PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
During FY07 and FY08 FHI had to revise down the number of PMTCT sites that it supports due to a variety
of factors including:
1) presence of other partners supporting PMTCT activities
2) geographical location - in district sites located close to a provincial PMTCT program it was decided that it
was not efficient or cost -effective to establish district level PMTCT services and
3) capacity of the site to provide PMTCT services. By the end of COP08-FY08 FHI supported six district
level PMTCT sites including Tan Chau, Tien Bien and Cho Moi in An Giang, Van Don and Mon Cai in
Quang Ninh and the Provincial Hospital in Lao Cai.
During FY08 a total of 1200 women received counseling and testing and 44 mother-infant pairs received
ART prophylaxis and follow up care.
In COP09 FHI will continue to support PMTCT activities in the above six sites through support for PMTCT
programs integrated into family-centered care out-patient clinics linked to counseling and testing services,
commune health stations, CHBC and district/provincial OBGYN departments. In FY09 FHI will support the
establishment of new PMTCT services in a total of 3 sites; two districts in Nghe An (Dien Chau district and 1
district TBD) and a district TBD in Dien Bien making a total of nine PMTCT sites supported by FHI. During
FY09, FHI will focus on improving quality of PMTCT services in all sites with in-service training, on the job
mentoring and QA/QI. FHI will focus efforts on improving access of women to PMTCT services by
supporting the development of strong referral links between PMTCT services at the commune and district
level, the district ante-natal and pediatric clinics and the district HIV out-patient clinic. CHBC teams will also
be trained in how to provide follow-up services to women/couples receiving PMTCT services. All pregnant
women will be assessed for their nutrition status and appropriate food interventions provided that are in
keeping with OGAC guidance on food and nutrition programs. Nutrition counseling and education including
safe infant feeding counseling, education and support will be integrated into all PMTCT programs.
FHI will work closely with key partners to provide high quality PMTCT services, in particular the MOH, US-
CDC, SCMS and UNICEF. This will include the revision and development of SOPs, training packages and
services systems including the possible use of DBS for PCR.
COP08 narrative
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-
Life GAP 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.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16393
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16393 16393.08 U.S. Agency for Family Health 7104 3107.08 $210,000
International International
Development
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Safe Motherhood
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
INTERVENTIONS FOR MEN WHO HAVE SEX WITH MEN (MSM): $84,622
FHI will continue to train health educators and peer educators to deliver effective AB messages as part of a
comprehensive ABC strategy for MSM in the six current sites in PEPFAR focus and selected provinces.
Outreach teams will incorporate AB messages, including partner reduction, in daily contacts with MSM and
where possible with peers and family members. Outreach workers will be trained to help clients develop
strategies to reduce risk of HIV transmission. BCC materials stressing similar messages will be distributed
appropriately. Additional risk reduction counseling, HIV counseling and testing, STI services and referrals
to substance abuse treatment will be available at MSM oriented drop-in centers.
FHI will continue to provide technical assistance to support the maintenance of the MSM internet-based
forum and website (http://adamzone.vn and http://naman.vn) which are managed by local organizations
(T&A Communications and Consultation of Investment in Health Promotion—CIHP). These websites
extend their reach to discrete MSM nationwide and will include discussions on being faithful and partner
reduction as part of its comprehensive ABC 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.
Number of individuals reached through community outreach that promotes HIV/AIDS prevention through
abstinence and/or being faithful: 5,000
Number of individuals trained to promote HIV/AIDS prevention programs through abstinence and/or being
faithful: 50
TRUCKERS INTERVENTION: $33,226
FHI, with its partners, will continue to strengthen two existing trucker interventions in HCMC, Hanoi, border
gates (such as Quang Ninh), The messages developed for these interventions focus on health and family
and include key themes of remaining faithful to a single partner.
A cross-sectional survey of truckers' risk behaviors will guide many aspects of the intervention. Regular
mapping of truck stops will guide the outreach interventions and distribution of targeted BCC messages.
Collaboration with petrol vendors, drink vendors and entertainment establishment owners to gain their
interest in and support for the interventions will be an integral part of the work. Similarly, collaboration with
other organizations, projects and community leaders will serve to expand coverage and strengthen referral
linkages.
abstinence and/or being faithful: 30,000
faithful: 70
PROVINCIAL OUTREACH COORDINATORS: $96,399
HVAB funding will support PEPFAR Outreach Coordinators housed in the Provincial AIDS Centers (PACs)
in nine strategic provinces where they will: 1) coordinate all PEPFAR Outreach/BCC activities and; (2)
ensure the coordination of PEPFAR activities with those sponsored by the government and other donors at
the provincial level. The outreach coordinators will serve as focal points for all outreach/BCC including, but
not limited to, injecting drug users (IDU), commercial sex workers (CSW), and MSM as well as coordinating
referrals to prevention, care and treatment and an increasing array of drug and alcohol abuse treatment
services in the province.
In order to ensure outreach coordinator effectiveness, FHI will continue to provide training in data
management, analysis and application. The provincial outreach coordinators will facilitate regular meetings
among PEPFAR and other implementation and management staff to 1) ensure consistent AB prevention
messages are mainstreamed; 2) facilitate donor efforts to avoid overlaps; and 3) maximize coverage of
target populations. They will facilitate ongoing monitoring and evaluation of outreach programs in the
provinces and ensure its integration into the provincial outreach plan.
abstinence and/or being faithful: N/A
faithful: 10
Continuing Activity: 15252
15252 9480.08 U.S. Agency for Family Health 7104 3107.08 $222,561
9480 9480.07 U.S. Agency for Family Health 5164 3107.07 Family Health $255,000
International International International
* Addressing male norms and behaviors
Estimated amount of funding that is planned for Human Capacity Development $100,000
Table 3.3.02:
INTERVENTIONS FOR MEN WHO HAVE SEX WITH MEN (MSM): $727,549
FHI will continue to support behavior change communication, STI interventions and referral to VCT and HIV
care and treatment for MSM in 6 current sites in PEPFAR focus and selected provinces and the
maintenance of the current internet-based forum and website. The program employs 5 complementary
strategies including outreach, drop-in centers, "MSM-friendly" services, community advocacy and
mobilization, and internet-based efforts. Programs will continue to target MSM at entertainment
establishments (e.g., massage parlors, saunas, bars), most at-risk MSM (e.g., male sex workers and MSM
using or injecting drugs), and hard-to-reach MSM including those who are isolated, non-gay identified and
married. In addition, FHI will work closely with PEPFAR condom social marketing partner PSI to accurately
forecast need for and distribution of PEPFAR supplied male and female condoms and water based
lubricant. FHI MSM prevention interventions will promote correct consistent condom use and will ensure
timely commodity distribution in target areas.
FHI will continue to provide technical assistance to support maintenance of the MSM internet-based forum
and websites (http://adamzone.vn and http://naman.vn) which are managed by local organizations (T&A
Communications and Consultation of Investment in Health Promotion—CIHP). These websites aim to
reach discrete 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. Approximately
50 individuals involved in administering and moderating the forum and website will be trained to provide on-
line counseling, and an estimated 5,000 individuals will be reached. FHI will work closely with T&A and
CIHP to build capacity and sustainability.
In FY 09 FHI will provide technical assistance and build capacity of local organizations including
government, NGOs and CBOs. This will include adaptation of training curricula, in-service training,
mentoring and technical assistance to intervention sites beyond FHI-supported implementing agencies. FHI
will also support formation of one-to-two local NGOs or CBOs, operated by and for MSM in Vietnam. FHI
will continue to advocate for MSM programming in the national HIV/AIDS strategic plan and to address
stigma and discrimination towards MSM.
Number of targeted condom service outlets: 65
behavior change other than abstinence and/or being faithful: 27,000
Number of Individuals trained to promote HIV/AIDS prevention through behavior change other than
Abstinence and/or being faithful: 200
INTERVENTIONS FOR COMMERCIAL SEX WORKERS (CSW): $813,426
With FY09 funding, FHI will continue to support high quality comprehensive outreach services for sex
workers and to maintain the successful "one-stop-shop" model of drop-in centers where women receive HIV
prevention information, condoms, STI treatment, VCT and referral to drug addiction counseling and HIV
care, treatment and social support. Recognizing the strong correlation of drug injection and HIV prevalence
among sex workers, FHI will prioritize reaching women doubly at risk of HIV transmission through drug use
and sex work.
