial management. Pact will monitor the performance and
quality of OHPS and other partner programming by review of quarterly reports, periodic site visits, and will
provide technical assistance and advisory services as needed. To facilitate effective reporting of results,
Pact will continue to support the development of rigorous monitoring and evaluation frameworks and data
collection systems, with the objective of ensuring complete and accurate reporting against targets and the
training, as well as one-on-one coaching and review of partner monitoring and evaluation systems and
tools.
Pact will also increase its focus on providing local partner organizations with technical assistance for HIV-
related institutional capacity building. Pact's organizational development program will focus on areas
identified as being highest priority for its local NGO/community-based organization (CBO) partners. These
are likely to include governance, strategic planning, financial management, human resources development
and management, advocacy, gender and equality issues, information systems, and external relations.
This activity will help PEPFAR reach the vision outlined in its five-year strategy for Vietnam by building upon
local capacity by training local leaders on impact mitigation, and on ways to coordinate rights-based,
evidence-based, and multi-sectoral HIVAIDS responses at the provincial level.
Pact sub-partner: Harvard Kennedy School of Government
Pact Vietnam will fund Harvard University's John F. Kennedy School of Government to work in partnership
to conduct this activity.
Building on the curriculum development, HIV/AIDS public policy training, and provincial HIV/AIDS planning
conducted in FY05 and FY06, the Kennedy School will partner with the Health Policy Initiative (HPI) and the
Ho Chi Minh National Political Academy (NPA) to provide training and technical assistance to provinces to
strengthen their HIV/AIDS plans. FY08 will be the final year of PEPFAR-funded technical assistance from
the Kennedy School to the NPA.
The objective of this program is to engage government cadres and Communist Party leaders more
effectively by improving their knowledge and strengthening their capacity to plan, direct, and coordinate
HIV/AIDS prevention and control activities in Vietnam.
During FY05 and FY06, over 350 policy makers were trained in AIDS public policy. Participants in these
trainings repeatedly expressed the need for training to be taken to the next step - that is, the development
of evidence-based multi-sectoral AIDS plans at the provincial level. Beginning in FY06, PEPFAR and other
donors, including the U.K.'s Department for International Development, expressed the need for coordinated
multi-sectoral HIV/AIDS planning. In response to these needs, the Kennedy School, the National Political
Academy, and HPI developed a planning curriculum that focuses on the development of effective, multi-
sectoral provincial AIDS plans that 1) are based on human rights, 2) combat stigma and discrimination, 3)
integrate gender issues, and 4) promote the greater involvement of people living with AIDS (GIPA) and civil
society engagement. The training workshops were designed so that by the end of the session the
participants were able to:
1. Understand how to develop and strengthen multi-sectoral HIV/AIDS plans for prevention, treatment, and
impact mitigation at the provincial level;
2. Understand the content of key national documents including the national HIV/AIDS strategy, nine
associated action plans, the national HIV/AIDS law and implementing guidelines of the law ;
3. Analyze their respective provincial HIV/AIDS plans and provide recommendations for modifying these
plans to integrate and strengthen attention to human rights, gender, GIPA, civil society engagement, and a
multi-sectoral approach; and
4. Develop specific process, output, and outcome indicators of performance and coordinate and harmonize
national, provincial, and donor targets.
Participants in the planning workshops include senior representatives from the departments of health, public
security, social affairs, education, planning and investment, finance, culture and communication, women's
and youth unions, the Communist Party, People's Councils, and People's Committees.
To enhance sustainability of the program, the Kennedy School faculty has focused its efforts in FY07 on
teaming with NPA faculty to build its capacity to facilitate and teach sessions of the planning workshops.
FY08 is the last year of PEPFAR funding for the Kennedy School to provide technical assistance because
the NPA faculty will have obtained the capacity to update the curriculum and train independently. Note that
a similar modality was used by the Kennedy School faculty to build capacity among the NPA faculty to teach
an HIV/AIDS public policy course, which NPA faculty are now conducting without Kennedy School
engagement.
