Evaluation of PEPFAR-Funded HIV Prevention Programs in Vietnam: Key results April, 2008

1. Evaluation of PEPFAR-Funded HIV Prevention Programs in Vietnam:Key resultsApril, 2008 Dr. Lora Sabin Dr. Mary Bachman DeSilva Center for International Health and Development Department of International Health Boston University School of Public Health

2. PEPFAR Evaluation: study collaborators Boston University SPH Lora Sabin, MA, PhD Mary Bachman DeSilva, MS, ScD Davidson H. Hamer, MD Taryn Vian, M.Sc. Danielle Lawrence, MPH Kelly McCoy, MPH Jordan Tuchman, MPH Ho Chi Minh City Statistical Office Le Thi Thanh Loan, PhD Abt Associates Inc. Theodore Hammet, PhD Funding provided by: USAID/Hanoi, Country Research Activity GHS-A-00-03-00020 Additional acknowledgments: Ahmar Hashmi, Jen Beard, Wayland Bergman, Bill MacLeod, Matt Fox, Don Thea, Jill Costello, Jon Simon, Deirdre Pierotti

3. Background • HIV/AIDS epidemic • Nationwide adult HIV prevalence: 0.5% • Most-at-risk populations: IDU, CSW, MSM • 2004-National Strategic Plan: focus on VCT, ART, harm reduction, other best practices • PEPFAR focus country since 2004, supporting many interventions including community outreach • 2006-BU asked to evaluate outreach interventions

4. Overview of Evaluation Design • Study using quantitative and qualitative methods to assess effectiveness of PEPFAR-funded outreach services provided by community outreach workers (PE and HE) to three MARP groups (IDU, CSW, MSM) in six provinces • Components: • Review of program statistics • Cross-sectional survey of PE/HE and MARP • In-depth interviews with outreach workers, MARP informants, other key informants

5. Primary Research questions 1. Are outreach workers well prepared to deliver services among MARPs? • Are outreach workers identifying and communicating well with clients? • Is BCC effective in changing behaviors? HE and PEs in Hoang Mai, Hanoi

6. Secondary Research questions 1. Are there differences between types of workers (peer educators versus health educators)? • How well do services harmonize with services provided by other donors and organizations? PE demonstrating needle cleaning

7. Quantitative Survey Sample • 2,222 MARP, of which • 1,101 intervention, 1,121 control • 1,212 CSW, 605 IDU, 408 MSM • 810 Hà Noi, 802 HCM, 310 Hai Phòng, 300 An Giang • 272 outreach workers, of which • 241 peer educators, 31 health educators • 86 Hà Noi, 49 HCM, 115 Hai Phòng, 22 An Giang

8. Qualitative Interviews • 217 respondents, of which • 101 MARP, 76 PE/HEs, 40 Key Informants • 43 Hà Noi, 53 HCM, 42 Hai Phòng, 35 An Giang, 44 Quang Ninh • 100 male, 116 female, 1 other

9. Findings: MARP Demographics Control group slightly younger, less likely to know status and be HIV+.

10. MARP Demographics: Risk Behaviors, Intervention vs. Control Control group lower risk

11. PE/HE Demographics PE more likely to be part-time

12. Results: How prepared are outreach workers? • Training and skills • Knowledge and qualifications • Supplies and financial support • Supervision

13. Preparation: Training & skills • Over 90% of PE and HE received pre-service training (mean=8 days), 95% received refresher training (mean= 2 days in last mo.) • Some differences by program: CARE & CDC/LG workers received 4.2 and 6.4 days, respectively, while FHI & MDM workers received 9.0 & 11.5 days, respectively. • PE/HE felt their training was appropriate, had adequately prepared them for their work

14. Preparation: Training & skills • A few gaps: 13% of PE and 26% of HE had not received infection control training • More FHI workers said they did not receive training on how to clean needles & syringes, while more MdM and CARE workers did not receive training in negotiation skills.

15. Preparation: Training & Skills • “Before I knew about these topics only through friends, but now [my] knowledge is more scientific and concrete.”PE in Hanoi • “Thanks to knowledge I got from training, I can approach the customers more easily; I know how to convince them so SWs, IDUs, and HIV+ people can benefit from services.”PE in Hai Phong • “[My work] is not totally like what is presented in books. There are some differences in reality. I can apply a part.”PE in Hai Phong