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.
SUMMARY AND BACKGROUND:
PEPFAR will support the Harvard Medical School AIDS Initiative in Vietnam (HAIVN) to work with the
Vietnam Ministry of Defense (MOD) in the training of military physicians and nurses employed by Vietnam's
Ministry of Defense (MOD) to provide Prevention of Mother to Child Transmission (PMTCT) care. In FY07
this activity was implemented by the U.S. Department of Defense (DOD) supported by the University of
Hawaii (UH). Because many of the trainings and workshops were held in Thailand and Hawaii, this
approach was costly and considered unsustainable, as technical advisors and military health professionals
often had to travel overseas. In addition MOD physicians and nurses also received little information about
local PMTCT guidelines and Vietnam's existing civilian services and referral networks.
As a result, this activity with UH as the implementing partner was yellow-lighted by OGAC. In order to
address these issues, in FY09, the in-country PEPFAR team determined that the CDC-supported HAIVN is
the most appropriate partner to ensure that MOD's physicians and nurses will receive the technical
assistance needed to effectively address PMTCT issues in the military community. Where military facilities
lack HIV-related services, MOD physicians will be encouraged to refer patients to civilian sites that already
offer services, including delivery and provision of infant formula.
The DOD in-country staff will actively participate in the PEPFAR care and treatment technical working group
to ensure close interagency coordination and oversight for this activity. In addition, in-country DOD staff will
work closely with the CDC-funded HAIVN to assure that they reach intended clinicians and care centers.
ACTIVITIES AND EXPECTED RESULTS:
HAIVN will be supported to conduct a five day training program on PMTCT. HAIVN will increase the
capacity of 25 military Obstetricians/Gynecologists and nurses through: clinical mentoring; ensuring MOH
guidelines are implemented; ensuring patients are linked to PEPFAR supported voluntary counseling and
testing sites located at the hospital; establishing links to civilian resources.
By the end of FY09, PMTCT services will be established in four Obstetrical/Gynecological clinics located
within the military hospitals that are supported by the PEPFAR Vietnam program. These military hospitals
and their locations are as follows: Hospital No. 103 in Hanoi, Hospital No. 175 in Ho Chi Minh City, Hospital
No. 121 in Can Tho, and Hospital No. 17 in Da Nang.
It is important to note that although military health care facilities are mandated to care for military personnel
and their family members, more than 80 percent of the clients who access their services are civilians.
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Military Populations
Workplace Programs
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $36,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Program Budget Code: 02 - HVAB Sexual Prevention: AB
Total Planned Funding for Program Budget Code: $1,808,397
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
The HIV/AIDS epidemic in Vietnam has historically been fueled by injecting drug use that has concentrated the burden of HIV in
marginalized, high-risk populations in urban centers and along drug transport corridors. PEPFAR-supported biological and
behavioral surveillance (IBBS) has documented HIV prevalence rates as high as 65% among injecting drug users (IDU) in at least
one PEPFAR priority province (Hai Phong), and has revealed that injecting drug use is likely the most important driver of new
infections among sex workers and other high-risk populations. For example, commercial sex workers (CSW) who report injecting
are three to 30 times more likely to be infected with HIV than those who do not, and the prevalence of injecting among CSW is a
strong predictor of HIV prevalence in this population. Overall, national HIV prevalence among populations of CSW is estimated at
about 4%, and the IBBS found HIV prevalence of 9% among men who have sex with men (MSM) in Hanoi and 5% in Ho Chi Minh
City.
Studies suggest that many married and unmarried men in Vietnam pay for sex with partners ranging from street-based sex
workers to women working at guest houses and entertainment establishments. Rapid social and economic change has ignited
hotspots for sexual transmission of HIV in urban settings, and increased migration for work has been accompanied by increases
in the number of entertainment establishments in which men can meet transactional sex partners. A 2004 DKT study found that
90% of mobile men reported having commercial sex, and the 2005 Survey and Assessment of Vietnamese Youth (SAVY) found
that 33% of sexually active urban men between the ages of 14 and 25 reported having had sex with a sex worker. Formative work
by PEPFAR partners suggests that it is not uncommon for urban men - and some women - to remain abstinent until marriage,
and then to have extramarital relationships. A Family Health International (FHI) study in entertainment establishments found that
60 to 70% of married men reported visiting sex workers, usually in the company of peers.
