Vietnam Fiscal Year 2008 Country PEPFAR Operational Plan (COP)


VIETNAM

Project Title: Vietnam Fiscal Year 2008 Country PEPFAR Operational Plan (COP)

Budget Summary:

  Field Programs Funding by Account  Central Programs  
   Notified November 2007 Notified February 2008 Notified as of February 2008  Allocations to Date
Implementing Agency GAP GHCS - State Subtotal: Field Programs Funding GAP GHCS - State Subtotal: Field Programs Funding Subtotal: GHCS Central Programs Grand Total:  Field & Central Funding
DOD                 -      352,500           352,500                 -    2,989,700        2,989,700                      -        3,342,200
DOL                 -                 -                      -                 -                 -                      -                      -                      -
HHS                 -      139,500           139,500    2,611,543  31,172,039       33,783,582                      -       33,923,082
Peace Corps                 -                 -                      -                 -                 -                      -                      -                      -
State                 -                 -                      -                 -                 -                      -                      -                      -
USAID                 -    8,546,000        8,546,000                 -  38,947,591       38,947,591                      -       47,493,591
TOTAL                 -    9,038,000        9,038,000    2,611,543  73,109,330       75,720,873                      -       84,758,873

HIV/AIDS Epidemic in Vietnam:
Adults (aged 15-49) HIV Prevalence Rate: 0.53% (UNAIDS, 2006)
Estimated number of People Living with HIV: 260,000 (UNAIDS, 2006)
Estimated number of Orphans due to AIDS: No official estimate available

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

Botswana

Total # Individuals Receiving Care and Support

Total # Individuals Receiving ART

End of FY 2004*

1,020

-

End of FY 2005**

13,100

700

End of FY 2006***

26,200

6,600

End of FY 2007****

47,400

11,700

End of FY 2008*****

68,513

17,000

End of FY 2009*****

108,795

22,000

* "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.
** �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.
*** "The 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.
**** "The Power of Partnerships: The President's Emergency Plan for AIDS Relief." 2008 Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, January 2008.
***** Projections from FY 2008 Country Operational Plan

Program Description/Country Context:

Vietnam, a densely populated country of 85.2 million, has an estimated 280,000 people living with HIV/AIDS (PLWHA) and an estimated overall population prevalence of 0.53% (UNAIDS, 2006). Several provinces with significant numbers of injecting drug users (IDUs) report prevalence rates above 1%. PEPFAR operates a comprehensive service delivery system in seven high-prevalence �focus� provinces: Hanoi, Ho Chi Minh City, Haiphong, Quang Ninh, An Giang, Can Tho, and recently-added Nghe An. In FY 2008, PEPFAR will expand into an eighth focus province, Son La. PEPFAR Vietnam also supports a tiered level of services based on epidemiologic need and other donor support in a total of 32 provinces. In this concentrated epidemic, transmission occurs primarily among persons engaged in high risk behaviors (PEHRBs) which includes IDUs, persons in prostitution, and men who have sex with men (MSM). The highest prevalence is among IDUs who represent 50%-60% of all reported cases. The number of IDUs who are HIV-infected was estimated to be 23.1% in 2006, reaching as high as 50-60% in some provinces. Vietnam is also one of 22 �high-burden� tuberculosis (TB) countries. HIV prevalence among TB patients is 4.9% nationally and has been rising steadily.

PEPFAR funding in FY 2008 will focus on the following programmatic areas to fulfill its contributions to the global 2-7-10 targets:

Prevention: $19,989,872 (28.6% of prevention, care and treatment budget)

The PEPFAR prevention portfolio in Vietnam includes intensive and targeted behavior change through abstinence and be faithful (AB) interventions, focused work in condoms and other prevention activities, prevention of mother-to-child transmission (PMTCT), injection safety, and blood safety.

