Revised_SOL-440-16-000002_Sustainable_HIV_Response_From_Technical_Assistance_(SHIFT)_USAID_VIETNAM.pdf

RFP ISSUANCE DATE: November 6, 2015 AMENDMENT 1: November 11, 2015 QUESTIONS DUE: November 18, 2015 AMENDMENT 2: November 24, 2015 PRE-PROPOSAL CONF: November 30, 2015 QUESTIONS (2nd Rd) DUE: December 4, 2015 CLOSING DATE: January 8, 2016 CLOSING TIME: 1600 hours Hanoi local time

SUBJECT: AMENDMENT #2, Request for Proposals (RFP) Number SOL-440-16-000002 Sustainable HIV Response From Technical Assistance (SHIFT) Project

The U.S. Agency for International Development's Mission in Vietnam (USAID/Vietnam) is seeking proposals from qualified organizations to provide the technical assistance described in Section C of the RFP. This procurement shall be a full and open competition awarded pursuant to Part 15 of the Federal Acquisition Regulation (FAR) (48 CFR Chapter 1). It is anticipated that a cost reimbursement plus fixed fee hybrid contract comprising of both completion and term types will be awarded for the services specified herein.

The period of performance under this contract is five years. The government estimate for Contract Line Item Number (CLIN) 01 of this contract is between $14-15 million. No estimate is provided for CLIN 02 although the level of effort is provided in Section F.5.

Offerors must submit technical and cost-related questions concerning this RFP to Ms. Praveena ViraSingh at pvirasingh@usaid.gov and Mr. Daniel Harter at dharter@usaid.gov no later than 16:00hrs Hanoi local time, November 18, 2015. Questions have been responded to through this amendment to the solicitation and are attached. Additionally, this amendment authorizes a second round of questions that are due to USAID no later than 16:00hrs Hanoi local time, December 4, 2015. All responses to questions and pre-proposal conference information will be publicly posted in a future amendment to this solicitation.

USAID will hold the pre-proposal conference for this solicitation on November 30, 2015 at the MELIÁ HANOI Hotel from 13:00 to 15:00 hrs Hanoi local time. Please register for the conference at https://docs.google.com/forms/d/1NWkv9P9hXHq2e4cGynj3Sp3w8wxlbtnWhCZUyKJR9AM/viewform with the name of individuals attending, your organization, and your e-mail contact information.

Please submit your technical and cost proposal in response to the RFP in accordance to the instructions specified in Section L of this solicitation. Proposal submissions must be submitted electronically to the email address provided in Section L – Submission/Delivery Instructions, no later than the date and time indicated in the cover page of the solicitation. Offerors are recommended to pay careful attention to, and complete in full, RFP Section K - Representations, Certifications and Acknowledgements. Offerors must also carefully consider Section L - Instructions to Offerors and Section M - Evaluation Factors for Award. Sections B through I of the solicitation will become the contract with blanks completed by the Contracting Officer. The proposal shall be prepared in two separate parts: the Technical Proposal shall address technical aspects only while the Business (Cost) Proposal shall present the costs and address related issues such as responsibility.

The Government reserves the right to award a contract without discussions or the submittal of final proposed revisions, based upon evaluation of the Offeror’s submitted technical and price information. Accordingly, the Offeror’s initial offer should contain its best terms for both price and technical proposal. Offerors should retain for their records a complete copy of their proposals for future reference. USAID anticipates one award under this solicitation.

Issuance of this amended solicitation does not in any way obligate the U.S. Government to award a contract nor does it commit the U.S. Government to pay for costs incurred in the preparation and submission of a proposal.

Thank you for your interest in USAID programs.

Sincerely, /s/

Daniel E. Harter Contracting Officer USAID/Vietnam

1. THIS CONTRACT IS A RATED ORDER RATING PAGE OF PAGES

UNDER DPAS (15 CFR 700)

2. CONTRACT NUMBER 3. SOLICITATION NUMBER 4. TYPE OF SOLICITATION 5. DATE ISSUED 6. REQUISITION/PURCHASE NUMBER

SEALED BID (IFB)

NEGOTIATED (RFP)

7. ISSUED BY CODE 8. ADDRESS OFFER TO (If other than Item 7)

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder".

9. Sealed offers in original and ___________________ copies for furnishing the supplies or services in the Schedule will be received at the place specified in Item 8, or if handcarried, in the depository located in until local time _______________________ (Hour) (Date)

CAUTION - LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All Offers are subject to all terms and conditions contained in this solicitation.

A. NAME B. TELEPHONE (NO COLLECT CALLS) C. E-MAIL ADDRESS

AREA CODE NUMBER EXT.

(X) SEC. DESCRIPTION PAGE(S) (X) SEC. DESCRIPTION PAGE(S)

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

A SOLICITATION/CONTRACT FORM I CONTRACT CLAUSES

B SUPPLIES OR SERVICES AND PRICES/COSTS PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

C DESCRIPTION/SPECS./WORK STATEMENT J LIST OF ATTACHMENTS

D PACKAGING AND MARKING PART IV - REPRESENTATIONS AND INSTRUCTIONS

E INSPECTION AND ACCEPTANCE

F DELIVERIES OR PERFORMANCE

G CONTRACT ADMINISTRATION DATA L INSTR., CONDS., AND NOTICES TO OFFERORS

H SPECIAL CONTRACT REQUIREMENTS M EVALUATION FACTORS FOR AWARD

K

REPRESENTATIONS, CERTIFICATIONS AND OTHER

STATEMENTS OF OFFERORS

NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

12. In compliance with the above, the undersigned agrees, if this offer is accepted within ________ calendar days (60 calendar days unless a different period is inserted by the offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the designated point(s), within the time specified in the schedule.

