Reaching HIV/AIDS Affected People with Integrated Development and Support" (RAPIDS) is a consortium of six organizations that provide integrated care and support, AB prevention, and ART adherence support in 49 of the 72 districts of all nine provinces (68% district geographic coverage). Consortium members include World Vision, Africare, CARE, CRS, The Salvation Army Zambia, and the Expanded Church Response, plus local CBO and FBO sub-grantees. The RAPIDS household approach extends care and support to youth, OVC, and PLWHA within the context of needs and priorities identified at a household level.

In FY 2006, RAPIDS reached 33,302 youth with abstinence and behavioral change for youth (ABY) messaging, and trained 6,568 youth in AB related activities, including 1,123 youth in livelihood options. In FY 2007, RAPIDS plans to scale-up activities to reach 43,189 youth directly with effective ABY interventions, at an average cost of $49 per client. Due to a sound Monitoring and Evaluation (M&E) system, RAPIDS is able to collect and analyze data on achievement of targets in a timely, accurate fashion, and uses data to plan future efforts. RAPIDS has capacity to analyze outcomes of AB activities, and will undertake a mid-term evaluation in FY 2006 with support from HORIZONS.

To reach these targets, and building on lessons learned from the mid-term evaluation, RAPIDS will continue to train local pastors, teachers, and peer educators to promote primarily abstinence messages for youth. The program will promote AB messages at community meetings, schools, church meetings, in one-to-one counseling, sporting events, during visits to home-based care (HBC) clients, and in work with youth. Faith-based and school leaders command respect in communities, and empowering them to reach youths is a field-tested strategy. Through its small grants support, RAPIDS will provide 30 small grants to faith- and community-based youth organizations for ABY and livelihood activities. To build local capacity, groups will receive training in financial and project management.

In FY 2007, RAPIDS will initiate targeted AB prevention strategies to focus on boys and young men given the central role they play in courtship and HIV transmission. Over 2,000 boys and young men will be trained in life skills with a focus on gender roles to bolster positive, risk-avoidance behaviors, and to counter negative stereotypes that encourage risky sexual behaviors. RAPIDS will encourage young men to get involved in HBC work and assume a community caring role. Youths will receive training in basic counseling and psycho-social support and AB prevention so that they can provide guidance to their peers who may be experiencing trauma of illness of their parents. RAPIDS will seek to reduce HIV transmission by promoting abstinence among unmarried young people aged 10-24 years and by encouraging faithfulness among young married couples. Through the Youth Forum, RAPIDS will work with GRZ to help implement and monitor the National Youth Policy.

RAPIDS will sensitize gate keepers such as traditional leaders and traditional initiators to ensure that they understand how to play an effective role in promoting AB among young people. In coordination with HCP, RAPIDS will distribute AB IEC materials, and use other strategies to disseminate information such as drama campaigns, sport, radio, and music festivals. In monitoring youth support activities, RAPIDS will continue to refine and adapt its M&E tools to align with overall PEPFAR and GRZ guidelines and indicators, which support the "Three Ones". RAPIDS will support consortium members in further developing ABY M&E systems capable of documenting interventions and demonstrating impact, and will encourage documentation of case studies and success at all levels.

RAPIDS will strengthen referral networks at the district level and will continue to work with GRZ structures such as District AIDS Task Forces (DATFs). The referral process shall involve key service providers, formalize collaborative relationships, and encourage follow-ups. RAPIDS partners and grantees will intensify prevention efforts to identify and refer at-risk youth to relevant services such as VCT, STI testing and treatment to extend the reach and impact of HIV/AIDS mitigation activities. RAPIDS will continue to support apprenticeships and internships through private sector partnerships that provide approximately 1,500 youth with work experience and job opportunities.

As a prevention strategy, RAPIDS will enhance the nutritional status of youth and at risk OVC by providing information and skills in good nutrition and food production appropriate to climatic, environmental, and cultural conditions. Youth will be provided skills in food

processing and utilization. This will enhance opportunities for youth to generate personal income, provide diversity in nutrition, and enhance food security to help youth avoid risky behavior and HIV infection. Life skills training will equip the target groups to identify, analyze, and deal with inequalities and power imbalances between women/girls and men/boys in communities. The program will also work with traditional initiators and leaders to eliminate harmful traditional and cultural practices that put youths at high risk such as dry sex, sexual cleansing, and wife inheritance. In addition, RAPIDS will work to reduce transactional sex, a high-risk coping strategy to which some poor young women turn as a last resort, by providing livelihood training and access to business startups.