Since the HIV/AIDS epidemic in Vietnam is fueled primarily by injection drug use, a substantial percentage of the annual PEPFAR investment in HIV/AIDS prevention is devoted to addressing this issue, in addition to preventing HIV/AIDS through sexual transmission. Given Vietnam�s large population and highly concentrated epidemic, AB programming will be focused on meeting the prevention needs of 60,000 high-risk youth, including street youth and young people in vocational and urban university settings. Programming will support partner reduction activities with a campaign targeting prospective clients of persons in prostitution. A key component of the AB program is technical assistance to reinforce protective sexual norms for in-school youth through HIV/AIDS education programs.

The PEPFAR team in Vietnam has prioritized the integration of addiction and relapse prevention services into its existing outreach programs for IDU, persons engaged in prostitution, and men who have sex with men (MSM) for FY 2008. To establish a more structured and targeted approach to prevent drug use, other prevention activities will promote norms among IDUs that discourage initiating others into drug use by integrating the evidence-based Break the Cycle model into existing IDU outreach programs. FY 2008 activities will continue to focus on targeted programs for high-risk youth and to address HIV-related drug and sexual risks. PEPFAR will expand condom social marketing efforts to raise the risk perceptions associated with multiple sexual partnerships and transactional sex, and improve access to condoms and risk reduction education in non-traditional venues, including massage parlors and karaoke bars.

Positive prevention will be addressed by mainstreaming prevention activities into care and treatment efforts, including the integration of specific risk reduction counseling for HIV-positive individuals and discordant couples into HIV counseling and testing services. FY 2008 activities will continue to expand to faith-based organizations, including organizing Buddhists and Catholics into interfaith teams to provide care and support in the home and community, and to address the complex issues related to prevention, stigma and discrimination.

Efforts in PMTCT will continue to focus on coordination of services and capacity building at national, provincial, and community levels, as well as strengthening linkages across all levels. PEPFAR support will expand services to both focus and non-focus provinces and continue to improve services at existing sites, with particular concentration on community outreach and the referral network between PMTCT, pediatric, and adult out-patient clinics.

In collaboration with the Ministry of Health's Vietnam Administration for HIV/AIDS Control (VAAC) and the World Health Organization (WHO), PEPFAR will help develop national injection safety guidelines, provide training related to dissemination of these guidelines, and procure sharps disposal equipment for eight focus provinces. PEPFAR�s blood safety efforts are conducted in collaboration with the Ministry of Defense (MOD), which maintains a health care system independent of the MOH. This support will continue in FY 2008 in additional military hospitals, with training in blood safety.

Principal Partners: Vietnam�s Ministry of Health, local Provincial AIDS Centers, Vietnam�s Ministry of Defense, University of Hawaii, Pact/Community Reach Vietnam, Family Health International, Constella Futures Group/Health Policy Initiative, United Nations Resident Coordinator, and To Be Determined partners in the Abstinence/Be Faithful and Condoms and Other Prevention program areas.

Care: $25,183,000 (36.1% of prevention, care and treatment budget)

Care and support efforts in Vietnam include counseling and testing (CT), clinical and home-based care, integration of TB and HIV treatment for co-infected patients, and support to orphans and vulnerable children (OVC).

The PEPFAR team continues to provide key technical assistance to MOH for national CT guideline development. FY 2008 activities will also support expansion of CT coverage and introduction of new interventions for MARPs in the highest prevalence provinces. Upstream and downstream support for CT in selected IDU rehabilitation centers will be expanded to additional urban centers. PEPFAR will also continue to advocate for approval of rapid test HIV confirmatory testing.

In FY 2008, PEPFAR will support collaborative work between the Government of Vietnam (GVN) and other implementing partners to build comprehensive care services from the community to the provincial levels. Together, PEPFAR partners will develop a minimum package of services, ensuring quality and consistency across sites. HIV clinical care and support activities will focus on improving the capacity to provide care and treatment for opportunistic infections, symptomatic and other disease prevention and care, and linking this care to CT and referral services.

As part of its policy focus in palliative care, PEPFAR will work closely with the GVN to implement national palliative care guidelines approved in 2006. Based on the results of an FY 2006 pilot program, PEPFAR will support comprehensive, integrated HIV prevention, treatment and pre- and post-release services for residents of government drug rehabilitation centers. These services will be coordinated with PEPFAR-trained case managers. Comprehensive psychosocial support, including addiction counseling, will be provided to residents re-entering the community.

The TB/HIV program allocation will be increased in FY 2008 and will address improved collaboration between TB and HIV programs in focus provinces to assure routine, standardized HIV testing of TB patients, TB screening of PLWHA, and referral of HIV-infected persons to diagnosis and TB care. PEPFAR will also strengthen linkages between TB clinics, pediatric and adult ART clinics, and PMTCT. In FY 2008, PEPFAR will also continue an assessment of TB infection control practices in PEPFAR-supported HIV/AIDS care and treatment sites, and work closely with private pharmacies and clinicians to promote collaborative public-private management of TB/HIV patients.

The number of children living with and affected by HIV/AIDS in Vietnam remains relatively low, with no accurate estimates of HIV/AIDS cases among children. Current services for orphans and vulnerable children (OVC) are minimal. PEPFAR will support development of a multi-sectoral plan for family-centered, community-based alternatives to institutional care and effective child protection systems. In FY 2008, support for OVC services will increase and ensure that each child identified by PEPFAR has access to OGAC's six essential services: health, nutrition, education, protection, psychosocial support, and shelter. The program will further 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 for implementation.

Principal Partners: Vietnam�s Ministry of Health, local Provincial AIDS Centers, Vietnam�s Ministry of Defense, University of Hawaii, Pact/Community Reach Vietnam, Family Health International, Constella Futures Group/Health Policy Initiative, United Nations Resident Coordinator, and Vietnam-CDC-Harvard Medical School AIDS Partnership follow-on.

Treatment: $24,650,000 (35.3% of prevention, care and treatment budget)

In FY 2008, PEPFAR support for treatment includes the establishment of effective drug procurement and dispersal systems; scale-up of ART in both adult and pediatric sites; strengthening of laboratory infrastructure; enhancement of human capacity; and more effective monitoring and evaluation systems.

Currently, 60 sites in six focus provinces are providing PEPFAR-supported adult, pediatric, and PMTCT-plus services for 12,800 PLWHA. In FY 2008, PEPFAR will continue to increase access to ARV services for adults and children in its focus provinces. District-based clinics will provide a basic package of services and act as magnet clinics for surrounding communities. PEPFAR will expand comprehensive, integrated HIV prevention, treatment, and pre- and post-release services for residents from IDU rehabilitation centers, based upon results from a pilot program initiated in FY 2006. To assure quality services and long-term sustainability, PEPFAR will continue to develop human capacity through clinical mentoring, ongoing supervision, and the development and implementation of a national training curriculum. Special attention will be given to education in addiction treatment, the interaction of substance abuse and ART, nursing, pharmaceutical, and social support to improve the quality of services, with health care workers trained to deliver ART services.

A key focus of PEPFAR�s laboratory program will be capacity building through procurement of equipment for clinical testing, establishing service contracts for maintaining key equipment, training, and strengthening donor partnerships. A high priority is improving MOH's capacity for commodity management by supporting the creation of an importation committee and inventory management system. In FY 2008, PEPFAR will also support DNA PCR and specimen collection using dried blood spot testing for infant diagnosis. PEPFAR will support MOD, in developing a reference laboratory in Ho Chi Minh City which will handle specimens from clinical centers covering both military and civilian populations.

Principal Partners: Vietnam�s Ministry of Health, Ho Chi Minh City Provincial AIDS Committee, National Institute of Hygiene and Epidemiology, Vietnam�s Ministry of Defense, Vietnam-CDC-Harvard Medical School AIDS Partnership follow-on, Management Sciences for Health, Partnership for Supply Chain Management, University of Hawaii, Pact/Community Reach Vietnam, Family Health International, Constella Futures Group/Health Policy Initiative, and the Armed Forces Research Institute for Medical Sciences.

Other Costs: $14,936,001

Strategic information (SI) is a key priority area in GVN�s National HIV/AIDS Strategy. Through the development of a certificate-based training curriculum, PEPFAR provides critical building blocks for SI institutional and human capacity. In FY 2008, PEPFAR will continue to offer technical assistance (TA) and training for evidence-based analysis and data for decision-making. PEPFAR will also support collection and improvement of data necessary for program decision making through TA for national and specialized surveillance activities, validation of estimations and projections, PEHRB size estimates, and routine health information system infrastructure. Program effectiveness will be measured through a targeted assessment of PEPFAR in-country support and institutionalization of program monitoring and data management systems.

PEPFAR�s investment in policy and systems strengthening interventions will primarily assist GVN in coordinating national HIV/AIDS activities including HIV/AIDS training for key government leaders. Sustainable systems will be developed through human resource capacity building and infrastructure strengthening at national, provincial, and district levels. PEPFAR activities in FY 2008 will address stigma and discrimination, civil society development, and implementation of the GVN National HIV/AIDS Law. PEPFAR will link program efforts through support to coordination committees in the areas of prevention, care, and treatment. Activities will also focus on developing standards of practice and certification of private health care providers in HIV/AIDS prevention, care and treatment. FY 2008 activities include development of an anti-stigma and anti-discrimination strategy across PEPFAR programs. Support for the greater involvement of people living with HIV/AIDS will continue through the expansion of PLWHA organizations and the further development of a national PLWHA network. Direct advocacy and policy development support will be provided for key military leadership and government leaders to benefit from regional HIV/AIDS policy trainings.

USG investment in management and staffing supports personnel to fill key technical and administrative staffing gaps across three U.S. government agencies, USAID, HHS/CDC, and DOD. These positions will ensure that USG is able to provide strong HIV/AIDS program management and monitoring assistance, as well as policy and technical leadership, to GVN.

Principal Partners: Vietnam�s Ministry of Health, Ho Chi Minh City Provincial AIDS Committee, Hanoi School of Public Health, National Institute of Hygiene and Epidemiology, Vietnam�s Ministry of Defense, Pact/Community Reach Vietnam, University of North Carolina/MEASURE Evaluation, UNAIDS, ORC/MACRO, Family Health International, Constella Futures Group/Health Policy Initiative, and To Be Determined partners focused on SI training and applications development.

Other Donors, Global Fund Activities, Coordination Mechanisms

The United States is the leading donor for HIV/AIDS interventions in Vietnam, providing $65.8 million in FY 2007. The second-largest source of support is the Global Fund to Fight HIV/AIDS, TB, and Malaria. In 2004, the Global Fund (GF) received $12 million in Round 1 funding for an HIV/AIDS program that ends in June 2008. Its target is to support 4,200 patients on ART by FY 2008 and to strengthen care, counseling, and support to PLWHA across the country. MOH, the principal recipient and implementing partner for the GF, has targeted 20 provinces for program implementation. PEPFAR provides direct support to Global Fund grant implementation as 1) a voting member on the country coordinating mechanism; 2) a provider of in-country technical assistance for grant application development; 3) a provider of financial and technical support to the Vietnam GF team through our implementing partners; and 4) a provider of technical support for on-site assistance to GF-supported care and treatment clinics.

In all, there are approximately 30 international non-governmental organizations (NGOs) and seven government-sanctioned local NGOs, nine United Nations organizations, five major bilateral agencies, and the GF, providing resources for HIV/AIDS programs in Vietnam. International organizations include faith-based groups and general development and specialized consulting firms. Local NGOs include specialized research organizations, program design and implementation organizations, and community-based organizations. Since 2005, the U.S. Ambassador has led an international group of donors in coordinating technical programming, program management, and policy intervention related to HIV/AIDS.

In August 2005, the Prime Minister of Vietnam established VAAC within the MOH to coordinate and oversee all HIV/AIDS activities including PEPFAR. The PEPFAR team meets regularly with key officials of VAAC and other departments within the MOH to ensure that PEPFAR programming not only complements but also strengthens the host government�s national response for prevention, care, and treatment of HIV/AIDS.

Program Contact: PEPFAR Coordinator, Jim Sarn

Time Frame: FY 2008 � FY 2009

Approved Funding by Program Area: Vietnam

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