But despite these reports, HIV prevalence in the general adult population in Vietnam has remained low at 0.5% (UNAIDS) - a
figure that is lower than the estimate for the US. While male clients of sex workers are an important target group for efforts to
prevent the diffusion of HIV from high-risk groups to members of the general population, it appears that the kinds of long-term and
concurrent sexual partnerships among both men and women that drive the spread of HIV in the highest prevalence countries are
not sufficiently common in Vietnam to sustain a generalized epidemic. No women, and only 1% of the men, surveyed in the
household-based 2005 Vietnam AIDS Indicator Survey (AIS), reported having more than one sexual partner in the past year,
though these figures likely reflect some social desirability bias resulting in underreporting. A late average age of sexual debut - 20
years for men and 19 for women - may also help to mitigate the risks of sexually transmitted infections among many youth. In the
AIS, less than 1% of never-married 18- to 24-year-old youth reported that they had ever had sex. However, according to the
Vietnam Ministry of Health (MOH), injection drug use accounts for more than 60% of new HIV infections among youth, and alcohol
and other drug use also appear to be important correlates of sexual risk in segments of the urban youth population.
Injecting drug use remains the central focus of USG-supported prevention efforts in Vietnam, but addressing risk behaviors
associated with commercial and transactional sex, MSM, male norms, and alcohol and other drug use, have all emerged as
critical prevention priorities. In addition, ensuring that CSW and other most at-risk populations (MARPs) beyond IDU have access
to addiction-related services - including programs supporting primary prevention of drug abuse, risk reduction, counseling, and
drug treatment - remains an HIV prevention imperative in Vietnam.
The social and geographic concentration of HIV in stigmatized and marginalized populations has prompted the USG and many
other donors to prioritize peer outreach approaches to efficiently bring HIV services to those with the greatest needs. The World
Bank, DfID, Global Fund (GF), and the Asian Development Bank (ADB) all fund peer outreach programming, but with limited
technical support.
However, using even the most conservative estimates of population sizes for MARPs, coverage of basic prevention services
remains low. For example, according to the latest program reports, PEPFAR-supported peer outreach efforts provided education
to a maximum of 31% of the CSW in Hanoi, a priority province. The successful referral of high-risk individuals to HIV counseling
and testing (CT) and other care and treatment services also remains a priority. According to the latest reports, less than 1% of
CSW in Hanoi have received CT. With these data in mind, the PEPFAR team will focus in FY09 on improving the coverage and
quality of services in existing catchment areas, without pursuing additional geographic expansion. In addition, the team will
redouble its efforts to improve CT uptake among MARPs by refining training for outreach workers, further integrating HIV
counseling and testing services in MARPs-friendly settings, expanding the use of provider-initiated counseling and testing
approaches in STI, TB, and methadone sites, and expanding the use of outreach-based HIV counseling and testing to bring
services more directly to high-risk and hard-to-reach populations.
In the initial "emergency" phase of PEPFAR support, the Vietnam team sought to empower peers who are themselves well-
connected to networks of high-risk and marginalized populations to offer or provide referrals to an expanding set of prevention,
care, and treatment services, as well as to play a greater role in program planning and advocacy. Over time, the program has put
mechanisms in place to supplement peer outreach for CSW, MSM, and IDU with: integration of addiction services into
programming for CSW and MSM; provision of outreach-based CT services; community-based drop-in centers offering addictions
counseling, CT, and sexually transmitted infection (STI) treatment; referrals to family planning services to prevent unintended
pregnancy among women at high risk for HIV infection; linkages to outpatient clinics (OPCs) offering a full range of HIV care and
treatment services; integration of intensive case-finding approaches for TB into programming for high-risk populations; and
linkages to community-based care and support.