Fresh interactive educational and motivational materials will ensure women do not become weary of
standard prevention messages. New mobile models of VCT and STI treatment will ensure treatment for
women who live far from static service sites, or have concerns about visiting a drop-in center associated
with sex work. To ensure adequate condom stocks at each intervention site, FHI will designate key staff in
each province to work closely with PEPFAR condom social marketing partner PSI. These staff will maintain
responsibility for submitting quarterly reports for PSI to accurately forecast need for and distribution of
PEPFAR supplied male and female condoms and water based lubricant. FHI CSW prevention interventions
will promote correct consistent condom use and will ensure timely distribution with focus on entertainment
establishments.
The FHI internal mandate to build capacity of local agencies to implement, manage and monitor CSW
interventions will be applied in all CSW service sites. In service of this goal, FHI will build capacity with
mass organizations such as the Women's Union and NGOs. These organizations will also receive technical
assistance to provide vocational training and job placement opportunities for women who want to leave sex
work.
Number of targeted condom service outlets: 435
behavior change other than abstinence and/or being faithful: 37,700
Abstinence and/or being faithful: 273
CAMBODIA CROSS BORDER INTERVENTION: $208,463
A recent rapid assessment suggests that several thousand Vietnamese women migrate to Cambodia each
year for short term work in casinos or as sex workers in various entertainment establishments. Evidence
further suggests that infection among relatively young and inexperienced women occurs more frequently
during the early period of sex work. The potential HIV infection risk is clear, but is it less clear how
Vietnamese women can be efficiently and effectively reached in the border area of Svay Rieng (Cambodia).
Casino staff work long hours and are tightly controlled by casino managers; they report reluctance to attend
group or formal peer education sessions during their spare time. Language barriers (and also possible legal
status issues) make effective outreach problematic for Vietnamese women in this area and in the brothels
and entertainment venues in Phnom Penh.
FHI/Vietnam and FHI/Cambodia will work with FHI/Cambodia's implementing partners (Reproductive Health
Association of Cambodia and the Cambodian Red Cross and other partners) to recruit, support, train and
supervise Vietnamese-speaking outreach workers and health care staff to serve Vietnamese commercial
Activity Narrative: sex workers and "entertainment workers" in Bavet town, Phnom Penh and 1 TBD province (identified
through COP 08 work). Vietnamese-speaking outreach workers and peer educators will reach both
community-based and casino-based sex worker/entertainment workers. An important component of the
outreach will be the design, development, production and wide distribution of HIV, reproductive health and
other health-related information. The outreach workers will be active participants in the design and
development of the BCC materials in order to ensure appropriate targeting. Such information will be both
print and electronic and will be available on both sides of the border—particularly those areas that appear to
be active source communities. FHI Cambodia's implementing partners will offer Vietnamese female sex
workers and their partners friendly VCT and STI services in Vietnamese language and refer them to
accessible care and treatment.
Number of targeted condom service outlets: 44
behavior change other than abstinence and/or being faithful: 1,500
Abstinence and/or being faithful: 39
TRUCKERS INTERVENTIONS: $286,252
FHI, with its partners, will continue to strengthen existing trucker interventions in HCMC, Hanoi, and border
gates such as Quang Ninh. These interventions for truckers aim to reduce commercial sex uptake and
promote safer sex behaviors and health seeking behaviors. They include condom promotion at trucking
rest-stops near commercial sex areas, diagnosis and treatment of STIs, and access to counseling and
testing.
A cross-sectional survey of truckers' risk behaviors and service utilization will guide the intervention and
provide evaluation data. Regular mapping of truck stops will guide the outreach interventions and
distribution of targeted BCC messages. The outreach interventions for truckers will closely cooperate with
interventions for FSWs in the same locations. The trucker interventions in Mong Cai district, Quang Ninh,
Hanoi and HCMC will be integrated with FSW interventions in the same locations. Collaboration with petrol
vendors, drink vendors and entertainment establishment owners to gain their interest in and support for the
interventions will be an integral part of the work. Collaboration with other organizations, projects and
community leaders will serve to expand coverage and strengthen referral linkages.
Number of targeted condom service outlets: 109
behavior change other than abstinence and/or being faithful: NA (to be reported in HVAB)
Abstinence and/or being faithful: NA (to be reported in HVAB)
HVOP funding will support PEPFAR Outreach Coordinators in nine provinces where the country's epidemic
is most severe. Provincial outreach coordinators will focus on the following: (1) coordinate all PEPFAR
Outreach/BCC activities; and (2) ensure the coordination of PEPFAR activities with programs sponsored by
the government and other donors at the provincial level. They are housed inside the PAC and serve as a
focal point for all Outreach/BCC. This includes, but is not limited to, outreach for injecting drug users (IDU),
commercial sex workers (CSW) and men who have sex with men (MSM) with referrals to prevention, care
and treatment. Coordinators will also facilitate referral to an increasing array of drug and alcohol abuse
treatment services in their provinces. In order for provincial outreach coordinators to work effectively, FHI
will continue to strengthen their capacity through training for data management, analysis and application.
With support from VAAC and technical assistance from FHI, these outreach coordinators will facilitate
regular meetings among PEPFAR and other staff to ensure availability and equal access to HIV prevention
services. They will develop and maintain comprehensive records of all Outreach/BCC activities and
resources supported by PEPFAR, the government and other donors in the province and will advise how to
resources may be most effectively and efficiently allocated.
Number of targeted condom service outlets: N/A
behavior change other than abstinence and/or being faithful: N/A
Abstinence and/or being faithful: N/A (to be reported in HVAB)
Continuing Activity: 15245
15245 9600.08 U.S. Agency for Family Health 7104 3107.08 $100,000
9600 9600.07 U.S. Agency for Family Health 5164 3107.07 Family Health $50,000
Estimated amount of funding that is planned for Human Capacity Development $500,000
Table 3.3.03:
IDU OUTREACH: $1,020,618
Despite significant resources available to combat HIV/AIDS in Vietnam, the country's large population and
concentrated epidemic calls for a highly focused approach to HIV prevention. This requires prioritizing high
coverage, effective behavior change strategies, and comprehensive services for most-at-risk populations,
especially those with risks related to drug use.
The 2005-2006 Integrated Biological and Behavioral Surveillance (IBBS) revealed that HIV infection rates
were three to thirty times higher among commercial sex workers (CSW) who reported IDU than those who
did not, and that drug injection was a strong predictor of overall HIV prevalence in this population Based
on recognition these populations are fueling the epidemic, outreach-based prevention efforts to reach drug
injectors (including injecting sex workers) have taken a high priority in the PEPFAR prevention portfolio. To
coordinate programmatic coverage and ensure access to a comprehensive package of services and
commodities, FHI leads PEPFAR/Vietnam IDU efforts with the MOH and works closely with DfID, World
Bank, Global Fund, and the Asian Development Bank to improve the system of community-based outreach,
peer and health education, drop-in centers and referrals to counseling and testing for IDU.
Activities
Using improved population size information and recommendations from the 2007-2008 Boston University
peer outreach evaluation, FHI will sharpen outreach partners' focus on IDU to increase quality and
coverage of existing interventions, improve referral to counseling and testing, and offer more needed
services at MARP-friendly community sites. Special attention will be paid to meeting the needs of hidden
and recently initiated injectors, employing the increasing array of community-based substance abuse
treatment alternatives to prevent drug user placement in (06) rehabilitation centers. To accomplish this,
enhanced training will hone peer educator and health educator skills; their efforts will be synchronized with
other donor initiatives by PEPFAR funded provincial outreach coordinators. Trained addiction counselors
will refocus their efforts on daily drug addiction counseling while their program management duties are
reduced. Integration of prevention interventions into "one-stop-shop" drop-in centers will ensure services are
consolidated and efficient referrals to counseling and testing are completed. Drop-in center activities will be
modified to serve not only IDU, but their family members as well.
