Vietnam FY 2007 Country Operational Plan (COP)


VIETNAM

Project Title: Vietnam Fiscal Year 2007 Country Operational Plan (COP)

Budget Summary:

  Field Programs Funding by Account  Central Programs Funding by Account  
   Notified as of March 2007 Notified as of June 2007 Notified as of November 2006   
Implementing Agency GAP GHAI Subtotal: Field Programs Funding GAP GHAI New Subtotal: Field Programs Funding GHAI Central Programs Total Dollars Allocated: Field & Central Funding
DOD 0 2,844,500 2,844,500 0 3,550,500 3,550,500 0 3,550,500
DOL 0 0 0 0 0 0 0 0
HHS 2,855,000 14,480,685 17,335,685 2,855,000 20,595,685 23,450,685 0 23,450,685
Peace Corps 0 0 0 0 0 0 0 0
State 0 0 0 0 0 0 0 0
USAID 0 31,863,815 31,863,815 0 38,788,815 38,788,815 0 38,788,815
TOTAL Approved 2,855,000 49,189,000 52,044,000 2,855,000 62,935,000 65,790,000 0 65,790,000

HIV/AIDS Epidemic in Vietnam:
Estimated Population: 84,238,000*
HIV Prevalence rate: 0.5%*�
# of HIV infected: 260,000*
Estimated # of OVCs: no official Vietnam Government or UNAIDS estimate
*Figures are from the 2006 Report on the Global AIDS Epidemic, UNAIDS
Prevalence is in adults only (15-49 years)

Country Results and Projections to Achieve 2-7-10 Goals:

Vietnam 

Total # Individuals

Receiving Care and Support

Total # Individuals Receiving ART

End of Fiscal Year 2004*

1,020 

0

End of Fiscal Year 2005**

13,100

700

End of Fiscal Year 2006***

26,200

6,600

End of Fiscal Year 2007****

40,257

9,000

End of Fiscal Year 2008****

68,513

17,000

*Results. �Engendering Bold Leadership: The President�s Emergency Plan for AIDS Relief.� First Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, March 2005
**Results. �Action Today, a Foundation for Tomorrow: The President�s Emergency Plan for AIDS Relief.� Second Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, February, 2006
***Results. �Power of Partnerships: The President�s Emergency Plan for AIDS Relief.� Third Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, February, 2007
****Fiscal Year 2007 Country Operational Plan targets

Program Description:

Vietnam, a densely populated country of 83.1 million, has an estimated 280,000 people living with HIV/AIDS (PLWHA), including 10,000 children (UNAIDS, 2005), and an estimated overall population prevalence of 0.53% (UNAIDS, 2006). However, several provinces with significant numbers of injecting drug users (IDU) report prevalence rates above 1%; PEPFAR focuses its efforts in seven of these high-prevalence provinces: Hanoi, Ho Chi Minh City (HCMC), Haiphong, Quang Ninh, An Giang, and Can Tho. In this concentrated epidemic, transmission primarily occurs among most-at-risk populations (MARPs), including IDU, people in prostitution, and men who have sex with men (MSM). The highest prevalence is among IDU (who represent 50%�60% of all reported cases); prevalence among IDU has increased from an estimated 25% in 2000 to 34% in 2005, reaching as high as 50-60% in some provinces. Vietnam is a high-burden tuberculosis (TB) country. HIV prevalence among TB patients is 4% nationally and 24% in HCMC (2005), and has been rising steadily.

Additional Funding: In June 2007, an additional $7,015,000 was allocated to strengthen activities in PMTCT, supporting rapid expansion of PMTCT services in high ANC prevalence provinces and PMTCT social marketing in seven focus provinces; TB/HIV, including strengthening laboratory capacity; counseling and testing; and prevention, to expand coverage and support activities for drug users, mainstream HIV prevention education in the school curriculum, and support pre-service training on HIV and drug use prevention for health professionals.

Emergency Plan funding will target the following programmatic areas to achieve the 2-7-10 targets:

Prevention: $14,163,571 (Field funded) (26.5% of prevention, care and treatment budget)

Prevention programs in Vietnam include: intensive and targeted behavior change; abstinence and be faithful interventions; injection safety; prevention of mother-to-child transmission (PMTCT); and blood safety. The USG will collaborate with non-governmental organizations (NGOs) to conduct outreach interventions to reduce men�s use of prostitutes in seven focus provinces where sexual transmission rates are high.

The USG will continue to support targeted behavior change communication (BCC) with MARPs, including IDU, CSW and their clients, and MSM through peer-based outreach and referral to drop-in centers, health clubs, and care and support services. The USG also will continue to engage government and business leaders in establishing local and national HIV/AIDS workplace policies and programs that increase access to testing and address discrimination against infected and affected workers. All BCC interventions (PEPFAR and other donors) will be coordinated by new PEPFAR-sponsored provincial outreach coordinators.