Looking ahead, the Vietnam team is emphasizing coordination and resource sharing across partners and with other donors to
strengthen service coverage and quality in the face of rising costs and fewer resources. Using the findings from Boston
University's (BU) recently completed evaluation of PEPFAR-supported peer outreach programs as a springboard for action,
PEPFAR continues to work with the Government of Vietnam (GVN) and other partners to support a series of national and
provincial workshops aimed at harmonizing approaches to hotspot mapping and size estimation, peer educator training,
commodities forecasting, program linkages, quality improvement, and monitoring and evaluation systems. The initial national
workshop was viewed as such a success that the MOH issued formal guidance codifying the workshop findings as
recommendations for conducting peer outreach efforts in Vietnam. Furthermore, the GVN has embraced PEPFAR-supported peer
outreach coordinators in PEPFAR priority provinces as formal focal points for local coordination, and is encouraging other donors
to support these positions in additional provinces.
Sex work is illegal in Vietnam, and government campaigns aimed at curtailing sex work have both made formal brothels rare, and
have caused the venues in which sex workers meet prospective clients to evolve rapidly. Street and scooter-based sex work is
now prevalent in urban centers, and PEPFAR partners are finding that the utility of peer outreach is limited by the independence
and high mobility of street- and scooter-based sex workers. To improve partner capacity to implement tailored strategies to
address the diverse needs of sex workers, PEPFAR will continue support for an assessment of targeted intervention approaches
to address the many forms of transactional sex in Vietnam, and particularly the needs of CSW who use drugs.
Entertainment establishments have also become common venues for sex workers and their clients to meet in Vietnam, but
ensuring access to prevention education and commodities in these settings remains challenging given owners' fear of police
scrutiny. Condoms are often unavailable at critical non-traditional outlets such as guest houses and karaoke bars. To supplement
peer outreach efforts, expanded condom social marketing programming through Population Services International (PSI) will raise
risk perceptions associated with multiple sexual partnerships and transactional sex, and will improve access to condoms and risk
reduction education in non-traditional venues. PEPFAR will continue to supply condoms for free distribution and social marketing
through the Condoms Commodities Fund. Through UNODC, the Ministry of Public Security (MOPS) will initiate education
programs for police and public security, to foster their support for the delivery of prevention services in key establishments and
among most at-risk populations. Through new awards, Abt Associates will draft national guidance for implementation of the 100%
Condom Use Program in entertainment establishments and will pilot this program in An Giang province. Chemonics will enhance
peer education programming for beer promoters and other women and men who may engage in transactional sex and will also
serve as a new technical focal point for identifying best practices in economic rehabilitation programming for former sex workers
and recovering IDU.
Complementing existing programs for sex workers, a consortium led by PSI will refine an outreach and media-based campaign
aimed at addressing risky male norms and promoting partner reduction and correct, consistent condom use for male clients of sex
workers. This initiative will also work in entertainment establishments to mitigate the HIV risks associated with alcohol use. In
addition, FHI will hone its efforts to address HIV risks faced by truckers and transport workers, and will build upon an assessment
conducted in FY08 to implement a cross-border program with the PEPFAR Cambodia team to address the needs of Vietnamese
women who engage in transactional sex along the border and in Phnom Penh.
Limited information is available on the diversity and size of the MSM population in Vietnam, but PEPFAR is working to address
this gap through strategic information activities, including the inclusion of MSM in future rounds of the IBBS. In FY09, FHI will
continue to innovate to better understand and address the needs of hard-to-reach and diverse MSM populations through
outreach, interventions in MSM-friendly entertainment establishments, and the implementation of a popular web-based
intervention providing education, counseling, and service referrals to MSM. UNAIDS will complement FHI's efforts by building the
capacity of MSM groups to implement sustainable prevention programming, and to engage in advocacy for access to HIV-related
services. This programming will also be expanded in FY09 to support advocacy networks for CSW and recovering IDU, to realize
the leading role these traditionally marginalized individuals can and should play in establishing national and local priorities for
action.