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.
FY08 funding will support three activities:
The first activity will include four provincial planning workshops for approximately 45 participants (15
participants from three provinces per training), totaling approximately 180 trained from 12 provinces.
The second activity will focus on the refinement and revision of planning curriculum. Planning curriculum
content will be updated with the latest epidemiological data and best practices in HIV/AIDS planning. The
Kennedy School will work with NPA faculty to provide assistance in updating the training materials,
including session power points, group discussion guidelines, templates for reporting back, and other training
materials. NPA faculty will be paired with Kennedy School faculty, who will mentor them on updating content
and developing teaching materials for planning.
The third activity will strengthen the capacity of faculty from the NPA to facilitate provincial level planning.
The Kennedy School has developed a strategy for building NPA capacity for sustaining the project activities
beyond FY08. The Kennedy School will pair with NPA faculty to develop and teach planning workshop
sessions. With each successive workshop, NPA faculty will take on greater responsibility for preparing and
facilitating the planning workshops. In addition, the Kennedy School in collaboration with HPI will support
NPA to integrate into the national and international community working on HIV/AIDS in Vietnam, including
participation in the UNAIDS-led HIV/AIDS Technical Working Group, national and international conferences,
and other fora. By the end of the FY08 COP funding year, NPA faculty will have the capacity to facilitate the
planning workshops and develop and teach the sessions and group exercises.
This activity narrative formerly included activities that have been migrated to Palliative Care: HBHC. The
following describes policy-level activities to be carried out in FY08.
There is unprecedented interest at the Ministry of Health (MOH) in mobilizing private health care providers
to support public sector HIV/AIDS programming in Vietnam. Several events in the last year have contributed
to this development. Key among them is a significant increase in the size of the private health sector,
coupled with the government's movement toward privatization of several MOH hospitals. There is also
heightened interest in meeting international standards in order to comply with Vietnam's accession to the
World Trade Organization. During a recent assessment, the director of the MOH/Vietnam Administration for
HIV/AIDS Control (VAAC) and the director of the MOH legal department expressed a strong desire to work
with the rapidly expanding private health sector in the area of HIV/AIDS.
Seizing on this change in the political environment, Pathfinder will launch an initiative at the central MOH
level to strengthen policies and regulations that will contribute to effective partnership between the public
and private health sectors in the areas of HIV/AIDS prevention, care and support. The initiative will build on
the lessons learned through Pathfinder's work in three PEPFAR-supported provinces.
Pathfinder will work closely with the MOH legal department to develop a "circular" (policy framework) to
guide the involvement of the private health sector in the provision of HIV/AIDS services. At a recent
workshop on public-private sector collaboration in health care, which included HIV/AIDS, the legal
department stated their intention to craft this circular. Specific issues to be addressed may include
accreditation of in-service training for private providers offering antiretroviral therapy, legal protection for
private sector providers working in HIV, private sector access to post-exposure prophylaxis, and
government contracting of the private sector to provide services for PLWHA. Pathfinder will support a
policy/legal expert to work with the legal department to develop the circular.
To help create support and understanding of the circular, Pathfinder will support a series of awareness-
raising and advocacy-related activities on private health sector participation in HIV/AIDS. Activities include:
1) working with the Vietnam Medical Association and the Hanoi Association of Private Providers to translate
and widely disseminate key articles on public-private health sector partnerships in HIV/AIDS; 2) fostering
dialogue between the national and provincial levels to demonstrate the success and lessons learned from
pilot work to address HIV/AIDS through public-private health sector partnership; 3) supporting a seminar
series at the national level, targeting key policy makers in the National Assembly and in civil society, as well
as high-level officials within the MOH on a series of topics related to international experience in working with
the private health sector to address HIV/AIDS issues; 4) supporting the Hanoi Association of Private
Providers to conduct awareness-raising on stigma and discrimination; and 5) conducting a study tour for a
select number of decision makers to observe how the public health sector can effectively mobilize and
coordinate with the private health sector in HIV/AIDS.
