With support from the USAID Sustainable HIV Response from Technical Assistance (SHIFT) Project, Nghe An province formally decided to cover the purchase of social health insurance (SHI) cards and the required 20 percent copayment for antiretroviral (ARV) drugs for all HIV patients. To enact this landmark decision, the first of its kind in Vietnam, the province earmarked $100,000 USD from its central budget to finance the purchase of SHI cards and ARV copayments. This commitment is remarkable given that Nghe An is a large province with a widely dispersed population and commensurate demands on its provincial budget. With support from the USAID Health and Finance and Governance Project, Hoa Binh and Hai Phong have also decided to cover 100 percent of the premium fee for SHI cards for all HIV patients in 2017. In all, these decisions provide a critical foundation for provincial HIV treatment schemes to become more locally sustainable, with more patients likely to be retained on antiretroviral therapy.