RAPIDS will form linkages with other USG-funded programs and GRZ service providers to support youth livelihoods programs to economically empower youth and enhance access to HIV/AIDS information. RAPIDS will work with micro-finance Institutions to disburse loans for youth small-enterprise activities, and with other USG-funded partners such as Land-O-Lakes and the PROFIT project to develop micro-finance options in support of youth (ABY) programming.

RAPIDS will continue to provide values-based life skills training for youth. Life skills training and abstinence promotion for youth includes practical components, such as training youth in agricultural skills, crafts (such as pottery and basket weaving), home economics, cooking and gardening, and other vocational skills as may be appropriate to each setting. The youth are linked to private businesses to explore workplace-type trainings and work with NGOs and/or agricultural extension agents for their assistance in training youth in farming practices and other sustainable activities.

RAPIDS main approach to promote sustainability is to mobilize communities nationwide to take a lead role in the response to HIV/AIDS in Zambia. To further sustainability of grassroots efforts, RAPIDS provides training to CBOs and FBOs, including local church pastors. The goal of this training is to improve management skills and increase trainees' ability to access existing HIV/AIDS resources. RAPIDS technical and material support for the development of prevention activities includes equipping HIV educators within FBO/CBO institutions with training of trainers program and training material designed to help them provide further training to supervisors, peer educators, and staff within their respective institutions and organizations. In addition, the RAPIDS small grants program will equip CBOs and FBOs to respond to HIV/AIDS in their communities more effectively through mentorship and training, and help sustain the HIV/AIDS mitigation efforts through the on-going work of a network of local partners after the RAPIDS program comes to an end.

This activity links to HVCT (#8944), HKID (#8947), HVAB (#8945) and HXTS (#8948) and to the RAPIDS PlayPump PPP (#9612), SUCCESS HBHC (#9180) and ZPCT HBHC (#8884).

This World Vision-led project, "Reaching HIV/AIDS Affected People with Integrated Development and Support" (RAPIDS) undertakes care and support activities in 49 of the 72 districts in Zambia. RAPIDS is a consortium of six organizations: World Vision, Africare, CARE, Catholic Relief Services (CRS), The Salvation Army, and Expanded Church Response (ECR), as well as other CBO and FBO local partners. RAPIDS uses a household approach to extend care and support to youth, OVC and PLWHA within the context of needs and priorities identified at a household level.

In FY 2006, RAPIDS reached 38,508 PLWHA with quality Home Based Care (HBC). In FY 2007, RAPIDS will provide HBC and support to 45,852 PLWHA in 49 of 72 districts (68% geographic coverage) in Zambia.

To ensure quality service delivery, RAPIDS will build the capacity of clients, families, caregivers, and their nurse supervisors through training, provision of material support, and technical assistance. Services will include: education to improve knowledge, attitudes, behaviors, and practices on HIV/AIDS, provision of drugs for the prevention and treatment of opportunistic infections, psychosocial and spiritual support, provision of medical equipment, symptom/pain assessment and management, and patient/family education and counseling. Community-based care coordinators will refer clients to various service providers. RAPIDS in partnership with the US Palliative Care Forum and other donors will advocate to the GRZ for a national Home Based Palliative Care policy and delivery framework in Zambia.

RAPIDS will continue to work with SUCCESS and other palliative care programs to promote synergy and complementarities. RAPIDS will also continue to link PLWHA to livelihood initiatives. In FY 2007, the program will expand interventions and linkages in HBC and move towards a full continuum of care, extending beyond the referral networks established in FY 2006.

RAPIDS will extend the outreach of HBC activities through 30 small grants to FBOs/CBOs, building the capacity of community level groups and organizations. To improve quality of care, RAPIDS will provide nurses and volunteers with caregiver kits through leveraging private and corporate donations. RAPIDS will also provide "client kits" that follow HIV/AIDS National guidelines on "minimum standards of care," to clients' households. To improve program efficiency and effectiveness and maintain volunteer morale and commitment, RAPIDS will provide caregiver volunteers with non-cash incentives, in part by leveraging public-private partnerships (PPP) with U.S. corporations. Items will include raincoats, bags, shoes, and bicycles. RAPIDS will implement a PlayPump PPP to bring water to communities with large numbers of HBC clients to prevent diarrhea, improve the hygiene, and reduce the incidence of infections among PLWHAs.