13. DISCOUNT FOR PROMPT PAYMENT 10 CALENDAR DAYS (%) 20 CALENDAR DAYS (%) 30 CALENDAR DAYS (%) CALENDAR DAYS (%)

(See Section I, Clause No. 52-232-8)

14. ACKNOWLEDGEMENT OF AMENDMENTS AMENDMENT NO. DATE AMENDMENT NO. DATE

(The offeror acknowledges receipt of amendments to the SOLICITATION for offerors and related documents numbered and dated:

CODE FACILITY

16. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER15A. NAME AND

ADDRESS

OF OFFEROR

(Type or print)

15B. TELEPHONE NUMBER 17. SIGNATURE 18. OFFER DATE

AREA CODE NUMBER EXT.

15C. CHECK IF REMITTANCE ADDRESS IS DIFFERENT FROM

ABOVE - ENTER SUCH ADDRESS IN SCHEDULE

19. ACCEPTED AS TO ITEMS NUMBERED 20. AMOUNT 21. ACCOUNTING AND APPROPRIATION

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION: 23. SUBMIT INVOICES TO ADDRESS SHOWN IN ITEM (4 copies unless otherwise specified)

10 U.S.C. 2304(a) ( ) 41 U.S.C. 253(c) ( )

24. ADMINISTERED BY (If other than Item 7) 25. PAYMENT WILL BE MADE BYCODE CODE

26. NAME OF CONTRACTING OFFICER (Type or print) 27. UNITED STATES OF AMERICA 28. AWARD DATE

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice.

(Signature of Contracting Officer)

(REV. 9-97)

10. FOR INFORMATION CALL:

11. TABLE OF CONTENTS

STANDARD FORM 33

SOLICITATION, OFFER AND AWARD

SOLICITATION

OFFER (Must be fully completed by offeror)

AWARD (To be completed by Government)

N/A 1 113

SOL-440-16-000002

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November 6, 2015

Daniel E. Harter dharter@usaid.gov

See Attached Table of Contents

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Office of Financial Management

USAID/RDMA

Athenee Tower, 25th Floor Bangkok, 10330 Thailand

RFP No. SOL-440-16-000002 Sustainable HIV Response From Technical Assistance (SHIFT) Project

Table of Contents

PART I - THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 PURPOSE

B.2 CONTRACT TYPE

B.3 ESTIMATED COST, FIXED FEE, AND OBLIGATED AMOUNT

B.4 CONTRACT LINE ITEMS

B.5 INDIRECT COSTS

B.6 ADVANCE UNDERSTANDINGS ON CEILING INDIRECT COST RATES AND FINAL

REIMBURSEMENT FOR INDIRECT COSTS

B.7 COST REIMBURSABLE

B.8 PAYMENT OF FIXED FEE

SECTION C - DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

SECTION D - PACKAGING AND MARKING

D.1 AIDAR 752.7009 MARKING (JAN 1993)

D.2 BRANDING STRATEGY

SECTION E - INSPECTION AND ACCEPTANCE

E.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

E.2 INSPECTION AND ACCEPTANCE

SECTION F - DELIVERIES OR PERFORMANCE

F.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

F.2 PERIOD OF PERFORMANCE

F.3 PLACE OF PERFORMANCE

F.4 PERFORMANCE STANDARDS

F.5 LEVEL OF EFFORT (CLIN 2)

F.6 REPORTS AND DELIVERABLES OR OUTPUTS

F.7 MANAGEMENT OF CONTRACT

F.8 KEY PERSONNEL

F.9 AUTHORIZED WORK DAY / WEEK

SECTION G - CONTRACT ADMINISTRATION DATA

G.1 AIDAR 752.7003 DOCUMENTATION FOR PAYMENT (NOV 1998)

G.2 ADMINISTRATIVE CONTRACTING OFFICE

G.3 CONTRACTING OFFICER'S AUTHORITY

G.4 CONTRACTING OFFICER’s REPRESENTATIVE (COR)

G.5 TECHNICAL DIRECTIONS/RELATIONSHIP WITH USAID

G.6 ACCEPTANCE AND APPROVAL

G.7 PAYING OFFICE

G.8 ACCOUNTING AND APPROPRIATION DATA

SECTION H - SPECIAL CONTRACT REQUIREMENTS

H.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

H.2 AIDAR 752.7004 EMERGENCY LOCATOR INFORMATION (JUL 1997)

H.3 LANGUAGE REQUIREMENTS

H.4 AIDAR 752.7005 SUBMISSION REQUIREMENTS FOR DEVELOPMENT EXPERIENCE

DOCUMENTS (SEP 2013)

H.5 INSURANCE AND SERVICES

H.6 CONTRACTOR’S STAFF SUPPORT, AND ADMINISTRATIVE AND LOGISTICS ARRANGEMENTS47

H.7 CONSENT TO SUBCONTRACTS

H.8 EXECUTIVE ORDER ON TERRORISM FINANCING

H.9 NONEXPENDABLE PROPERTY PURCHASES AND INFORMATION TECHNOLOGY RESOURCES 49

H.10 AUTHORIZED GEOGRAPHIC CODE

H.11 ADS 302.3.5.20 CONFERENCE PLANNING AND REQUIRED APPROVALS (AUGUST 2013)

H.12 FOREIGN GOVERNMENT DELEGATIONS TO INTERNATIONAL CONFERENCES (JAN 2002)

H.13 CONFIDENTIALITY AND OWNERSHIP OF INTELLECTUAL PROPERTY

H.14 REPORTING OF FOREIGN TAXES (JULY 2007)

H.15 USAID DISABILITY POLICY - (DEC 2004) (ACQUISITION AND ASSISTANCE POLICY

DIRECTIVE 04-17)

H.16 PROHIBITIION OF ASSISTANCE TO DRUG TRAFFICKERS

H.17 ADS 302.3.5.9 NONDISCRIMINATION (JUN 2012)

H.18 TITLE TO AND CARE OF PROPERTY

H.19 ENVIRONMENTAL COMPLIANCE

H.20 EXCHANGE VISITORS AND TRAINING

H.21 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNEL (JULY 2007)