Health educators and peers will utilize their networks to contact community-based IDU, employing key
messages to advocate behavior change and a reduction of drug use and risky sexual practices. One key
message is the importance of learning HIV status to protect drug users' health and the health of their
families. IDU will be encouraged to access drop-in centers and other service points where they will receive
information, motivation, condoms and referral to VCT and HIV care and treatment. A second key message
is that there is hope for people who wish to stop using drugs. IDU who want to quit using will be placed in
direct contact with trained addiction counselors; in Hanoi, HCMC and Hai Phong they will be linked to the
national pilot methadone treatment program. For IDU who are unable to stop using, clients will be
encouraged to avoid sharing injecting equipment will be directed to points where clean injecting equipment
is available.
Recognizing that economic rehabilitation is a critical part of the path to recovery, FHI will assist recovering
drug users to obtain employment and will work with employers to place recovering clients. In FY 08 new
PEPFAR partner Chemonics initiated nationwide efforts to assist economic rehabilitation of recovering drug
users. In close collaboration with the Chemonics program, FHI will work with recovering users, prioritizing
re-building of confidence and self-esteem; improving life skills; training in basic job-search skills; and
preparation for regular employment. Recovering clients will be encouraged to achieve realistic goals, in
conjunction with continuing addiction counseling, relapse prevention counseling, methadone treatment and
other social services tailored to individual needs.
FHI will develop IDU outreach programs in Quang Ninh, Hai Phong, and Can Tho as model learning sites to
build government agency and other donor program capacity. In country study tours to these model sites will
foster capacity of other provincial programs and leverage resources contributing to a sustainable national
response to HIV prevention.
prevention of drug use: 21,000
Number of individuals trained to promote HIV/AIDS prevention through prevention of drug use: 100
METHADONE IMPLEMENTATION: $ 560,000
The national pilot Methadone Maintenance Therapy (MMT) program began operation in April 2008 with 6
pilot MMT clinics in Hai Phong and HCMC. In FY 08 an additional 6 MMT clinics were opened in Hanoi.
Throughout the process FHI has used PEPFAR funds to support Vietnamese government implementation
of five pilot clinics, maintaining strong links to HIV service delivery through existing outpatient clinics. FHI
MMT sites continue to receive methadone from central procurement managed by the MOH with PEPFAR
financial and technical support through SCMS. Pre-service and in-service training at all national MMT clinics
is implemented by FHI, providing needed technical support for clinicians and staff. In FY09 FHI will continue
to support implementation of the national methadone program through the Vietnam Administration of AIDS
Control (VAAC).
FY09 funding will allow FHI to maintain 5 existing MMT clinics in Hanoi, Hai Phong and HCMC while
expanding to 4 new sites selected in consultation with the MOH, PEPFAR and other stakeholders.
Development and expansion of the program will stress: 1) integration of methadone treatment with HIV
prevention, care and treatment; 2) links to social support such as job creation and vocational training; 3)
expanded addiction counseling and psychosocial support; 4) increased involvement families and the
community; and 5) increased involvement of patients in peer support.
prevention of drug use: 1,450
Activity Narrative: Number of individuals trained to promote HIV/AIDS prevention through prevention of drug use: 36
METHADONE EVALUATION: $250,000
Basic program monitoring and evaluation are requisite components of any new health intervention.
Evaluation of the national pilot Methadone Maintenance Therapy program will provide valuable information
for PEPFAR, the government and other stakeholders to improve program function and make wise planning
decisions. Through this activity, FHI will examine the effectiveness of the methadone pilot for opiate users
in Hai Phong and Ho Chi Minh City by measuring and monitoring: drug use and drug injecting behavior;
drug-related criminal behavior; sexual risk behavior; HIV, Hepatitis and Hepatitis C infection; physical and
mental health indicators; and quality of life measures. The evaluation will follow a cohort with baseline and
follow-up data collected at admission and every 3 months thereafter. Data will be collected through a
standard protocol for program check-in with individual clients. Standard data collection forms will be used
for data extraction from patient files and from short individual interviews. The data will be used for
continuous program quality improvement. All clients enrolled in the program will be interviewed. It is
expected that approximately 1,000 individuals will be enrolled in pilot methadone maintenance programs in
HCMC and Hai Phong.
The data collection forms will be developed using as reference the Addiction Severity Index (or ASI), a
standard tool widely used to monitor patients receiving drug treatment services. WHO quality of life
measurement tools (WHOQOL-BREF) and additional individual behavioral questions will measure program
impact on patients. Other data will be gathered from routine data collection forms at the clinics. These tools
were developed for use by physicians and counselors to assess client plans and placement. It is expected
these tools will be standardized as part of the patients' clinical records once their utility has been
demonstrated to the Ministry of Health.
prevention of drug use: N/A
Number of individuals trained to promote HIV/AIDS prevention through prevention of drug use: N/A
TRANSITIONS PILOT PROGRAM $150,000
In August 2006 the Ho Chi Minh City Provincial AIDS Committee and PEPFAR/Vietnam launched a pilot
program to provide comprehensive substance abuse and HIV prevention, care and treatment for residents
of the Nhi Xuan rehabilitation center prior to their release. Similar services (peer education, VCT, case
management, and HIV care and treatment) were established in HCMC target districts 1, 4, 8 and Binh
Thanh to ensure continuity of care as residents transitioned from center to home community. Since the
program's inception, FHI has played a key role in the pilot, training and placing addiction counselors and
case managers in Nhi Xuan and all target districts, providing salary support for key staff and managing HIV
outpatient care in districts 8 and Binh Thanh.
FY09 funds will continue support for the original pilot transition program by promoting family and community
reintegration for returnees, preventing drug relapse, and providing medical care for HIV patients in the Nhi
Xuan center and target districts. This will be accomplished through: 1) salary support for case
management; 2) support for voluntary DOLISA social workers participating in the transitional pilot; 3) drug
relapse prevention counseling and psychological counseling in target districts; 4) improved access to HIV
treatment and social support for returnees; and 5) linking clients to available methadone therapy. All
services will strive to integrate HIV and substance abuse prevention, care and treatment, and to assure
quality through mentoring and supervision. Basic program monitoring, quality assurance and quality
improvement will be continued for the original pilot program in Nhi Xuan and 4 HCMC districts, and for the
Hanoi Community Support Center for recovering drug users.
prevention of drug use: 3,500
(1,500 reached by drug addiction counselors/case managers: and 2,000 reached by trained social workers)
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $200,000
Table 3.3.06:
By the end of COP07 FHI was supporting just over 24,000 PLHIV and their care-givers with basic health
care and support services in 26 continuum of care sites across PEPFAR focus provinces.
During COP08 PEPFAR will fund FHI to provide basic health care and support services for a total of 30,274
PLHIV and their care-givers. In COP09 no new continuum of care sites will be established. Rather the focus
will be on sustainability, coverage saturation and maximizing efficiency of existing sites to provide quality
services to an increasing number of clients. Nutrition is a particular focus of health care services provided
by FHI supported sites in COP 08 and COP09.
Continuum of care sites will continue to provide basic health care and support for PLHIV and their care-
givers and family members including 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-related complications and emotional support. Community
and home-based care teams play a critical role in providing palliative care to PLHIV 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 providers.
Home care teams and PLHIV support groups work with health center staff to promote ART adherence.
Palliative care services including pain management (using oral morphine and other analgesics), depression
and anxiety and end of life care will be incrementally scaled up across sites taking into account lessons
learned from the palliative care quality assurance program carried out by FHI in FY08. In FY08, FHI
supported the establishment of a mobile team of health care workers to provide HIV care and support
services to residents of four Drug Rehabilitation centers close to Hanoi. This activity will be continued in
FY09.
In COP09-FY10, FHI will focus efforts on scaling up its nutrition program across CoC sites. Community
based screening and clinical nutrition assessments will be offered to all clients. Nutrition education and
counseling and therapeutic and supplementary food will be provided to all clients meeting OGAC criteria for
a food intervention. Clients will be discharged from the nutrition program when exit criteria are met.
At the national level, FHI will continue to take the lead in developing PEPFAR partner and GVN capacity in
community and home-based palliative care. Technical support and capacity building will continue to be
provided to PEPFAR CHBC partners, Global Fund (GF) and VAAC to develop guidelines, standard
operating procedures, and training packages. FHI will also continue to play a leading role in implementing
the national palliative care guidelines through provincial advocacy and on-going sensitization of leaders,
developing clinical tools and building the capacity of integrated palliative care learning sites for the MOH
and partners. FHI will continue to provide leadership in the scale up of nutrition and food security services.
