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.
Subdivisions of Program Areas, these track general higher level sub-classifications of expenditure.
Subdivisions of Major categories, these are the most detailed expenditure data.
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
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
This is a new activity in FY08.
Family Health International (FHI) will contribute toward the Vietnamese national PMTCT scale-up strategy
by providing PMTCT services at district sites, where FHI also has adult and pediatrics care and treatment
services in a family-centered model.
To date FHI provides PMTCT services at three sites: one district-level PMTCT site (Van Don District, Quang
Ninh Province) and two other sites implemented with partners (UNICEF in Tan Chau, An Giang and CDC-
LifeGAP in Cam Pha, Quang Ninh). A total of 60 women have received PMTCT counseling and testing
across these three sites since FHI became involved in PMTCT in March 2007 and a total of five mother-
infant pairs have received full ART/PMTCT coverage.
In FY07 FHI expanded PMTCT services to three new districts: Thot Not, Can Tho; Hai An, Hai Phong; and
Tinh Bien, An Giang. A total of 700 women will receive counseling and an estimated 53 mother-infant pairs
will receive full ART/PMTCT coverage. In FY08 FHI will expand PMTCT services to seven more districts,
bringing the total number of districts receiving PMTCT services to 13.
FHI's approach is based on family-centered care principles, integrating PMTCT into existing FHI-supported
continuum of care (CoC) sites which consist of linked HIV out-patient clinics (OPCs) and home-care teams.
PMTCT services will be integrated into ANC and "opt-out" HIV counseling and testing will be implemented in
all sites. Clinical staging and evaluation for OI, TB, cotrimoxazole prophylaxis and treatment will be
provided during and after pregnancy for mothers at FHI-supported OPCs, that are located nearby. ARV
prophylaxis and follow-up will be provided at the OPC.
Infants will be given single-dose Nevirapine and one week of AZT. Infant follow-up includes cotrimoxazole
at six weeks; formula for six months, if needed, and if mother and counselor agree that the option is
acceptable, feasible, affordable, safe, and sustainable; antibody testing at 18 months as directed by national
guidelines; and DNA PCR testing for early infant diagnosis (EID) at two and six months, currently through
two labs, one in the North and one in the South. HIV-infected babies will continue to receive formula
supplement until 12 months of age and will be closely monitored for growth and nutritional status.
FHI will support the development of strong referral links between PMTCT services at the commune and
district level. Home-based care teams will continue to be trained in how to provide follow-up services to
women/couples receiving PMTCT services. To create a more enabling environment, FHI will support local
stigma and discrimination reduction activities.
FHI will work closely with key partners to provide high-quality PMTCT services, in particular the Vietnam
Ministry of Health, US CDC, Management Sciences for Health, and UNICEF. This will include joint
development of standard operating procedures (SOPs) and services systems including the use of dried
blood spots (DBS) for PCR.
In order to ensure quality services, FHI will support the training, mentoring, QA/QI, and supportive
supervision of PMTCT providers in close coordination with the Vietnam Administration of HIV/AIDS Control
(VAAC) and other PEPFAR partners.
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:
• From October 2006 through July 2007 FHI has provided BCC to a combined total of 177,000 most-at-risk
populations (this includes approximately 19,000 FSW, 130,000 clients, 8,000 IDU, and 20,000 MSM). Many
of these were potential clients of CSW reached through the "Live Like A Real Man" campaign targeting men
in entertainment establishments where commercial sex may be arranged. The follow-on CSW client work
was competitively awarded to a consortium of partners led by PSI. Hence, FY08 target numbers will be
lower than FY07 figures.
• In FY08, the PEPFAR prevention strategy will sharpen partners' focus on high risk populations to increase
capacity of existing interventions, reach more individuals, improve referral to counseling and testing, and to
offer more relevant services at MARP friendly community sites and on an outreach basis. To this end, skills
of outreach workers, case managers, health educators, and other personnel will be improved through
technical assistance from experienced, existing sites. Highly trained case managers and addiction
counselors will reduce program management functions to apply addiction counseling skills for IDU on a
• FHI will receive FY08 funding to support AB programming for truck drivers, a population identified as
engaging in high-risk behavior with female sex workers, along the national highway corridor. Peer outreach
workers and health educators will intercept men at truck stops and other locations along the national
highway to encouraged reduced use of commercial sex workers as part of a comprehensive ABC
• Through FY08 funding, FHI will implement HIV prevention programs in 10 provinces where PEPFAR
works. In one or more provinces FHI will be the primary partner providing HIV prevention, care and
treatment services for an entire province, in close partnership with the MOH VAAC.
FY07 Activity Narrative:
PEPFAR will support FHI to train health educators and peer educators to deliver effective AB messages to
appropriate most-at-risk populations (MARPs) in the six current and one planned focus provinces, in
addition to three prevention-oriented provinces, reaching a total of 48,000 people. Outreach teams will
incorporate AB messaging in daily contacts with drug users, men who have sex with men (MSM) and,
where possible, with peers and family members of MARPs, stressing the reduction of sexual partnerships.
Outreach workers will be trained in peer counseling skills to help clients develop strategies to reduce risk of
HIV transmission. Behavior Change Communication (BCC) materials stressing similar messages will be
distributed to key populations through outreach activities and at drop-in centers where clients can receive
additional counseling, HIV counseling and testing, and other services.
FHI will receive funding from PEPFAR to address male cultural and social norms to stress marital fidelity
among current or potential clients of female sex workers (FSW) in all focus provinces. The intervention is
based on FY05 and 06 research among FSW clients that identified situational factors—such as drinking
with co-workers and peer pressure—that often lead to sex worker visits. Health promoters will employ
intensive outreach to target 70,000 high-risk men in entertainment establishments, such as beer bars,
karaoke, hotels and other locations identified through mapping. One hundred health promoters will be
trained to convey abstinence and be faithful messages to men.
FHI will cooperate with Health Policy Initiative to promote greater involvement of People Living With
HIV/AIDS (PLWHA) in abstinence and faithfulness approaches, building PLWHA skills to counsel clients on
the importance of fidelity to one partner as part of a comprehensive prevention strategy (refer to HVOP FHI
10207). PEPFAR will support training for 50 service providers and 100 PLWHA peers who will counsel
clients at out-patient clinics, PLWHA support group meetings and home-based care visits. Twenty-five
hundred positive PLWHA will be reached through peer counseling sessions that stress fidelity as a primary
means to prevent infection or cross-infection.
FHI will provide a sub-grant and technical assistance to support Vietnam-based NGO Consultation of
Investment in Health Promotion's (CIHP) internet-based counseling and HIV/AIDS education program,
which aims to reach MSM nationwide, and will include discussions on being faithful and partner reduction as
part of its comprehensive prevention approach. Counseling will be provided in a manner that enables MSM
accessing on-line service to strategize appropriate ways to reduce risk of HIV transmission. Forty five MSM
peer educators will be trained to provide on-line counseling, and an estimated 2,400 individuals will be
reached. FHI will work closely with CIHP to build overall capacity and sustainability.
FHI will expand the scope and scale of substance abuse treatment options initiated in FY05 and FY06 by
FHI to enable Vietnam to attain and retain an adequate number of health workers needed to address drug
addiction sufficiently in focus provinces, and to accomplish PEPFAR goals. Training sessions will be
developed and delivered as a series of coordinated, strategic interventions that address the lack of
community based treatment options and absence of experienced substance abuse counselors. Both pre-
service and long term training will assist development of a skilled cadre of substance abuse counselors
through recruitment of new staff and leveraging existing resources by training government and other donors'
workforces. A comprehensive array of substance abuse treatment options supports the PEPFAR Vietnam 5
-Year Strategy to bolster Vietnam's national drug control policy. These activities will result in more than 300
individuals trained in substance abuse treatment and more than 6,000 reached with prevention messaging
based on abstinence from drug use (see HVOP FHI 10207) and abstinence and being faithful as an
essential means of preventing HIV transmission (6,000 person target).