H.22 HOMELAND SECURITY PRESIDENTIAL DIRECTIVE-12 (HSPD-12) (SEPTEMBER 2006)

H.23 ADS 302.3.5.22 SUBMISSION OF DATASETS TO THE DEVELOPMENT DATA LIBRARY (DDL)

(OCT 2014)

H.24 USAID IMPLEMENTING PARTNER NOTICES (IPN) PORTAL FOR ACQUISITION (JULY 2014)

H.25 ADS 302.3.5.19 USAID-FINANCED THIRD-PARTY WEBSITES (AUGUST 2013)

H.26 ADS 302.3.5.16(a)(1) CONSCIENCE CLAUSE IMPLEMENTATION (ACQUISITION) –

SOLICITATION PROVISION (February 2012) H.27 ADS 302.3.5.16(a)(3) CONDOMS (ACQUISITION) (SEPTEMBER 2014) H.28 ADS 302.3.5.16(a)(4) PROHIBITION ON THE PROMOTION OR ADVOCACY OF THE

LEGALIZATION OR PRACTICE OF PROSTITUTION OR SEX TRAFFICKING (SEPTEMBER 2014)61

H.29 AIDAR 752.7101 VOLUNTARY POPULATION PLANNING ACTIVITIES (JUNE 2008)

H.30 ACTIVITY REGISTRATION

PART II - CONTRACT CLAUSES

SECTION I - CONTRACT CLAUSES

I.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

I.2 52.204-1 APPROVAL OF CONTRACT (DEC 1989)

I.3 FAR 52.229-8 TAXES - FOREIGN COST-REIMBURSEMENT CONTRACTS (MAR 1990)

I.4 FAR 52.232-99 PROVIDING ACCELARATED PAYMENT TO SMALL BUSINESS SUBCONTRACTORS

(DEVIATION) (AUG 2012)

I.5 FAR 52.247-67 SUBMISSION OF TRANSPORTATION DOCUMENTS FOR AUDIT (FEB 2006)

I.6 AIDAR 752.228-3 WORKER’S COMPENSATION INSURANCE (DEFENSE BASE ACT) (JUL 2014)

I.7 AIDAR 752.231-71 SALARY SUPPLEMENTS FOR HG EMPLOYEES (OCT 1998)

I.8 AIDAR 752.7034 ACKNOWLEDGMENT AND DISCLAIMER (DEC 1991)

PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACHMENTS

SECTION J - LIST OF ATTACHMENTS

PART IV - REPRESENTATIONS AND INSTRUCTIONS

SECTION L - INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS

L.1 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998)

L.2 FAR 52.216-1 TYPE OF CONTRACT (APR 1984)

L.3 FAR 52.233-2 SERVICE OF PROTEST (SEP 2006)

L.4 FAR 52-215-1 INSTRUCTIONS TO OFFERORS-COMPETITIVE ACQUISITION (JAN 2004) and

Alternate I (OCT 1997)

SECTION M - EVALUATION FACTORS FOR AWARD

PART I - THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 PURPOSE

The purpose of this contract is to strengthen human, organizational, and systems capacity to lead the national HIV and AIDS response and deliver innovative enhancements in HIV and AIDS services in Vietnam. This objective is expected to be accomplished through direct service delivery and technical assistance to key stakeholders in targeted provinces to ensure USAID can successfully transition USAID-supported HIV and AID services to the provincial government GVN by the end of the project.

B.2 CONTRACT TYPE

Contracting Line Item Number (CLIN) 1 is Cost-Plus-Fixed Fee (CPFF) completion type and CLIN 2 is CPFF term type. For the consideration set forth below, the Contractor shall provide the performance requirements described in Section C and the deliverables or outputs described in Section F.

B.3 ESTIMATED COST, FIXED FEE, AND OBLIGATED AMOUNT

(a) The estimated cost for the performance of the work required hereunder, exclusive of fixed fee, if any, is approximately TBD. The fixed fee, if any, is TBD. The estimated cost plus fixed fee, if any, is TBD.

(b) Within the estimated cost plus fixed fee (if any) specified in paragraph (a) above, the amount currently obligated and available for reimbursement of allowable costs incurred by the Contractor (and payment of fee, if any) for performance hereunder is TBD. The Contractor shall not exceed the aforesaid obligated amount.

(c) Funds obligated hereunder are anticipated to be sufficient through [To be inserted at the time of award].

(d) The Contractor will not be paid any sum in excess of the Total Estimated Cost.

B.4 CONTRACT LINE ITEMS

CLIN 1 (CPFF completion)

a. Total Estimated Cost $TBD

b. Fixed Fee $TBD

c. Total Estimated Cost plus Fixed Fee $TBD

CLIN 2 (CPFF term)

a. Total Estimated Cost $TBD

b. Fixed Fee $TBD

c. Total Estimated Cost Plus Fixed Fee $TBD

B.5 INDIRECT COSTS

Pending establishment of revised provisional or final indirect cost rates, allowable indirect costs shall be reimbursed on the basis of the following negotiated provisional or predetermined rates and the appropriate bases:

Description Rate Base Type Period

1/ 1/ 1/ 2/ 2/ 2/ 3/ 3/ 3/

1/Base of Application:

Type of Rate:

Period:

2/Base of Application:

Type of Rate:

Period:

3/Base of Application:

Type of Rate:

Period:

B.6 ADVANCE UNDERSTANDINGS ON CEILING INDIRECT COST RATES AND FINAL

REIMBURSEMENT FOR INDIRECT COSTS

(1) Reimbursement for indirect costs shall be at the lower of the negotiated final (or predetermined) rates or the following ceiling rates:

Description Rate Base Period

% 1/ 1/ % 2/ 2/ % 3/ 3/

1/ Base of Application:

Period:

2/ Base of Application:

Period:

3/ Base of Application Period

(2) The Government will not be obligated to pay any additional amount should the final indirect cost rates exceed the negotiated ceiling rates. If the final indirect cost rates are less than the negotiated ceiling rates, the negotiated rates will be reduced to conform to the lower rates.