In FY10, a review of FHI's nutrition program will be conducted to document successes, lessons learned and
ways forward to assist the GVN in institutionalizing its own nutrition and HIV program.
In FY09 the following FBOs will continue to receive support: the Hanoi Buddhist Association in Hanoi, NAV
in Hai Phong and CRS in HCMC.
2) COP 08 narrative
In 2008, this activity consisted of two activities in COPRS. This year, Vietnam has decided to enter one
activity per partner/program area. The narratives below are the two HBHC activities for this partner from
2008.
COMPILED 2008 ACTIVITY SUMMARY:
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
Activity Narrative: 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 levels.
- 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 care giving guide for CBC teams, QA/QI
tools for PMTCT and TB and a number of SOPs for clinical service delivery.
Continuing Activity: 19468
19468 19468.08 U.S. Agency for Family Health 7104 3107.08 $200,000
* TB
Program Budget Code: 09 - HTXS Treatment: Adult Treatment
Total Planned Funding for Program Budget Code: $8,732,226
Total Planned Funding for Program Budget Code: $0
Table 3.3.09:
1) COP 09 narrative
This activity is linked to HVOP, MTCT, HBHC, HVTB, PDCS, PDTX, HKID
This is an ongoing activity. By the end of COP08 Family Health International (FHI) was supporting 23 adult
treatment sites across PEPFAR supported provinces. The number of sites reduced from that originally
planned in response to requests from both USG and the Vietnam MOH regarding geographical coverage.
During FY08 2195 adults were newly initiated on ART, 6580 adults continued ART and 7238 individuals had
ever been started on ART at FHI supported sites.
In COP09 PEPFAR will fund FHI to provide treatment for a total of 8343 adults (including 1763 newly
initiating adults) in 23 out-patient clinics (OPC). No new adult HIV treatment sites will be established. Rather
the focus will be on maximizing efficiency of existing sites to offer ART to all of those who are clinically
eligible for ARV therapy in addition to quality assurance/quality improvement. A particular focus in FY09 will
be the screening and clinical assessment of the nutritional status of adult PLHIV on ART. All adults on ART
will undergo regular clinical assessment and monitoring of nutritional status and will be provided with
nutrition education and counseling and where appropriate, a therapeutic food intervention, that is in keeping
with OGAC guidance.
In FY08 FHI supported the establishment of a mobile team of health workers to support ART for HIV
infected individuals in four Drug Rehabilitation Centers close to Hanoi. This activity will be continued in
ARV therapy will be provided to adults at community-based ART sites providing a comprehensive package
of integrated care, treatment and support services. The ART strategy will focus on client-centered
adherence, psychosocial support and case management to facilitate referral and access to community
based support services. PLHIV 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 skills. In sites where the methadone pilot is operational - ART will be closely linked to
methadone maintenance therapy to further support adherence to ART for opioid dependent PLHIV.
ARV sites will be supported through training, supportive supervision, QA-QI and clinical mentoring.
Established ART sites will function as model training sites for health care workers at new clinics as Vietnam
continues to scale up. Outcomes of the ARV program will be evaluated in some sites, including clinical
outcomes, psychosocial well-being, adherence and patient retention.
This is a continuing activity from FY07. The narrative below is unchanged from the FY07 COP. Major
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).
Activity Narrative: 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 PLHIV groups
in Binh Thanh District, District 8, Thu Duc District and Hoc Mon District, to provide appropriate referral,
coordinated care, and intensive adherence support for all clients to be re-integrated into the community.
FHI will begin implementation of a medication-assisted therapy program in a joint ARV/methadone
substitution therapy program (pending development of VAAC implementation guidelines and approval) in
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, PLHIV 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 PLHIV 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. PLHIV 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 skills.
Continuing Activity: 15259
15259 5838.08 U.S. Agency for Family Health 7104 3107.08 $1,340,000
9415 5838.07 U.S. Agency for Family Health 5164 3107.07 Family Health $939,000
5838 5838.06 U.S. Agency for Family Health 3107 3107.06 (INGO- former $280,000
International International FHI/IMPACT)
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $110,000
and Service Delivery
This activity is linked to HVOP, PDTX, MTCT, HBHC, HVTB, HKID, and HTXS.
This is a new program area but is an ongoing activity for FHI. By the end of COP08 FHI was supporting nine
sites where outpatient clinical HIV care and support is provided to children in the same site as adult care,
treatment and support in integrated Family Centered Care (FCC) Out-patient clinics (OPC). The number of
sites reduced from that initially outlined in the last COP planning cycle due to a reduction in the number of
provinces where USG and the MOH requested that FHI work. During FY08 222 children were provided with
clinical outpatient pediatric care and support.
During COP09 FHI will expand support to an additional district (district TBD in Dien Bien) to establish
pediatric HIV outpatient care services. Thus by the end of FY09 PEPFAR will have funded FHI to support
outpatient pediatric clinical care and support services for a total of 320 children in ten family centered care
out-patient clinics. A focus will be on maximizing efficiency of existing sites to offer quality clinical care to all
children in addition to quality assurance/quality improvement. A particular focus for QA/QI in FY09 will be
assessing and monitoring the nutritional status of all children and providing food and nutrition education and
counseling to care-givers plus food to children in accordance with OGAC regulations.
Family centered care sites will continue to provide HIV infected children with basic health care and support
including OI prophylaxis and treatment of common OIs, screening for TB, related laboratory services;
referral of complex OIs and TB, management of symptoms, pain, and HIV-related complications and
emotional support. Community and home-based care teams will continue to play a critical role in providing
palliative care to children and families infected and affected with HIV and will provide 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 providers. Home care teams and
PLHIV support groups work with health center staff to promote ART adherence.
In these outpatient family centered care sites where children are also assessed for their eligibility for ART.
Pediatric ART is provided along with intense adherence support for families and care-givers
Pediatric care and support clinical sites will be supported through training, supportive supervision, QA-QI
and clinical mentoring. Established pediatric sites will function as model training sites for health care
workers at new clinics as Vietnam continues to scale up. Lessons learned from providing family-centered
care in other sites will be incorporated into the scale up of pediatric services ensuring that children have
increased access to care and treatment services at the district level.
Whilst targets are provided in the narrative for this program area - it should be recognized that these are
developed for internal monitoring only. Pediatric care and support data from FHI supported sites will be
included in OVC data - and will not be double counted in this section .
In COP 08 there were more than one activity for this program area. It was merged into a single activity in
COPRS for 2009. The following is the first activity narrative from COP08.
• In FY08 Family Health International (FHI) will maintain 17 current continuum of care (CoC) sites and
• FHI will continue to provide an updated package of technical assistance (TA) and tools to all CoC palliative
• FHI will continue to provide OPC based palliative care to people with HIV in 22 CoC sites; and provide
• In FY08 FHI will pilot integrated palliative care in two to four sites. Integration of palliative care includes
• FHI will continue providing TA to the Ministry of Health (MOH) on developing the national palliative care
• In FY08 FHI will continue to support the Department of Therapy (DOT) to strengthen palliative care at
• FHI will continue to integrate family centered care into CBC and OPC services through training of pediatric
care (FCC) training and service tools to support FCC integration.
• 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
levels.
• By April 2007 FHI reached 5,700 PLWHA with palliative care services through the continuum of care from
Activity Narrative: both clinic and community-based care activities. Two international NGOs (Catholic Relief Services and
• FHI trained more than 100 individuals in community and home-based care, and built the capacity of more
• FHI produced an H/CBC training curriculum in Vietnamese, a care giving guide for CBC teams, QA/QI
Table 3.3.10:
This activity is linked to HVOP, PDCS, MTCT, HBHC, HVTB, HKID, and HTXS.
This is a new program area but is an ongoing activity for FHI. By the end of COP08-FY08 FHI was
supporting nine sites where pediatric treatment is provided in the same clinic as adult care and treatment in
integrated Family Centered Care (FCC) Out-patient clinics (OPC). The number of sites reduced from that
initially intended in the last COP planning cycle due to a reduction in the number of provinces that both USG
and the MOH requested FHI to work in. During this time period 60 children were newly initiated on ART, 117
children continued ART and 129 children had ever been started on ART at FHI supported sites.