To mitigate HIV risk among youth, the Vietnam team will support two efforts: first, a partnership through Pact, Inc. with Save the
Children US that emphasizes preventing sexual and drug use related risks among street youth, orphans, and youth in vocational
training institutions. This effort will address gender norms that contribute to young men's HIV risk and will also integrate
assessments to identify the characteristics of youth that are most likely to initiate or engage in sexual or drug-using risk behavior.
Second, a relatively small investment in supporting the integration of HIV prevention education into secondary school curricula in
support of the Ministry of Education and Training should help to reinforce and maintain a low level of risk behavior among a large
segment of the youth population in Vietnam. This programming complements a five-year ADB project supporting media and
community-based interventions for mainstream and higher-risk youth.
Positive prevention will be addressed by continuing to mainstream prevention activities into care and treatment efforts, including
the integration of specific risk reduction counseling for HIV-infected individuals and discordant couples into HIV counseling and
testing services. Abt will also build the capacity of members of PLHIV groups to provide prevention counseling and services in
community settings to PLHIV and their family members and peers.
To address a key programming gap in Vietnam, PEPFAR will provide new support to UNODC in FY09 to expand access to HIV-
related services among prison populations in Vietnam. Although little is known about HIV prevalence rates in prisons in Vietnam,
many prisons house large populations of individuals who were convicted of drug- and/or sex work-related offences, and few HIV-
related services are available in prison settings. UNODC will work with MOPS to develop national guidelines for providing drug
treatment and HIV services in prison settings; training prison staff; and piloting services in one or two prisons in PEPFAR focus
provinces.
With DOD support in FY09, a bio-behavioral survey on sexual and drug risks in the military will be conducted to inform future
investments in strategic HIV prevention programming for this population.
To ensure access to comprehensive programming among MARPs in Vietnam, all HVAB activities will also receive HVOP funding.
For the purposes of assessing program coverage, partners have been asked only to count individuals reached via interactive one-
on-one and small group educational approaches towards direct targets. FY09 targets have been established according to the
proportion of effort partners are devoting to activities that are split-funded across the HVAB, HVOP and IDUP budget codes. The
introduction of the new IDUP budget code - with no accompanying targets - may make it appear that the PEPFAR program in
Vietnam is reaching fewer individuals, because so many individuals previously counted as beneficiaries of HVOP programming
were IDU. However, we have tried to provide targets for IDUP activities in that section of the COP to mitigate this perception.
Table 3.3.02:
In FY08, the Harvard Medical School AIDS Initiative in Vietnam (HAIVN) worked with the Ministry of
Health's Vietnam Administration for HIV/AIDS Control (VAAC) to develop a national-level curriculum and
strategy for training physicians and nurses on HIV/AIDS care and treatment. Training of the trainer (TOT)
courses were conducted for physician trainers in Hanoi and Ho Chi Minh City (HCMC). With FY09 funding,
HAIVN will continue to support VAAC and the provincial AIDS centers (PACs) in PEPFAR focus provinces
to implement the training strategy. This activity will build a sustainable national team to provide training to
physicians in HIV/AIDS clinics to support the ongoing scale-up of HIV/AIDS care and treatment in Vietnam.
The team will provide initial trainings and regular follow-up workshops to provide continuing medical
education and retraining. HAIVN will also work with VAAC and regional and provincial trainers to provide
regular updates to physicians through workshops, newsletters, the Internet, and other educational
resources.
In addition to didactic training activities, HAIVN staff will work with partner agencies in each of the provinces
that receive PEPFAR-funded medications in order to provide on-site clinical mentoring and quality of care
supervision at more than 40 HIV/AIDS outpatient clinics (OPCs) supported by PEPFAR and MOH. At the
regional level, partner agencies include the National Institute for Infectious and Tropical Diseases (NIITD) in
Hanoi and the Tropical Disease Hospital in HCMC. At the provincial level, HAIVN will partner with provincial
general hospitals in the seven PEPFAR-focus provinces to support clinical care activities at district-based
OPCs and in adjacent provinces.
