20 October 2017 - Vietnam’s HIV epidemic was originally driven by injection drug use. People who inject drugs still constitute nearly half of the country’s HIV cases. In past years PEPFAR programs made significant strides in convincing local authorities to scale up methadone maintenance therapy (MMT). After intensive effort, local stakeholders embraced MMT as a cost effective, evidence-based and humane means to interrupt HIV transmission and treat drug abuse. The USAID SHIFT project recently coached local MMT mentors and HIV experts to assess the technical capacity, performance and sustainability of MMT sites in Nghe An and Dien Bien provinces. They found impressive service scale-up, with commitments to enroll 7,400 MMT patients by 2019. However, some sites failed to hit ‘gold standard’ targets for 12-month treatment retention. The local teams worked with each site to tackle this issue and create service improvement plans, which they will help implement and monitor in the months ahead. While PEPFAR phased out direct service delivery (DSD) support for MMT in recent years, the Government of Vietnam is undertaking ambitious efforts to rapidly scale-up voluntary methadone therapy. Similarly, Vietnam will continue scaling-up antiretroviral therapy for HIV even as PEPFAR DSD support for HIV treatment ends in 2018. The MMT domain therefor serves as an apt arena to test and refine technical assistance models which ensure continued service quality and sustainability with reduced international funding. USAID SHIFT has confirmed that previously-supported sites and services can not only continue and expand in the post-DSD era. The project has affirmed that consistent coaching, advocacy, and low cost TA can successfully institutionalize the capacity needed to monitor and improve these services.