FHI will expand a nationwide network of case managers, drug counselors, and social workers for inpatient
and community substance abuse programs. This activity began with FY05 and FY06 FHI training of
addictions counselors and case managers in Haiphong and Ho Chi Minh City. In 2007, PEPFAR will support
FHI to train more than 30 new counselors and will integrate a Training Of Trainers (TOT) for 12 of the most
qualified counselors. All trainees will be taught to employ a prioritized AB message in conjunction with
abstinence from drug use. Developing a nationwide core of counselors and case managers will help
Activity Narrative: "legitimize" the profession of addiction counseling and ensure sustainability without continued reliance on
expensive foreign technical assistance.
FHI: BCC Coordination
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:
• Family Health International was selected to implement this FY07 TBD activity.
• FY07 plans called for provincial outreach coordinators in four PEPFAR focus provinces. Through FY08
funding, the USG team will support FHI placement of provincial outreach coordinators in nine provinces
where the epidemic is most severe.
FY07 Activity Narrative:
Both HVAB and HVOP funding for this activity will support the recruitment and placement of a provincial
outreach coordinator in each of four focus provinces where the epidemic is most severe. Provincial outreach
coordinators will work closely with Provincial Health Departments and will take the lead coordinating all
PEPFAR Behavior Change Communication (BCC) activities and linking them to activities sponsored by
Government of Vietnam (GVN) and other donors. The PEPFAR outreach coordinators will be responsible
for improving the scope and scale of PEPFAR and other BCC programs which include AB interventions as
part of a broad strategic portfolio to avert 660,000 new HIV infections. Funding for this activity will ensure
that BCC innovation incorporates abstinence and fidelity messaging as a component integrated in outreach
messaging to appropriate at-risk populations and lower risk youth, including clients of sex workers, in- and
out-of-school youth, and women who are at increased vulnerability for sex work. Messaging on risk
hierarchy will emphasize that abstinence and/or faithfulness to one partner are effective means of avoiding
HIV transmission. Coordinators will ensure the availability of full network model services, including STI
treatment, AIDS care and support and addiction counseling.
FHI: Cross Border project
Funding for this new activity in FY08 will support an innovative new collaboration between two USG
PEPFAR country teams. The PEPFAR Vietnam Team and its prime partner, Family Health
International/Vietnam will partner with the PEPFAR Cambodia Team and its prime partner, Family Health
International/Cambodia to design and implement a targeted cross-border program for Vietnamese CSW
migrating between Vietnam and Cambodia.
Anecdotal information on both sides of the Cambodian-Vietnamese border suggests that Vietnamese
women from the Mekong Delta migrate across the border into Cambodia to earn money in sex work. There
is a major concern that this cross-border migration for sex work in Cambodia may be a significant factor in
driving the epidemic along the border provinces in both countries. There is also a growing concern that
development of new casinos on the Cambodian side of the border, as well as a new highway currently
under construction that will run from Bangkok through Cambodia and on into Ho Chi Minh City, will increase
mobility and draw both Vietnamese sex workers and clients to the Cambodian border provinces. It is also
reported that many Vietnamese sex workers make their way to Phnom Penh, and from there migrate to
other Cambodian provinces or other countries.
In FY07, members of the Vietnam and Cambodia PEPFAR teams identified that existing sentinel
surveillance and behavioral surveillance data available in both countries did not provide sufficient
information to analyze the situational context along the border. The two teams jointly agreed to conduct
small-scale qualitative studies/assessments to collect preliminary data on cross-border migration and
transactional sex in the border provinces.
Funding in FY08 will support: (1) rapid assessments in the provinces on both sides of border where the
epidemic is most severe; (2) the development, implementation, and monitoring of a model interactive
outreach program of peer networks of Vietnamese former or current female sex workers who would ensure
that women have knowledge of and gain access to services and also have options for returning home.
The goal of this joint work is to apply improved knowledge about the situational context around the border
region to develop a model outreach program to provide CSW with access to HIV prevention programs, meet
the needs of vulnerable women at risk for HIV infection, and provide options for these women to return
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:
• Family Health International was selected to implement this FY07 TBD activity.
• FY07 plans called for provincial outreach coordinators in four PEPFAR focus provinces. Through FY08,
the USG team will support FHI placement of provincial outreach coordinators in nine provinces where the
epidemic is most severe.
FY07 Activity Narrative:
Both HVAB and HVOP funding will support PEPFAR outreach coordinators the four focus provinces where
the country's epidemic is most severe, namely Hanoi, Haiphong, Quang Ninh and HCMC. Provincial
outreach coordinators will: coordinate all PEPFAR BCC activities; and ensure the coordination of PEPFAR
activities with other activities sponsored by government and other donors at the provincial level. In
accordance with Vietnam's National HIV/AIDS Strategy to employ proactive behavior change
communication to reduce HIV transmission, TBD partner will place a provincial outreach and referral
coordinator in each of the four focus provinces. Provincial coordinators will be responsible for thousands of
upstream targets reached through improved scope and scale of PEPFAR and other BCC programs.
The coordinators will be employed through a local or international non-governmental organization (NGO) to
synchronize efforts with the Provincial AIDS Committee (PAC), and will sit inside the PAC. They will work
closely with Provincial Health Departments. Each provincial outreach coordinator will serve as a focal point
for all BCC including, but not limited to, injecting drug users (IDU), commercial sex workers (CSW) and men
having sex with men (MSM) as well as referrals to prevention, care and treatment and an increasing array
of drug and alcohol abuse treatment services.
Provincial coordinators will develop and maintain comprehensive knowledge of all BCC activities supported
by PEPFAR, government agencies and other donors. They will facilitate ongoing monitoring and evaluation
of outreach programs to ensure programs prioritize key prevention messages and that quality prevention
programming is mainstreamed into care and treatment services for clients and their families. Coordinators
will facilitate regular meetings among PEPFAR and other staff to ensure maximum coverage of target
populations, to facilitate dovetailing of donors' efforts, to improve BCC efforts and to minimize waste or
overlap. As suggested by 2006 PEPFAR Prevention Technical Assistance visits, outreach coordinators will
bear particular oversight responsibility for BCC innovations targeting establishment-based sex workers,
hidden drug users and vulnerable youth to ensure equitable access to HIV prevention services. The
coordinator position will serve as a model for VAAC and PACs, allowing the government to sustain these
activities with little additional financial input.
• From October 2006 through July 2007 FHI has provided BCC to 177,000 most-at-risk populations. Many
were potential CSW clients reached through the "Live Like A Real Man" campaign targeting men in
entertainment establishments where commercial sex may be arranged. Follow-on CSW client work was
competitively awarded to a consortium of partners led by PSI. Hence, FY 08 target numbers will be lower
than FY07 figures.
• The FY08 PEPFAR prevention strategy will sharpen partners' focus on high risk populations to increase
capacity, improve VCT uptake and offer more services at MARP friendly community sites and on an
outreach basis. Drop-in centers for MARPs will be enhanced with services such as job placement and skills
training to increase first-time and repeat visits.
