In many PEPFAR countries, most funding for a national HIV program comes from the host country. Nevertheless, programs for pecific communities and key populations (KP) remain largely dependent on external donor financing through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund). Local public resources to support the KP response have remained underused due to a shortage of social contracting systems, limited social health insurance capacity, and undefined policy frameworks.
As part of the efforts to scale-up HIV testing services (HTS) and prevention interventions, along with proactive referrals to antiretroviral treatment (ART), PrEP for HIV prevention was formally made available in late 2015. However, there were no data on the acceptability to guide targeting and roll-out. Since PrEP is a relatively new prevention intervention in PEPFAR countries, PEPFAR’s partners will need technical assistance to scale best practices with fidelity and to ensure that implementation addresses the diversity of target populations across varied settings.
Until recently, most countries with external donor support provided HIV services free of charge. Declining donor funds require countries to identify other opportunities to mobilize domestic financial resources. Vietnam needed to fill resource gaps and deploy cost-effective strategies to increase prevention efforts and case detection, facilitate immediate enrollment on antiretroviral therapy (ART), and strengthen support services to ensure sustained HIV viral suppression.