During COP09-FY09 FHI will continue to support the same nine pediatric treatment sites that were
supported in FY08. In addition FHI will support the establishment of one new pediatric HIV care and
treatment site, integrated with adult HIV care and treatment in a family centered care outpatient clinic in a
district TBD in Dien Bien. By the end of FY09 PEPFAR will have funded FHI to provide ARV treatment for a
total of 225 children (including 108 children newly initiating ART) in ten FCC sites across PEFPAR support
provinces. A focus will be on maximizing efficiency of existing sites to offer ART to all of those children who
are clinically eligible in addition to quality assurance/quality improvement. A particular focus in FY09 will be
assessing and monitoring the nutrition status of all children on ART and providing food and nutrition
education and counseling to care-givers and good to children in accordance with OGAC regulations.
ARV therapy will be provided to children at community-based family centered care ART sites providing a
comprehensive package of integrated care, treatment, prevention and support services linked with PMTCT
and OVC services. The pediatric ART strategy will focus on linkage with PMTCT programs for early infant
diagnosis, family-centered adherence, psychosocial support, OVC programming and case management to
facilitate referral and access to community based support services.
Pediatric ARV sites will be supported through training, supportive supervision, QA-QI and clinical mentoring.
continues to scale up. Lessons learned from providing family-centered care in other sites will be
incorporated into the scale up of ART ensuring that children have increased access to care and treatment
services at the district level.
• In FY08, Family Health International (FHI) will scale up ART in a total of 20 district-level continuum of care
• Pediatric ART will be scaled up such that 13 of the 20 adult ART sites will offer pediatric ART through a
• In FY08 FHI will strengthen the linkage between PMTCT and care and treatment services to enable the
• 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
• Using FY07 funding, FHI is currently scaling up adult ART services in a total of 15 CoC sites across the
ARV sites will be supported through training, supportive supervision, and mentoring of a multidisciplinary
Activity Narrative: In Ho Chi Minh City (HCMC), all FHI-supported ART sites will be linked to 06 centers, which are
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
community.
adherence counselors, PLWHA groups, family, and HBC teams where appropriate. FHI will work with
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
skills.
Table 3.3.11:
This is an on-going activity. By the end of FY09 FHI supported TB-HIV services in 20 CoC sites across the
seven PEPFAR supported provinces. During FY09 a total of 1500 individuals with TB and HIV, enrolled in
FHI supported out-patient clinics received and completed TB treatment provided by the National TB
program. Approximately seven thousand PLHIV were screened for TB prior to starting ARV therapy or were
referred for TB screening and management on the basis of clinical signs and symptoms of TB.
In FY10 FHI will continue support for the improved management of HIV-TB co infection in all 20 CoC sites
by supporting and funding TB screening and referral, improving coordination of TB and HIV services,
capacity building for TB and HIV clinicians and some staff time. All clinics eligible for ART will receive TB
screening prior to starting therapy. In addition all PLHIV enrolled in outpatient care with symptoms of TB will
be screened and referred to the TB service. Any individual with suspected or confirmed TB will be referred
to the adjoining district (or provincial) TB clinic for TB treatment and on-going management. Particular
attention will be paid to screening those with TB-HIV for malnutrition and providing nutrition support in
keeping with OGAC guidelines.
TB-HIV screening and referral will be provided for approximately 9,000 HIV-infected persons in 20 CoC
sites across the 7 PEPFAR supported provinces. It is anticipated that 2000 individuals enrolled in FHI Care
and Treatment CoC sites will complete treatment for TB by the end of FY10. At least 200 individuals will be
trained to provide screening and treatment of TB-HIV co-infection and to support TB/HIV coordination
activities at the district level.
FHI will continue to provide funding to strengthen the district TB and HIV coordination activities at the
district level through several targeted activities, including annual technical meetings between TB and HIV
clinicians, development of Standard Operating Procedures (SOP), quarterly network model coordination
meetings, regular monthly case conferences between TB and HIV clinicians at clinical sites and quarterly
supportive supervision visits.
2) COP 08 narrative:
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
supervision visits.
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.
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
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.
Continuing Activity: 15256
15256 9565.08 U.S. Agency for Family Health 7104 3107.08 $127,000
9565 9565.07 U.S. Agency for Family Health 5164 3107.07 Family Health $74,000
Program Budget Code: 13 - HKID Care: OVC
Total Planned Funding for Program Budget Code: $3,318,324
Program Area Narrative:
PROGRAM AREA SETTING
PEPFAR/Vietnam began offering programs for orphans and vulnerable children (OVC) in FY05. Since that time it has refined the
methods of providing services and increased the number of local partners to better meet the basic needs of OVC in the country.
There is no single approved figure for the number of OVC affected by HIV/AIDS in Vietnam. Data about the number of children
infected with and affected by HIV/AIDS is limited, which makes program planning and resource allocation difficult. The
Government of Vietnam (GVN) estimates that up to 10,000 children in Vietnam are living with HIV/AIDS. The Ministry of Labor,
Invalids, and Social Affairs (MOLISA) uses the UNAIDS estimate of 68,874 children orphaned due to AIDS (as of the end of
2007). In addition to the number of infected children and orphans, there are an estimated 132,000 children of or living in the same
households with PLHIV currently in facility-based clinical care.
Through the planned activities for FY09 the quality of services will continue to be strengthened and the outreach to OVC
broadened. There is a heightened awareness in Vietnam of the special needs of OVC either living in or left as orphans by HIV-
infected, drug-addicted parents. The experience of living in such circumstances places these children at increased risk. The
Vietnam OVC program encompasses the case management approach, which assesses the needs of each child reached and then
provides appropriate services to that child. The six basic services (health, education, food and nutrition, psychosocial support,
legal protection, and shelter) are at the core of Vietnam's OVC program. Over the last two years, PEPFAR/Vietnam has stressed
the improvement of community and clinic linkages (prevention of mother-to-child transmission services, adult care and treatment,
and pediatric care and treatment) to increase the number of children identified and to keep them in a comprehensive continuum of
care delivery system.
Implementation of different types of group care at the community level will offer a real option to families to keep infected and
affected children in the community. These programs also provide a resource to the transitions program (see Pediatric Care and
Treatment for further information on facility-based care for HIV-infected children). Programs planned in FY09 will continue to
follow these basic strategic principles for OVC programming through improved quality of services to children and increased
options for community-based care.
KEY ACCOMPLISHMENTS
The OVC program has gained much ground over the past year in Vietnam. Policy initiatives have made great inroads, new groups
care models are being implemented, better linkages with clinic-based care have been realized -- all of which create a better
environment for providing improved care and support services for OVC. First, the National Plan of Action (NPA) for OVC Infected
and Affected by HIV and AIDS is in the final stages of development awaiting signature by the Prime Minister's office. Work on the
NPA was supported by PEPFAR in FY07 and FY08. Intensive workshops have been held with high officials and staff from the
ministries of health, education, and social affairs. These separate workshops have galvanized support for the action plan in these
important areas, and set the stage for support in implementation. PEPFAR, along with other donors (e.g., UNICEF, VSO
International, Pact Vietnam, Save the Children US/UK, Catholic Relief Services, the Clinton HIV/AIDS Initiative, and Doctors of the
World), are expected to provide support for various components of the FY09 detailed action plan. While other donors provide
funds (notably UNICEF), PEPFAR is by far the largest donor for OVC in Vietnam, albeit small, reaching a limited number of OVC.
The Global Fund has not been tapped to support programs for OVC in the past, but with the approved NPA, it is expected that
planned activities that benefit OVC will be incorporated into Global Fund proposals in the future.
The GVN, through the NPA, has set targets for the provision of care and treatment for OVC. By the year 2020, it is anticipated that
90% of all HIV-infected mothers and their infants receive: 1) Antiretroviral Therapy (ART) and life-long HIV care and treatment; 2)
comprehensive health care and HIV-related treatment; 3) lower secondary education and/or vocational training; 4) support to live
in a safe environment within a family or kinship group or in a small-scale community-based center; and 5) basic economic needs
met. PEPFAR is directly reaching approximately 6,000 children affected by HIV (2-3% of the total) and plans to increase that
number to 11,000 (4-5%) over the next two years. While these percentages may seem small, one of the intents of the NPA is to
galvanize support from other donors so that the plan's targets can be reached by 2020.