At the national level, HAIVN will continue to partner with VAAC to complete the development of the
HIV/AIDS care and treatment clinical training curriculum. The curriculum will be updated as needed in
response to new information and changes in Vietnam's national guidelines and protocols. HAIVN will
continue to provide technical assistance to VAAC and other partners on clinical issues, including care and
support, antiretroviral treatment (ART), TB/HIV, and the prevention of mother-to-child transmission
(PMTCT). HAIVN will continue to work with the VAAC care and treatment department to monitor the quality
of clinical care and support services throughout the country.
In Hanoi, HAIVN will partner with NIITD to provide clinical training on HIV/AIDS care and support at the
national, regional, and provincial levels. A new director took control of NIITD in October 2008 and is
enthusiastic about building the capacity of the organization to provide training on HIV/AIDS care and
treatment. This will present a new opportunity to build the institution into the national leader in HIV/AIDS
clinical training. NIITD will provide TOT courses to expand the number of physicians qualified to teach in
clinical training courses on HIV/AIDS throughout the country. At the regional level, NIITD will support
HIV/AIDS training courses on HIV/AIDS care and support in Hanoi and the northern provinces. NIITD will
also be responsible for providing baseline and refresher training to all physicians working in PEPFAR-
supported and other donor-supported HIV outpatient clinics in this region. At the city level, NIITD will
organize regular clinical conferences and will provide consultation services for patients with complex
medical problems or ARV treatment failure.
In HCMC, HAIVN will continue to partner with the HCMC Provincial AIDS Committee (HCMC PAC) and the
Tropical Disease Hospital to support the city-wide HIV network. The HIV network implements training
courses, provides clinical consultations, and supervises the quality of clinical care in the city and in the
southern provinces.
HAIVN will also partner with HCMC PAC to develop human resource capacity to deliver palliative care
services at the Nhan Ai Hospital, a hospice for HIV-infected patients. By September 2008, Nhan Ai had 70
patients. In FY09, the hospital is scheduled to receive up to 300 patients and will implement ARV treatment
in addition to palliative care.
In both Hanoi and HCMC, clinical electives will be offered for small groups of medical students in their final
year of school. The electives are designed to provide short but intensive training in HIV/AIDS clinical care.
One of the goals is to increase the number of physicians who choose to work in HIV clinics after graduation.
HAIVN will continue to support VAAC and the Vietnam Nursing Association (VNA) to provide training for
nurses on basic and advanced HIV/AIDS care. In previous years, 65 nurse trainers have completed the joint
PEPFAR-supported Vietnam Nursing Association (VNA)-Harvard Medical School Training-of-trainers (TOT)
nursing program. In FY08, HAIVN supported VNA to complete a national curriculum for nursing training on
HIV/AIDS. Programming in FY09 will continue to build nursing capacity in the provinces by providing
curriculum, training materials, and technical and financial support to implement training that will benefit
approximately 500 nurses.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15265
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15265 5519.08 HHS/Centers for To Be Determined 7106 3096.08 VCHAP Follow-
Disease Control & on
Prevention
9551 5519.07 HHS/Centers for Harvard 5178 3096.07 VCHAP $700,000
Disease Control & University, Medical
Prevention School - Division
of AIDS
5519 5519.06 HHS/Centers for Harvard 3096 3096.06 VCHAP $200,000
Estimated amount of funding that is planned for Human Capacity Development $400,000
Table 3.3.08:
PEPFAR will support the Harvard Medical School AIDS Initiative in Vietnam (HAIVN) to assist the Ministry
of Health (MOH) and the Ministry of Defense (MOD) to train physicians and nurses to provide adult
antiretroviral treatment (ART) and antiretroviral services. HAIVN will support MOH's Vietnam Administration
for HIV/AIDS Control (VAAC) and provincial AIDS centers (PACs) as well as MOD's treating Military
Hospitals to build a sustainable model to provide training on HIV/AIDS care and treatment to health care
workers as the program continues to expand. This will be accomplished through: 1) providing technical
assistance to VAAC on the development of curriculum and training materials for physicians and nurses; 2)
supporting training to health care workers in ART clinics supported by PEPFAR and other donors; 3)
providing regular clinical mentoring at PEPFAR-supported outpatient clinics (OPCs); 4) supporting capacity
building at local tertiary care and provincial-level institutions to assume a greater role in providing training
and supportive supervision; and 5) providing educational support and regular clinical updates to physicians
and nurses through workshops, newsletters, website resources, and/or clinical manuals.
