This additional funding will go to scaling up the prevention for positives program. The purpose of this training program is to provide counselors with an integrated program for training HIV-positive people in both maintaining their health and helping to prevent new infections.

This activity links with Project Concern International (PCI) and JHPIEGO's assistance to the Zambia Defense Force (ZDF) comprehensive HIV/AIDS care and treatment programs. Linked activities are OHPS (#9171), OHPS (#9087), OHPS (#8810), HLAB (# 9096), HVAB (#9170), HVOP (#8786), HVCT (#8785), HBPC (#8787), HTXS (#9089), HVSI (#8788), and MTCT (#9088). The DoD PEPFAR office in Lusaka will administer this program.

Since the establishment of the office, the DoD PEPFAR program has been actively engaged in supporting the Zambia Defense Force (ZDF)'s HIV/AIDS activities by strengthening the partnership with the office of Defense Force Medical Services (DFMS). Both the manager and coordinator have regular meetings with the Director General at DFMS as well as the ZDF medical staff. Based on this strong relationship and previous support, in FY 2007, the DoD PEFPAR office will focus on sustainability of the ZDF HIV/AIDS program by engaging further in sensitizing leadership with support from the Defense Attaché Office (DAO) and US Mission and assisting the HIV/AIDS coordinator's office strengthen program development and financing while emphasizing the ZDF's ownership of their HIV/AIDS program. This has also involved partnering with other international institutions. The principal international partner for the ZDF will is the Naval Medical Center—San Diego (NMCSD). In FY 2005 and FY 2006, ZDF physicians participated in the NMCSD "mini-residency" in ARV services. Follow-on reciprocal twinning visits resulted in improved clinical services at the main military hospital, Maina Soko, as well as the development of plans for a family support unit (FSU) modeled on the University Teaching Hospital (UTH), and development of a Prevention for Positives and Stay Healthy positive living program.

Activities for FY 2007 include the following: 1. Family Support Unit: The Zambian Defense Force has received PEPFAR funding and has requested assistance from NMCSD/ San Diego civilian agencies in the creation of a multidisciplinary clinic; opportunistic infection management/prevention, palliative care, and post exposure prophylaxis programs. Using funds from this activity, pediatricians and infectious disease/HIV clinicians from NMCSD will offer technical assistance, train providers, and mentor/twin with ZDF counterparts at Maina Soko, to develop a joint ARV services/FSU multidisciplinary clinic for Maina Soko HIV-positive patients and their families. ZDF practitioners will also visit NMCSD to engage with their counterparts learn best practices and improve their professional knowledge. This activity will materially strengthen ARV services, palliative care services, and OVC services. The ultimate intent would be to make Maina Soko the premier military academic medical site in Zambia.

2. Stay Healthy Program (Positive living/Prevention for Positives workshops): In FY 2005, workshop guidelines and materials were designed and these were aimed at strengthening capacity of people living with HIV/AIDS (PLWHA). PLWHA in the military camps and surrounding areas would be responsible for their support groups and mobilizing members. Stay healthy messages include prevention, adherence, and messages of encouragement. Positive living and Prevention for Positives workshops were developed with the assistance of NMCSD replicating similar systems used. In FY 2006, the same tools were used in training and ZDF have seen an increase in PLWHA support groups. This activity will continue to retain existing members of the support groups and train new members.

3. Zambian Defense Force Nursing College: Recruiting ZDF Nurses will address the critical lack of nursing resources in the ZDF as well as augment civilian care in Zambia. ZDF medical services are routinely utilized at civilian sites to address civilian worker shortages and in case of disaster management. NMCSD palliative care nurses will work to mentor nursing students at the college and train them in basics of palliative care and community health for PLWHA.

4. Infectious Diseases Institute (IDI): the DoD has negotiated an opportunity to send nurses and clinical officers for two-week training at IDI, Makerere University in Uganda. This training provides instruction on care and treatment of HIV/AIDS patients, including ARV services, and has proven highly cost-effective in increasing the number of clinical

providers within the ZDF. The ZDF medical staff have not benefited from the trainings conducted for the government health workers. Both in FY 2005 and FY 2006, the DoD PEPFAR office has supported the DFMS in sending clinical officers and nurses identified from the model sites for specialist care training. This has helped in building capacity of medical personnel at the model sites and will enable the provision of comprehensive HIV/AIDS care and treatment services. In FY 2007, clinical officers and nurses from the final model sites will be sent for the course. These clinical officers and nurses trained at all the modal sites will act as trainers of trainers and will be training others in the surrounding regions.

5. Mobile VCT unit: PCI (Activity #8788) supports mobile VCT services for the ZDF. NMCSD will assist to strengthen services offered by the mobile unit with the possible upgrade into a health promotions unit. NMCSD will provide technical assistance to expand the range and improve the quality of testing and counseling services offered.

Other activities will involve maintaining a direct partnership with Navy Medical Center, San Diego. The United States Navy has worked in conjunction with the University of California San Diego (UCSD) in training foreign military physicians about antiretrovirals, opportunistic infections, statistics, computers, and management of HIV infected DoD personnel. Zambia has participated in this training and has visited the NMCSD multidisciplinary HIV clinic and a mobile VCT unit. Physicians from NMCSD have visited the main military hospital in Zambia and have identified areas where NMCSD can provide assistance. NMCSD will coordinate and see to the dissemination and implementation of the palliative care guidelines. This also involves training of the Positive Living Group during the Stay Healthy program to continue supporting PLWHA and their support groups in the Zambia Defense Force. Strengthening the ZDF nursing school by providing technical assistance will be one of the activities in FY2007. This is important because the ZDF medical personnel are used as a backstop when Zambia's medical personnel are either on strike or overwhelmed by a disaster. Building the capacity of the ZDF medical staff is beneficial to the entire nation. The DoD PEPFAR office would also continue to send ZDF medical officers to the Infectious Disease Institute, Kampala, Uganda for training in HIV/AIDS management. This is a training facility recommended as a center of excellence for HIV/AIDS training courses. The goal of the program is to build capacity of DFMS and its staff and ensure sustainability in their HIV/AIDS programs.

This additional funding will goes to scaling up the prevention for positives program. The purpose of this training program is to provide counselors with an integrated program for training HIV-positive people in both maintaining their health and helping to prevent new infections.

In FY 2005, the Department of Defense (DoD) created two positions to manage all DoD funded activities at the U.S. Mission to Zambia having to do with the President's Emergency Plan for AIDS Relief (PEPFAR) in Zambia. The DoD PEPFAR program manager oversees all DoD managed PEPFAR-funded activities in the country. The current HIV/AIDS program covers activities in almost all program areas. The major duties include serving as the Defense Attaché Office's (DAO) principal advisor on HIV/AIDS in Zambia, providing support for the post's Emergency Plan Committee and post's Emergency Plan advisory group, representing DoD PEPFAR programs, and liaising with the Government of Zambia, other donors, and U.S. Government implementing partners for coordination, information sharing, and other issues. This position supervises the DAO PEPFAR Coordinator.

The coordinator is responsible for logistics and administrative support as well as contributions to assessment, planning and monitoring of the DoD programs. The coordinator acts as a primary contact for the DoD-funded infrastructure and construction programs planned in the activity #9096. This involves coordination and communicating with the contracting officers from the Regional Procurement Specialist Office (RPSO) and Buildings Department at the Ministry of Works and Supplies (MoWS). The coordinator is also responsible for the procurement of medical equipment and other supplies.

In FY 2006, due to an increase in activities, it became extremely necessary to hire a third staff member to provide monitoring and evaluation support. The M&E advisor is responsible for financial management, monitoring, assessment, planning, monitoring and evaluation of the DoD HIV/AIDS program. M&E support will also access tools that partners are using in collecting data. The M&E advisor will collaborate with other USG agencies to ensure standardized reporting and will also visit the more isolated clinics of the ZDF Medical Services network. The M&E advisor will be supervised by the DoD PEPFAR program manager.

The management budget will cover salaries, administrative costs, communication, printing and other material reproduction costs, vehicle maintenance, office equipment maintenance, travel costs (training, meetings, and conferences), M&E and supervisory visits. The ICASS charge will be included, starting in FY 2006. Contractual services have been budgeted for TDY and contracting officers' visits. The funds cover per-diem and other logistical support for the MoWS staff and the coordinator in a process of assessment, reviewing, M&E, and quality assurance of the construction sites, contracting with MoWS permits a substantial cost savings in comparison with using private contractors.