To prevent malaria in PLWHA and their families, RAPIDS will work with the National Malaria Control Center and PATH and other stakeholders to promote use of Insecticide Treated Bed Nets (ITNs). RAPIDS will secure a significant number of ITNs through public channels, and more may procure more through private donations. PEPFAR funds will support ITN warehousing, internal distribution, transport, training/awareness raising and monitoring by caregivers so that clients use ITNs consistently, resulting in effective leveraging of PEPFAR funds for a positive, life-saving health impact.

The management of severe pain is a challenge, due to limited access to pain relief drugs. RAPIDS refers PLWHA to nearby health facilities for severe pain management. RAPIDS is working with other USG partners to implement the USG palliative care strategy to address these issues. RAPIDS will help develop a minimum standard of care for PLWHA for regular access to and use of simple to moderate pain management drugs and advocate for Zambia to adopt updated methods for management of simple to severe pain, as endorsed by the World Health Organization (WHO). This effort will be in line with national guidelines and recommendations for home based and palliative care.

Building on experience from FY 2006, RAPIDS will provide targeted nutritional

supplements for PLWHA to help sustain the immune system and to maintain body weight. Severely malnourished patients will receive Ready to Use Therapeutic Food (RUTF), while moderately malnourished PLWHA will receive High Energy Protein Supplements (HEPS). All clients will receive nutrition counseling and education. RAPIDS reached 12,000 PLWHA households with seed materials distribution in FY 2006. In FY 2007, the coverage will expand to 15,000 PLWHA households. RAPIDS will also intensify the promotion of formation of Positive Living Groups with livelihood options.

RAPIDS will continue to train caregivers and HBC providers in how to combat stigma and discrimination by increasing understanding of the HIV/AIDS and the challenges faced by PLWHA; encouraging participation of PLWHA in design and implementation of project activities; and by promoting involvement of youth and men as caregivers. RAPIDS will also mainstream gender equality in its care and support activities. RAPIDS provides capacity building to community committees working on home-based care and support activities, and is scaling-up support- and youth-groups. To reduce stigma, RAPIDS will broadening anti-stigma messages and activities through existing community groups and churches.

RAPIDS works through communities and is mobilizing community committees as the primary mechanism to provide care and support to PLWHA and vulnerable households. These community committees draw their membership from a broad spectrum of community stakeholders in an effort to ensure multi-sectoral representation and a holistic and coordinated response. RAPIDS is achieving significant momentum in mobilizing communities and ensuring that communities take the lead in mitigating the impact of HIV/AIDS and sees this as the key to long-term sustainability in the response to HIV/AIDS in Zambia.

To further the sustainability of current grassroots efforts, RAPIDS provides training to CBOs and FBOs to provide care and support to PLWHA, including children and adolescents. RAPIDS also includes training in such critical areas as advocacy and paralegal support. RAPIDS facilitates establishment of linkages between communities and other service providers. RAPIDS also provides training designed to improve management skills and the ability of local community-based organizations to access existing HIV/AIDS resource streams. To ensure continuity of prevention, care and treatment, RAPIDS implements a "training of trainers" program that equips HIV/AIDS service providers in FBOs and CBOs. This serves as a mechanism to ensure long-term scale up of training of supervisors, peer educators, and staff within their respective institutions and organizations. Advocacy efforts will continue to link caregivers with MOH and help to establish a national HBC program that can absorb the HBC caregivers trained by RAPIDS and other NGOs towards sustainability.

RAPIDS ensures that its program integrates into existing district structures of both the GRZ and NGOs, and helps to build the capacity of these structures to sustain them beyond the life of the program. RAPIDS will contribute to the sustainability by solidifying and reinforcing critical networks and alliances, sharing lessons learned and best practices, leveraging resources, forming partnerships, avoiding duplication, and advocating for the promotion of improved policy in home based and palliative care support.

This activity also relates to activities in HVCT (#8944), HBPC (#8946), HVAB (#8945) and HTXS (#8948), as well as to Track 1 and other USG OVC projects in Zambia.

The World Vision-led project "Reaching HIV/AIDS Affected People with Integrated Development and Support" (RAPIDS), the flagship USG Zambia Orphans and Vulnerable Children (OVC) project, is a consortium comprised of six organizations: World Vision, Africare, CARE, CRS, The Salvation Army, and the Expanded Church Response, and other FBO and CBO local partners. RAPIDS provides OVC care and support activities in 49 districts, representing 68% coverage of all districts. RAPIDS uses a household approach, creating a basis for supporting youth, OVC, and PLWHA within the context of needs and priorities identified at a household level.