At the national level, HAIVN has worked with VAAC to develop a national training curriculum for doctors
working at the provincial and district levels. Training of the Trainer (TOT) workshops are being held in FY08
to train those who will lead the workshops. HAIVN will continue to work with VAAC to update training
materials to reflect new information on ARV drugs and to respond to changes in Vietnam's national
guidelines and protocols. Additional TOT workshops will be held in Hanoi and Ho Chi Minh City (HCMC) to
increase the number of qualified trainers. HAIVN will also continue to provide technical assistance to
VAAC's technical working groups, including Adult Care and Treatment, Prevention of Mother-to-Child
Transmission (PMTCT), and Pharmacy and Therapeutics.
At the regional level, HAIVN will continue to work with the two highest-level tertiary care hospitals in
Vietnam: the National Institute for Infectious and Tropical Diseases (NIITD) in Hanoi and the Tropical
Disease Hospital (TDH) in HCMC. Each hospital will implement ART training courses for physicians using
the national curriculum. HAIVN will work with each institution to train their staff and build their capacity for
providing clinical training and supervision at the provincial and regional level. In addition to training courses,
the two hospitals will provide consultation services on clinical management of ARV patients and quality
assurance activities on clinical care to provincial and district clinics in their region. Technical support will be
provided to develop capacity for distance consultation and training activities in order to allow more frequent
communication and build stronger linkages between the regional facilities and provincial clinical experts.
HAIVN will support training and clinical mentoring activities in each of the provinces that receive ARV drugs
procured by PEPFAR. In the seven PEPFAR focus provinces, HAIVN will work with PACs and the provincial
-level hospitals to support clinical training and the supervision of ARV services within each province. The
long-term goal is to build capacity at the provincial level for providing training, clinical consultation, and
quality of care supervision to district-level HIV OPCs. Where appropriate, provincial hospitals will also link
with adjacent provinces to provide these support services to areas with less capacity and fewer resources.
Advanced training activities will be offered to key personnel at provincial hospitals in order to improve their
knowledge on ART and to build linkages between the provincial and regional experts. In non-PEPFAR-
focus provinces that receive ARVs through the PEPFAR program, HAIVN will provide regular clinical
mentoring on ART to new sites as they begin to implement ART programs. As each site gains more
experience, they will be expected to offer clinical mentoring to, and supervision of, less-experienced
provincial and regional institutions.
HAIVN will partner with the Vietnam Ministry of Defense (MOD) to support ART services at four established
outpatient clinics (OPCs) located within the infectious disease departments of military hospitals in Hanoi,
HCMC, Da Nang and Can Tho. Similar to the activities taking place at civilian sites, HAIVN will: support
training and clinical mentoring activities in order to build capacity and a sustainable TOT workforce; ensure
that MOD sites follow MOH treatment guidelines; and help MOD sites link to civilian resources. It is
important to note that although military health care facilities are mandated to care for military personnel and
family members, approximately 80 per cent of the clients who access services are civilians.
Continuing Activity: 15266
15266 5831.08 HHS/Centers for To Be Determined 7106 3096.08 VCHAP Follow-
9394 5831.07 HHS/Centers for Harvard 5178 3096.07 VCHAP $1,101,222
5831 5831.06 HHS/Centers for Harvard 3096 3096.06 VCHAP $230,000
Estimated amount of funding that is planned for Human Capacity Development $431,700
Table 3.3.09:
The Harvard Medical School AIDS Initiative in Vietnam (HAIVN) will work with the Vietnam government and
selected partner agencies to help meet the Ministry of Health's (MOH) objective of providing antiretroviral
treatment (ART) to 100% of children who meet the clinical criteria by 2010. In collaboration with the Clinton
HIV/AIDS Initiative (CHAI), technical assistance will be provided to the Vietnam Administration for HIV/AIDS
Control (VAAC), to develop a national training curriculum on pediatric HIV care and treatment. This will
incorporate the new Vietnam HIV/AIDS treatment guidelines, which are to be released at the end of 2008.