New sub-grantees were identified and began implementing innovative community-based model programs for OVC that were
intended to keep vulnerable children in the community instead of having them sent off to institutional care. These community-
based alternative care programs are still in the initial start-up phase. Best practices from these model programs will inform
additional services for OVC in FY09.
CHALLENGES/OPPORTUNITIES
While some of the gains are on target with OVC programming, challenges remain. Stigma and discrimination are still major
barriers for children accessing health care and schooling (Save the Children, 2008). Inflation, which is running at more than 25%,
has translated into economic hardship for many Vietnamese, particularly for families of OVC. Insufficient food for these children
and their ill and unemployed family members reduces the likelihood of improving their health status with antiretroviral therapy
(ART). Late start-up ART for children and their parents is detrimental to healthy families. Psychosocial support at both the clinical
and community level is weak; additional training and mentoring is needed. Good social work models are not available in Vietnam;
therefore, future planning will need to consider developing these approaches further.
The quality and coverage of PEPFAR-supported services to OVC remains uneven. Given the vertical nature of the Vietnam
clinical settings, access to health care is problematic for children. Children have to be diagnosed and treated in a pediatric
hospital, while their parents use adult facilities at other medical sites. Lack of appropriate referrals, untrained staff, and stigma and
discrimination at the clinic level, and lack of money for transportation across the city or from another province poses problems for
needy families seeking to obtain care for their infants and older children. Adult programs lack mechanisms to identify OVC and
provide needed services. There is little follow-up of referrals to know if clients took advantage of recommended services. Pre-
adolescent and adolescent OVC have no age-appropriate programs designed to specifically fit their needs and interests.
Vocational training is not available to most OVC. Family caregivers receive little or no social or economic support.
The limited number of strong OVC implementing partners is also a current gap. Family Health International (FHI) and
Pact/Vietnam (through its 10 sub-partners) provide an expansive program for OVC, but they are limited in their ability to expand:
FHI because of the 8% single partner funding limit and Pact because their primary responsibility is to strengthen civil society.
Nordic Assistance to Vietnam (NAV), a New Partnership Initiative grantee, has not yet been able to rapidly roll-out its programs
and is hampered by GVN restrictions on the registration of civil society organizations.
KEY STRATEGY ELEMENTS
1. Focus on scale-up. It is anticipated that additional community-based organizations (CBOs) starting new OVC programs will
scale up programs during FY09. It is also expected that NAV will soon be fully operational. Greater attention will be given to the
identification of OVC at GVN clinic-based facilities supported by PEPFAR (e.g., PMTCT, adult care and treatment, and counseling
and testing sites). Community-based care providers will be supported to make more referrals of OVC in high-risk situations such
as families of injecting drug users (IDU), commercial sex workers (CSW), and especially adolescents who live in high-risk
environments and may be tempted to start using drugs. Based on PEPFAR/Vietnam's history of scaling up (991 in FY05, 2,002 in
FY06, 3,976 in FY07, and an anticipated 6,513 in FY08), we have set a target of 8,795 for FY08 and 13,500 for FY09.
2. Improved quality. Setting standards for OVC care will be a priority in FY09, now that the NPA has paved the way for greater
attention to quality OVC programs. Tools to measure quality assurance and quality improvement are being developed to assist
service providers to identify weaknesses and develop improved programs. Training and re-training of staff and volunteers on
quality services for care providers for OVC has proven to be effective in improving quality over time. A standardized training
curriculum has helped ensure consistency across service providers.
3. Coordinated care. Ways will be explored to coordinate comprehensive care for OVC though networks and leveraging other
resources. A coordination workshop to be held in Ho Chi Minh City (HCMC) in late 2008 will be the first attempt to establish a
network of program implementers that can share ideas and resources across the spectrum of service areas. Meetings are
planned twice a year.
4. Reaching particularly vulnerable children. Based on the FY08 planned food and nutrition scale-up, community-based and clinic
care providers will be better able to screen and assess nutritional needs and provide supplemental nutrition and therapeutic food.
This program will reach a group of very vulnerable children born to HIV-infected mothers, but who do not have access to ART. By
providing a food incentive, perhaps more mothers will want to engage in the program, so that their children grow up healthy. Once
children are in the system, referrals and escorts to needed services will keep them in the system.
4. Strengthen capacity. Given the weak civil society in Vietnam, PEPFAR has made building the capacity of local CBOs, and local
government staff at provincial and district levels, which were identified in FY07 and FY08, a priority. Pact will take the lead role in
strengthening local capacity through tools they use internationally. In FY08, Pact's target was to strengthen nine sub-partners. In
FY09, it is expected that Pact will strengthen up to 15 CBOs and local groups (e.g., local women's unions and PLHIV groups).
5. Build knowledge. In FY09, it is expected that training will occur around food and nutrition education; how to conduct nutrition
assessments; and the development and implementation of OVC standards. Emphasis will also be on initiating a curriculum for
social workers around OVC and improving the awareness, knowledge, and skills in how to identify children in need and ways to
provide better services.
PEPFAR/Vietnam has promoted a comprehensive program for OVC and will continue to keep this emphasis alive. Once OVC are
identified, whether through community-based care, treatment, PMTCT services, counseling and testing at pediatric hospitals, or
IDU family members, every attempt will be made to keep children in the system and referred to the appropriate next step in the
continuum of care. "No child lost" will be the motto for OVC in FY09. With this approach alone it is expected that the number of
children reached will increase. Outreach in selected new sites will also add to more OVC being served.
In COP09, PEPFAR-supported community-based programs, particularly those in HKID and PDCS program areas, will concentrate
on working with a wide variety of governmental and local quasi-governmental partners, in an attempt to build better local capacity
and sustainable systems within Vietnam. The widespread base of the Women's Union, and the Vietnamese Red Cross, along with
district-level government offices of the Department of Labor, Invalids and Social Affairs, education and culture and others will
contribute to improving the sustainability of the program.
POLICY
Policy and guidelines are in place to provide OVC affected by HIV/AIDS with needed services. However, stigma and
discrimination have blocked full and transparent access to these services. Partners implementing OVC services will work closely
with the Health Policy Initiative project that is scheduled to augment the current legal support centers to assist people who have
been denied access to education and other services. This effort will test the policies that are in place and may serve to draw
attention to the shortcomings of the policies, which then can be revised.
Table 3.3.13:
This activity is linked to HVOP, MTCT, HVTB, HTXS, PDCS, PDTX and HBHC.
This is an ongoing activity. By the end of COP08-FY08 FHI was supporting more than 3,500 OVC in 23
continuum of care sites across PEPFAR focus provinces.
In COP09 PEPFAR will fund FHI to provide OVC services for a total of 4,305 OVC through family centered
care outpatient clinics and community and home based care services in the PEPFAR focus provinces. No
new OVC programs will be established. Rather the focus will be on sustainability, coverage saturation and
maximizing efficiency of existing programs to provide quality services to an increasing number of OVC and
their caregivers. Comprehensive case management, service retention and nutrition are a particular focus of
OVC services provided by FHI supported sites in FY09.
OVC services will continue to be provided using a case management approach, where community and
home-based care teams and OPC case managers work together to assess and routinely support the needs
of OVC. The OVC program focuses on the 6+1 service areas. Services include comprehensive OVC and
family needs assessment, development of family care plans, routine home follow-up and care, psychosocial
support, child development and education assistance, food security and nutrition support referral to health
care services, adherence support, economic assistance and enrollment in social welfare schemes,
protection and referral to other social and health care services.
In COP09-FY09 FHI will focus on scaling up its nutrition program for OVC across CoC sites. Community
based screening and clinical nutrition assessments will be offered to all enrolled families. A tailored package
of nutrition education and counseling will be provided to care-givers and therapeutic and supplementary
food will be provided to all children meeting OGAC criteria for a nutrition/food intervention.
A new activity in FY09 is an OVC program quality assessment. The purpose of the OVC program quality
assessment is to monitor the quality of FHI's OVC program and ensure that quality OVC services are being
provided in both the out-patient and community settings supported by FHI. This will allow FHI to focus on
the specific improvements and adjustments needed to continuously improve the delivery of OVC services in
the sites we support. It will also enable FHI to share findings and lessons with other PEPFAR partners and
hopefully increase efforts to improve OVC implementation and quality across other providers.