The USG will work with government ministries, mass media organizations, and partners to strengthen a national abstinence and be faithful media and community outreach campaign targeting urban and rural youth. A campaign targeting potential clients of people in prostitution will reach men directly. Peer education activities in three focus provinces (Hanoi, HCMC, and Quang Ninh) will target in- and out-of-school and street youth.

In partnership with the Ministry of Health (MOH), Vietnam Administration for AIDS Control (VAAC), the USG and the World Health Organization (WHO) will develop national injection safety guidelines, training related to dissemination of these guidelines, and will support the procurement of sharps disposal equipment for the seven focus provinces.

In the area of PMTCT, the USG will coordinate services and build capacity at national, provincial and community levels, and will increase linkages among all levels. Emergency Plan support will continue to improve services at existing sites, with particular focus on community outreach and the referral network between PMTCT and pediatric and adult outpatient clinics (OPCs).

The Emergency Plan focuses its blood safety efforts on a program within the Ministry of Defense (MOD), which has a health care system independent of the MOH. This support will continue in fiscal year 2007.

Principal Partners: MOH, local Provincial AIDS Committees (PACs), MOD, Academy for Educational Development (AED), University of Hawaii, Pact/Community Reach, CARE International, Medecins du Monde (MdM) France, Pathfinder International, Save the Children U.S., STI and HIV/AIDS Prevention Center, UNAIDS, Family Health International (FHI), and Health Policy Initiative (HPI).

Care: $18,230,540 (Field funded) (34.1% of prevention, care and treatment budget)

Care activities in Vietnam include counseling and testing (CT), clinical and home-based care, basic palliative care, integration of TB and HIV programs, and orphans and vulnerable children (OVC). The USG will provide technical assistance to the MOH for national CT guideline development, and will support expansion of CT coverage, introducing new interventions for MARPs in the highest prevalence provinces.

In fiscal year 2007, the Emergency Plan will support collaborative work to build comprehensive care services from the community to provincial levels. The USG will work with VAAC and other partners to develop a minimum package of services to ensure quality and consistency across sites. HIV clinical care and support activities focus on improving the capacity to provide care and treatment for opportunistic infections (OI), symptomatic and other disease prevention and care, and linking this care to CT and referral services.

The USG will work with the Government of Vietnam (GVN) to implement national palliative care guidelines approved in 2006. Based on the results of a pilot program, the Emergency Plan will support comprehensive, integrated HIV prevention, treatment and pre- and post-release services for residents from IDU rehabilitation centers. These services will be coordinated with Emergency Plan-trained case managers. Comprehensive psychosocial support, including addiction counseling, will be provided to residents entering the community.

To address the increasing HIV prevalence among TB patients, the USG will improve collaboration between TB and HIV programs in focus provinces, to ensure routine, standardized HIV testing of TB patients, TB screening of PLHWA, and referral of HIV-infected persons to diagnosis and TB care. The USG will also strengthen TB-HIV linkages among TB clinics, pediatric and adult clinics, and PMTCT programs.

The number of children living with and affected by HIV/AIDS in Vietnam remains relatively low, with 8,500 estimated HIV/AIDS cases in children under 15. Current services for OVC are minimal. The Emergency Plan will support development of a multi-sectoral plan for family-centered care, community-based alternatives to institutional care, and functioning child protection systems. In fiscal year 2007, support for OVC services will more than double previous coverage and will integrate OVC into care and support programs in clinics as well as in the home and community. PEPFAR will support development of community-reintegration programs for abandoned and institutionalized children, which can serve as national models.

Principal Partners: MOH, HCMC PAC, MOD, Vietnam-CDC-Harvard Medical School AIDS Partnership, University of Hawaii, Pact, CARE International, MdM France, Worldwide Orphans Foundation, Mai Hoa AIDS Center, Center for Community Health and Development, UN Volunteers, UNAIDS, WHO, FHI, and HPI.

Treatment: $21,130,151 (Field funded) (39.5% of prevention, care and treatment budget)

Emergency Plan support for antiretroviral therapy (ART) includes: establishment of effective drug procurement and dispersal systems; policy development; strengthening of laboratory infrastructure; enhancement of human capacity; and effective monitoring and evaluation (M&E) systems. Currently, 36 sites in six high-prevalence provinces are providing adult, pediatric, and PMTCT-plus services for 3,000 PLWHA. In fiscal year 2007, the USG will continue to scale up ARV services for adults and children in the focus provinces. District-based clinics will provide a basic package of services and serve as �magnet� clinics for surrounding districts. To ensure quality services and long-term sustainability, the USG will develop human capacity through clinical mentoring, ongoing supervision, and development and implementation of a national training curriculum. Special attention will be given to education in addiction treatment and its interactions with ART, nursing, pharmaceutical, and social support programs, to improve the overall quality of services.