• Highly trained case managers will reduce program management functions to provide addiction counseling
for IDU on a regular basis. Linkages and integration of prevention interventions into "one-stop" centers will
be promoted so that services are consolidated and efficient.
• Through FY08 funding, FHI community outreach programs will scale up to include prevention activities in
10 provinces where PEPFAR works. In one or more provinces FHI will be the primary partner providing HIV
prevention, care and treatment services for an entire province, in close partnership with the MOH VAAC.
Targets will include 21,000 IDU; 31,000 FSW; 40,000 current or potential clients of sex workers (truckers);
29,000 MSM; and will train 100 peers in discordant couple counseling skills.
• FHI will also receive FY08 funding to support programming for truck drivers, a population identified as
PEPFAR supports Family Health International (FHI) to take the lead NGO role working with MOH to
promote health education outreach for high risk clients. FHI plays a strong role in prevention for commercial
sex worker (CSW) clients (with new Pact TBD partner 9494) and PLWHA (through cooperation with HPI).
This activity will reach the following most at-risk populations with effective ABC behavior change
communication; 14,000 IDU, 22,000 FSW, 70,000 current or potential clients of sex workers, 14,400 MSM;
and will train 100 peers in discordant couple counseling skills. Interventions will incorporate OGAC technical
guidance on ABC and IDU prevention programming, and the PEPFAR Vietnam Five-year Strategy to avert
HIV infections. FHI will implement high quality HIV prevention services targeting key populations and
geographic areas where Vietnam's epidemic is most severe.
All BCC outreach activities are coordinated with the PEPFAR-supported provincial outreach coordinators to
ensure coverage is efficient. FHI will support HIV prevention in the seven focus provinces, addressing
unique needs of male and female injectors, in conjunction with MOH outreach (complementing districts with
unmet needs). Health educators and peers will contact intravenous drug users (IDU), stressing the
importance of learning HIV status to protect one's health and the health of their family. This interpersonal
approach will encourage drug users to access the network model, including drop-in centers, where IDU
have access to CT, care and treatment, and an array of drug and alcohol abuse treatment options. A
methadone treatment program will be piloted in three focus provinces. For IDU who are unable to stop
using, clients will be encouraged to avoid sharing injecting equipment and reduce other risky behaviors.
Building on FY05 and FY06 outreach and drop-in center activities, services will be expanded to Lang Son
and Khanh Hoa provinces where significant IDU populations are found. FHI will develop the provinces of
Quang Ninh, Haiphong, Ho Chi Minh City (HCMC), and Lang Son as learning sites to build capacity of
government agencies and other donors. In-country study tours will foster local capacity, leverage other
resources and build sustained national capacity to address local HIV prevention needs.
FHI will scale up targeted behavior change interventions for female sex workers (FSW) in Can Tho, HCMC,
Hanoi, Haiphong, and three new provinces. Services for FSW include STI diagnosis and treatment, condom
negotiation skills to ensure vulnerable women are empowered to prevent HIV infection, links to vocational
training for women who wish to leave sex work, and comprehensive network services. To facilitate women's
equal access to HIV/AIDS services, "one-stop shop" model women's health clubs will be enhanced to offer
CT and STI treatment as well as referral for OI prophylaxis, PMTCT and ART treatment. Women who desire
to leave prostitution will be referred to vocational training and job placement. Women who require
assistance with substance abuse problems will have access to an increasing array of treatment options to
include counseling and, potentially, medication assisted therapy.
FHI will target clients and potential clients of sex workers to change male norms, reducing transactional sex
and multiple partners in the seven focus provinces, in conjunction with the Pact/TBD "Live Like a Real Man"
program, and coordinated by the outreach coordinator to maximize coverage. FY07 efforts will expand
interpersonal outreach as teams of trained educators explain the risks to health, family, and employment
associated with visiting sex workers. For men who are unable to remain faithful to one partner, outreach
workers will promote partner reduction and correct, consistent condom use.
FHI will employ a range of activities to address issues of discrimination and the double stigma attached to
MSM. Current programs advocate a comprehensive ABC approach to HIV prevention with interactive
outreach programs and drop-in centers where MSM can access an integrated network model. Programs will
be scaled up in Ho Chi Minh City (HCMC), Hanoi, Can Tho, Khanh Hoa and a new site in Ha Long. FHI will
expand outreach in MSM hotspots identified through mapping of bars, dance clubs, cafes, sauna-massage
locations and public "cruising" areas. MSM learning centers will be established with help from staff of local
NGO SHAPC in Hanoi, and HCMC-PAC will provide technical assistance (TA) for scale-up of interventions
Activity Narrative: at new MSM intervention sites. Additionally, FHI will provide a sub-grant and technical assistance to the
local non-governmental organization (NGO) Center of Investment for Health Promotion (CIHP) to develop
internet-based efforts to reach men having sex with men (MSM). FHI will assist CIHP in training 45 MSM
peer educators to provide prevention education, counseling, and referrals to 2,400 MSM through a website-
based service. CIHP will develop a website with updated information on HIV/AIDS programs and services
targeting MSM, including referral for CT, MSM drop-in centers offering peer support, MSM outreach
programs/support clubs offering access to condoms and additional information and education.
Increasing incidence of HIV among partners of drug users necessitates effective interventions among
discordant couples, to empower women to refuse unsafe sexual practices, and encourage correct and
consistent condom use. FHI will leverage existing structures, supporting PLWHA groups to use peer
counseling and group meetings in districts in 10 PEPFAR focus provinces. FHI will create links and stronger
referral between OPCs and treatment services for discordant couples. Condoms will be provided and
promoted intensively during outreach opportunities and at all drop-in-centers for FSW, MSM and IDU, and
outpatient centers (OPCs).
Plus up funds will be used to support and expand two peer education and outreach activities.
1. Family Health International and its local partners will train 100 non-using peer educators who will provide
support to an estimated 2,500 recovering drug users who are in the process of transitioning from
rehabilitation centers to their communities. These peers will provide a critical role in helping recovering drug
users to stabilize their lives, specifically in the area of drug use relapse prevention and accessing drug
treatment services, VCT, and, if HIV+, care and treatment services. They will work in existing PEPFAR
focus provinces of Ho Chi Minh City, An Giang, Can Tho, Hanoi, Hai Phong, and Quang Ninh. Existing peer
educators who have remained off of drugs will assist in training new peers. In collaboration with case
managers, non-using peer educators will lead support groups for recovering drug users and assist them to
stay off of drugs.
2. Family Health International will work with its local partners to train 200 peer educators who will provide
HIV risk reduction information and motivation support to an estimated 2,000 female sex workers (FSW),
1,500 injection drug users (IDU), and 1,000 men who have sex with men (MSM). These peers will be drawn
from areas within the PEPFAR focus provinces of Ho Chi Minh City, An Giang, Can Tho, Hanoi, Hai PHong,
and Quang Ninh that lack sufficient coverage. Urban areas in 2-3 non-focus provinces will be selected in
discussion with the PEPFAR Vietnam Team. These will be areas where there are large concentrations of
former drug users who are leaving rehabilitation centers and moving back to their communities. Mappings of
high concentrations of FSW, IDU, and MSM will be used to plan which areas are in need of peer
FHI staff together with trained peers will scale up these interventions.
FHI: Addiction Counseling
• FHI has trained and placed 50 case managers/addiction counselors to support drug abuse and relapse
prevention. In FY08, an additional 50 case managers will be trained to provide addiction counseling
services in five additional provinces. Additionally, continuing education activities to build advanced
counseling skills will be provided to the previously trained case managers.