VAAC will disseminate the guidelines, and provide baseline training on the new rules, to physicians
providing pediatric ART in Hanoi, Ho Chi Minh City (HCMC), and other locations to be determined.
HAIVN will provide regular clinical mentoring and technical assistance on ART to three tertiary referral
pediatric hospitals: the National Pediatrics Hospital in Hanoi and Pediatric Hospitals No. 1 and No. 2 in
HCMC. These hospitals will assume responsibility for providing consultation services and quality of care
supervision to pediatric HIV outpatient clinics (OPCs) at the provincial and district levels. HAIVN will support
monthly clinical pediatric HIV conferences in Hanoi and HCMC to update clinical care issues, provide
consultation on difficult cases, and coordinate pediatric care activities.
Pediatric HIV experts on the HAIVN staff will provide regular clinical mentoring to provincial-level facilities
that offer HIV care to children in the PEPFAR-focus provinces and in other provinces as requested by MOH.
Technical assistance on HIV care for orphans and vulnerable children (OVC) will be provided at one
orphanage in HCMC, Tam Binh No. 2 Center, and the Mai Hoa Hospice in HCMC.
HAIVN will work with the Vietnam Nursing Association (VNA) to provide training for nurses on HIV care for
children and for OVC. Specific training modules and materials will be developed for use with the VNA
HIV/AIDS nursing training curriculum.
Health-related Wraparound Programs
* Child Survival Activities
Estimated amount of funding that is planned for Human Capacity Development $100,000
Table 3.3.10:
1) COP09 narrative
HIV/AIDS Initiative (CHAI), technical assistance will be provided to the MOH/Vietnam Administration for
HIV/AIDS Control (VAAC), to develop a national training curriculum on pediatric HIV care and treatment.
This will incorporate the new Vietnam HIV/AIDS treatment guidelines, which are to be released at the end of
2008. VAAC will disseminate the guidelines, and provide baseline training, to physicians providing pediatric
ART in Hanoi, Ho Chi Minh City (HCMC), and other locations to be determined.
HCMC. These hospitals already provide ARV services to over 600 children, more than half of all children on
ART in Vietnam. With HAIVN support, these hospitals will provide consultation services and quality of care
supervision to pediatric HIV outpatient clinics at the provincial and district levels.
that offer ARV services to children in the seven PEPFAR-focus provinces and in other provinces as
requested by MOH. Technical assistance for ART to OVC's will also be provided at one orphanage, Tam
Binh No. 2 Center, and the Mai Hoa Hospice in HCMC.
HAIVN will continue to collaborate with CHAI on training curriculum development, technical assistance to
PEPFAR and MOH-funded sites, and clinical mentoring under the auspices of MOH/VAAC. HAIVN will
continue their facilitating roles for a monthly pediatric workshop at Pediatrics Hospital #1 in HCMC, and for a
case conference at Bach Mai hospital in Hanoi. HAIVN will also continue to facilitate a clinical information-
sharing network.
2) COP 08 narrative
This is a continuing activity from FY07.
In FY08, PEPFAR will release a Request for Applications (RFA) to follow on the work done by Harvard
Medical School through the Vietnam-CDC-Harvard Medical School AIDS Partnership (VCHAP) to provide
training, supportive supervision, technical assistance and capacity building on HIV/AIDS palliative care. The
current agreement will end in April 2008. Technical assistance (TA) includes taking part in regular meetings
and working groups, providing assistance with guidelines and protocol development, and developing and
implementing training activities related to clinical care. VCHAP currently provides training support in ARV
treatment, nursing care, palliative care, methadone/addiction medicine, pediatrics.
VCHAP worked with the Ministry of Health/Vietnam Administration for HIV/AIDS Control (MOH/VAAC) in
2007 to develop a national level curriculum and strategy for training physicians and nurses on HIV/AIDS.