The USG will continue to build national and provincial laboratory capacity by supporting training in lab-related services; procuring necessary laboratory equipment, test kits, and basic diagnostics for HIV-related care and treatment activities; and developing quality assurance/quality control (QA/QC) systems.

Principal Partners: MOH, HCMC PAC, National Institute of Hygiene and Epidemiology (NIHE), MOD, Vietnam-CDC-Harvard Medical School AIDS Partnership, Management Sciences for Health, Supply Chain Management Services, University of Hawaii, Pact, MdM France, World Wide Orphans, Mai Hoa AIDS Center, FHI, and HPI.

Other Costs: $12,265,738

Strategic information (SI) is one of the high priority areas in the GVN�s National HIV/AIDS Strategy. Through the development of a certificate-based training curriculum, the USG will help build SI institutional and human capacity. Additionally, the USG will provide technical assistance and training for evidence-based analysis and decision-making. The Emergency Plan will support improvement of surveillance activities; validation of estimations and projections; MARP size estimates; and routine health information system infrastructure. Program effectiveness will be measured through a targeted assessment of USG in-country support and institutionalization of program monitoring and data management systems.

The USG will focus on activities related to policy and systems strengthening, to assist the GVN in coordinating national HIV/AIDS activities, including HIV/AIDS training for key GVN leaders. Sustainable systems will be developed through human resources capacity building and infrastructure strengthening at the national, provincial, and district levels. Emergency Plan support will address stigma and discrimination, civil society development, and implementation of the National HIV/AIDS Law. The USG will link program efforts through support of coordination committees in the areas of care and treatment, PMTCT, CT, and TB. Direct advocacy and policy development support will be provided to enable key military leaders to attend regional and international trainings and conferences.

Principal Partners: MOH, HCMC PAC, Hanoi School of Public Health, NIHE, MOD, AED/SMARTWork, Pact, University of North Carolina/ MEASURE Evaluation, UNAIDS, Partner TBD (Evaluation of drug rehabilitation center activities, SI training and applications development), ORC/MACRO, HIVQUAL, University of Washington/ITECH, Harvard University Kennedy School, International Center for Research on Women, Pathfinder International, Institute for Social Development Studies, UNDP, UNAIDS, WHO, FHI, and HPI.

Management and staffing costs will support in-country personnel at HHS/CDC, HHS/SAMHSA, USAID, and the DOD. Funds will ensure program management, monitoring and accountability, and policy and technical leadership within the Vietnam national response; they also will cover compensation, logistics, travel, and office and administrative costs.

Other Donors, Global Fund Activities, Coordination Mechanisms:

There are approximately 30 international NGOs and seven government-sanctioned technical local NGOs, nine UN organizations, five major bilateral agencies and the Global Fund providing resources for HIV/AIDS programs. International organizations include faith-based, general development, and specialized consulting firms. Local NGOs include specialized research organizations, program design and implementation organizations, and community-based organizations. UN organizations include UNAIDS, WHO, UNICEF, UNODC, UNFPA, UNESCO, UN Volunteers, ILO, and UNDP. Since 2005, the U.S. Ambassador has led an international group of donors in coordinating technical programming, program management, and policy intervention.

The Global Fund project began in 2004 and runs to June 2008, with $12 million in Round 1 funding. Its mission is to support 3,000 persons on ART in fiscal year 2007 and to strengthen care, counseling, and support for PLWHA. The MOH, the principal recipient and implementing partner, has targeted 20 provinces for programs. The Emergency Plan has provided direct support to Global Fund grant implementation in the following ways: 1) as a voting member on the CCM; 2) through in-country technical assistance for grant application development; 3) through upstream support to the Vietnam Global Fund team through implementing partners; and 4) through support for on-site technical assistance to Global Fund-supported care and treatment clinics.

In August 2005, the Prime Minister established the Vietnam Administration of HIV/AIDS Control within the MOH, in order to coordinate and oversee all HIV/AIDS activities, including those supported by the Emergency Plan. The USG team regularly meets with key officials of departments under the MOH, to ensure that Emergency Plan assistance continues to complement and support the GVN strategy for prevention, care, and treatment.

Program Contact: Emergency Plan Coordinator, Valerie Koscelnik

Time Frame: Fiscal year 2007 � fiscal year 2008

Approved Funding by Program Area: Vietnam

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