• Case managers will be trained to provide individual, group and family counseling through peer support
groups, partner and family education groups, and community education activities.
• Case managers will be stationed at additional approved methadone implementation sites to support
relapse prevention and promote other complementary services, such as CT, care and treatment, and peer
• Approximately 3,000 high-risk individuals will be reached by the case managers with activities that
promote HIV/AIDS prevention through behavior change beyond abstinence and/or being faithful.
Family Health International will continue to build the capacity and skills of individuals who have been trained
in addictions counseling and case management. This cadre of approximately 30 new professionals was
initially trained in 2006 but requires continual skill upgrading to meet the demands of approximately 2,000
recovering drug users with services and strategies that promote drug use relapse prevention, drug
treatment, including methadone, and HIV prevention. Case managers will also help HIV+ drug users with
ARV drug adherence. They are currently stationed in existing outreach centers for drug users or outpatient
care (OPC) clinics in the existing PEPFAR focus provinces of Ho Chi Minh City, An Giang, Can Tho, Hanoi,
Hai Phong, and Quang Ninh. Metropolitan areas of other provinces will be added where an expressed need
is identified in collaboration with PEPFAR partners.
These case managers build off of the experience from work started in the previous year in Ho Chi Minh City
under the 06 center pilot for recovering drug users leaving rehabilitation centers. More experienced case
managers from Ho Chi Minh City who have undergone a training-of-trainers program will serve as trainers
for new recruits in other provinces. They will provide training in helping recovering drug users understand
and negotiate solutions to their drug cravings, relapse triggers, and family and social support issues. They
will also help them to set up local non-drug using peer support groups. Case managers will also be
stationed in methadone sites. Finally, case managers will remain up-to-date on the building array of
services available in localities and ensure that their clients are actively taking advantage of these services.
FHI: Sustainable addictions training
International evidence supports the efficacy of a skilled and well-trained addiction workforce to reduce drug
use, criminal activity and sexual behavior that place individuals at high risk for HIV infection. Recognizing
that heroin injection remains the upstream cause of most new HIV infections in Vietnam, PEPFAR has
invested significant resources to recruit and train 50 professional drug addiction counselors since 2005.
High demand for these key staff and tremendous unmet needs among clients highlight the need for a
sustainable system of training and professional development for future leaders in the substance abuse field.
The system must reinforce skills in case management and evidence-based substance abuse treatment to
develop a workforce of competent health care, social service and law enforcement professionals for clients
whose drug using behaviors place them at risk. To this end, FHI will implement a capacity building program
to develop an addiction workforce through technical assistance and training for treatment providers, social
workers and related professional groups. Through this process, FHI will also develop and maintain an
interdisciplinary consortium of health care and related fields, and government personnel knowledgeable
about research-based approaches to substance abuse treatment and recovery.
This activity has 3 components. First, partners will develop basic training courses on the principles of
addiction and the relationship between addiction and HIV and other infectious diseases. These basic
courses will offered to staff from a cross-section of agencies that serve populations at high risk for
substance abuse and HIV infection. Examples include staff from government and non-governmental
organizations (NGOs) involved in home- and clinic-based HIV care and treatment, government social
workers who monitor current and former drug users in the community, medical and other public health
students, and outreach workers supported by PEPFAR and other donors. Through this component
PEPFAR will train 100 individuals in the basics principles of addiction.
Second, FHI will provide a basic introductory course on addiction counseling, promoting comprehensive and
consistent service, for international NGOs and government organizations. An advanced course on
addiction counseling will improve skills of those already trained but in need of specialized training for work
with families, adolescents or other groups affected by addiction. Two training of trainer sessions (TOT) will
provide for continuation beyond the life of this activity and publication of the curricula will enable sustained
training for future drug counselors. Through this component PEPFAR will train 40 individuals as
professional addictions counselors.
Through the third component, FHI will expand efforts to train DOLISA social workers as case managers for
recovering drug users. Basic social work principles will refocus function from parole officer to that of
supportive case manager, responsible for following up with drug users in the community and referring them
to needed HIV care, addiction services, and vocational and other training and support. Basic case manager
training will be supported by advanced guidance on working with special populations, the family and youth.
An advanced course will be provided to case manager supervisors in the selected province. Program
evaluation will be accomplished through routine data collection. Through this component PEPFAR will train
Food and nutrition has been a major concern for PEPFAR partners to better meet the needs of
undernourished children and adults on ART in Vietnam. With OGAC's new Food and Nutrition guidelines,
which allow for a broader use of PEPFAR funds for severely undernourished HIV+ clients, Vietnam is ready
to gear-up needed services. In order to stay within the guidelines, technical assistance from the FANTA
project is needed to work with local food and nutrition experts to develop guidelines for diagnosis and a
training curriculum for case managers within the cultural context of Vietnam.
While Vietnam has had a minimal food and nutrition program since PEPFAR started, it is insufficient in
providing needed foods to babies, and positive children and mothers. Some COP07 Plus-Up funding was
available to PEPFAR partners to strengthen this nascent program and additional progress is being
observed. However, there is still a large gap between the need for food and nutrition by some of our very
poor clients and the services that are available to them. It is timely to scale-up the food and nutrition
program to better assist HIV positive clients in adapting to their drug regimes. The area of emphasis for this
activity will focus on new-borns, babies and young children. It is important to obtain specialized
professionals who have PEPFAR experiences in diagnosis, both clinical and non-clinical, and skills in
determining criteria for entrance and exiting food programs for this particular aduience. The FANTA project
staff can provide this experience and expertise.
It is expected that FANTA will provide a short TDY in June/July 2008 to help the USG Care and Treatment
TWG plan activities for COP09. With these funds for COP08 implementation, FANTA will provide technical
assistance to help develop regulations and guidelines and training curriculum. A list of some of the
expected activities includes:
Review current F&N feeding programs in PEPFAR clinics and at community level.
Review guidelines available and in progress that promote feeding programs
Assess need for supplemental feeding programs for adults and pediatric clients with approximate length of
Assess what foods are needed and what local foods can be used for food packages
Determine the best way to distribute food packages
Make recommendations of how best to implement a comprehensive supplemental feeding program
Implement a pilot feeding program, to be initiated during COP08 implementation period
Develop a work plan to gear-up F&N activities under COP09
Under COP07, PEPFAR initiated the national medication assisted therapy (MAT) program, which provides
methadone for injecting drug users (IDU). Expansion of MAT has recently been approved by the Ministry of
Health (MOH) without waiting for the "required" annual report. Observational reports to date have shown
government officials the benefits of MAT and based on these case reports, the MOH approved the opening
of 6 additional methadone clinics, primarily for Hanoi.
USAID currently supports Family Health International (FHI) which has opened three pilot methadone sites
(with FY07 funding), one in HCMC and two sites in Hai Phong. These three sites will be funded in 2008 with
monies in the FY08 FHI activity narrative. FHI has been chosen to open three more sites, with at least two
in Hanoi. A third site for FHI will need to await MOH decisions as to location.
In FY08, USAID will also provide substantial technical assistance (TA) to the methadone program in
collaboration with other PEPFAR partners and the MOH/Vietnam Administration for AIDS Control (VAAC).
This TA is expected to include program and technical management, training, and on-site monitoring for
service providers and is funded under several other activities.
This is a continuing activity from FY07.
• In FY08 Family Health International (FHI) will maintain 17 current continuum of care (CoC) sites and
establish five new CoC sites in locations TBD based on the new priority provinces. The CoC consists of HIV
out-patient clinics (OPCs), TB screening and treatment, community- and home-based care (H/CBC) and
referral support, services for OVC, PLWHA and family support groups and prevention counseling.
• FHI will continue to provide an updated package of technical assistance (TA) and tools to all CoC palliative
care and treatment sites including training, mentoring and supervision and the development and provision of
technical tools to assist local partners in implementation of palliative care services.
• FHI will continue to provide OPC based palliative care to people with HIV in 22 CoC sites; and provide
H/CBC and referral support to people with HIV and families through 65 teams in all 22 sites with referrals to
counseling, testing and care and treatment as necessary.
• In FY08 FHI will pilot integrated palliative care in two to four sites. Integration of palliative care includes
training in palliative care for adults and children in OPC, CBC and introduction of oral morphine where
feasible. It will also include development of clinical tools to aid integration of full palliative care package and
an evaluation of the effectiveness of the approach.
• FHI will continue providing TA to the Ministry of Health (MOH) on developing the national palliative care
program (MOH working group, dissemination of and training in national palliative care guidelines, reform of
opioid regulations, certification training of nurses, improving opioid supply, monitoring opioid use for
palliative care across the country, etc).
• In FY08 FHI will continue to support the Department of Therapy (DOT) to strengthen palliative care at
central and provincial levels through training with TBD follow-on to VCHAP partner to include national
guidelines, PLWHA rights to pain management, and opioid policies.
• FHI will continue to integrate family centered care into CBC and OPC services through training of pediatric
HIV clinicians, family care case managers and CBC teams in each CoC. FHI will also create family-centered
care (FCC) training and service tools to support FCC integration.
• In FY08 FHI will continue to support the pilot methadone program; continue to provide technical support to
the Vietnam Administration for HIV/AIDS Control (VAAC) in developing technical guidelines, training and
supporting capacity building for methadone programming.
• In FY08 FHI will conduct a program assessment of the quality and effectiveness of CBC and OVC
services; roll-out of nutrition tools and training among all sites; and establish and/or continue quality
assurance/quality improvement (QA/QI) of all palliative care programs in all 23 CoC sites.
• Continue to provide technical support to VAAC to operationalize CBC services. Continue to provide
technical support to the VAAC and provincial centers in establishing a CoC at the provincial and district
• By April 2007 FHI reached 5,700 PLWHA with palliative care services through the continuum of care from
both clinic and community-based care activities. Two international NGOs (Catholic Relief Services and
Nordic Assistance to Vietnam) along with 30+ local governmental partners and community-based
organizations (CBOs) are working with FHI to provide palliative care services.
• FHI trained more than 100 individuals in community and home-based care, and built the capacity of more
than 200 clinicians.
• FHI produced an H/CBC training curriculum in Vietnamese, a caregiving guide for CBC teams, QA/QI tools
for PMTCT and TB and a number of SOPs for clinical service delivery.
FY07 Activity Narrative:
Family Health International (FHI) takes the lead in supporting MOH/VAAC and HCMC PAC in providing
technical assistance for the provision of palliative care and support services at the district and commune
levels, complementing districts that are not covered comprehensively by VAAC and GF. FHI also takes the
lead in developing and training PEPFAR partners including VAAC on H/CBC and support. In collaboration
with VAAC, GF, HCMC-PAC, Catholic Relief Services (CRS) focus province provincial AIDS centers, and
additional F/CBOs, FHI will support 7,900 PLWHAs in 21 sites in 7 focus provinces.
The PEPFAR-supported care network consists of provincial level tertiary care with the full range of clinical
services, district level secondary care with out-patient and in-patient care (with the exception of treatment of
complex OIs and HIV-related complications), TB/HIV referral, ART, and commune level H/CBC with support
to OVC. In FY07 FHI will scale up district and commune-level services to include: (1) urban care sites in
HCMC and Hanoi, (2) rural care sites in An Giang, Can Tho, and Quang Ninh, and 3) integrated prevention
and medication-assisted therapy in select focus provinces for injecting drug users (IDU).
FY07 district care sites will be managed by current and newly trained provincial management and district
care provider staff composed of PLWHA, Communist Party officials, health care workers, religious leaders,
and CBO personnel. These staff will improve referral systems by coordinating with PEPFAR partners to
utilize uniform referral forms and standard operating procedures at care sites. FHI will also work with
PEPFAR partners to develop HIV care and prevention service guides for PLWHA and providers, which will
be provided to all PEPFAR and GF-supported sites.
Coverage will be increased to additional sites via care provider training, and onsite mentoring and
supportive supervision. District outpatient services will be integrated into existing district health centers
(DHCs). OPCs will be linked with inpatient care at DHCs, and, in addition to H/CBC, will continue to provide
prevention counseling and commodities, assessment of psychosocial situation and OVC needs, regular
clinical evaluation and monitoring, OI prophylaxis and treatment of common OIs, screening for TB, related
laboratory services; treatment literacy and intensive treatment preparedness; referral of complex OIs and
TB, management of symptoms, pain, and HIV/AIDS-related complications, nutrition and emotional support.
To facilitate rapid care scale-up, Binh Thanh, Thu Duc and Cam Pha districts (from HCMC and Quang Ninh
provinces - one southern and one northern) will be used as HIV care and support learning centers.
All OPC services are linked with HBC teams to ensure seamless follow-up between home care and hospital
care. HBC teams play a critical role in providing palliative care to PLWHA and families providing pain relief,
symptom management, adherence counseling support, nutrition and livelihood assistance, emotional
counseling, links to spiritual care, end-of-life care and planning and care for OVC. Home care and PLWHA
groups will work with health center staff to promote ART and methadone adherence (for those sites
providing methadone to drug users). Referrals to tertiary care for PLWHA clients will be managed by the
district health center staff and home care teams. H/CBC services will be linked with services implemented
Activity Narrative: by other PEPFAR partners.
IDU access to a full range of prevention, treatment, and care interventions will be increased through case
management in all districts, but with emphasis on those released from government rehabilitation centers
and involved in the methadone pilot. Case managers and former IDU peers for drug users and former drug
users (supported by HCMC PAC) will ensure that all residents released from government rehabilitation
centers have access to relapse prevention counseling, family supportive counseling, and other risk-
reduction. In Haiphong and Quang Ninh, IDU who are HIV positive will be able to enroll in medication-
assisted therapy (MAT) co-administered with ART where clinically eligible, provided the government of
Vietnam (GVN) approves the pilot protocol. Clinicians, adherence counselors, case managers, and HBC
teams will receive comprehensive training in addiction, ART, methadone co-therapy, and ART adherence
support for IDU. Providers in HCMC and Haiphong will be trained as mentors for future IDU care training
At the national level, technical support and capacity building will be provided to PEPFAR H/CBC partners,
GF and VAAC to develop guidelines, standard operating procedures, and training packages. FHI will also
assist in the review and revision of national opioid policies (see FHI Policy System Strengthening 9430).
FHI will support implementatation of three methadone clinics linked to HIV service delivery in existing
outpatient clinics. Methadone will be procured in collaboration with other international partners and MOH.
Additional funding will support five activities: 1) Assessment and development of existing Vietnam nutrition
guidelines, incorporation of international recommendations and development of procedures for
implementation in all PEPFAR funded palliative care sites; 2) Additional provincial level advocacy will be
provided in the 7 focus provinces to increase awareness of the national palliative care guidelines and boost
support for the national palliative care fellowship program; 3) Funding for DOT to produce and disseminate
national home-based care guidelines; 4) Implementation of enhanced STI diagnostics and treatment into
selected outpatient clinics; 5) Expansion of training for staff in PEPFAR and other funded OPCS in providing
psychosocial assessment, support and appropriate referrals. Funding will improve quality of current
services and plans, but will not add to targets.
In FY08, Family Health International (FHI) will expand its activities to 20 continuum of care (CoC) sites in 10
provinces. Activities will include TB disease screening, referral of TB patients to TB treatment services,
improved coordination of TB and HIV services, and capacity building for TB and HIV clinicians. TB-HIV
screening and referral will be provided for 7,500 PLWHA, and TB treatment for 1,500 HIV-infected TB
patients. At least 150 clinical personnel will be trained to provide screening and treatment of HIV-associated
TB and to support TB/HIV coordination activities at the district level. FHI will provide funding to strengthen
district TB and HIV coordination, including annual technical meetings between TB and HIV clinicians,
development of standard operating procedures, quarterly network model coordination meetings, regular
monthly case conferences between TB and HIV clinicians at clinical sites and quarterly supportive
In FY07, FHI supported expanded TB and HIV services in nine CoC sites in six provinces. An estimated
5,000 PLWHA were screened for TB using symptoms and chest radiography, and 1,100 PLWHA were
treated for TB disease.
FHI will 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.
FY07 Activity Narrative:
Funding will provide TB screening and appropriate referral for 7,900 HIV-infected persons in 21 outpatient
clinics in the seven focus provinces, referral to TB treatment for 790 PLWHA, train 250 individuals to
provide clinical prophylaxis and/or treatment for TB to PLWHA and will support TB/HIV coordination
activities at the district level.
Family Health International (FHI) will support HIV outpatient clinics in 21 districts in the seven focus
provinces where clients receive care, support, counseling and ART services. Funding will support training
sessions for HIV and TB physicians and staff time. As with all PEPFAR-supported clinics, clients will receive
TB screening once per year and additional screening as needed for symptoms and prior to commencement
of ART. All patients with suspected or confirmed TB will be referred to the adjoining district TB clinic for
further management. A PEPFAR strategic goal is increasing the collaboration and linkages between the TB
and HIV programs at the district, provincial and national levels. Funding will be provided to strengthen the
district TB and HIV coordination activities implemented through VAAC through several targeted activities,
including annual technical meetings between TB and HIV clinicians, development of Standard Operating
Procedures (SOPs), quarterly network model coordination meetings, regular monthly case conferences
between TB and HIV clinicians at clinical sites and quarterly supportive supervision visits.
• Family Health International (FHI) will continue to work with children infected and affected with HIV/AIDS
using the case management approach (adapted from OGAC's Child Status Index) to assess needs, and will
follow up to ensure identified needs are met and comprehensive programs for OVC are available. OVC care
services will continue to be integrated into continuum of care (CoC) sites and made available in 22
• FHI will continue to ensure comprehensive care and support to OVC including health care, access to
school, emotional support, psychosocial counseling, sufficient nutritional support, safety and security.
• FHI will increase their efforts to identify potential children with HIV through community groups, CoC
coordination committees and mass media and encourage high risk children to get counseling and testing.
• FHI will expand early childhood development-focused playgroups to all CoC sites.
• FHI will continue to work with the government, other PEPFAR partners and other donors in developing
national policies, guidelines and systems to support children affected by HIV.
• FHI will provide training and support in family-centered care case management to grantees and PEPFAR
• FHI will increase its efforts to reduce stigma and discrimination of OVC affected by HIV/AIDS through
• In FY08, FHI will provide 3,500 OVC with relevant services and train 350 care givers, directly through the
CoC and along with its two international partners (Catholic Relief Services and Nordic Assistance to
Vietnam) and its 30+ local governmental and community-based organization (CBO) partners.
• By April 2007, FHI's activities reached 1,497 OVC with services addressing the six basic needs.
• FHI established comprehensive family-centered care services in three CoC and partial services in three
• FHI contributed to the development of the draft national plan of action for children and HIV/AIDS.
FY07 Activity Narrative:
FHI will provide family-centered care for OVC and caregivers through out-patient clinics and home- and
community-based care and support services in the PEPFAR focus provinces. This activity will help ensure
that children's developmental needs are met through a range of services, as appropriate to meet the unique
needs of each child. FHI will help ensure quality of care by building the capacity of OVC care providers and
expand coverage OVC care services through partnerships with home-based care teams, local NGOs, the
Women's Union, the Ministry of Labor, Invalids and Social Affairs (MOLISA) and the Vietnam Commission
for Population, Families and Children (VNCPFC). Through this activity, 1,030 OVC will receive services, and
350 professional and family caregivers will be trained.
OVC services will be provided through case-management services at eight district out-patient HIV/AIDS
clinics (OPCs) which provide comprehensive health care services, including pediatric ART. OVC services
will also be provided through home-based care services that extend the reach of these clinics to the
OVC services will be provided in accordance with the PEPFAR core OVC services package, and will
include: comprehensive needs assessment, counseling and psychosocial support, development of a service
plan to assist OVC and their caregivers in meeting prioritized needs and service referral in the community.
Direct services will also be provides including: health care services, adherence support, food/nutrition
support for children (in accordance with OGAC guidelines), and referral to other social and health care
services including referral to MOH pediatric hospitals and links to Integrated Management of Childhood
Illnesses services (C-IMCI) offered through commune health stations. FHI will train families to provide care
and support at home, including adherence support for pediatric ART and other medications. The project will
support school enrollment and provide educational activities/therapeutic play groups with children. FHI will
also support PLWHA and caregiver support groups, link parents and OVC caregivers to income generation
services and employment referral services, and provide succession planning, including preparing wills and
identifying stand-by caregivers.
Through this activity, OVC services will also be offered through partnerships with community based
organizations in Haiphong (Nordic Assistance to Vietnam [NAV]) and Hanoi (Hien Quang Pagoda). OVC
services will be delivered in a way that supports family-centered care, partnering with and building the
capacity of caregivers' to address their children's needs.
In addition, FHI will collaborate with UNICEF, Save the Children, PEPFAR and other stakeholders to
provide technical support and assistance for the development of OVC care and protection guidelines,
including the development of the Vietnam National HIV/AIDS Strategy.
FHI staff will continuously strengthen their capacity for OVC service delivery, through training, mentoring,
and program monitoring and feedback from PEPFAR and FHI management. FHI will contribute to meetings
among implementing partners, to establish consensus on core service packages, facilitate exchange of
materials and lessons learned, and identify and address gaps in services and referrals. FHI will also provide
capacity-building and technical assistance to other PEPFAR partners in implementing OVC (especially in
the context of home- and community-based care).
This is a continuing activity from FY07. The narrative below is unchanged from the FY07 COP. Major
• Ten VCT clinics have been established using a provider-initiated HIV testing and counseling (PITC) model
in both public and private STI clinics in focus provinces.
• In FY08, same-hour test result notification will be expanded to all eight focus provinces based on the
results of a pilot in 2007.
• Outreach-based VCT will be piloted targeting sex partners and family members of PLWHA in Hanoi in
coordination with PLWHA groups.
• HIV testing - emphasizing prevention counseling and couples counseling - will be scaled up at most at-
risk population (MARP)-friendly drop-in centers in focus provinces in coordination with the PEPFAR
prevention technical working group.
• Three trainings will be held in preparation for the national roll-out of rapid testing, in coordination with
PEPFAR laboratory team, and the National Institute for Hygiene and Epidemiology.
In FY07, PEPFAR will support FHI to train 200 counselors and provide counseling and testing (CT) services
for 16,500 clients at twelve VCT sites in seven PEPFAR focus provinces.
FHI will expand and strengthen CT services in the Network model, strengthen the absorptive capacity of
eight existing CT sites in Hanoi, Haiphong, Quang Ninh and Ho Chi Minh City (HCMC) and develop four
new CT sites in HIV hotspots in Hanoi, Can Tho, An Giang and the seventh PEPFAR focus province. All
sites will be fully integrated into district care out-patient clinics (OPC) and PEPFAR funded drop-in centers
(DIC) and will have strong referral links to all Network model prevention and care and treatment services.
CT counselors will function as case managers, providing client-centered initial and follow-up counseling
services to negative and positive clients, and facilitating client referral to relevant services. Training and TA
will be provided to existing CT sites to restructure counselor workload and to increase their efficiency and
absorptive capacity, particularly in HCMC where thousands of residents from 06 centers, government
centers for rehabilitating drug users (06 centers), will be released by the end of FY07.
FHI will also promote CT among most at-risk populations (MARP). MARP outreach workers and PLWHA
will encourage testing among networks of injecting drug users (IDU), commercial sex workers (CSW) and
their clients, and MSM to prevent infection and to interrupt rapid transmission patterns among the newly
infected, linking them to CT offered in local DICs. CT social marketing and MARP-focused outreach to
reduce stigma and discrimination will increase the awareness of CT benefits while decreasing barriers to
FHI will work with HCMC Provincial AIDS Committee (PAC) to strengthen the referral system between 06
centers, CT, Care and Treatment, and PMTCT by training healthcare workers and developing clear referral
guidance and tools for peer educators (PE), counselors, and case managers.
FHI will form a national cadre of CT counselors. The Anonymous Testing Sites (ATS) and Bach Mai VCT
Centers will provide technical assistance (TA) to developing CT services supported by other PEPFAR
partners. TA services will include study tours, one to two weeks of in-service practicum, supportive
supervision visits to newer VCT sites, and basic and advanced HIV counseling training. Both sites will lead
case consultation meetings for CT counselors.
FHI will also focus on strengthening the national CT program with a view to sustainability. FHI will work with
the Ministry of Health/Vietnam Administration of HIV/AIDS Control (MOH/VAAC) and other partners to
develop a national CT training curriculum based on HHS/CDC guidance and other resources. In addition,
FHI will contribute to the finalization of national CT guidelines and the development of CT SOPs and QA/QC
tools to establish national standards of quality CT services. Capacity building of health providers in CT will
contribute to sustainability of future CT service provision. TA for the development of national counseling and
testing standards will also strengthen national capacity in CT.
changes to this activity since approval in the FY07 COP are:
• In FY08, Family Health International (FHI) will scale up ART in a total of 20 district-level continuum of care
(CoC) adult ART sites across nine of the PEPFAR provinces (five new adult ART sites in FY08). FHI will
provide treatment for a total of 5,458 adults (including 1,073 newly initiating adults).
• Pediatric ART will be scaled up such that 13 of the 20 adult ART sites will offer pediatric ART through a
family-centered care model (seven new pediatric ART sites in FY08). FHI will provide treatment to a total of
207 children by September 2009.
• In FY08 FHI will strengthen the linkage between PMTCT and care and treatment services to enable the
early detection of both pregnant women and infants who need ART for their own health.
• FHI will scale up the number of joint ARV/methadone sites (total number TBD).
• During FY08 FHI will support the development of an advanced adherence training curriculum.
• To date FHI has established eight CoC ART sites which have enrolled a total of 2,265 adults and 41
children on ART (three of the eight CoC sites are currently providing ART to children).
• Using FY07 funding, FHI is currently scaling up adult ART services in a total of 15 CoC sites across the
seven PEPFAR provinces as described in the FY07 narrative. FHI plans to support 4,385 adults (2,120 new
adult individuals) on ART across these 15 adult ART CoC sites. Using FY07 funding, FHI is currently
scaling up pediatric ART in six of the 15 CoC sites and will support 107 children on ART.
FY07 Activity Narrative:
This activity will focus on four main objectives: coverage and access, quality, support for injecting drug
users (IDUs), and capacity building. In FY07, PEPFAR will fund FHI to provide treatment for a total of 3,690
adult and pediatric patients (including 1,900 new patients).
ARV therapy will be provided to adults and children through community-based ART sites providing a
comprehensive package of integrated care, treatment and prevention services. In support of the PEPFAR
strategy of improving support for vulnerable populations, particularly current and past IDUs, the strategy will
focus on client-centered adherence, additional psychosocial and addiction counseling and case
management support to facilitate access to services in the community (key legislative issue: stigma). Family
-centered ART sites will increase access to treatment services for HIV infected mothers and children (key
legislative issue: gender). As of August 2006, FHI is supporting 710 patients on ART in six treatment sites in
three provinces and, in accordance with the PEPFAR geographic scale up and coverage plan, will expand
to 20 sites in seven focus provinces. All new sites will function as district magnet sites covering surrounding
districts linked to community- and home-based care (C/HBC) services in each of the districts. Each site will
be selected in conjunction with the Ministry of Health/Vietnam Administration of HIV/AIDS Control
(MOH/VAAC) and the PEPFAR care and treatment technical working group (TWG).
ARV sites will be supported through training, supportive supervision, and mentoring of a multidisciplinary
out-patient clinic (OPC) team responsible for providing treatment services as well as care and support and
prevention with positives services. Sites will support sustainability by functioning as model training sites for
health care workers at new clinics as Vietnam continues to scale up. In accordance with the PEPFAR SI
plan for monitoring and evaluation, outcomes of the ARV program will be evaluated in some sites, including
clinical outcomes, psychosocial well-being, adherence and patient retention. Program lessons learned will
guide future programming.
In Ho Chi Minh City (HCMC), all FHI-supported ART sites will be linked to 06 centers, which are
government centers for rehabilitating drug users. Case management support and discharge planning will be
provided to 06 center residents, and adherence preparation supported for the sub-set of residents eligible
for ART. FHI will continue to equip case mangers, OPC and HBC teams, peer educators, and PLWHA
groups in Binh Thanh District, District 8, Thu Duc District and Hoc Mon District, to provide appropriate
referral, coordinated care, and intensive adherence support for all clients to be re-integrated into the
FHI will begin implementation of a medication-assisted therapy program in a joint ARV/methadone
substitution therapy program (pending development of VAAC implementation guidelines and approval) in
two provinces. Intensive adherence and psychosocial support will be provided to IDU clients through a
directly assisted therapy program of methadone and ARV therapy with intensive support from OPC
adherence counselors, PLWHA groups, family, and HBC teams where appropriate. FHI will work with
Vietnam CDC Harvard Medical School AIDS Partnership to develop didactic training on ARV-methadone
therapy and will provide ongoing mentorship from experienced providers. This program will be evaluated
and results disseminated as an advocacy tool and to improve methadone/HIV programming both within
Vietnam and across the region.
As a part of PEPFAR/Global Fund (GF) collaboration, FHI will provide intensive mentoring, infrastructure
development and lab monitoring support at two district-based clinics jointly supported by GF. These sites
will be scaled up as "magnet" sites and then taken over by the government of Vietnam with support from GF
Round 6 funding. If Round 6 funding is not approved, FHI will support ongoing services at these two sites.
FHI will continue to provide capacity-building in ART adherence support to VAAC and other PEPFAR
partners for the development of adherence counseling systems to prepare and support PLWHA on ART.
FHI will support VAAC to develop an adherence toolkit for adults and children containing training for
adherence counselors, job aids for counselors, and client information and training in use of the toolkit.
PLWHA support groups will be equipped with the skills and materials necessary to provide treatment
adherence support to members and their families; and provide HBC teams with lay adherence counseling
This is a continuing activity from FY07. The narrative below is unchanged from FY07. Major changes to this
activity since FY07 approval are:
• As a continuation of FY07 support for evaluation of PEPFAR activities in 06 rehabilitation centers, Family
Health International (FHI) will monitor outcomes of the "Integrated HIV and Drug Abuse Prevention, Care
and Treatment Pilot Program in Ho Chi Minh City" to ensure appropriate PEPFAR prevention and care
programs. With clear guidance from both OGAC and the PEPFAR team, FHI will work with local partners to
collect data from center participants returning to the community to collect information on relapse to drug
use, injecting and sexual behaviors, and other health and social outcomes, including quality of life, mental
health, and social integration. Successful interventions in this population will be critical for prevention and
reducing the burden of the epidemic in Vietnam. Rigorous monitoring of these activities will help ensure
• FHI will continue to provide technical assistance (TA) to Vietnam's National Institute of Hygiene and
Epidemiology (NIHE) on the acquisition of improved epidemiologic data on most-at-risk populations
(MARPS), especially injecting drug user (IDU) populations. FHI will continue to explore various options for
better population size estimations, enhancements of Integrated Biological and Behavioral Surveillance
(IBBS) activities, and improved surveillance methodologies. As these specific activities are developed in
conjunction with the PEPFAR prevention, care and treatment, and strategic information (SI) teams, they will
be submitted for human subjects research clearance or non-research determination as appropriate. FHI as
a primary implementer of PEPFAR programs, and NIHE as the government of Vietnam (GVN) agency
responsible for HIV epidemiology are the best suited partners for improving information for program
planning and focus. FHI is the primary SI partner for improving data quality and use capacity amongst local
organizations. These resources will focus on further developing these activities. Considered activities
include measuring incidence and prevalence, assessing risk factors for HIV infection and exposures to
interventions, and evaluation of the effectiveness of interventions in preventing the spread of HIV. In
addition, the evaluation will incorporate BED capture enzyme immunoassay validation.The adjustment
factor derived from the BED assay validation will be applied to sentinel surveillance specimens to obtain
incidence trend data in Vietnam.
• Another component of FHI's strategic information activities is to conduct a survey among long distance
truck drivers and migrant workers, who are potentially high risk groups for HIV infection. A behavioral survey
in 2001 showed that one half of long distance truck drivers and one third of male migrant workers in
Vietnam have had sex with a commercial sex worker (CSW) in the past year. A more comprehensive sexual
risk behavior survey among these groups would help program planners understand the transmission risks of
these potential bridging populations. FHI will partner with local organizations to conduct a cross-sectional
survey among mobile groups in provinces where they can be accessed and provided with interventions.
• FHI will provide TA to NIHE in obtaining population size estimates as needed for program coverage
assessment and planning. A variety of methodologies is currently being piloted and applied to obtain size
estimates of IDU, CSW and men who have sex with men (MSM) populations in the PEPFAR focus
provinces. FHI will work with NIHE to support program areas needing population size estimates, to
potentially include OVC and MARP populations in non-focus provinces where substantial prevention
interventions are planned.
• FHI has contributed to the development of the national monitoring and evaluation (M&E) framework and
will continue to provide TA to VAAC to implement M&E at the central and provincial levels, with particular
attention to data quality assurance. FHI will identify methodologies and approaches to improving data
quality across prevention and care and treatment programs, including standardizing data collection and
quality assurance instruments, and will build local capacity at provincial AIDS centers for conducting data
In the first component of this activity PEPFAR will partner with FHI to collect biologic and behavioral data
among MARPs for appropriate program planning and policy development. In FY05, PEPFAR supported the
Ministry of Health (MOH) to implement an additional round of second generation, integrated biological and
behavioral surveillance (IBBS) among MARPs in the six current PEPFAR focus provinces (Hanoi,
Haiphong, Quang Ninh, HCMC, Can Tho, and An Giang) and Danang. The survey was implemented by FHI
and NIHE, in collaboration with Provincial Preventive Medicine Centers (PMC) and HCMC Provincial AIDS
Committee (PAC), a provincial coordination body. Findings from the survey are being finalized. In FY07,
PEPFAR will support another round of IBBS in previous survey provinces and one new focus province to be
selected in collaboration with MOH. These data will be linked to previous IBBS surveys and will provide
information on impact and outcomes for prevention programs and provide an updated state of Vietnam's
epidemic for focused program planning. The information will also be used to support advocacy and policy
activities. The survey activity will be linked to routine surveillance activities through GVN partners to ensure
continued development of surveillance information systems, methodologies, and skills of public health
personnel. FHI will partner with NIHE to develop a more sustainable behavioral sero-surveillance program
in Vietnam. FHI will provide technical support for the survey and partner with NIHE (for the north) and
HCMC Pasteur Institute (for the south), which will serve as implementing agencies in collaboration with
provincial public health personnel. In the second component of this activity PEPFAR will support FHI to
provide oversight to surveillance of the clients of CSWs. FHI will partner with NIHE to conduct this activity.
This is a particularly hard to identify at-risk population where little information is available on their risk and
estimation of population size. FHI will provide TA to NIHE to develop methodology that will be incorporated
into other routine sentinel surveillance activities and assist with capacity building at NIHE to conduct this
surveillance independently in the future. In the third component of this activity FHI will continue to implement
the Analysis and Advocacy (A2) project funded by PEPFAR from FY 2005 to produce quality data analysis
and synthesis and work in collaboration with Health Policy Initiative (HPI) (related activity HVSI 9369) to
advocate for appropriate responses to the Vietnam HIV/AIDS epidemic. In FY07, FHI will: continue national
and provincial-level data collection so that implication of surveillance, survey, targeted evaluation, and
program assessment results and other data are fully utilized for modeling the HIV/AIDS epidemic, policy
implications and interventions; conduct workshops in collaboration with HPI on the use of data; provide
concrete programmatic implications to the PEPFAR team as well as PEPFAR partners; collaborate with
other international and local partners to continue supporting VAAC in integrated and advocacy under the
Activity Narrative: framework of A2 - this project will utilize the strengths of both VAAC and PEPFAR for the appropriate use of
data in policy-making and intervention development; and apply the A2 framework to implement advocacy
activities in other focus provinces including Hanoi, Quang Ninh, Can Tho and An Giang. The ultimate goals
of this activity are to: 1) provide outcome indicators and coverage information for PEPFAR-supported
prevention programming among MARPs in Vietnam; 2) strengthen the capacity of government staff on data
utilization; 3) provide information to explain changes in HIV prevalence, including the impact of PEPFAR-
funded prevention programming; 4) provide epidemiologic and behavioral data in specialized formats
tailored for advocacy to policymakers; and 5) to develop a clear understanding of the HIV/AIDS epidemic in
Vietnam so that that effective national policies and appropriately targeted programs can be developed.
Finally, FHI will continue to partner with the University Training Center for Health Care Professionals-HCMC
and HCMC PAC in conducting enhanced patient monitoring and quality improvement. The abstraction of
these data from either electronic or hard-copy patient medical records in 4 outpatient clinics in HCMC will
provide information beyond routine patient monitoring important for program planning and continuous
quality improvement. The activities will be coordinated with related activities described under the HCMC
PAC activity narrative (HVSI 9243).