With FY08 funding, Partner TBD will continue to support VAAC and the provincial AIDS centers (PACs) in
the PEPFAR focus provinces to implement the training strategy. This activity will build a sustainable national
team to provide training on HIV/AIDS palliative care to physicians in new clinics to support the ongoing
scale up of HIV care and treatment in Vietnam. The team will provide initial trainings and regular follow-up
workshops to provide continuing medical education and re-training. Partner TBD will also work with VAAC
and provincial trainers to provide regular updates to physicians through forums such as workshops,
newsletters, web site resources, and/or clinical manuals.
In addition to didactic training activities, Partner TBD staff will work with partner agencies in each of the
PEPFAR focus provinces to provide regular on-site clinical mentoring at more than 30 HIV out-patient
clinics (OPCs) supported by PEPFAR. These sites include the two highest-level tertiary care hospitals in
Vietnam: The National Institute for Infectious and Tropical Diseases in Hanoi and the Tropical Disease
Hospital in Ho Chi Minh City (HCMC). Partner TBD will also be available to provide TA at non-PEPFAR
sites if requested by VAAC.
Partner TBD will continue to support the VAAC and the Vietnam Nursing Association (VNA) to provide
training for nurses on basic and advanced HIV/AIDS care. Nursing courses will be led by nurses who have
completed the VCHAP training of trainers (TOT) nursing program. Programming will continue to build
nursing capacity in the provinces through provision of the curriculum, training materials, and technical and
financial support for implementing the nurse training benefiting approximately 500 nurses. Partner TBD will
work with medical and nursing universities to establish a pre-service delivery program for students to
acquire more focused training on HIV prior to graduation.
Partner TBD will continue to support the development of palliative care as a medical specialty in Vietnam.
Through partnerships with the National Cancer Hospital, Department of Therapy (DOT) of the MOH, and
PEPFAR partners (USAID, Family Health International), a three-month Palliative Care certification program,
which began with the first six trainees in FY07, will be expanded to 12 trainees in FY08. Additional training
courses will be held to teach palliative care to 70 HIV/AIDS and cancer physicians in the PEPFAR focus
provinces. Partner TBD will also continue to provide TA to the DOT on palliative care, including the rational
use of opioid medications and advocating for changes in the opioid control regulations to allow greater use
of pain control medications for HIV-infected patients and cancer patients.
Methadone maintenance treatment is scheduled to be available by the beginning of 2008. Partner TBD will
assist the MOH in developing and implementing the training curriculum for healthcare workers assigned to
the methadone clinics. In FY08, Partner TBD will continue training and clinical mentoring on opioid
substitution therapy and will provide additional training and onsite mentoring as the number of methadone
clinics expands.
Table 3.3.11:
Vietnam Ministry of Defense (MOD) in the training of military physicians and nurses to provide TB/HIV care.
In FY07 this activity was implemented by the U.S. Department of Defense (DOD) supported University of
often had to travel overseas. In addition, MOD physicians and nurses received little information about local
TB/HIV guidelines and Vietnam's existing civilian services and referral networks. As a result, this activity
with UH as the implementing partner was yellow-lighted by OGAC. In order to address these problematic
issues, in FY09, the in-country PEPFAR team determined that the CDC-supported HAIVN is the most
appropriate partner to ensure that MOD's physicians and nurses will receive the technical assistance and
support needed to effectively address TB/HIV issues in the military community. Where military facilities lack
HIV-related services, MOD physicians will be encouraged to refer patients to civilian sites that already offer
services.
HAIVN will be supported to conduct a five day training program on TB/HIV. HAIVN will increase the capacity
of 25 military TB physicians and nurses working in infectious disease departments through: clinical
mentoring; ensuring MOH guidelines are implemented; ensuring patients are linked to PEPFAR supported
voluntary counseling and testing sites located at the hospital; establishing links to civilian resources.
By the end of FY09, TB/HIV services will be established in four TB clinics located within the infectious
disease department of the military hospitals that are supported by the PEPFAR Vietnam program. These
military hospitals and their locations are as follows: Hospital No. 103 in Hanoi, Hospital No. 175 in Ho Chi
Minh City, Hospital No. 121 in Can Tho, and Hospital No. 17 in Da Nang.
* TB
Table 3.3.12:
