Ministry of health. Program of Action on HIV/AIDS surveillance, monitoring and evaluation

Transcription

1 Ministry of health Program of Action on HIV/AIDS surveillance, monitoring and evaluation Hµ Néi 2007

2 ABBREVIATIONS CSW IDU M&E NID NIHE STI VCT Commercial Sex worker Injecting drug use Monitoring and Evaluation National Institute of Dermatology National Institute of Hygiene and Epidemiology Sexual transmitted infection Voluntary Counseling and Testing 1

3 PART I: RATIONALE FOR THE DEVELOPMENT OF THE PROGRAM OF ACTION I. LEGAL BASIS OF THE DEVELOPMENT OF THE PROGRAM OF ACTION 1. Resolution No 46 NQ/TW dated 23/02/2005 of Ministry of Politics on the tasks of health care and to protect and promote people's health in new situation. 2. Directive No 54CT/TW dated 30/11/2005 of Party Central Committee s Secretariat on Strengthening the leadership in HIV/AIDS control and prevention in new situation. 3. Law on HIV/AIDS Prevention and Control 4. Directive No 02/2003/CTTTg dated 24/02/2003 of the Prime Minister in strengthening HIV/AIDS control and prevention. 5. Decision No 36/2004/Q TTg dated 7/3/2004 of the Prime Minister approving the National Strategy on HIV/AIDS Prevention and Control till 2010 with a vision to II. GLOBAL AND VIET NAM HIV/AIDS EPIDEMIC SITUATIONS 1. Global HIV/AIDS epidemic situation According to Joint United Nations Program on HIV/AIDS (UNAIDS) and World Health Organization (WHO), HIV/AIDS epidemic first appeared in late 1970s and early 1980s in Africa. In the South, South East Asia and East Asia and the Pacific s, HIV/AIDS epidemics appeared in the late 1980s. Epidemics appeared in East Europe and Middle East in the early 1990s. By the end of 2005, UNAIDS and WHO estimated that there were 40.3 million people living with HIV. In 2005, only 4.9 million people were newly infected with HIV and 3.1 million people died of AIDS. HIV prevalence was highest in SubSaharan Africa with 25.8 million people living with HIV (two thirds of the number of people living with HIV globally), and was second highest in Asia and the Pacific s (AIDS epidemic update, UNAIDS, Dec 2005). The HIV epidemics appeared in Asia relatively late. The first HIV case was reported in Thailand in 1985, and then HIV was reported in Cambodia and Myanmar in late 1990s. The most common routes of HIV transmission in this region were heterosexual intercourse and injecting drug use. According to UNAIDS, HIV epidemics are increasing in East Europe, Central Asia and East Asia. In East Europe and Central Asia, the number of people living with HIV increased 25% (up to 1.6 million) since 2003, and the number of people who died of AIDS was double in the same period. In East Asia, the number of new HIV infections in

4 was 20% higher than the two previous years (up to people). (AIDS Epidemic Update, UNAIDS, Dec 2005). According to UNAIDS, HIV epidemics are increasing in Asia and the Pacific s especially, in China, Papua New Guinea and Viet Nam. There is evidence that the epidemics are also increasing dramatically in Pakistan and Indonesia. The reasons for these HIV epidemics increase in this region might be due to the large number of developing countries in the region, the high rate of poverty and hunger, the venue of many drug producers. These are challenges for HIV prevention and control efforts in these regions as well as the world. 2. Viet Nam HIV epidemic situation 2.1. HIV/AIDS figures: By 31/12/2006, the cumulative number of HIV reported cases in Viet Nam was 116,565 people. Among those, 20,195 people developed AIDS and 11,802 people died of AIDS. In 2006, there were 12,454 new reported cases of HIV, including 2,906 people developed AIDS and 1,731 peopled died of AIDS Characteristics of HIV/AIDS epidemic in the period of a) Annually, there are more than 10,000 HIV newly reported cases. The number of reported cases was highest in 2003 with 16,980 cases. Since 2003, the number of newly reported cases of HIV has been decreasing each year. However, it remains at a high level. b) HIV epidemic is still in concentrated phase. HIV infections were mainly in mostatrisk groups such as injecting drug users and sex workers; c) The ratio of male to female among HIV infected cases was 6:1 (among HIV reported cases, 85.19% were males and 14.54% were females), this ratio has remained relatively stable since 1993; d1) The majority of HIV infected people were young. The people at the age group of 2039 were 78.94% of HIV reported cases; d2) The results of HIV sentinel surveillence show that the HIV epidemic was still increasing but not as fast as before: HIV prevalence among IDUs reached its highest level in 2001 and 2002 at 29.4%. It decreased to 25.5% in 2005; 3

5 The HIV prevalence among FSWs reached its highest level in 2002 at 5.9%. It decreased to 4.4% in 2004; In the groups of STI patients, pregnant women, military conscripts, there is evidence that the HIV epidemic was not increasing as fast as in the previous years e) The epidemics are largely concentrated in some provincies/cities. The HIV prevalence per 100,000 people was highest in Quang Ninh. However, Ho Chi Minh City had the largest number of HIV reported cases (17,407 cases) which was 14% of the total of nationalwide HIV reported cases. g) The epidemics were not increasing as fast as they were before, but there were many favorable factors for widerspread epidemics in many provinces. The knowledge about HIV of most at risk groups continued to be very low, the percentage of sharing needles among IDUs was from 22% to 44%. The condom use among CSWs was increasing but it is still at low level (5 65%); h) There were signs that the epidemics had started to spread into the general population: the HIV prevalence among military conscripts and pregnant women are 0.44% and 0.35%, respectively. III. HIV SURVEILLANCE, MONITORING AND EVALUATION IN OTHER COUNTRIES AND IN VIET NAM 1. HIV/AIDS/STI surveillance, monitoring and evaluation in other countries Through out the world, there are many contries have effectively implemented HIV monitoring and evaluation. These countries acknowledge the immportance of monitoring and evaluation. UNAIDS and WHO are among these organizations that contributed trimendously to this task. At regional level, by now China and Cambodia have issued the HIV program monitoring and evalation indicator sets 2. HIV surveillance, Monitoring and Evaluation in Viet Nam 2.1. Achievement a) Management, Supervision and Implementation of HIV surveillance program. The structure of HIV/AIDS surveillance system 4

6 + At the central level: Sub committee for HIV surveillance was established in 1995 under the AIDS Division (currently named Executive Board of HIV/AIDS prevention Project); + At provincial level: Sub committee for HIV/AIDS surveillance was established on the foundation of Department of Epidemiology in Preventive Medicine Center under the AIDS Division or Provincial AIDS Standing Bureau in all 64 provincies/cities; + At distric level: District Preventive Medicine Center is assigned to implement the HIV/AIDS surveillance task. Management and directions: + In June 2006, the National Assembly passed the Law on HIV/AIDS Prevention and Control. In Article 1, chapter III, there are 3 items relating to HIV surveillance in this law. + On 24 February 2003, Ministry of Health assisted the Prime Minister in issuing the Directive No 02/2003/CTTTg regarding strengthening HIV Prevention and Control tasks, in which includes specific regulations about the repsonsibilities for implementing HIV/AIDS surveillance measures; + On 17 March 2004, the Prime Minister approved the Natiaonal Strategy on HIV Prevention and Control till 2010 with a Vision to HIV surveillance, monitoring and evaluation is one of the important programs of action required to succesufully implement the National Strategy; + Ministry of Health issued many documents on HIV/AIDS surveillance, such as Decision No 1418/2000/Q BYT dated 04/5/2000 issued by Minister of Ministry of Health regarding the National Guideline on HIV/AIDS surveillance; Decision No 2691/2002/Q BYT dated 19/7/2002 issued by Miniter of Ministry of Health regarding Guideline of STIs surveillance in Viet Nam ; Decree No 11/2001/CTBYT dated 31/10/2001 issued by Minister of Minstry of Health regarding strengthening the HIV/AIDS control and prevention... These documents serve as legal basis for HIV Pevention amd Control activities including HIV surveillance. b) Professional activities: 5

7 HIV reporting actitvities has been implemented throughout country. In 2000, a database for HIV reported cases was set up using special software. The software was upgraded in 2006; HIV sentinel surveillance was started in 8 provinces in 1994 and expanded into 40 provinces in Six target populations are IDUs, CSWs, STI patients, TB patients, pregnant women and military conscripts. The crosssectional surveys are repeated annually (from May to August). The sample size is 400 for mostatrisk groups and 800 for lower risk groups; STI surveillance: Provincial Centers for Dermatology report the number of STI detected cases to the National Institute of Dermatology twice a year according to the National STI surveillance Guideline. The STI sentinel survellance was started in 2002 in 10 provinces. It was integrated with HIV sentinel surveillance. The target populations are CSWs, STI patients, pregnant women and others (e.g. military conscripts...). It is repeated annually from May to August; Behavioral surveillance was started in 2000 in 5 provinces. The target populations are IDUs, CSWs and mobile populations; HIV testing: The number of laboratories which are accredited to confirm the HIV testing results has increased from 4 to 69 in 50 provinces/cities. Monitoring and Evalation commenced in Difficulties, Limitations a) As HIV/AIDS surveillance, Monitoring and Evaluation activities were implemented throughout the country in all populations, many difficulties and challenges have arisen: There were no HIV accredited laboratories in 14 provinces; It was difficult to reach the mostatrisk populations to meet minimum sample sizes requirements; The M&E system did not function in harmony, there are overlaps in functions and responsiblities as the tasks were not clear devided between different levels; Reports from various related agenices/sectors are not unified and not under a specific procedure. The data quality was poor. There were no clear mechanisms for surveillance, M&E data and information exchange and use. 6

8 b) The benefits and incentives for staffs who were working in laboratories and surveillance system were inadequate and inappropriate to realistic context; c) Health workers were not aware of the important of surveillance. Therefore, they did not invest sufficient time and effort in surveillance. In addition, staff turnover within the surveillance system was quite high. d) Human and financial resourses for surveillance, M&E were not sufficient. The resources was allocated mainly to sentinel and reporting cases surveillance programs. There were no resources allocated to program M&E. IV. THE IMPORTANCE OF HIV/AIDS/STI SURVEILLANCE, MONITORING AND EVALUATION 1. The importance of HIV/AIDS surveillance 1.1. To monitor the trends of HIV to control and project the HIV epidemics; 1.2. To provide data to develop interventions and plans for HIV prevention and patient care and treatment in Viet Nam. 2. The importance of Monitoring and Evaluation: 2.1. Monitoring and Evaluation helps to calculate and allocate resources to maximize the effectiveness of resources; 2.2. Monitor and Evaluate whether the activities are being implemented as planned. To provide timely and accurate information to adjust activities in real contexts and to find effective resolutions In general, surveillance, monitoring and evalution will provide an overall picture of HIV epidemic and HIV prevention and control activities in Viet Nam in order to orient and select the effective interventions which are appropriate with existing resources. 7

9 PART II: PROGRAM OF ACTION HIV/AIDS/STI SURVEILLANCE, MONITORING AND EVALUATION I. GOAL To provide accurate, timely and sufficient information to develop plans and policies for effective HIV prevention and control; to monitor and supervise comprehensively HIV prevention and control; to evaluate the effectiveness of the intervention, prevention, care and treatment activities of the national HIV program. II. SPECIFIC OBJECTIVES 1. To establish the HIV/AIDS/STI surveillance, monitoring and evaluation system from the central to local level. guidelines. 2. To complete the national HIV/AIDS/STI surveillance, monitoring and evaluation systems 3. To unify the HIV/AIDS/STI surveillance, monitoring and evaluation reporting % of cities and provinces have laboratories that are accredited to confirm HIV positive results. Establish 08 laboratories that can perform HIV confirmation tests by molecular techniques and virus isolation by % of HIV tests are performed accordingly to volunteer counseling and testing regulations. There are at least 100 volunteer counseling and testing centers that meet the national standards by % of sentinel provinces will collect enough sample sizes of HIV/AIDS/STI surveillance; integrate serosurveillance with behavioral surveillance. program. 7. Periodically conduct census survey on national HIV/AIDS control and prevention % of provinces/cities have capacity to monitor, evaluate, and project HIV/AIDS/STI by

10 III. PRINCIPLES OF PROGRAM IMPLEMENTATION 1. Surveillance, Monitoring and Evaluation system is a unified and unique system, from the central to local level, based on the surveillance system. 2. Monitoring and Evaluation of the national HIV prevention and control program must be compliant with the national HIV monitoring and evaluation set of indicators. 3. Strengthen the collaboration among units, organizations, sectors, and other institutions in HIV surveillance, monitoring and evaluation. 4. Allocate resources, prioritize the implementation of HIV/AIDS/STI surveillance, monitoring and evaluation in areas, where the HIV prevalence is high, later on, and expand to the whole nation. IV. IMPLEMENTATION RESOLUTIONS 1. Resolutions for Organizational structures a) Strengthen the HIV/AIDS surveillance system, establish and complete the HIV montioring and evaluation units at all levels.; b) Strengthen the direction and coordination from the central to local level; regularly supervise the HIV surveillance, monitoring and evaluation system. 2. Technical resolution a) Develop a national guidelines on technical implementation of the HIV surveillance, monitoring and evaluation; b) Complete the data collecting and reporting systems of HIV/AIDS/STI surveillance, monitoring and evaluation; c) Provide facilities, upgrade the relevant infrustructures, strengthen human resources for HIV laboratory system, standard VCT centers, units for collecting, storing, reporting and exchanging information of HIV/AIDS/STI surveillance program, HIV monitoring and evaluation; 9

11 d) Strengthen international collaboration in HIV/AIDS/STI surveillance program, HIV monitoring and evaluation; evaluation. e) Conduct studies in area of HIV/AIDS/STI surveillance, HIV monitoring and 3. Resolutions for strengthening the management capacity 3.1. Develop policies to attract human resources for HIV/AIDS/STI surveillance, HIV monitoring and evaluation; 3.2. Provide technical assisstance from high levels to low levels in HIV/AIDS/STI surveillance program, HIV/AIDS control and prevention program monitoring and evaluation; 3.4. Train and retrain technical skills for staffs who are participating in HIV/AIDS/STI surveillance program, HIV/AIDS control and prevention program monitoring and evaluation at all levels; 3.4. Increase supervising activities of HIV/AIDS/STI surveillance, HIV monitoring and evaluation; 4. Resolutions to increase resources 4.1. Budget for HIV monitoring and evaluation will take 15% 20% of the total budget for HIV prevention and control ( including international aids); 4.2. Strengthen the collaboration with all national and international organizations participating in HIV prevention and control programs in order to maximise resources for HIV/AIDS/STI surveillance, HIV monitoring and evaluation; c) Gradually socialize HIV counselling and testing by charging some fees. IV. PROGRAM OF ACTION 1. Objective 1: To establish the HIV/AIDS/STI surveillance and the HIV monitoring and evaluation system from the central level to local level To establish a system of HIV/AIDS/STI surveillance, HIV monitoring and evaluation units: 10

12 a) Establish a unit for HIV/AIDS/STI surveillance, national HIV monitoring and evaluation at The Viet Nam Administration for AIDS Control (Department of HIV/AIDS/STI surveillance) Ministry of Health; b) Establish regional units for HIV/AIDS/STI surveillance, HIV monitoring and evaluation: + In the North: located at National Institue of Hygiene and Epidemiology; + In the South: located at Hochiminh City Pasteur Institute; + In the Central: located at Nha Trang Pasteur Institute; + In the Central High Plateau: lacated at Tay Nguyen Institue of Hygiene and Epidemiology; c) Establish provincial units for HIV/AIDS/STI surveillance, HIV monitoring and evaluation, located at Provincial AIDS Centers; d) Develop a road map for the establishment of district monitoring and evaluation units at District Preventive Medicine Centers. It is targetted that by 2010, 50% of districts will have had functional unit for monitoring and evaluation; 2. Strengthen the capacity for the National HIV/AIDS/STI surveillance, HIV monitoring and evaluation system a) Establish a techincal assistant group for HIV/AIDS/STI surveillance, HIV monitoring and evaluation system, which includes the representatives from different related ministries, sectors, and international orgarnizations; b) Develop training materials on monitoring and evaluation which meet international standards, develop training framework on HIV/AIDS/STI surveillance, HIV monitoring and evaluation ; c) Establish a group of national trainers on HIV/AIDS/STI surveillance, HIV monitoring and evaluation; d1) Strengthen capacity of staffs at all levels through organizing training courses, training on the job and supervising the implementation at commune and district levels; d2) Train potential human resourses by gradually introducing training in M&E into training courses at Medical schools. 11

13 e) Increase in investment for facilities, human resources for M&E units at all levels, according to the needs which relevantt to the stages of the system development. 2. Objective 2: To complete the national guidelines for HIV/AIDS/STI surveillance, HIV monitoring and evaluation Develop national guidelines on program monitoring and evaluation: division of resonsibilities by levels, collaboration mechanism amongst M&E units 2.2. Issue a set of indicators for HIV monitoring and evaluation, which meets the requirements of national HIV monitoring and evaluation; 3.3. Develop a national guideline on the set of indicators for HIV monitoring and evaluation; develop information and data collection tools which are appropriate to each phase of the HIV epidemic. 3. Objective 3: To unify the data of HIV/AIDS/STI surveillance, HIV monitoring and evaluation 3.1. Review all the HIV related data in the country, ensure the uniformity and comprehensiveness of the national HIV prevention and control program data; 3.2. Assign the focal points responsible for HIV/STI data managements from the central to local levels; 3.3. Develop guidelines on HIV/STI data collection, management, storage, report, analysis, use and dissemination; 3.4. Improve and develop software for HIV data management; develop data management software for management of the national HIV monitoring and evaluation indicators, VCT and drugresistance; 3.5. Establish a electronic information system for HIV/AIDS data Collect all HIV/STI data and information from different sources including: reports of health care system, reports of HIV surveillance, monitoring and evaluation system; reports from organisations pariticipating in HIV/AIDS prevention and control activities; adhoc studies on HIV transmission risks, intervention models; synthetic analyses of HIV control and prevention activities; 12

14 3.7. Train and retrain staffs who are working with statistic and analyses of HIV/AIDS/STI surveillance data. 4. Objective 4: 100% of cities and provinces have laboratories which are accredited to confirm HIV positive results. There will be least 08 laboratories can perform HIV confirmation tests by molecular techniques and viral isolation by Develop, revise and update HIV/STI testing guidelines a) Develop, revise guidelines on techniques of HIV testing and techniques for STI testing; b) Develop quality assurance procedures for HIV testing; c) Develep the mechanism, guidelines on laboratory quality assuarance, increase the responsibilities of National and regional institutions in HIV/AIDS/STI testing quality assurance Strengthen the capacity of laboratory system at all levels a) Develop the plan of facilities provision, upgrade of the infrustructures and human resource training for HIV laboratories of Provincial AIDS centers, especially, at provinces which do not have accredited laboratories to confirm HIV positive; b) Develop the plan to build 08 HIV laboratories which can perform molecular tests and virus isolation at Naiontional Institute of Hygiene and Epidemiology, Ho Chi Minh City Pasteur Institute, Nha Trang Paster Institute, Tay Nguyen Institute of Hygiene and Epidemiology and in some targeted provinces to ensure the quality of those laboratories meet the internaional standards by 2010; c)strengthen capacity in diagnosis of opportunitistic infections, molecular testing techniques, genome sequencing and virus cultures to assist vaccine development in the future; d1) Strengthen capacity for HIV prevention and control centres at regions where can molecular techniques and virus cultures can be performed, in sentinel areas; d2) Provide laboratory equipments for Preventive Medicine Centers at distric level to ensure that there are at least 50% of District preventive medicine centers can perform HIV rapid tests by 2010; 13

15 e) Provide sufficient HIV test bioproducts for HIV epidemiological surveillance from the central to local levels; f) Periodically investigate and supervise the management and use of HIV test bioproducts for HIV diagnoses; 4.3. Training staff working on HIV/STI testing: a) Train and retrain HIV/STI testing laboratory staffs from central to local levels; Regularaly conduct long term and short term training for staff working in HIV/STI testing at laboratories from central to local levels. Collaborate with international laboratories on training HIV/STI laboratory staffs; b) Strengthen training on HIV testing technique for students at medical schools, especially for bachelor dregree in laboratory testing. 5. Objective 5: 100% of HIV tests are performed accordingly to voluntary counselling and testing regulations. There are at least 100 voluntary counselling and testing centers, which meet the national standards by Develop procedures and guidelines on voluntary counselling and testing, standardize VCT centers Develop plans of equipment provision and staff training to ensure that there will be at least 1 VCT center which meets national standards at each province; 5.3. Implement VCT at distict level, ensure that 50% of districts have the VCT pgrogram by Target to counsel at least 80% of most at risk populations; 5.4. Integrate HIV/AIDS counselling into other health care programs, family planning program, mother and child health care program and primary health care program; 5.5. Develop VCT networks and referral networks, link with health care and social support networks. Mobilize private sector to participate in counselling and support programs; 5.6. Gradually introduce the VCT program into detaining centres, prisions, educational centers, rehabilitation centers, social welfare centres, centres for social education, labour and treatment; 14

16 5.7. Conduct standard trainings on VCT. 6. Objective 6: 100% of sentinel provinces will collect enough sample sizes of HIV/AIDS surveillance in 40 provinces and STI surveillance in 10 provinces; 100% of provinces will have enough sample sizes in integrating serosurveillance with behavioral surveillance program in 10 provinces HIV sentinel surveillance a) Develop and revise the sentinel surveillance protocols, develop guidelnes and manuals for sentinel surveillance; b) Consolidate the quality of sentinel surveillance in 40 provines, continue to expand program into rural areas; c) Pilot new methods in sentinel surveillance; d) Pilot to include men who have sex with men population into sentinel surveillance program in targeted provinces by STI sentinel surveillance a) Continue to consolidate the STI sentinel surveillance in 10 provinces and expand the program into 10 additional provinces in 2008; b) Apply Polimerase Chain Reaction (PCR) technique in STI surveillance in 5 provinces by 2010; c) Improve the STI sentinel surveillance reporting system, provide diagnose equipments and data storage equipments to provincial dermatology centers; d1) Continue to integrate STI sentinel surveillance into HIV behavioural and sero surveillance; d2) Expand the surveillance program to other STIs and drug resistance in some provincies/cities; e) Develop a plan to provide equipments to the National Reference Laboratory at National Institute of Dermatology and 3 other institutes who are responsible for STI control and prevention in the South, the Central and the central highland; 15

17 6.3. Behavioural surveillance a) Conduct behavioural surveillance in 10 provinces in 2007 and expand it to other provinces in the coming years; surveillance. b) Decide on the sites, methodologies and organizational implementations of behavioral 6.4. Detected Case reporting procedures; a) Gradually implement the HIV detected case reporting according to VCT b) Strengthen the collaboration with international experts to seek technical supports in HIV /STI testing techniques; c) Supervise cases, conduct epidemiological investigation for each HIV case at community through local health care network Integrate behavioural and sero surveillance with STI surveillance (IBBS) a) Develop technical guidelines on the integration of behavioural, sero surveillance with STI surveillance programs; b) Continue to conduct IBBS in 2007 and in 10 provinces in Objective 7: Periodically conduct census on national HIV prevention and control program Establish a technical assistant group for national HIV survey; 7.2. Conduct national census in 2007 and 2010 based on national set of indicators; 7.3. Conduct drugresistant surveillance in national hospitals and national health care institutes in 2007 and in selected provinces. 8. Object 8: 100% of provinces/cities have capacity to monitor, evaluate and project HIV/AIDS/STI by

18 8.1. Develop plans to provide equipments, strengthen capacities for HIV surveillance, monitoring and evaluation staffs from central to local level, especially for provincial level; 8.2. Pilot the estimation and projection in 5 provinces (Ha Noi, Quang Ninh, Can Tho, Hochiminh City and Hai Phong) in 2007, then expand to all provinces in 2010; 8.3. Conduct HIV/AIDS Estimation and projection in every two years. 17

19 V. PROGRAM OF ACTION THROUGH 2010 TT I 1 2 Activities Begin Time Finish Location Implementing Collaboration Budget (Unit: 1,000,000 VND) Objective 1: To establish the HIV/AIDS/STI surveillance, monitoring and evaluation system from the central to local level. Establish HIV/AIDS/STI surveillance, monitoring and evaluation units Establish a national unit for HIV/AIDS/STI surveillance, monitoring and evaluation Establish regional units for HIV/AIDS/STI surveillance, monitoring and evaluation Establish provincials units for HIV/AIDS/STI surveillance, monitoring and evaluation Establish district units for HIV/AIDS/STI surveillance, monitoring and evaluation Increase the investment for facilities, human resources, and financial resources of monitoring and evaluation units at all levels. Strengthen the capacity of the National HIV/AIDS/STI surveillance, monitoring and evaluation system. Establish a group of technical assistants for the HIV/AIDS/STI surveillance, national NIHE 04 Regional Institutions 04 Regional Institutions 04 Regional Institutions 04 Regional Institutions 13, Ha Noi NIHE # Expected outcome 01 uniform functioning and effective system 01 Technical group 18

20 TT II III 1 Time Budget Activities Implementing Collaboration (Unit: Expected Location Begin Finish 1,000,000 outcome VND) HIVmonitoring and evaluation system. Develop training materials on 01 standardized monitoring and evaluation which Ha Noi NIHE 60 document set meet international standards. Establish a group of national trainers 05 National on HIV/AIDS/STI surveillance, Ha Noi 250 trainers monitoring and evaluation. Strengthen the capacity of staff at all levels # Create potential future staff by Ha Noi adding training courses on Public Health Ha Noi Medical monitoring and evaluation in School School medical schools Staff/year Objective 2: To complete the national HIV/AIDS/STI surveillance, HIV monitoring and evaluation guidelines. Develop national guidelines on Ha Noi program monitoring and evaluation Guideline Issue a set of national HIV/AIDS Ha Noi indicators indicators Develop guidelines on the national Ha Noi set of indicators HIV/AIDS Guideline Objective 3: To Unify the data of HIV/AIDS/STI surveillance, HIV monitoring and evaluation (increase data collection, management, storage, analysis and dissemination). Review HIV/AIDS/STI data nationwide to ensure uniformity Institutions 04 Regional and comprehensiveness of national 500 Uniformed data HIV data. 19

21 TT IV 1 a Activities Assign focal points to be responsible for HIV/AIDS/STI data management from central to local levels. Develop guidlines on HIV/AIDS/STI data collection, management, reporting, analysis and dissemination. Improve and develop software for HIV/AIDS data management; develop data management software for the national HIV monitoring and evaluation indicators, VCT and drugresistance. Establish an electronic information system for HIV/AIDS data. Collect HIV/AIDS/STI data and information from a range of sources. Train and retrain staff working with statistical analyses of HIV/AIDS/STI surveillance data. Begin Time Finish Location Implementing Provincial level Ha Noi Ha Noi Ha Noi Budget Collaboration (Unit: Expected 1,000,000 outcome VND) # Legislation Department Internaitonal Organizations Information Technology Center, MOH Agreed points Guideline softwares system 50 All data collected 50 Training Objective 4: Ensure that all cities and provinces have laboratories which are accredited to confirm HIV positive results. There are at least 8 laboratories, which can perform HIV confirmation tests by molecular techniques and can do viral culture by Develop, revise and update HIV/AIDS/STI testing guidelines. Develop, revise protocols on techniques of HIV/AIDS testing and Ha Noi NIHE VN NID protocols focal 20

22 TT b c 2 a. b c Activities Begin Time Finish Location Implementing techniques of STI testing. Develop quality assurance procedures for HIV testing; Ha Noi NIHE Develep mechanisms, guidelines on laboratory quality assuarance; increase the responsibilities of national and regional institutions in HIV/AIDS/STI testing quality assurance. Strengthen the capacity of the laboratory system at all levels. Develop plan of facilities provision, upgrade infrastructure and human resource training for HIV laboratories at provincial AIDS centres Develop a plan to build 8 HIV laboratories which can perform molecular tests and virus cultures 4 regional institutions and in some targeted provinces. Strengthen the capacity in diagnosis of opportunistic infections, molecular testing techniques, genome sequencing and virus cultures to assist vaccine development in the future Ha Noi Institutions, 04 Provinces regions 04 Regional Institutions 04 Regional Institutions 04 Provinces 04 Regional Institutions Budget Collaboration (Unit: Expected 1,000,000 outcome VND) International organizations procedure mechanism research centers 04 regional centers d1 Strengthen the capacity of AIDS Nation 04 Regional Toµn bé phßng 21

23 TT Activities prevention and control centers at regions which can perform molecular techniques and virus cultures in target regions; Provide laboratory equipment for Preventive Medicine Centers at district level to ensure that at least D2 50% of District preventive medicine centers can perform HIV rapid test by 2010; Provide sufficient HIV test bioproducts for HIV epidemiological e surveillance at all levels, from the central to local levels; Periodically investigate and supervise the management and f usage of HIV test bioproducts for HIV diagnoses. 3 Staff training V Train and retrain HIV laboratory staff, from the central to local levels; Strengthen HIV testing technique training pgrograms for students at medical schools, especially for students at Nursing schools. Begin Time Finish Budget Implementing Collaboration (Unit: Expected Location 1,000,000 outcome VND) wide Institutions xðt nghiöm cña c së iòu trþ nhiôm HIV Domestic and Abroad Ha Noi, HCM 04 Regional Institutions Ha Noi Medical School 04 Regional Institutions 04 Regional Institutions Internaitonal Organization 04 Regional Institutions Medical Schools % district Preventive Medicine Center can perform rapid tests All HIV laboratories All HIV laboratories Increased capacity of staffs at the central level B Sc/year Objective 5: 100% HIV tests are performed accordingly to voluntary counseling and testing regulations. There are at least 100 voluntary counseling and testing centers which meet the national standards by

24 TT 1 2 Activities Develop procedures and guidelines on voluntary counseling and testing, standardize VCT centers Develop plans for equipment provision and staff training to ensure that there will be at least 1 VCT center which meets national standards at each province; Begin Time Finish Location Implementing Ha Noi Implement VCT at distict level; Integrate HIV/AIDS counseling into other health care programs, family planning program, mother and child health care program and primary health care program; Develop VCT networks and referral networks, link with health care and social support networks. Mobilize private sector to participate in the counseling and support programs; Step by step, introduce the VCT program into jails, prisons, educational centers, rehabilitation Budget Collaboration (Unit: Expected 1,000,000 outcome VND) 100% VCT centers meet 500 national standards # 4, ,000 32, % provinces have standardized VCT centers 50% of disticts implement the program; 80% of most at risk population access these services 100% integrated health care programs are functioning Mobilize the particitpation of communities at maximum level 50% residents of these centers access to VCT 23

25 TT Activities centers, education, treatment and social labor centres; Begin Time Finish 7 Conduct standard trainings on VCT VI Location Implementing Budget Collaboration (Unit: Expected 1,000,000 outcome VND) services 6, % provincial staffs are trained; 50% district staffs are trained Objective 6: 100% of sentinel provinces will collect enough sample sizes of HIV/AIDS surveillance in 40 provinces and STI surveillance in 10 provinces; 100% of provinces will have enough sample sizes in integrating serosurveillance with behavioral surveillance program in 10 provinces. 1 HIV sentinel surveillance Develop and revise the sentinel surveillance protocols, develop guidelines and manuals for sentinel surveillance; Improve the quality of sentinel surveillance in 40 provines, continue to expand the program into rural areas; Pilot new methods in sentinel surveillance; Pilot to include men who have sex with men population into sentinel surveillance program in targeted provinces by STI sentinel surveillance Ha Noi NIHE provinces NIHE 30, provinces NIHE guideline 5,000 HIV prevalence in different populations Make decision whether should pilot or not Implementation in 10 provinces 24

26 TT Activities Continue to consolidate the STI sentinel surveillance in 10 provinces and expand the program into 10 additional provinces in 2008; Apply Polimerase Chain Reaction technique (PCR) in STI surveillance in 5 provinces by 2010; Improve the STI sentinel surveillance reporting system, provide diagnose equipment and data storage equipment to provincial dematology and veronology centers; Continue to integrate STI sentinel surveillance into HIV behavioral and sero surveillance; Expand the STIs and drug resistant surveillance program to other target provincies; Develop a plan to provide equipment to National Reference Laboratory at National Institute of Dermatology and venerology and 3 other institutions who are responsible for STI control and prevention in the south, the central and the central high Platau; 3 Behavioral surveillance Implement the behavioral surveillance program in 10 Begin Time Finish Location 10 provinces Implementing provinces VN NID provinces 10 provinces 10 provinces Budget Collaboration (Unit: Expected 1,000,000 outcome VND) VN NID 500 VN NID 1,000 Implementation in 20 provinces 1,000 Implementation in 5 provinces # regions VN NID provinces 600 Report timely and accurately Implementation of integrated surveillance Strengthened STI surveillance 04 National Reference Laboratories Determine which 25

27 TT Activities provinces in 2007 and expand it to other provinces later; Agree on the sites, methods and organizational implementation of behavioral surveillance program. 4 Detected Case report Step by step, implement the HIV case reporting according to VCT procedures; 5 Strengthen the collaboration with international experts to seek support in HIV/AIDS/STI testing techniques; Supervise cases, epidemiological investigation with each HIV case at community level through local health care network Integrate behavioral and sero surveillance with STI surveillance (IBBS) Develop technical guidelines on integration of behavioral and sero surveillance with STI surveillance programs; Continue to conduct IBBS in 2007 in 10 provinces and intergrated Begin Time Finish Location 15 provinces Implementing Ha Noi NIHE Ha Noi provinces Budget Collaboration (Unit: Expected 1,000,000 outcome VND) behaviors are warning signals Implementation of behavioral 100 surveillance on large scale HIV testing follows VCT procedures 01 control system 01 completed surveillance and epidemiological investigation system guideline provinces implemented 26

28 TT VII Implement drugresistant surveillance in national hospitals and institutions in 2007 and in selected provinces Institutions Provinces VIII Object 8: 100% provinces/cities have capacity to monitor, evaluate and project HIV/AIDS/STI by Develop a plan to provide equipment, strengthen capacities for HIV/AIDS surveillance, monitoring and evaluation staff from central to local level, especially for provincial level; Pilot the HIV/AIDS estimation and projection in 5 provinces (Ha Noi, Quang Ninh, Can Tho, Hochiminh City and Hai Phong) in 2007, then expand to all provinces in 2010; Time Budget Implementing Collaboration (Unit: Expected Activities Location Begin Finish 1,000,000 outcome VND) surveillance in IBBS Objective 7: Periodically conduct census survey on national HIV/AIDS control and prevention program. Establish a technical assistant group 01 technical Ha Noi 100 for national HIV/AIDS survey; group Survey in 10 provinces in 2007 Conduct census surveys on 2007 provinces in Survey in 30 and 2010 based on national indicator ,000 sets; 2008 Census survey in provinces 27 5, Drugresistant surveillance in provinces Report accurate data and provide updated information for planning and intervention implementation. Analysis and aggreate data in 10 provinces

29 TT 3 Activities Conduct HIV/AIDS estimation and projection every two years. Begin Time Finish Location Implementing Ha Noi Budget Collaboration (Unit: Expected 1,000,000 outcome VND) HIV/AIDS estimation and 700 projection in 2007 and

30 IMPLEMENTAION TIMELIINE TT Activities I Objective To establish and improve the system of HIV/AIDS/STI surveillance, HIV/AIDS program monitoring and evaluation units Strengthen the capacity for the system of national HIV/AIDS monitoring and evaluation II Objective 2 1 Develop national guidelines on monitoring and evaluation 2 Issue a national HIV/AIDS indicator set x x x x X x x 3 Develop a national guideline on national HIV/AIDS indicator set x x X x x III Objective 3 Review the HIV/AIDS data through out country to ensure the uniformity of national 1 HIV/AIDS control and prevention program data Assign focal points to be responsible for HIV/AIDS/STI data management from the 2 central to local levels; Develop guidelines on HIV/AIDS/STI data collection, management, report, analysis 3 and dissemination; Update and develop software for HIV/AIDS data management; develop data 4 management software for the indicator set of national HIV/AIDS control and prevention program monitoring and evaluation, VCT and drugresistant; x x x x 5 Establish an electronic information system for HIV/AIDS data x x x x 6 Collect HIV/AIDS/STI data and information from different sources x x x x x 7 Provide information for Viet Nam HIV/AIDS website, disseminate data of HIV/AIDS/STI surveillance, HIV/AIDS prevention and control monitoring and x x x x x 29

31 TT Activities evaluation for concerned and related partners; Train and retrain staff who are working with statistics and analyses of HIV/AIDS/STI 8 surveillance data IV Objective x x x x x 1 Develop, revise and update HIV/AIDS/STI testing guidelines x x x x x 2 Strengthen the capacity of laboratory system at all levels x x x x x 3 Staff training x x x x x V Objective 5 1 Develop procedures and guidelines on voluntary counseling and testing, standardize VCT centers. Develop the guidelines on quality accessment of VCT centers which x x x x meet national standards; 2 Develop plans for equipment provision and staff training to ensure that there will be at least 1 VCT center which meets national standards in each province; x x x 3 Implement VCT at distict level x x x 4 Integrate HIV/AIDS counseling into other health care programs, family planning program, mother and child health care program and primary health care program; x x x x x 5 Develop VCT networks and referral networks, link with health care and social support networks. Mobilize private sector to participate the counseling and support programs; x x x 6 Step by step, introduce the VCT program into jails, prisions, educational centers, rehabilitation centers, education, treatment and social labor centres; x x x 7 Conduct standard trainings on VCT x x x VI Objective 6 1 Sentinel Surveillance Develop and revise the sentinel surveillance protocols, develop guidelines and manuals for sentinel surveillance; Improve the quality of sentinel surveillance in 40 provinces, continue to expand the program into rural areas; x x x x x x x 30

32 TT Activities Pilot new models in sentinel surveillance; x x x x Pilot to include men who have sex with men population into sentinel surveillance program in targeted provinces by x x x 2 STI sentinel surveillance Continue to improve the STI sentinel surveillance in 10 provinces and expand the program into 10 additional provinces in 2008; x x x Apply Polimerase Chain Reaction technique (PCR) in STI surveillance in 5 provinces by 2010; x x x x x Improve the STI sentinel surveillance reporting system, provide diagnostic equipment and data storage equipments to provincial dematology and veronology centers; x x x Continue to integrate STI sentinel surveillance into HIV behovioral and sero surveillance; x x x x x Expand the STIs and drug resistant surveillance program to other target provincies; x x x Develop a plan to provide equipment to the National Reference Laboratory at National Institute of Dermatology and venerology and 3 other institutions who are responsible x x x for STI control and prevention in the south, the central and the Central high Platau; 3 Behavioral surveillance Implement the behavioral surveillance program in 10 provinces in 2007 and expand it to other provinces later; x x x x Agree on the sites, methods and organizational implementation of behavioral surveillance program. x x x x 4 Detected case report Step by step, implement the HIV detected case reporting according to VCT procedures; x x x Strengthen the collaboration with international experts to seek supports in HIV/AIDS/STI testing techniques; x x x Implement case management, epidemiological investigation with each HIV case at community level through local health care network x x x 5 Integrate behavioral and sero surveillance with STI surveillance (IBBS) 31

33 TT Activities Develop technical guidelines on integration of behavioral and sero surveillance with STI surveillance programs; Continue to conduct IBBS in 2007 and intergrated surveillance in 10 provinces in VII Objective 7 x x 1 Establish a technical assistant group for national HIV/AIDS survey; x 2 Conduct census surveys on 2007 and 2010 based on national indicator sets; x x x x 3 Implement drugresistant surveillance in national hospitals and institutions in 2007 and in selected provinces. x x x x VIII Objective 8 1 Develop a plan to provide equipment, strengthen capacities for HIV/AIDS surveillance, monitoring and evaluation staff from central to local level, especially for x x x x x provincial level; Pilot the HIV/AIDS estimation and projection in 5 provinces (Ha Noi, Quang Ninh, 2 Can Tho, Hochiminh City and Hai Phong) in 2007, then expand to all provinces in 2010; x x x x 3 Conduct HIV/AIDS Estimation and Projection every two years. x x x 32

34 PART III: BUDGET Based on the estimated budget of the National Strategy on HIV/AIDS control and prevention and UNAIDS guideline, the budget of monitoring and evaluation should be 10% of the total budget. ViÖt Nam needs 20% of the total budget to establish the system at the beginning and 10% of the total budget to maintain the activities of the monitoring and evaluation system. Calculation method: the estimated budget is 30% of the estimated budget of the national strategy. Unit: 1,000,000 VND Year High estimate Medium estimate , , , , , , , , , ,280 TOTALS 1,303, ,540 33

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36 PART IV: ORGANIZATION OF IMPLEMENTATION 1. The Ministry of Health directs the establishment and organizes the implementaion of HIV surveillance and program monitoring and evaluation units as following: 1.1. Viet Nam Adminisration for AIDS control is the national unit for HIV/AIDS/STI surveillance, national program monitoring and evaluation. It is responsible for providing direction, managing comprehensively, and collaborating with other organizations in making plans, organizing the implementation of the program of actions on HIV/AIDS surveillance, national program monitoring and evaluation, collecting information and reporting to higher levels The National Institute of Hygiene and Epidemiology is responsible for technical assisstance for national HIV/AIDS surveillance, program monitoring and evaluation systems. The National Institute of Hygiene and Epidemiolgy and the other 3 regional HIV/AIDS surveillance, monitoring and evaluation institutions (Pasteur Institute in Hochiminh City, Pasteur Institute in Nha Trang, Tay Nguyen Institute of Hygiene and Epidemiology) are responsible for: making plans and organizing the implementation of activities at the regional level; periodically reporting to The Viet Nam Administration for AIDS Control; managing, directing, monitoring and evaluating all activities of HIV surveillance; monitoring and evaluating programs in all provinces in the regions, as well as in hospitals and other organizations which belong to Ministry of Health which are located in the provinces of assigned areas Provincial Departments of Health will direct related organizations to establish the provincial unit for HIV/AIDS surveillance, program monitoring and evaluation. Under the direction of the Department of Health and other Departments, all HIV/AIDS control and prevention projects and related organizations are responsible for making plans, organizing the implementaion of HIV/AIDS surveillance, program monitoring and evaluation in the province and periodically reporting to the regional unit of HIV/AIDS surveillance, monitoring and evaluation District Preventive Medicine Centers are responsible for cooperating with other related organizations regarding HIV/AIDS surveillance, program monitoring and evaluation in the district and organizing implementation in the communes. 2. The Ministry of Health, Provincial People s Committees, Provincial Departments of Health, Steering committee for HIV/AIDS, drug use and prostitue control and prevention, other Ministries, branches and other related orgnanizations allocate budget for surveillance, HIV/AIDS program monitoring and evaluation activities. 35