FBOs will continue to be supported through OVC programs implemented by the Hanoi Buddhist Association
in Hanoi, NAV in Hai Phong and CRS in HCMC.
FHI will continue to support the GVN (MOH, MOLISA) and international partners through training, mentoring
and technical assistance and supportive supervision to provide quality and holistic services to OVC and
families. 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 continue to provide capacity-building and technical assistance to other
PEPFAR partners in implementing OVC programs. In addition, FHI will provide technical assistance to the
implementation of the OVC National Plan of Action through continued collaboration with MOLISA, MOH,
UNICEF, PACT, Save the Children, Clinton Foundation and other key partners.
In FY08:
• 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
locations.
• 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
partners.
• FHI will increase its efforts to reduce stigma and discrimination of OVC affected by HIV/AIDS through
district campaigns.
• 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
additional locations.
• FHI contributed to the development of the draft national plan of action for children and HIV/AIDS.
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
Activity Narrative: 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).
350 professional and family caregivers will be trained.
Activity Narrative: OVC services will be provided in accordance with the PEPFAR core OVC services package, and will
Continuing Activity: 15257
15257 5454.08 U.S. Agency for Family Health 7104 3107.08 $680,000
9537 5454.07 U.S. Agency for Family Health 5164 3107.07 Family Health $390,000
5454 5454.06 U.S. Agency for Family Health 3107 3107.06 (INGO- former $150,000
* Increasing women's access to income and productive resources
* Increasing women's legal rights
HIV counseling and testing (CT) remains a critical element of the Government of Vietnam and PEPFAR HIV
prevention, care and treatment strategy. Counseling and testing affords an opportunity for clients to
evaluate their risk behaviors and consider options for behavior change. HIV-negative clients have the
opportunity to reduce their risks while HIV-positive clients are linked to life saving health care and a chance
to protect their families, sexual partners and peers. Through FY09 support, FHI will train 150 counselors
and provide counseling and testing for 40,000 clients at 30 CT sites in PEPFAR focus provinces. This will
be accomplished through several initiatives to set national service standards, refocus efforts on most at risk
populations, and deploy new CT models to expand reach. Each of these strengthens the national CT
program while ensuring long term sustainability.
First, FHI will continue longstanding support for two centers of excellence: the Anonymous Testing Site
(ATS) in HCMC and Bach Mai CT Center in Hanoi. These sites provide technical assistance to new testing
facilities supported by PEPFAR and other donor partners. This technical assistance takes many forms,
including study tours, in-service practice, supportive supervision, and training for basic and advanced HIV
counseling. Both the ATS and Bach Mai sites will lead case consultation meetings for CT counselors.
Second, FHI will strengthen the absorptive capacity of 30 existing CT sites, integrating them into district
outpatient clinics (OPC), PEPFAR funded drop-in centers and local health care service providers. New
hospital-based provider-initiated testing and counseling (PITC) sites will be closely monitored to ensure
quality; an end of year PITC evaluation will inform future plans for routine counseling and testing initiated at
health service points. HIV screening will be completed at local laboratories, and where possible clients will
receive negative results within a day. At health facility based CT locations with a nearby laboratory, negative
test results will be returned to clients in an hour. Training and technical assistance at existing sites will
restructure counselor workload, increasing their efficiency and absorptive capacity.
Third, based on coverage information and on results from the 2006-2007 Boston University peer outreach
evaluation, FHI will refocus efforts to improve CT referrals from community outreach targeting MARPs.
While outreach worker contacts with IDU, sex workers and MSM remain important, the numbers of contacts
who seek counseling and testing and receive their test results will become a primary indicator of program
success. In close collaboration with innovative and hard-hitting CT social marketing efforts from PEPFAR
partner PSI, FHI will prioritize training to improve outreach workers' referral skills and adapt existing CT
training curricula making them suitable for use in community outreach. Social marketing and a renewed
focus on MARPs will stress the benefits of knowing one's status while reducing stigma and other barriers to
seeking testing.
Fourth, FHI will work with the PEPFAR team, VAAC and other partners to standardize a mobile outreach CT
service model. Five mobile CT teams will be established at sites selected in agreement with key
stakeholders. Working closely with outreach workers and PLWHA groups, the mobile teams will encourage
testing among MARPs, especially hard to reach MARPs and those who may be worried about attending
clinics. The mobile model will interrupt rapid transmission patterns among the newly infected, linking clients
to community based prevention services including prevention information, condoms, an increasing array of
substance abuse treatment options and vocational training for recovering IDU or for women who wish to
leave sex work.
Number of service outlets providing counseling and testing according to national and international
standards: 30
Number of individuals who received counseling and testing for HIV and received their test results (excluding
TB): 40,000.
Continuing Activity: 15258
15258 9508.08 U.S. Agency for Family Health 7104 3107.08 $1,360,000
Estimated amount of funding that is planned for Human Capacity Development $300,000
Program Budget Code: 15 - HTXD ARV Drugs
Total Planned Funding for Program Budget Code: $2,480,000
Over the past several years, antiretroviral therapy (ART) in Vietnam has gone from being available to only a few to a routine
course of treatment for many PLHIV, in large part due to funding from PEPFAR. As a major supplier of ARVs in Vietnam,
PEPFAR currently offers 21 different antiretroviral (ARV) drugs, including the FDA tentatively-approved stavudine-based fixed-
dose combination, which treats nearly half of the 15,000 patients receiving ARVs supported by PEPFAR. Generic drugs have
helped bring down the annual cost of first-line treatment to as low as $100 per patient. Only about 2.5% of patients need second-
line treatment, yet the cost of procuring these drugs still amounts to 10% of the total PEPFAR Vietnam antiretroviral budget. By
the end of FY09, PEPFAR plans to directly support 36,000 patients by providing them with ARVs.
In FY07 and FY08, PEPFAR's antiretroviral procurement was managed by the Supply Chain Management System (SCMS). The
medicines are distributed under the supervision of the Vietnam Ministry of Health (MOH) and have approval and
quality/registration certification from both the World Health Organization (WHO) and the U.S. Food and Drug Administration
(FDA). ARV drugs are delivered to the Central Pharmaceutical Company No. 1 (CPC#1), a Hanoi-based joint stock company,
which has a distribution network throughout Vietnam. Each delivery/batch of ARVs is accompanied by a Certificate of Analysis
and Certificate of Origin in accordance with the regulations and quality standards of the country of manufacture.
In recent years, there have been several dramatic improvements in how ARVs are procured and distributed. Permission to import
FDA tentatively-approved generic drugs in 2006 led to faster delivery and significantly reduced prices. Low-cost ARVs mean that
PEPFAR can now provide treatment to patients not only at PEPFAR sites but also to those sites funded by the government of
Vietnam and the Global Fund (GF). Efforts are now being coordinated to supply second-line ARVs to MOH and GFATM sites, as
well as to redistribute drugs in storage due to expire. In order to improve the distribution system, a central pharmacy unit within
MOH was established in 2008. This unit, supported by PEPFAR and the Clinton HIV/AIDS Initiative (CHAI), has now been placed
in charge of coordinating the distribution and management of all ARVs.
Vietnam has historically delivered ARVs directly to the provinces, each of which has different levels of forecasting ability and
infrastructure. With multiple donors purchasing ARVs using parallel systems of procurement and distribution, there was
duplication and wasted efforts. Acknowledging this fact, MOH recently assigned SCMS's current partner, CPC#1, to be
responsible for the storage and distribution of all ARVs imported into the country. This has helped improve the coordination and
management of ARV supplies, regardless of funding sources.
Though there have been some improvements, PEPFAR's early ART efforts were hindered by lengthy drug approval processes,
slow delivery from manufacturers, delayed arrival of donor funds, and restrictions on purchasing cheaper generics. In addition to
the importation of FDA tentatively-approved generic first-line ARVs, second-line generic ARVs are now being granted FDA
tentative approval. It is expected that most second-line ARVs will be available from generic manufacturers by the end of FY09.