(3) This understanding shall not change any monetary ceiling, obligation, or specific cost allowance or disallowance. Any changes in classifying or allocating indirect costs require the prior written approval of the Contracting Officer.

B.7 COST REIMBURSABLE

The U.S. dollar costs allowable shall be limited to reasonable, allocable and necessary costs determined in accordance with FAR 52.216-7, Allowable Cost and Payment, FAR 52.216-8, Fixed Fee, if applicable, and AIDAR 752.7003, Documentation for Payment.

B.8 PAYMENT OF FIXED FEE

Fixed Fee Payment: Payment of fixed fee will be made upon receipt of a proper invoice and shall be allocated based upon the proportion of the work performed in the period covered by the invoice. At the time of each payment of allowable costs to the Contractor, the USAID paying office ordinarily pays the Contractor a percentage of the fixed fee that directly corresponds to the percentage of allowable costs being paid. Three exceptions to paying fixed fee in this manner apply:

(1) If the Contracting Officer determines that this method results in paying a disproportionately higher ratio of fixed fee than the percentage of work the Contractor has completed, then the Contracting Officer may suspend further payment of any fixed fee until the Contractor has made sufficient progress to justify further payment, up to the agreed percentage.

(2) For CLIN 1, Payment of fixed fee will be made upon receipt of a proper invoice and shall be allocated based upon the proportion of the work performed in the period covered by the invoice. In accordance with FAR 52-216-8, Fixed Fee, the Contracting Officer will withhold 15% of the total fee or $100,000, whichever is less until the required awards conditions under the reference clause have been met

(3) For CLIN 2, Subject to FAR 52.216-8, Fixed Fee, if applicable, payment of fixed fee shall be allocated based upon the proportion of the level of effort (LOE) specified in Section F.5 that was provided by the contractor in the period covered by the invoice. In the event that the Contractor does not provide the total LOE stipulated in Section F.5, the total amount of fixed fee will be reduced in similar proportion.

[END OF SECTION B]

SECTION C - DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

C.1 TITLE

The title of the project is: Sustainable HIV Response From Technical Assistance (SHIFT) Project

C.2 INTRODUCTION

SHIFT will address USAID/Vietnam development objective #2: Capacity Strengthened to Protect and Improve Health and Well-being, and specifically intermediate result 2.1: Strengthened host country ownership of a sustainable HIV/AIDS response1. The illustrative indicators under intermediate result 2.1 include: (1) Percentage of HIV/AIDS services provided by Government of Vietnam (GVN) systems/financing, (2) HIV/AIDS prevalence among adults ages 15-49, and (3) Level of stigma and discrimination.

The purpose of SHIFT is to strengthen human, organizational, and systems capacity to lead the national HIV and AIDS response and deliver innovative enhancements in HIV and AIDS services.

SHIFT is expected to accomplish this purpose by providing direct service delivery and technical assistance to key stakeholders in targeted provinces to ensure USAID can successfully transition USAID-supported HIV and AIDS services to the provincial government by the end of the project.

Key definitions include:

Direct Service Delivery (DSD) The provision of resources used to (1) support provision of key staff and/or commodities, and (2) provide frequent, at least quarterly, technical assistance to improve the quality of services.

Technical Assistance (TA) The provision of expertise to strengthen and improve the quality, effectiveness, and efficiency of facilities (site-level) and systems (above-site level) performance. Attachment J gives an illustrative list of the potential expertise needed under this contract.

Transition The process to restore responsibility, financial, technical and system support for HIV services to the GVN and civil society organizations, while ensuring quality and sustainability of services.

Epidemic Control The point at which new HIV infections have decreased and fall below the number of AIDS-related deaths.

Priority provinces* Vietnam provinces identified with high HIV burden and a strong potential to reach epidemic control. PEPFAR support to these provinces currently includes active case-finding and

1 https://www.usaid.gov/sites/default/files/documents/1861/CDCS%20Vietnam%20public_version%20final.pdf expanded HIV/AIDS services before transition. In 2015, five provinces are identified as priority provinces (Dien Bien, Son La, Nghe An, Thanh Hoa, and Ho Chi Minh City).

Maintenance provinces* Vietnam provinces where PEPFAR support for (1) active case-finding has stopped, (2) anti-retroviral (ART) drugs is capped equivalent to PEPFAR patient enrollment as of March 31, 2016, (3) recurrent operating costs and human resources will be transitioned by the end of fiscal year 2018, and

(4) provision of TA continues as needed. In 2015, twenty-nine provinces have been identified as maintenance provinces*.

*See Figure 3: Vietnam Map for more details and map

CLIN 1: Provide direct service delivery to achieve targets in priority provinces and transition services in maintenance and priority provinces.

Task 1.1: Scale-up services along the entire CoPC in PEPFAR/Vietnam priority provinces to achieve “90-90-90” HIV case-finding, care, and treatment targets.

Task 1.2: Maintain direct service delivery (DSD) and then fully transition ownership of remaining sites in maintenance provinces supported through the USAID SMART TA Project.

CLIN 2: Provide demand-driven HIV/AIDS technical assistance.

Task 2.1: Establish a demand-driven mechanism for technical assistance (TA) provision.

Subtask 2.1.1: Provide demand-driven TA at the national level and provincial levels to build sustainable HIV/AIDS services and systems.

Subtask 2.1.2: Deliver demand-driven TA at the site level in priority and maintenance PEPFAR/Vietnam provinces to ensure quality and maintainable HIV/AIDS services.

C.3 BACKGROUND

C.3.1 USG-PEPFAR

During 2004-2008, the first phase of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), Vietnam was a focus country for HIV and AIDS prevention, care and treatment scale-up. The PEPFAR program is comprised of USAID, the Centers for Disease Control and Prevention (CDC), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Department of Defense (DOD), and the State Department

(STATE).

PEPFAR is administered by the Office of the Global AIDS Coordinator (OGAC) which has selected Vietnam as one of five "Co-Finance Sub-group of Technical Assistance Countries”. The countries were selected on the basis of their economic growth and perceived ability to assume greater responsibility for funding and leadership of the national HIV and AIDS response. The USG Vietnam team is working with national and provincial departments and institutions to responsibly transition HIV and AIDS services, human resources, and commodities to the GVN and local entities.

C.3.1.2 Achievements

Since PEPFAR's launch in Vietnam in 2005, the program has purchased the majority of HIV commodities, including anti-retroviral (ART) drugs and methadone in the country; scaled up facility-based care and support, including human resource investments; provided technical support in policy, planning, implementation and evaluation; and built the capacity of civil society organizations (CSOs) and the private sector to provide HIV services and commodities outside of state institutions.

After 10 years in partnership with Vietnam, PEPFAR has helped forge a bilateral partnership between the United States and Vietnam that has contributed to more than 93,000 people on ART and 30,000 people on methadone maintenance treatment (MMT). Presently, PEPFAR Vietnam supports more than 51 percent of ART in Vietnam. PEPFAR Vietnam has also contributed to: the 43 percent decline in new HIV infections since 2005; the development of national quality standards that have improved the quality of care for HIV patients; the shift in perception of HIV from a social evil to a public health response; and the positioning of Vietnam as a regional/global leader toward ending AIDS.

C.3.1.3 Challenges

PEPFAR and the Global Fund have signaled their intent to cap and/or reduce funding over the next few years.

Significantly greater levels of domestic financing are expected from Vietnam in order to justify further donor investment. There is no centralized mechanism within Vietnam’s Ministry of Health (MOH) to conduct national level quantification and through which domestic resources for HIV procurements can channeled.

Vietnam’s Social Health Insurance (SHI) currently only covers 30 percent of persons living with HIV/AIDS (PLHIV) and does not cover the majority of HIV services.

Approximately 20 percent of PLHIV do not know their HIV status and a higher proportion of those diagnosed and reported with HIV are not successfully linked to care. Many HIV patients come directly to national/provincial level hospitals for diagnosis and treatment due to concerns about the quality of district-level hospitals, which has led to overcrowding. The use of unique identification codes across HIV services is not standardized and this makes it difficult for planning and for health care workers to track clients across the CoPC cascade.

Figure 1: HIV CARE CONTINUUM

C.3.1.4 PEPFAR Strategy 2015-2020

In collaboration with UNAIDS, OGAC has adopted a Global Strategy on AIDS: by 2020, 90 percent of all people living with HIV will know their HIV status, 90 percent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90 percent of all people receiving antiretroviral therapy will have viral suppression. When this three-part target is achieved, at least 73 percent of all people living with HIV worldwide will be virally suppressed – a two- to three-fold increase over current rough estimates of viral suppression. Modelling suggests that achieving these targets by 2020 will enable the world to end the AIDS epidemic by 2030.

Figure 2: OGAC GLOBAL STRATEGY ON AIDS

In keeping with this strategy, beginning in 2015, the PEPFAR strategy in Vietnam will shift to prioritize five provinces, illustrated in red and green (see Vietnam map below). Three priority provinces (Dien Bien, Son La and Nghe An) will focus on active case finding and expanded ART enrollment at PEPFAR-supported outpatient clinics, and the other two priority provinces: (Thanh Hoa and Ho Chi Minh City) will receive intensified TA and active case finding only - with ART support from other sources to ensure the enrollment. Integral to this policy is ART drug support for current patients in 29 provinces, illustrated in blue (see Vietnam map below) with PEPFAR contributing an amount of ART drugs equivalent to patient enrollment at PEPFAR-supported sites “capped” as of March 31, 2016. TA activities central to the expansion of service delivery will be implemented in the five priority provinces and in other maintenance provinces. PEPFAR's TA will focus on sustaining HIV/AIDS services into the current GVN health care system.

Figure 3: VIETNAM MAP

C.3.2 USG-USAID

USAID/Vietnam’s Country Development Cooperation Strategy for 2014-2018 includes strengthening capacity to protect human health and well-being through strengthening host country ownership for a sustainable national HIV and AIDS response.

C.3.2.1 SMART TA

The Sustainable Management of the HIV/AIDS Response and Transition to Technical Assistance Project – or “SMART TA”, is USAID’s current five-year, $45 million initiative that strives to ensure the provision of quality, comprehensive and sustainable HIV services through a strengthened national response. It is designed to contribute directly to the targets identified in the National Strategy on HIV/AIDS Prevention and Control in Vietnam and the Partnership Framework between the Government of the United States of America and the Government of the Socialist Republic of Vietnam for HIV/AIDS Prevention and Control. This project was awarded in 2011 and will end in 2016.

In 2014 USAID/Vietnam commissioned an evaluation of the SMART TA project (The report is public -https://www.usaid.gov/sites/default/files/documents/1861/FINAL- VEMSS_SMART_TA_Evaluation_Report_FINAL_Submission-07082015.pdf). After 3 years of implementation, the project has many achievements, notably: (1) the promotion of the CoPC cascade in Vietnam which has been accepted as the HIV mission vision at all levels of government, and (2) the successful promotion of models, such the Mountainous Model mobilizing GVN hamlet health care workers and facility health care system to achieve 90-90-90 targets in the mountainous settings, the Enhanced Outreach Approach model for case-finding, and the 3-1 integration model of HTC-MMT-ART clinics. One of the major findings of the recent independent evaluation was that SMART TA was instrumental in launching and institutionalizing a MMT model that has proven high effective in bringing back people who inject drugs (PWIDs) into the health care system and linking patients to HIV testing, counseling, and treatment.

C.3.3 Vietnam-General

While Vietnam’s economy recently achieved lower-middle-income status, the national healthcare system remains significantly under-developed with inequitable resource distribution. The GVN does not allocate significant resources to the national HIV/AIDS response, with HIV/AIDS spending representing just 2 percent of total national health spending. By 2015, the country has reached its Millennium Development Goals 4 and 5 related to child and maternal health. However, it has not achieved its targets for MDG 6, combating HIV/AIDS.

C.3.3.1 Legal and Policy Environment on HIV/AIDS

In the past, the GVN pledged to reduce rates of new HIV infections in key populations by half by 2015 as part of a larger global initiative to realize the "three zeros": zero new infections, zero new deaths, and zero stigma and discrimination. The GVN has now adopted the Global 90-90-90 Strategy on AIDS (see section C.3.1.4).

The GVN recognizes the need to invest in more impactful, cost-efficient, and sustainable approaches to deliver critical, evidence-based interventions. The only Millennium Development Goal Vietnam is at risk of not achieving by 2015 is: to control HIV/AIDS, malaria, tuberculosis, and other diseases.

National HIV laws are enacted by the Vietnam National Assembly. The National Committee for the Prevention of Drug Use, Sex Work, HIV, AIDS and Other Social Vices is a cross-ministerial committee mandated with coordinating the national HIV and AIDS response. Each of the ministries involved in HIV/AIDS programs; the MOH, the Ministry of Public Security, and the Ministry of Labor, Invalids, and Social Affairs (MOLISA), has its own systems, funding, reporting requirements, projects, and relationships with donors. Most HIV donors work directly with the Vietnam Administration for HIV/AIDS Control (VAAC) housed within the MOH. The

VAAC holds most of the resources, primarily from PEPFAR and the Global Fund. At lower levels, district health facilities usually provide curative and preventive HIV services separately and report to Provincial AIDS Centers (PACs). PACs report to the Provincial Department of Health.

There are laws and varying degrees of enforcement surrounding compulsory centers (commonly referred to as '06 centers') for mandatory detoxification for PWID. However, laws have been passed that acknowledge drug abuse as an illness requiring treatment rather than as a social evil and there is now momentum to support a rehabilitative rather than punitive response to substance abuse. These challenges can complicate working on prevention and treatment of HIV among PWID.

C.3.3.2 HIV/AIDS Epidemic

There were an estimated 256,818 people living with HIV in Vietnam as of 2014, with 139,911 cumulative AIDS-related deaths reported (Estimation and Projection Package (EPP), 2013). In recent years, new cases of HIV have declined from a reported 16,000 per year in 2010 to 11,825 in 2014. The epidemic in Vietnam is comprised of many sub-epidemics and remains concentrated among three populations defined by high levels of HIV-transmission risk behaviors, including: PWID, men who have sex with men (MSM), and female sex workers (FSWs). The distribution of cases by key population (KP) and ART coverage rate also varies significantly by region, province, and within provinces, highlighting the need for a geographically tailored response.

Injecting drug use is the primary contributor of HIV transmission in Vietnam. While the national HIV prevalence rate is 0.26 percent for ages 15-49 years, the 2013 estimation and projection based on data from three rounds of the HIV/STI Integrated Behavioral and Biological Survey (IBBS) and national sentinel HIV surveillance shows that up to 21 percent of the estimated 271,506 PWID (range: 158,000-385,000) are living with HIV. PWID are found throughout the country, but an estimated 80 percent of the drug using population lives in 22 of Vietnam's 63 provinces. While prevalence among PWID is decreasing in some provinces, the epidemic is still alarmingly high in most provinces surveyed. HIV prevalence among PWID is particularly high in provinces including Ho Chi Minh City (HCMC) (29 percent), Thai Nguyen (41.53 percent), Thanh Hoa (38.45 percent), Dien Bien (38.8 percent), Son La (38.8 percent), Lai Chau (38.8 percent), Nghe An (30.87 percent), and Quang Ninh (48.64 percent) (source: EPP 2013, 2014 projection).

In recent years, there has been greater recognition of the HIV epidemic among MSM in Vietnam and numerous studies have highlighted increasing risk behaviors in the MSM community. The estimated MSM population is 382,506 (range 191,000 – 573,000) with EPP estimates of HIV prevalence up to 12 percent in Hanoi and

HCMC.

There are an estimated 72,000 FSWs (range: 36,000-108,000) in Vietnam. Data from three rounds of IBBS show that HIV prevalence among FSWs varies largely by province and exceeds 10 percent in Hanoi, Hai Phong, Can Tho, and HCMC in 2013. IBBS also indicates that street-based FSWs have a relatively higher HIV burden (7.1 – 31.9 percent) compared to venue-based FSWs (2.4-13.9 percent).

Overlapping risk behaviors amplify HIV transmission risks for FSWs and MSM who also inject drugs, as 2013 IBBS data indicate that the odds of an FSW or MSM being infected with HIV are significantly higher among those who also report injecting drug use. An estimated six to 24 percent of venue-based FSWs also inject drugs. Among FSW who inject drugs, HIV prevalence is 26-50 percent. According to 2014 HSS data, 30-40 percent of MSM in five southern provinces reported previous or current sex work and 12-17 percent reported injecting drugs.

The sizes and distribution of KPs vary. PWID are concentrated in HCMC, Hanoi, Son La, the Red River Delta and the northwest region; FSWs are highest in big cities including HCMC, Hanoi, Can Tho, Hai Phong, the Mekong Delta and southwestern Vietnam; and self-reported, disclosed MSM are clustered in major cities. The size estimations of PWID and FSWs are based on government reports, program mapping, case reports, population census estimates, and reports on arrests and entertainment venue work. MSM population size in HCMC and Hanoi are two percent of the adult male population, based on the UNAIDs recommendation that MSM account for one to three percent of the adult male population.

Sexual partners of these KPs are an additional at-risk population that requires targeted interventions. Fifty-four percent of HIV-positive women reported that their only HIV risk behavior was sex with a long-term partner with high-risk behavior.