Pathfinder will encourage the MOH to form an advisory group, as well as promote dialogue at the national
level on the wide range of public and private health sector issues associated with HIV/AIDS programs and
services.
Pact sub-partner: International Center for Research on Women, Vietnam's Institute for Social Development
Studies
This is a continuing activity from FY06, and will follow on FY07 stigma and discrimination activity funded
through Pact.
Pact will fund the International Center for Research on Women (ICRW) and Vietnam's Institute for Social
Development Studies (ISDS) to work in partnership to conduct this activity.
In FY06, ICRW and the ISDS adapted the Stigma Reduction Tool Kit for Vietnam. The two organizations
developed a strong complementary relationship while working together over the past four years on a
program of research and intervention related to HIV/AIDS-related stigma. ICRW will be the principal
implementing partner for this activity, working in partnership with ISDS to develop and implement all
activities. As is standard practice for stigma-reduction activities conducted by ICRW and ISDS, PLWHA will
play an integral role. PLWHA organizations will be included in the rapid assessment conducted at the
central and provincial levels and at a meeting to disseminate findings. It is also anticipated that PLWHA will
attend the regional trainings as both participants and co-facilitators.
In FY08, ICRW and ISDS will develop a comprehensive strategy for integrating and expanding stigma
reduction and provision of technical assistance, training, and tools to PEPFAR's implementing partners. As
a first step, ICRW and ISDS will conduct a rapid assessment of PEPFAR-supported programming efforts at
the central level and in four focus provinces. They will then develop a comprehensive strategy for enhancing
stigma-reduction programming efforts in these areas. A dissemination meeting with key PEPFAR partners,
including PLWHA organizations will then be held to garner input and support for this strategy. Following the
finalization of the comprehensive strategy, three regional trainings will be conducted with PEPFAR
implementing partners, including PLWHA partner organizations, on HIV/AIDS-related stigma and
discrimination reduction. These activities will enable country program managers and implementers to scale-
up stigma reduction efforts in a complementary manner to ensure large-scale reductions in stigma.
Reductions in stigma will improve HIV/AIDS prevention, care and treatment efforts at multiple levels
throughout Vietnamese society, including prevention with positives and increased uptake of HIV/AIDS
prevention modalities, HIV/AIDS testing and antiretroviral treatment. If necessary, ICRW and ISDS will
provide support to PEPFAR partner organizations to implement their stigma-reduction action plans the
following year.
Specific activities include:
1. A rapid assessment of PEPFAR-funded activities will be conducted using a combination of qualitative and
quantitative methods (e.g., key informant interviews, focus group discussions, and brief evaluation tools). At
the central level, interviews with senior management and project coordinators from international, ministerial,
PLWHA, and NGO partners will provide information on current stigma reduction activities and identify key
gaps and areas for collaboration. At the provincial level, interviews with project staff will provide important
information about specific needs and challenges faced during implementation.
2. A comprehensive strategy will be developed based on the needs assessment and country experience to
date. The strategy will identify concrete ways to integrate stigma-reduction into existing programming, as
well as key entry points for stigma-focused programming.
3. A workshop will be held in Hanoi with key PEPFAR partners to present the results of the assessment and
receive feedback on the comprehensive strategy developed, after which a final report will be prepared and
submitted.
4. Regional trainings will be conducted for up to a total of 120 participants to ensure national coverage.
These three-day trainings will use the Stigma Reduction Toolkit to build capacity among local partners to
conduct stigma reduction activities. The first two days will focus on sensitization and capacity building and
the last day will focus on action planning.
5. An electronic PDF document containing findings from the country program assessment and outlining a
comprehensive strategy for integrating and expanding stigma reduction throughout PEPFAR programs will
be prepared.