In the first half of FY 2006, RAPIDS reached 149,188 OVC with services and trained 4280 OVC caregivers out of an annual target of 180,000 OVC and 6,000 caregivers. In FY 2007, RAPIDS will scale up care and support to 196,595 OVC and train 6,553 caregivers. RAPIDS uses a network approach at national, provincial, and district levels, linking with other donors, USG partners, and GRZ. New caregivers will receive training in quality OVC care and support; psychosocial support; legal and social protection.

In collaboration with the Zambia Malaria Foundation and the Malaria Control Centre, RAPIDS will provide ITNs to OVC. To support OVC livelihoods and food security, RAPIDS will provide agricultural inputs (seed, livestock, and irrigation equipment for OVC households and caregivers), as well as training in food processing, storage and utilization. The program will promote OVC livelihood options, such as small business development, and micro-finance (in collaboration with Opportunity International), with appropriate training. RAPIDS will continue to provide nutrition training and food supplementation for 16,000 severely food insecure OVC households. Involvement and participation of female headed households, and especially of elderly "granny" caregivers, will help ensure gender equity. RAPIDS will link with Zambia Police Victims Support Units (VSU) and paralegal support centers to deal with gender-based violence (GBV) and child abuse cases, and will promote community sensitization.

RAPIDS will provide the following: non-cash incentives and tools for work, including bicycles, clothes, shoes, and umbrellas for volunteer caregivers; school fees, uniforms, shoes, text-books to help OVC continue their education; and support to train teachers and rehabilitate community schools. RAPIDS will collaborate with CHANGES2 (secondary school OVC scholarship program). RAPIDS will leverage private donations including blankets, clothes, shoes, and support to community schools with educational materials, and small grants for infrastructure rehabilitation. U.S. Peace Corps Volunteers will help build capacity, and help improve the quality of grass-roots service.

RAPIDS will continue support to Family Support Units (FSUs) for Children Living with HIV/AIDS (CLWHA) at hospitals in Ndola, Lusaka, Livingstone and the Northern Province, providing psychosocial support to Children Living with HIV/AIDS (CLWHA), their parents and guardians, specializing in "play therapy" (play activities for HIV+ children to reduce stigma and discrimination). RAPIDS will support non-medical services of the FSUs, linking children to CDC-supported CT and Pediatric ART services (P-ART), and support ART adherence.

Thus far, most Pediatric ART (PART) is clinic based, with little outreach into communities. RAPIDS will encourage parents and guardians to seek CT for children, provide community-based support for PART adherence, and offer psychosocial support for CLWHA and family members. RAPIDS will seek to leverage wrap-around nutritional support for HIV+ OVC, by linking with FFP programs and WFP, and will support P-ART adherence.

In FY 2007, RAPIDS will continue to collaborate with other USG funded ART projects (ZPCT, AIDSRelief and CIDRZ) to increase access to P-ART. RAPIDS will identify and refer HIV positive children of PLWHA to P-ART services where available. Interventions will include increased promotion of early CT, community-based care and support for parents of P-ART clients, and adherence and psychosocial support for infected/affected children. RAPIDS will train HBC providers and caregivers in care and support for CLWHA including counseling. Caregivers will follow children born to mothers in PMTCT programs through home visits, and will refer HIV+ children to health care, CT, ART and adherence support.

RAPIDS consortium members will provide up to 31 small grants to FBOs and CBOs to enhance their capacity and enable them to expand OVC outreach and partnerships, and to help train caregivers, peer educators, and clergy in OVC care and support.

RAPIDS is a key member of the National HIV/AIDS/STI/TB Council (NAC) OVC Technical Working Group (TWG) and the National OVC Steering Committee. Since FY 2005, RAPIDS has supported a policy advisor at the Ministry of Youth, Sport and Child Development, and contributed to the 2005 National Child Policy. In FY 2007, RAPIDS will help operationalize the National Child Policy, the GRZ Mid Term OVC Plan 2005-2007, and help develop the National Plan of Action for Children. RAPIDS will train staff, members of district structures and the media. With SHARe, RAPIDS will work on OVC policy and advocacy issues. RAPIDS will continue to support the annual ‘Populations Impacted by HIV/AIDS Media Awards' (prizes to media professionals who provided quality reporting on HIV/AIDS).

RAPIDS will support an OVC Forum Technical Advisor to operationalize the USG/Zambia OVC plan. RAPIDS will provide technical assistance to the Ministry of Community Development and Social Services, and to 30 local organizations. Fifteen CBOs/FBOs in the Northern Province will receive $75,000 to build capacity in OVC programming, organizational development, and to address malnutrition using the Positive Deviance-HEARTH Model.

Towards sustainability, RAPIDS trains volunteer caregivers and community committee members. These volunteers do not receive monetary incentives and do not depend on external support. Livelihood options for the caregivers contribute towards sustained services.

In FY 2007, RAPIDS will conduct a Mid-Term Evaluation and Targeted Evaluation to improve OVC programming; and monitor activities through field visits and data collection. RAPIDS will report in line with final OGAC OVC guidance. RAPIDS will coordinate with other USG OVC activities to avoid double counting of OVC.

Exit strategies for RAPIDS OVC activities include linking with government support, hospitals, and government structures at district level through District AIDS Task Forces (DATFs). For sustainability of local organizations, RAPIDS provides training and small grants to CBOs and FBOs supporting OVC programming to improve their programmatic and management skills and ability to provide quality service and access to other existing HIV/AIDS resources.

This activity links to activities in HKID (#8947), HBHC (#8946), HVAB (#8945) and HTXS (#8948), as well as to Track 1.0 OVC projects, and other PEPFAR funded projects in Zambia.

"Reaching HIV/AIDS Affected People with Integrated Development and Support" project (RAPIDS), undertakes care and support activities in 49 of the 72 districts in Zambia (68% geographic coverage at district level). RAPIDS is a consortium of six organizations: World Vision, Africare, CARE, CRS, The Salvation Army, and the Expanded Church Response, and CBO/FBO small grant recipients. The RAPIDS "household approach" extends care and support, including counseling and testing, to youth, orphans and vulnerable children (OVC), and chronically ill adults and children tailored to the needs and priorities identified at a household level.

RAPIDS integrates CT services into all its care and support activities targeting youth, OVC, and people living with HIV/AIDS (PLWHA), including children living with HIV/AIDS (CLWHA). In FY 2006, RAPIDS integrated CT linkages into home-based care and expects to refer 4,000 individuals for CT by year-end.

In FY 2007, for the first time, RAPIDS will provide direct community-based CT targeted at 11,661 individuals, at an estimated cost of $49 for each client who is counseled, tested and receives their test result. RAPIDS will train and mobilize its HBC and OVC volunteer caregivers and youth networks to promote universal CT in their communities. RAPIDS will fund local organizations certified in CT to provide family-based CT following national protocols for rapid testing. RAPIDS sets its targets using a sound M&E system, which also allows it to collect data and analyze achievement of targets in a timely, accurate fashion, and use data to plan future efforts. Geographic coverage of RAPIDS CT will increase yearly through FY 2008 as the numbers of volunteers trained increases and more community awareness and demand is generated.

In FY 2007, RAPIDS will provide training in counseling and testing to health care providers who are part of the home-based care programs. Where possible, health providers will link to the district level supply chain of VCT kits. In the event of localized stock-outs, RAPIDS will coordinate with District Health Management Teams, the central level Medical Stores Ltd., and other USG partners to access and distribute HIV test kits to trained health care providers. The health care providers will provide CT to clients referred by volunteer caregivers and their supervisors as well as through mobile outreach services in the communities. RAPIDS will also train Family Support Unit (FSU) staff to promote CT for all children and their family members and will collaborate with CDC to expand CT through FSU outreach services for children. The trained health care providers will train caregivers as lay counselors using national and international standards to provide counseling at the household level and refer clients to both mobile and static CT services for professional counseling and testing. Strong linkages will be made with GRZ health centers at district level to ensure post-test follow up and feedback.

RAPIDS will seek creative and practical ways to connect communities to CT through sensitization on the importance of CT, counteracting myths about CT, and linking with GRZ and other USG partners implementing CT. RAPIDS will use its unique community-based approach to provide family-based CT. Through the household or family centered approach, RAPIDS will reach target populations, which include OVC, youth, and HBC clients and their family members. RAPIDS will work with existing partners currently providing CT services in order to scale up on their activities. In addition to direct counseling and testing RAPIDS will continue with its CT referrals and will develop a system to link post-test clients to prevention, care, and ART services. CT promotional materials developed by the GRZ and other USG programs such as HCP will be accessed and distributed. All six RAPIDS partners will implement CT activities to ensure that it reaches its CT targets.

To promote operational linkages and enhance the network model approach, RAPIDS will forge partnerships with other USG-supported initiatives that provide CT such as ZPCT, AIDSRelief, CIDRZ, Corridors of Hope II, and PSI New Start clinics. Each of the RAPIDS consortium partners, and some of its FBO/CBO sub-grantees, will include direct provision or support of CT in OVC, youth, and HBC programming. RAPIDS will follow GRZ National Counseling and Testing Guidelines on CT protocols and parental consent for the testing of

children.

To ensure that males and females have equal access to CT, RAPIDS will plan using a gender-sensitive lens. RAPIDS will focus on reducing barriers to CT that men and women face, address the special concerns of single and married persons, including reducing the risk of violence for married women who seek CT without advance knowledge or consent of their spouse. RAPIDS will target youth at-risk and children in HIV/AIDS-affected families using strategies that are age-appropriate and respond to family and social context. RAPIDS will work with FBOs and faith leaders to encourage congregants to undergo CT and to reduce stigma and discrimination through supporting mobile testing at churches especially during religious celebrations and other church events.

RAPIDS' main strategy for promoting sustainable CT services is based on its community mobilization and capacity building activities. RAPIDS will continue to focus on training volunteer caregivers who are the main service deliverers to the community. In order to sustain grassroots CT efforts, RAPIDS will build the capacity of CBO/FBO small grant recipients to promote and mobilize CT services and to integrate CT into HBC and OVC programming. RAPIDS will strengthen linkages between community groups and district services and AIDS task forces for the continued provision of management and CT skills training and access to HIV/AIDS resources. RAPIDS will continue to implement a training of trainers program aimed at equipping community-based organizations with skilled program trainers capable of training caregivers and peer educators in their communities.

To ensure sustainable community- and family-based CT services and demand beyond the life of the program, RAPIDS will build the capacity of district and local services to implement CT promotion and mobile services. RAPIDS will also contribute to the sustainability of the HIV/AIDS response by solidifying and reinforcing critical networks and alliances, sharing lessons learned and best practices, leveraging resources, forming partnerships, ensuring that duplication is not occurring, and advocating for the promotion of improved CT support.

This activity relates to HKID (#8947), HBHC (#8946) HVAB (#8945), HVCT (#8944), and is linked to other PEPFAR funded ART activities.

The World Vision-led project "Reaching HIV/AIDS Affected People with Integrated Development and Support" (RAPIDS) is a consortium of six organizations that provide integrated care and support, AB prevention, and ART adherence support in 49 of the 72 districts of all nine provinces, representing 68% district geographic coverage. Consortium members include World Vision, Africare, CARE, CRS, The Salvation Army Zambia, and the Expanded Church Response, plus local CBO and FBO sub-grantees. RAPIDS uses a household approach to extend care and support to youth, OVC, and PLWHA within the context of needs and priorities identified at a household level.

In FY 2005, RAPIDS was provided with OGAC plus up funding to strengthen ART networking through the creation of linkages between home-based palliative care and USG supported ART facilities, and to integrate ART Adherence into home-based palliative care. Through this networking model, RAPIDS in collaboration with CIDRZ, ZPCT, and AIDSRelief has increased the number of adult and pediatric clients reaching and receiving ART services. Furthermore, RAPIDS community-based volunteers are providing the critically required daily adherence support for ARV clients.

In FY 2007, RAPIDS will be a leading provider of community-based ART referrals and ART adherence. In FY 2006, RAPIDS targeted ART adherence support to 2,300 ART clients, but due to delays in start-up funding, by mid-2006 had reached 522 individuals. RAPIDS will reach 12,000 beneficiaries in FY 2007 with ART access and adherence support services. RAPIDS sets targets using a sound M&E system, which also allows it to collect data and analyze achievement of targets in a timely, accurate fashion, and use data to plan future efforts. Geographic coverage of adherence support will increase yearly through FY 2008 as the number of ART sites increases, and more clients start ART and require RAPIDS' support.

An exciting development is RAPIDS expansion of community-based support to families with HIV positive children and children on ART (P-ART). RAPIDS will continue and strengthen linkages from home-based care to Family Support Units (FSUs) in Lusaka, Livingstone, Ndola and another FSU to be established in Northern Zambia, which also provides support to HIV positive adult family members of P-ART children. RAPIDS will build on proven integrated methods to encourage family oriented CT, promote community support for ART adherence, build psychosocial support for PLWHA and their family members, address stigma and discrimination in the community, and deal with the needs of caregivers of ART clients.

During FY 2007, RAPIDS will continue to collaborate with other USG funded ART projects such as ZPCT, AIDSRelief, and CIDRZ to ensure that home-based care clients benefit fully from the GRZ scale-up of ART and have access to ART services. Interventions will include: increased ART awareness-building, promotion of early CT, community-based care and support for parents managing P-ART, adherence promotion, and psychosocial support for infected children. RAPIDS will continue to create linkages to ART clinic-based services. RAPIDS will upgrade the ART adherence skills and knowledge of home-based care (HBC) caregivers.

To ensure a continuum of care, RAPIDS will provide support for ART adherence for families with children or adults on ART. To ensure an effective link between RAPIDS and ART providers, RAPIDS will continue to train HBC caregivers and medical personnel in ART adherence, prevention of resistance to ART, and monitoring of side effects. Other activities will include: education on the prevention of re-infection especially for PLWHA on ART treatment, training and follow-up on ART adherence, and strengthening linkages with health systems for clinical care and ART and social support networks such as VCT, PMTCT, and nutrition support.

In a new significant component, RAPIDS will increase access to ART by supporting laboratory investigations, to include full blood counts and CD4 at health centers and hospitals that are not supported by other USG funded programs. The program will assist in servicing laboratory equipment at ART centers where linkages with other USG funded programs cannot provide services. As needed, RAPIDS will assist patients with transport

to access ART services.

Building on experiences from FY 2006, RAPIDS will provide targeted nutritional supplements for malnourished PLWHA on ART to sustain the immune system, and to maintain body weight. Severely malnourished ART patients will receive Ready to Use Therapeutic Food in readiness for ART treatment, while those with moderate malnutrition will be provided with High Energy Protein Supplements. All clients will receive nutrition counseling and education.

RAPIDS will intensify community-based ART literacy, and ART adherence support and care for ART clients. Caregivers will conduct regular adherence home visits. Positive Living adherence supporters will provide psychosocial and spiritual support, nutrition counseling, education and monitoring, and support families with children or adults on ART in 47 districts.

RAPIDS will continue to strengthen the linkages and referral between HBC and nearby health facilities. RAPIDS will significantly increase the number of HBC coordinators and caregivers trained in ART literacy and adherence, management of OIs and side effects, and in referral networking. To enhance the quality of ART support and adherence, RAPIDS will work with PLHWA together with their families and local communities to access ART. The program will identify client transport options, link them with CT programs and ART services, and leverage food supplements from WFP and FFP.

RAPIDS will address gender concerns so that male and female beneficiaries are included on the ART program equitably, and will show this by disaggregating results by gender in the semi-annual report. All RAPIDS activities, including ART adherence, are designed to reduce stigma and discrimination through training of caregivers and health providers.

RAPIDS will promote the sustainability of ART linkages and adherence support by mobilizing and strengthening community committees drawn from a spectrum of community stakeholders to ensure representation and a holistic and coordinated response. RAPIDS is achieving momentum in mobilizing communities to take the lead. This is a key to long-term sustainability. To further sustainability, RAPIDS will train CBOs and FBOs in ART literacy and ART adherence support, and in advocacy and paralegal support. RAPIDS has linked communities to other resources and provides training to improve their management skills and ability to access existing HIV/AIDS resources, such as the Global Fund, and other donor funding.

To ensure continuity of care, RAPIDS has designed and is implementing a training of trainers program targeting HIV/AIDS service providers and trainers in FBOs and CBOs. RAPIDS partner, Africare, includes ART literacy in values-based life skills training for youth and partner organizations. RAPIDS ensures that ART adherence is integrated into existing government and NGOs programs to build capacity. Peace Corps volunteers will support the program to contribute towards a deepened quality of service at the grassroots level.

RAPIDS will also contribute to the sustainability by solidifying and reinforcing critical networks and alliances, sharing lessons learned and best practices, leveraging resources; forming partnerships with other donors such as Global Fund and other multilateral donors, minimizing duplication, and advocating for improved policies. RAPIDS will continue to partner with the GRZ at district and national level to integrate ART literacy and adherence into HBC and other community work.