Emerging evidence suggests a link between gender-based violence, unprotected sex, and HIV infection. This research suggests that sexual violence against girls and women, including within marriage, places women at higher risk of HIV infection not only because forced sex is almost always unprotected sex, but also because violent sex can result in abrasions which facilitate HIV transmission. Furthermore, physical and emotional abuse, or fear of it, undermines some MSM, female PWID, FSW, and women’s ability to negotiate safer sex with their regular partners.

C.3.3.3 HIV/Tuberculosis Co-Infection

Vietnam ranks 12th among the WHO's list of 22 countries comprising 80 percent of the global tuberculosis (TB) burden. In 2014, there were 106,000 new TB cases and an estimated 29,000 TB deaths; translating into approximately 80 deaths every day. The TB case detection rate is 54 percent, far below the global target of 70 percent. TB and HIV service integration is still below par; in 2014, only 43 percent of TB patients were tested for HIV, and 8 percent reporting positive. Thus, approximately 8500 TB/HIV co-infection cases were reported in 2014. The estimated number of new cases of Multi-Drug Resistant TB 7 (MDR-TB) each year is 3,500.

The total number of MDR-TB patients treated is still as low as 600; this is probably due to limited detection and treatment capacity.

The majority of TB funding, approximately 70 percent, provided to the TB National Targeted Program (NTP) goes toward procurement of first line drugs. TB treatment is provided free of charge to TB patients. TB detection requires close collaboration between the HIV and TB systems, but those systems are managed largely as two parallel systems. Provider-initiated testing and counselling services are offered at TB clinics for TB patients and when a TB patient is identified as HIV positive, they are referred to HIV clinics for HIV care and treatment services. Registered HIV/AIDS clinic patients, if positive after TB screening, are referred to TB clinics for further TB work up and treatment. Therefore, the linkage between the two systems is important. In general, PEPFAR and Global Fund supported provinces are those with referrals in place from TB to OPC and vice versa. However, at the national level, there is not a standardized reporting system for these referrals.

Therefore, no data on the number of TB/HIV patients treated annually is reported, either to VAAC or to the

National TB Control Program. In FY2015 and all HIV test kits for TB patients will be transitioned from PEPFAR funding to TB programming with Global Fund resources.

C.3.3.4 Stigma and Discrimination

The 2015 Stigma Index results reveal formidable barriers to achieving “90-90-90” HIV testing and treatment targets for Vietnam and the global goal of ending AIDS by 2030. High levels of stigma and discrimination (S&D) combined with low confidence in the confidentiality of HIV testing mean that many PLHIV only seek an HIV test after their immune systems has become extremely weak and they develop opportunistic infections.

While there have been some positive changes with regard to the S&D experienced by FSWs in Vietnam since 2011, high levels of S&D remain and make it difficult to identify persons most-at-risk and enable them to access and receive care across the CoPC.

Fear of being exposed as a drug user and the likelihood of being sent to a compulsory rehabilitation (06) center is considered a strong deterrent for PWID from registering at MMT sites and entering the CoPC. MSM appear to suffer the highest levels of S&D, especially discriminatory reactions from partners and family, social exclusion, and self-stigmatization. The preponderance of HIV+ MSM have not disclosed their status to sexual partners and to their families and this carries with it strong negative implications for HIV prevention and support within the CoPC for MSM.

C.3.3.5 HIV-AIDS Funding

The National HIV program faces critical resource gaps as the major international donors (USG/PEPFAR and the Global Fund) have signaled their intent to substantially reduce funding in the coming years. The present financial situation, however, presents significant challenges for the GVN to sustain progress made towards controlling the epidemic and to absorb the costs of PEPFAR-supported PLWHA currently on treatment.

The GVN’s approach to sustainably finance the HIV response is contained in Prime Minister Decision 1899, which references a plan for “Financial stability for HIV/AIDS control activities for 2013-2020”. The plan emphasizes resource mobilization from diversified funding sources as well as improved efficiency. Social health insurance (SHI) is considered a key potential source to cover HIV services. A significant step to accessing the SHI funds is the integration of HIV/AIDS services into the general health system. USAID currently supports these aims by strengthening the evidence base for increasing domestic investment in the HIV response and maximizing the potential of existing domestic resources to cover HIV needs. This includes reforming SHI to enable key populations to use their health insurance to pay for HIV services while ensuring that the costs of HIV services are not transferred to PLHIV as donor funds are withdrawn.

C.4 STATEMENT OF WORK

USAID/Vietnam seeks to strengthen human, organizational, and systems capacity to lead the national HIV and AIDS response and deliver innovative enhancements in HIV and AIDS services.

After ten years of PEPFAR investments in Vietnam, USAID remains committed to helping the country achieve epidemic control in targeted provinces. USAID/Vietnam will prioritize achieving 90-90-90 targets while building upon best practices implemented from the SMART TA project and lessons learned from the recent SMART TA evaluation. The program shall contribute to USAID’s development objectives for human health and well-being, technical and management capacity, stigma and discrimination, fragmented governance, and civil society and private sector engagement.

In year one, the focus will be to optimize the CoPC cascade in Dien Bien and Nghe An provinces and active case finding in HCMC to support the new PEPFAR model that prioritizes achieving epidemic control. This will include the continuation of accelerated active case-finding and HIV testing and counseling among key populations, improving linkages and retention to care and treatment, and support for viral load monitoring of patients. All of these activities shall be implemented with a sustainable focus toward building country capacity and strengthening systems.

SHIFT shall (1) provide DSD to provinces that have participated in the SMART TA Project, then (2) gradually, but entirely transition those services, predominantly and presumably to the GVN. SHIFT shall provide targeted policy and planning interventions in conjunction with national and provincial health authorities to fully transition financial, administrative, and technical ownership of HIV/AIDS services in Vietnam to the GVN. At least during the first three years, the Contractor shall provide sub-contracts to provincial governments to ensure the continuation of HIV services. In addition to the indicators defined in the contractual results for tasks 1.1, 1.2, and 2.1 below, the Contractor shall adhere to and be expected to report on all required PEPFAR Vietnam indicators in compliance with Global PEPFAR monitoring and reporting (MER) requirements. The contractor will be expected to report on indicators defined in the contractual results for Tasks 1.1 and 1.2. To view current MER guidance, use the link: http://www.pepfar.gov/reports/guidance/index.htm

The Contractor shall complement resources available for other funded HIV/AIDS initiatives in the country, including other PEPFAR/USAID and PEPFAR/CDC funded programs as well as the Global Fund, the Clinton Health Access Initiative, and other USG-funded programs.

To achieve the goal of this contract, the Contractor shall:

CLIN 1: Provide direct service delivery (DSD) to achieve targets in priority provinces and transition services in maintenance and priority provinces.

Task 1.1: Scale-up services along the entire CoPC in PEPFAR/Vietnam priority provinces to achieve “90-90-90” HIV case-finding, care, and treatment targets.

In support of the new model of PEPFAR service delivery and in order to demonstrate epidemic control, the Contractor shall provide HIV/AIDS-related DSD in Dien Bien and Nghe An provinces and HIV case finding in HCMC. The specific goal shall be to scale-up services along the entire CoPC in Dien Bien and Nghe An provinces, and active case finding in HCMC, in order to achieve “90-90-90” HIV case-finding, treatment, and retention targets. DSD related to the attainment of PEPAR annual targets to key populations in these focus provinces shall be prioritized. Contingent on out-year PEPFAR Vietnam policy, priority provinces and targets may be established or changed during the contract.

Contractual Results for task 1.1:

Result Description Minimum Expected Results Date 10/2017 10/2018 10/2019 10/2020

10/2021

1 # of KPs reached and referred to HTC services in priority provinces

12,000 6,000 6,000

2 Proportion from row #1 above that are

HIV +

>4% >4% >4%

3 # KPs HIV tested and received result in USAID supported priority and maintenance provinces

75,000 30,000 30,000

4 # PLWHA newly starting on ART in in USAID supported priority and maintenance provinces

3,100 800 700

5 # PLWHA sustained on treatment in USAID supported cohort

22,000 22,800 23,500

6 # PLWHA virally suppressed in USAID supported cohort

17,010 19,800 20,520

*USAID DSD to focus provinces is targeted to end by October 2018. After this, it is expected that USAID HIV/AIDS assistance to Vietnam provinces will follow a sustaining, transition, and TA model.

Task 1.2: Maintain DSD and then fully transition ownership of remaining sites in maintenance provinces supported through the USAID SMART TA Project.

Through the end of year 3 of the contract, the Contractor shall provide time-limited DSD to maintain and then fully transition human, administrative, and financial ownership of remaining DSD sites that are currently supported through the USAID SMART TA Project. USAID plans to provide the Contractor upon award completed and vetted transition plans for each province. Specifically, during the first three years of the contract, the Contractor shall continue to support DSD and transition of DSD in eight PEPFAR/Vietnam maintenance provinces (An Giang, Bac Giang, Can Tho, Hai Phong, Hanoi, Lao Cai, Quang Ninh, and Thai Binh) that have participated in the SMART TA Project and in three PEPFAR/Vietnam priority provinces (HCMC, Nghe An and Dien Bien). This support shall also be transitioned to other entities, predominantly and presumably to the GVN, by 2018. A priority task is to fully integrate all HIV services into the regular health care system. This includes integrating all HIV services into the health insurance reimbursement system and the health information system of hospitals. The ultimate transition goal will be to increase health insurance enrollment and utilization among key populations and PLWHA so that HIV services are covered by social health insurance. The Contractor shall provide individual experts or teams of experts to provide DSD to remaining SMART TA-supported DSD sites to seek solutions to specific challenges faced in the transition process. Transitioned services would not only be financially sustainable but must also continue with the degree of quality that would be consistent with PEPFAR and national guidelines/standards. To ensure a sustainable transition the Contractor shall collect data that demonstrate the sustainability of transitioned DSD sites.

Contractual Results for task 1.2:

Result Description Minimum Expected Results Date 10/2017 10/2018 10/2019 10/2020* 10/2021

# of hospitals from SMART TA Project and priority provinces that have social health insurance reimbursement for ART and other related HIV services as defined by the National Basic Health Services Package.

10 20 30 37 44

# of hospitals from SMART TA Project and priority provinces that have an functioning health information system to support HIV social health insurance reimbursement and program reporting

10 20 30 37 44

# of cumulative DSD sites from SMART TA Project and priority provinces transitioned

10 44 89

*USAID DSD to focus provinces is targeted to end by October 2018. After this, it is expected that USAID HIV/AIDS assistance to Vietnam provinces will follow a sustaining, transition, and TA model.

Possible interventions specific to CLIN 1 above may include, but are not limited to:

Provide time-limited DSD for active case finding in HCMC and reach – test –start – retain in Dien Bien and Nghe An provinces in year one in a manner which will ensure continuity of services and sustainable transition.

Provide time-limited DSD to former SMART TA-supported sites in a manner which will ensure continuity of services and sustainable transition.

Develop and/or collect indicator data that demonstrate the sustainability of SMART TA transitioned DSD sites in PEPFAR/Vietnam maintenance provinces.

Strengthen capacity and organizational readiness to fully transition human, administrative, and financial ownership.

Coordinate with other agencies, especially the GVN, to ensure that transitioning services are sustainable.

CLIN 2: Provide demand-driven HIV/AIDS technical assistance.

Task 2.1: Establish a demand-driven mechanism for TA provision.

Subtask 2.1.1: Provide demand-driven TA at the national level and provincial levels to build sustainable HIV/AIDS services and systems.

The Contractor shall establish a demand-driven HIV/AIDS TA system to build sustainable HIV/AIDS services in priority provinces and in provinces that are currently or have traditionally been supported by PEPFAR (see Section C.3). The TA mechanism will follow the general guidelines described in Section C.5 and Appendix A.

The goal of this component is to…