Currently, second-line ARVs cost ten times more than first-line ARVs, but in the future the new generic second-line medications
will represent a smaller percentage of the ARV budget. Lopinavir/ritonavir, currently must be procured as Aluvia, which is the most
expensive second-line drug at $1,000 per patient per year. The cost for lopinavir/ritonavir may decrease 50% in the next year due
to a new FDA-certified generic that is expected to be available in the next six months.
In FY09, the key strategy elements will center around two project goals. First, SCMS will assist the government of Vietnam to
design and implement a more efficient and effective national system for the distribution of HIV medicines and related
commodities. This will be done by capacity building and training at MOH's Vietnam Administration for HIV/AIDS Control (VAAC)
and at the provincial and clinic levels. There will be an emphasis on creating long-term commodity security by integrating donor
contributions in medicine procurement, specifically the Global Fund, CHAI, and the World Bank. Plans for supporting pediatric
patients currently receiving ARVs from CHAI and the international drug purchasing facility, UNITAID, will be developed. The
design and roll out of standard operating procedures, training methodology, and information systems will be key activities to
ensure program sustainability.
Second, SCMS will continue to improve quantification, procurement, storage, and distribution of HIV/AIDS-related commodities
supported through PEPFAR partners. This will ensure that there is an uninterrupted supply of medicines for the existing PEPFAR-
supported clinical sites while more supply chain activities are transitioned over to the government of Vietnam. PEPFAR will
continue procuring first- and second-line ARVs to support adult ART and prevention of mother-to-child transmission treatment at
PEPFAR- and non-PEPFAR-supported sites, in accordance with Vietnam's standard treatment guidelines and USAID's
procurement and distribution regulations. Distribution is an important additional function for the SCMS Vietnam program. It not
only handles the distribution of PEPFAR-supplied medicines but it also supports other donors, such as CHAI's purchase of
pediatric medicines, by facilitating the importation, storage, and distribution of pediatric ARVs to sites throughout the country and
covers the redistribution of medicines from the different donor programs.
A component to both strategies is conducting on-going monitoring and evaluation, using a manual pharmacy Management
Information System (MIS), which allows for the monitoring of ARV stocks at clinical sites on a monthly basis. An electronic MIS
may be developed, with collaboration between MOH and PEPFAR that includes a supply chain function. Continued monitoring
and evaluation of dispensary management and standards of practice is carried out by SCMS program associates who visit
PEPFAR dispensaries on a regular basis.
Table 3.3.15:
This is a continuing activity from FY08. FHI is a primary implementing partner and as a result, SI activities
are on-going.
FHI will be supported in FY09 for the PEPFAR Strategic Information priority areas of human capacity
development and data synthesis and use, while continuing to conduct routine program monitoring on all
programs and basic program evaluation of prioritized program areas. These areas include ART services,
basic HIV clinical and community-based care, medication-assisted therapy (MAT), and prevention peer
outreach programs
Data Synthesis and Use:
FHI will work with the Ho Chi Minh City Provincial AIDS Committee (HCMC PAC) and HPI to conduct a
second round of the Advocacy and Analysis (A-squared) Project. The first round in 2005 had provided
invaluable information for HCMC PAC programs resulting in reallocation of resources to better address the
growing HIV epidemic among most at risk populations. The second round shares the same objectives,
including: 1) providing outcome indicators and coverage information for PEPFAR-supported prevention
programming among MARPs in Vietnam; 2) strengthening government staff capacity for data utilization; 3)
providing information to explain changes in HIV prevalence, including the impact of PEPFAR-funded
prevention programming; 4) providing epidemiologic and behavioral data in specialized formats tailored for
advocacy to policymakers; and 5) developing a clear understanding of the HIV/AIDS epidemic in Vietnam
so that that effective national policies and appropriately targeted programs can be developed.
Other data use activities will include publication and dissemination of the second round of integrated
biological and behavioral surveillance (IBBS). For increased understanding of behavioral trends illustrated
by quantitative IBBS results, a small scale supplemental survey using qualitative methods, such as focus-
group discussions, will be conducted to provide a more complete picture of the issues challenging HIV
programs.
Continuing to focus on GVN-centered capacity development for SI, FHI will also participate in VAAC-led
data triangulation activities, supporting epidemiological and program data gathering and participating in
analysis and dissemination workshops. All FHI service delivery activities are conducted in GVN facilities
and subsequent data analysis and feedback to GVN implementing and technical staff result in program
ownership and ultimate sustainability.
Reporting:
FHI will upgrade the existing prevention peer-outreach program database in collaboration with the original
PEPFAR supported Vietnamese-based contractor Innovative-Soft to expand the nationally standardized
application for service delivery through peer outreach education and DIC programs. This system will help
maximize work efficiency at the field level and enable data analysis to assist project partners in continuous
quality improvement. In addition, this will be automatically connected to a Geographic Information System
(GIS) for better visualization, outreach coordination and decision making. This software will be installed for
all FHI supported prevention sites and training will be provided to all software users.
Quality of routine monitoring data will continue to be strengthened through the integration of data quality
audits (DQA) as part of regular QA/QI visits to project sites. This will include review on data collection,
recording and reporting procedures in practice and random checking for accuracy of current data collected
and reported by project partners.
Monitoring:
With the need to ensure that all activities and services to target populations delivered under USAID/FHI
support meet quality standards, especially in the current expanding status, FHI with its project partners will
maintain official periodical QA/QI trips to existing and newly operated project sites across all program areas.
This aims to be an opportunity for all partners involved to review their current implementation, results and
progress to the planned targets, understanding issues and developing plan for quality improvement.
National experience sharing workshop on QA/QI implementation will be organized at the end of the second
QA/QI round.
MARP size estimation activities are suggested to conduct bi-annually, in sandwich with IBBS to provide
estimations of the number of people in each most-at-risk population groups for each locality. This will
support targeted resource allocation, program planning, implementation and evaluation. It will also provide
information on the coverage of the currently operating interventions in project areas. Data sources for
estimation will come from existing data on MARPs, routine monitoring data, and cross-sectional surveys on
these populations.
In the purpose to have a system to help with regular monitoring and improving the quality of both prevention
outreach and clinical program activities, together with maintaining and extracting results from prevention
database, FHI will utilize a recently developed software HIVQUAL by HIVQUAL - US program. This
software will be acquired and installed at FHI country office and all relevant FHI partners. Service providers
will use this application to review and analyze their performance for quality improvement, through key
quality indicators such as HIV Monitoring (Viral Load and CD4), HIV Care, ARV Therapy Management,
Adherence to ARV Therapy, etc.
Basic Program Evaluation:
FHI will continue longitudinal monitoring of patients on ART. This is patient data abstraction and
assessment of various quality of life indicators for adult PLWHA initiating ART at FHI clinics in HCMC.
These patients have been followed longitudinally over time since 2006 and assessed with relation to health-
related quality of life, functioning, support, risk behavior and well-being over time. This activity informs care
and treatment programs the psychosocial outcomes and impact of ART on the lives of PLWHA and
determinants of success on therapy.
Activity Narrative: HMIS:
Based on practical experiences and lessons learned from GIS application at Country Office (CO) level, FHI
will support and provide technical assistance and transfer technology to VAAC for better monitoring,
management and coordination at national level as well as upgrade the software at CO and scale up the
application to provincial partners of PEPFAR focus locations. Instruction training on GIS application will be
provided to all selected provincial staff. Data sources include routine monitoring data and quarterly data on
hotspot mapping for each locality, in order to produce useful information for program monitoring and
management.
HCD:
FHI will share its experience and provide technical assistance in QA/QI, M&E and GIS for relevant
stakeholders working in HIV field in Vietnam including VAAC's, PACs and PEPFAR partners, with the aim to
help strengthen a collaborative QA/QI system in the field, and support better HIV program management and
coordination of VAAC and PACs. FHI will join to facilitate some basic and advanced training on M&E since
having solid experiences and expertise on this.
Continuing Activity: 15260
15260 5702.08 U.S. Agency for Family Health 7104 3107.08 $445,000
9370 5702.07 U.S. Agency for Family Health 5164 3107.07 Family Health $520,000
5702 5702.06 U.S. Agency for Family Health 3107 3107.06 (INGO- former $125,000
Estimated amount of funding that is planned for Human Capacity Development $175,000
Table 3.3.17:
