The funding level for this activity in FY 2008 will remain the same as in FY 2007. Only minor narrative

updates have been made to highlight progress and achievements.

This activity relates to activities in MTCT Zambia Exclusive Breastfeeding Survey (ZEBS).

In support of the Zambia national framework as well as strengthen the capacity of the national health

system to provide sustainable HIV/AIDS services, the United States Government through CDC directly

supports the Southern Provincial Health Office (SPHO) in its plan to better coordinate and oversee

prevention of mother to child transmission of HIV (PMTCT) services, to provide training, and expand

PMTCT services to health centers currently not covered by Boston University Center for International Health

and Development, Zambia (BUCIHDZ) (formerly the Zambia Exclusive Breastfeeding Study, ZEBS).

BUCIHDZ will continue to provide PMTCT services in districts where they currently work but with the

coordination and leadership of the SPHO to ensure uniformity and standardization of the PMTCT services.

In order to create a sustainable PMTCT program, the SPHO will play a key role in ensuring that technical

supportive supervision is provided to these districts and will coordinate all PMTCT services and

implementing partner (BUCIHDZ) to ensure optimal resource utilization.

Southern Province has 11 districts and all districts are providing PMTCT services which have now been

scaled up due to the extra technical and financial support provided in FY 2007 by United States

Government (USG) supported partner: Academy of Educational Development and ZEBS, (now known as

BUCIHDZ). Out of 217 maternal and child health centers in the province, the USG in FY 2007 supported a

total of 165 PMTCT sites while the SPHO directly supported 19 sites with training of health workers. In joint

partnership with Boston University (BU), the PHO ensured that all the 184 sites provided PMTCT services in

these underserved districts. A total of 309 health workers and community health cadres have been trained

in the provision of the services. Of the sites that provide PMTCT services, 25 also provide antiretroviral

(ART) services, whilst 173 provide tuberculosis (TB) treatment, counseling and testing, and other palliative

care services to which the pregnant women are also referred through an established referral system. In FY

2008, this system will be rigorously strengthened to ensure that all HIV+ pregnant women have their CD4

count done, are given an efficacious regimen for ARV prophylaxis, are screened for TB and further linked

ART services for initiation of comprehensive HIV care, and to orphans and vulnerable children (OVC) and

palliative services.

In FY 2008, this activity will continue to supplement PMTCT training in the 3 districts not supported by BU

(i.e. Namwala, Sinazongwe, and Itezhi-Itezhi) with training of providers and scaling up the number of

PMTCT sites in order to roll-out the services to the rural most populations. The services provided at these

sites will be in line with the core PMTCT interventions as stipulated in the protocol guidance. The SPHO will

train 300 health workers through this activity. The SPHO working in partnership with BU, will ensure that

additional PMTCT sites will be established in the districts that are implementing PMTCT and they will

extend to four other districts, namely Kalomo, Kazungula, Livingstone and Choma. As this is a joint effort

with BU, it has been agreed that to avoid double counting of targets, the SPHO will only report on the

number of health workers trained and BU will ensure through TA that services are established and hence

will report on the remaining 3 indicators. Other activities to be implemented will include monitoring visits,

training of 50 program managers in the implementation and monitoring of the PMTCT services including

Focused Ante Natal Care (FANC), dissemination of national policy and guidelines on PMTCT, strengthening

of MCH services, and standardization of PMTCT services.

One factor that hinders the PMTCT program is the lack of active male involvement and the SPHO in

partnership with Men Take Action will train 250 male community based PMTCT agents/mentors as a key

activity in strengthening community participation in the roll-out of this activity. The SPHO's involvement in

the coordination of the program will ensure geographical coverage and coordinated planning among

districts for the integration of PMTCT services into routine maternal and child health units which will lead to

the development of a sustainable model where Government of the Republic of Zambia plays a key role in

the continued delivery and sustainability of PMTCT services.

In FY 2008, in joint collaboration with BU, the SPHO will spearhead the scale-up of PMTCT services in

Southern Province in-line with the national expansion plan. This support will enable key technical staff from

SPHO to coordinate, plan, and integrate services with BU. This activity will include expanding and linking

PMTCT services with other HIV services in the province including Pediatric ART services, through mapping

of services during the performance audits spearheaded by the SPHO every quarter, as well as the creation

of a referral system for HIV/AIDS services.

Support will continue to be provided to strengthen PMTCT services in the Southern province through

improving coverage of counseling and testing amongst pregnant women, improving uptake of prophylaxis

among HIV+ pregnant women identified, and through strengthening of tracking and follow-up care services

for HIV exposed infants and their families by adequately trained and mentored health workers and

community health workers.

In FY 2008, the SPHO will continue with this activity through enhanced coordination of training and

supervision of PMTCT services through the planning of PMTCT services at the district level, and the

integration and strengthening of PMTCT into maternal and child health. Support systems established in FY

2007 will be used in FY 2008 to ensure sustainability of the PMTCT scale-up such as improved PMTCT

supply chain management, improving the monitoring and reporting system and strengthening the referral

systems.

A critical activity will be the development and strengthening of follow-up of HIV exposed infants by linking

this activity to Integrated Management of Childhood Illnesses (IMCI) and community based village registers

and records, as well as pediatric ART services. The initial plan will be targeted at Sinazongwe, Namwala

and Itezhi-Tezhi districts with the view of scaling up the model to other district.

In FY 2008, SPHO will strengthen district and health centre PMTCT coordination through quarterly and

monthly planning review meetings with Maternal Child Health Coordinators and district Health Information

Officers. Strategic information will be collected, aggregated, and analyzed for M&E purposes. It is the

responsibility of each District Health Management Team to submit this information to the SPHO through the

Activity Narrative: Data Management Office. To ease this process, the SPHO will continue to support one data associate at

each District Health Office and one based at PHO with much needed logistics to ensure smooth data

collection, compilation, and submission.

Targets set for this activity cover a period ending September 30, 2009.

Oct 08 Reprogramming: Additional funding will be used to implement a partner reduction program.

Prevention activities will be intensified as outlined in the Zambia National Strategic Framework 2006-2010,

to engage innovative strategies to influence behavior change and expand the UTH prevention activities

investigation with HIV positive couples and also with couples at Chipata General Hospital. Training, as well

as staff transport will also be provided to implement prevention for positives in a clinical setting.

Two hundred and fifty couples will be grouped in five cohorts that will meet monthly for a period of one year.

The cohorts will be exposed to communication skills for negotiating safe sex and how to use both male and

female condoms correctly.

This activity is linked with the other activities supported by the USG for the SPHO including counseling and

testing, TB/HIV, and ARV services.

Southern Province reports an HIV prevalence of 16.2%, STI incidence rate for above 5 years at 22.3 /1000

and Tuberculosis (TB) incidence rate of 415/100,000,. The Province ranks third behind Lusaka and the

Copperbelt provinces in terms of HIV and TB burden in Zambia. Livingstone district, which is the provincial

capital of southern province, reports extremely high HIV prevalence (30.8%), STI incidence rate of

30.6 /1000 and TB notified cases for the province was 6,103 at the end of 2006.

In FY 2007, SPHO provided support for establishment and strengthening of Youth friendly corner services

in the 11 districts in 55 health facilities out of the provincial total of 222 and supported the training of 80

health workers including district focal persons and partners in complete package of adolescent reproductive

health services. Support was also provided for the provision of supplies such IEC materials, audio visual

equipment (TV and VCR), support for community sensitization and strengthening health facility

implementation including orientation of staff and peer HIV, counseling. This was an additional activity that

was supported under counseling and testing. By the end of FY2007, over 15,000 youth were reached with

integrated information on STI, HIV, ANC, abortion, condom use, family planning and other prevention

strategies.

The youth friendly services function under the existing health care services and are part of the government

run facility and provide a point for access to health services, condom collection, and social activities;

however the attrition rate among the youth running the centers is high. This is why training involves both

health care workers who are more permanent and the fluid population of youth. This has the advantage of

services continuing as youth move on in life with education and career development opportunities. Health

staff continue to mentor and train new recruits. Once the youths move on with their lives and careers, they

have the benefit of carrying with them knowledge and life skills about HIV/AIDS and related services and

are able to act as peers for the communities that they train/study and work with.

In FY08, Southern Provincial Health Office (SPHO) will increase access to counseling and testing services

for young people as a continuing strategy in the prevention of STI/HIV infection by providing direct support

to 11 Districts Health Offices in the establishment and strengthening of Youth Friendly Reproductive Health

Services (YFHS). This activity will focus on strengthening HIV/STI prevention services employing the

friendly opt out approach incorporating health care provider initiated counseling and testing and STI

treatment and management services. By ensuring that prevention of unplanned pregnancies through the

provision of safe and appropriate contraceptive methods for the adolescents are in place, the SPHO will

further contribute to reduction in the number of HIV exposed infants in the province. This will be

accomplished through training of 100 health providers from 100 sites to work with young people. This will

increase the sites which offer YFHS to 155. 110 peer HIV counselors will be trained, 2 from each of the old

55 sites.

By the end of FY2008, 70% of health facilities in the province shall offer complete package of Adolescent

friendly health services. The program shall target the youths aged 10-24 yrs and reach 20,000 young

people with integrated information on SRH/ STI/TB/HIV/AIDS and ART services by the end of FY08.

The SPHO realizes that in the majority of health facilities the youth corners do not have facilities and

services that attract the patronage of the youth which in turn hinders the the control of STI/HIV amongst this

population. Thus support will be provided for refurbishment (renovations/extensions and furniture) of the

sites by renovating 3 YFHS corners in each of the 11 districts including supply of IEC materials (caps, bags,

T-shirts, canvas, flyers, brochures), audio visual equipment (TVs, VCRs, radios, camera and video

recorders and tapes), and provide transport support (bicycles and funds) for outreach activities in the

communities. This activity will be enhanced by the support to dramas groups in all the 155 sites.

Quarterly supervisory visits will be provided to at least 6 sites in each district for performance improvement.

The data collection tools developed by WHO will be adopted and used for monitoring the quality of the

services provided. The strengthening of YFHS will also improve young people's health seeking behavior

and thus facilitate early diagnosis and management of TB and STIs including HIV. Linkages to TB/ART

services will also be strengthened.

Targets set for this activity cover a period ending September 30, 2009.

The funding level for this activity in FY 2008 has increased since FY 2007. Narrative changes include

updates on progress made and expansion of activities.

This activity relates to activities in counseling and testing activity, laboratory infrastructure, palliative care:

basic health support activity, and HIV/TB activities.

Southern Province reports an HIV prevalence of 16.2% and Tuberculosis (TB) incidence rate of

415/100,000 as at the end of 2006. The Province ranks third behind Lusaka and the Copperbelt provinces

in terms of HIV and TB burden in Zambia. Livingstone district, which is the Provincial capital of Southern

province, reports extremely high HIV prevalence (30.8%) and TB notified cases for the province was 6,103

at the end of 2006. The smear positive rate was 25.8% with a cure rate of 82.2 % in the same year. The

provincial statistics show that 67.1% of TB patients are co-infected with HIV whilst local data from the

Livingstone General Hospital, Maramba and Dambwa Clinics suggest that over 70% of TB patients are HIV

infected. Based on performance assessment standards of 80%, SPHO targets to raise the acceptance rate

of TB patients testing for HIV to 80% in 2008 as the data collection tools were only available in the 3rd

quarter 2006.

Building on the successful implementation of the TB/HIV collaborative activities since 2005, the USG

provided funds directly to the Sothern Province Health Office (SPHO) for the scaling-up of the services in all

11 districts in the province in 2007. The direct support to the SPHO provided an opportunity to strengthen

the capacity for a more rapid scale-up of activities and ensure sustainability of the program by enhancing

local ownership. The SPHO provided training in TB/HIV integration to 130 health care workers in all the 11

districts in the province to enhance the implementation of these activities in 19 TB diagnostic/ART sites.

The SPHO further trained 152 health workers in Diagnostic Counseling and Testing (DCT) using the

national training manual and 170 health care workers in TB/HIV integration by end of 2007. In order to

increase community participation in this program area, the SPHO trained 200 community members as lay

counselors and provided funds directly to the districts for the implementation of these training activities. In

FY 2007, the number of health centers providing integrated TB/HIV activities increased to a total of 173,

representing 78% of the total number of possible sites (222). Staff have been trained in DCT in 93 sites,

whilst psychosocial counselors have been trained to provide TB/HIV services in an additional 87 sites. By

the end of FY2007, direct district support would result in training of an additional 300 health workers in

TB/HIV collaborative activities. The training provided is based on the training of trainers' model utilizing the

core group of trainers resulting from the USG supported activities of JHPIEGO in FY 2006 and FY2007

(activity 9032). Other activities supported with the funding have been the strengthening of referral links

between the TB and HIV treatment programs to ensure that all HIV-infected TB patients are referred for

ART and all HIV-infected patients are screened for TB. The SPHO technical implementation team includes

the CDC Field Office Manager, the Clinical Care Specialist employed through HSSP, Clinical Care

Specialist, Provincial TB Focal Point Person, Provincial Biomedical Scientist and Data Management

Specialist, all employed through the MoH based at the SPHO. As a result of the support an estimated 70%

(4200) of the 6000 expected TB patients will have received counseling and testing services.

The SPHO works with the district health offices to ensure that linkages between the TB/HIV program and

existing home based care programs funded through the USG (SUCCESS and RAPIDS) and other donors

are well coordinated. Six hundred (600) community based treatment supporters that are currently used to

supervise directly observed treatment for TB patients will receive additional training in TB/HIV integration

and adherence counseling with the potential to provide support for adherence to ART by the end of 2007.

The Ministry of Health supports the implementation of the DOTS strategy with funds from the Global Fund.

In order to ensure accuracy of data and quality of care, the SPHO and district health offices will conduct

quarterly program monitoring and technical support supervision (TSS) visits to the health centers and

provide technical assistance to address identified areas of weakness. As a result of this activity an

estimated 3,000 HIV infected individuals would have received TB treatment according to national

guidelines.

As part of the national guidelines for the implementation of TB/HIV activities, the program ensures that all

HIV infected individuals in ART and PMTCT sites receive screening for TB. It is expected that 65 % of all

individuals testing HIV positive will receive screening for TB. Isoniazid preventive treatment (IPT) for HIV

positive individuals does not currently form part of the national guidelines for TB/HIV activities and hence

will not be implemented. However should the Ministry of Health adopt this intervention, the PHO will

implement IPT

To further enhance equity in coverage of TB/HIV services, the SPHO will work with CIDRZ and Boston

University (BU) to provide technical assistance in the integration of TB/HIV care in the sites where CIDRZ

and BU support exists in ART/PMTCT clinics.

Twelve (12) new TB diagnostic centers will be opened in the five highest HIV/TB districts in the province

(Livingstone, Monze, Mazabuka, Siavonga, and Choma) by the end of 2007 using resources from the USG.

These sites will be supported for infrastructure improvements to create a conducive environment for client

TB HIV activities by March 2008. .

The Provincial TB/HIV coordinating committee that is tasked with the strategic direction, planning and

supervision of the TB/HIV integration activities throughout the province will continue to be supported.

Membership on this committee is drawn from the TB Program, Clinical Care Unit (which oversees HIV/AIDS

care), and ART Program, community care and advocacy groups, and HIV counseling/testing partners. This

committee shall continue to meet on a quarterly basis. Similar structure will be established and supported

at district level.

Regular review meetings, linked to TB directly observed treatment strategy (DOTS) review meetings and

symposia which are co-funded by the Global Fund will continue to be held. The SPHO will continue to

support the linkage of all activities and trainings to other funded programs like the Global Fund against TB,

HIV, and Malaria.

In FY08, the SPHO will continue to strengthen the community component of integrated TBHIV management

Activity Narrative: through the training of 600 Community treatment supporters bringing the total to 1200 in the province. The

SPHO will provide support towards training of 300 HW in DCT, in order to provide integrated TB/HIV

services in 200 (90%) of the 222 facilities in the province. The Provincial and district TB/HIV coordinating

committees will be strengthened and quarterly district supervisors meetings supported as a way of

strengthening supervisory capacities at district level. This activity will be carried out as a part of quality

assurance including increasing the proportion of HIV patients being screened for TB. In order to enhance

the capacity for monitoring and evaluation of TB/HIV program the TSS visits will include a component of

training in the use of information for management decisions at district level, including ensuring that health

workers are competent in the use of data collection and recording tools. Thirty percent (30 %) of the total

funding to this activity will be directed at infrastructure improvements in order to reduce the risk of

transmission of TB in 10 sites with a focus on clinical areas where patients may have undiagnosed TB. The

sites to benefit from this activity include Livingstone district (Livingstone General Hospital, Maramba Clinic,

Dambwa Clinic), Kalomo( Siachitema HC and Zimba Hospital), Choma(Shampande Clinic), Sinazongwe

Hospital, Itezhi-tezhi hospital, Siavonga Hospital and Gwembe Hospital respectively. The renovations will

be specific for the site and may include improving the ventilation in waiting areas.

With an additional $100,000 Plus-up funds for TB/HIV the SPHO will renovate an additional 4 sites in the

province, focusing on the sites with the largest number of ART patients. In addition the PHO will conduct

training in the guidelines on Prevention of TB in Health Care settings under production by JHPIEGO. for key

hospital staff in the 11 districts with a goal of training 25 staff. Additional funds will be used to fully equip the

TB ward at the Livingstone General Hospital constructed by the Department of Defense (DoD) and provided

with basic furniture and equipment by CDC.

As a result of this support to the SPHO, 80% of an estimated 7,000 TB patients, will access TB diagnostic

services, and receive HIV counseling and testing over 12 months. The SPHO will use the recently revised

TB registers and forms to capture this data. In addition it is estimated that 70% of the clients testing HIV

positive in other service areas will be screened for TB and referred for appropriate care.

Targets set for this activity cover a period ending September 30, 2009.

The funding level for this activity in FY 2008 will remain the same as in FY 2007. Only minor narrative

updates have been made to highlight progress and achievements.

Related activities: This activity is linked to CHAZ HVTB, SPHO ART, SPHO HLAB, HVTB JHPIEGO, HVCT

DAPP, HVCT mobile VCT TBD, CRS HVCT

The HIV prevalence rate in Southern Province is 16.2% among adults aged 15-49 years while the

tuberculosis (TB) incidence rate in 2005 was 415/100,000 of the population while the TB notification was

reported at 594/100,000. According to the DHS 2002, syphilis prevalence rate among adults aged 15-49 in

2002 was 4.1%.

In FY2005 and FY2006, USG directly funded the Southern Province Health office (SPHO) to expand

counseling and testing (CT) services in the 19 TB diagnostic and antiretroviral therapy (ART) centers in

Southern Province. In 2006, the SPHO focused on the five highest HIV/TB burden districts; Choma,

Livingstone, Mazabuka, Monze and Siavonga where 20 health workers were trained in psychosocial CT and

200 community members were trained as lay counselors. Funds also supported the Mosi-O-Tunya Family

Support Unit (FSU) at Livingstone General Hospital (LGH) with logistics for running the FSU and support for

counselors.

In FY 2007, the SPHO trained 34 health workers in psychosocial counseling and 20 additional lay HIV

counselor supervisors. Also 270 community members were trained as lay counselors. The SPHO also

offered health workers previously trained on ART and opportunistic infections (OI), management training in

the following areas: ARV drug adherence counseling, prevention of HIV transmission in those who test

positive (positive prevention), issues around disclosure discordance, and an update on current protocols in

HIV testing and HIV management. In addition, 69 % of HIV positive individuals were screened for TB and

referred for appropriate management. All these areas were covered in new training in FY 2007.

An Additional focus of this activity focused on strengthening HIV/STI prevention services and STI treatment

services for youth in FY2007. In FY 2008, this activity will be further strengthened and directly supported

under other prevention to streamline reporting and have targeted focus on the prevention of STIs including

HIV.

In 2008, additional 300 community resource persons and community adherence supporters will be trained.

The SPHO will continue to expand community component of counseling and testing by training 600

community HIV counselors, strengthen linkages with partners like Kara Counseling and Testing Trust,

Provincial and District AIDS Task Forces, New Start Centre and other organizations involved in counseling

and testing, through quarterly consultative planning and review meetings

In order to expand the services offered and provide adequate space for counseling, resources will be

allocated to minor renovations at 3 CT sites in each district of the Southern Province. Direct support will

continue to be provided to the Mosi-O-Tunya Family Support Centre (MFSU) HIV counseling initiative at

Livingstone General Hospital. In addition to the MFSU similar support will be extended to FSU's to six sites;

Livingstone District, Monze Mission Hospital, Monze District, Choma General Hospital, Mazabuka District

and Itezhi-Itezhi District. It is anticipated that by the end of FY 2008, an estimated 15,000 clients will be

reached.

Expansion of CT services for HIV remains a key activity that helps achieve the goals of the President's

Emergency Plan for AIDS Relief (PEPFAR) by strengthening the identification of individuals at high-risk of

being infected and linking them to care and support service (SPHO HTXS Activity and SPHO HLAB

Activity). In FY 2007, USG has continued to support the PHO to provide CT in the routine care of patients

with TB and sexually transmitted infections (STIs) and strengthen linkages with the ART services in 54 sites

within the 11 districts in the Southern Province. Regular supportive supervision in the districts will be

conducted by the SPHO technical committee members with a view of mentoring local district supervisors

and thereby building supervisory capacity and ensuring quality of counseling and testing services.

Two health workers will be trained on HIV adherence counseling and rapid testing using standardized

guidelines and protocols at the Ministry of Health in each of the 54 ART sites totaling 108 trained HW. It is

hoped that this training of health workers will result in improved adherence by TB patients on ART and

improve the cure rate from 77.4 % in 2005 to 95 % in 2008. The training will continue to strengthen the

linkages between the CT services and the STI, TB, and ART programs to ensure that HIV positive patients

are routinely screened for TB and STIs. It is expected that 70 % of all individuals testing HIV positive will

receive screening for TB. With the expanded CT services in the province, it is expected that 35,000

individuals will receive counseling and testing for HIV by the end of FY2008.

This activity, in addition to the work that JHPIEGO (#9035) will collaborate with the mobile CT targeting

mobile population and agribusiness, and the program to provide mobile/boat VCT in Namwala and Itezhi-

Tezhi (#9742).

To sustain this program, the districts will include the activities in the Government of the Republic of Zambia

annual district health plans. Emphasis on training and incorporation of CT in all service delivery points

empowers staff and ensures long term sustainability.

Targets set for this activity cover a period ending September 30, 2009.

The funding level for this activity in FY 2008 will remain the same as in FY 2007. Only minor narrative

updates have been made to highlight progress and achievements.

This activity is linked to EGPAF and CRS.

The Southern Provincial Health Office (SPHO) proposes to expand antiretroviral (ART) services in the

province in FY 2008. Expansion and consolidation of services will occur by working closely with partners

within the province such as the Center for Infectious Disease Research in Zambia (CIDRZ) and Catholic

Relief Services (CRS). There will be close communication, exchange of ideas, and experiences between

the providers in the province through clinical symposia in order to continue providing improved and quality

antiretroviral (ARV) treatment services.

The prevalence of HIV in Southern Province was estimated at 16.2 % at the end of 2004. With the

increasing burden of HIV-positive diagnosed individuals and the government's policy on the provision of free

ART, the demand for ART services continues to increase.

In FY 2006, the SPHO ART subcommittee was strengthened and continued its gradual expansion to make

ART accessible to the population, while at the same time maintaining quality standards and considering

aspects of sustainability. The first priority was to complete phase two of the implementation program to

provide ART services at the district hospital level. A second priority was to focus on a number of health

centers in underserved areas, such as Sinazongwe Health Center in Sinazongwe District and Mukuni

Health Center in Kazungula District.

In FY 2006, the target for Southern Province was set at a minimum of 25 ART centers and 11,856 patients

on treatment, which was successfully achieved at the end of 2006. In FY 2007, the United States

Government (USG) supported the SPHO to increase the number of ART sites form 26 to 40 by opening up

14 new sites in selected health centers, resulting in achieving the set target of 14,460 by December 2007.

Since CIDRZ proposes to open additional sites in the province, the selection of sites will be done in close

consultation with SPHO and District Health Offices (DHO) to avoid overlap, duplication, and to increase

geographical coverage within the province. In FY 2007, 30 sites were assessed for accreditation with the

Medical Council of Zambia. In FY 2008, the SPHO will increase the number of sites to 54 and assess these

for accreditation. With the expansion of the sites, it is expected that 6,000 new patients eligible for ART will

be enrolled by the end of FY 2008.

The Southern Province is a large province with several remote health facilities making it difficult for clients to

access ART services. The infrastructure in these health centers is inadequate and generally not conducive

for friendly ART services. In FY 2008, the SPHO will direct part of the USG support towards infrastructure

improvements for at least three ART sites in each of the 11 districts in the province.

The Ministry of Health still faces an enormous human resources crisis. The need for trained health workers

to offer ART/Opportunistic Infections (OI) services is still a critical requirement for effective and quality ART

services. In each of the 14 new sites, six health workers will be trained on ART / OI management totaling

84. Further training gaps will be identified from the existing facilities especially the hospitals in the five high

HIV burden districts of Livingstone, Monze, Choma, Mazabuka, and Siavonga (10 hospitals) and at least

three(3) health workers will be trained per hospital (total of 30). The provincial database of ART training

needs for all districts (names and cadres) will continue to be revised and updated on a regular basis to

include changes in staffing levels. In FY 2008, the Provincial ART Sub-committee will continue to coordinate

the ART program in the province in collaboration with partners like CIDRZ. The PHO will support the DHO

to conduct site assessment for the targeted 14 new ART sites, using the existing assessment tools.

Though having done very well in terms of reaching the targets for adult/adolescent enrollments onto ART,

the province continues to lag behind in regards to pediatric ART enrollments. Except for Livingstone

General Hospital and Monze Mission Hospital, which are on schedule for achieving their targets for pediatric

ART enrollments, the rest of the province is at less than 30% of their set targets. In order to address the

significant weakness in the pediatric ART component, the PHO will allocate resources for capacity building

in Comprehensive Pediatric HIV Care and Treatment, increase linkages with PMTCT, and expand early

infant diagnosis by polymerase chain reaction mainly in Itezhi-Tezhi, Namwala, Sinazongwe, Gwembe and

Siavonga districts. Fifteen percent of the funding will be spent on expanding pediatric ART.

However, considering that HIV/AIDS management concepts are rapidly evolving, and that the clinical

problems encountered with ART treated individuals continue to evolve with increasing duration on therapy,

a lot more attention will be paid to the up-dating of knowledge and skills for these health workers. Such

continuing professional development (CPD) will be achieved through increased on-site technical supportive

supervision (TSS) and technical assistance (TA) by specialists and the holding of quarterly clinical symposia

for 40 previously trained health workers.

Further, with increased counseling and testing capacity, more TSS will be required to strengthen linkages

between community counseling and other services to Tuberculosis (TB), PMTCT and ART services.

In FY 2008, there will be acceleration in the expansion and decentralization process which was started in

FY 2007 to the district level in-line with the current national ART scale-up plan to ensure that ART delivery

becomes an integrated service in the basic health care package. This will ensure sustainability and

ownership of ART services. In this case, the Provincial ART Sub-committee will focus on monitoring and

evaluation. Aspects such as the identification of potential ART centers, the structured assessments of the

identified sites and the supervision of the service will continue to be implemented by the DHOs. District

health teams will be encouraged to form ART subcommittees for effective coordination.

The PHO will support the holding of quarterly review meetings at the provincial level involving key district

program officers. The meetings will both serve as a monitoring and evaluation coordinating forum as well as

to provide a forum for the district managers to review performance of the services and share best practices

across districts in the continued scale-up of ART services

Support will be provided to health center staff to work with community leaders, neighborhood health

committees, trained birth attendants, treatment supporters, and community health workers in increasing

Activity Narrative: awareness on the availability and benefits of ART services. To strengthen this community component, 350

community members will be trained in home based care and supported to follow-up and care for patients at

community level. This, cumulatively, is expected to result in 25,000 HIV patients with province-wide

coverage being enrolled on ART by the end of 2008.

Targets set for this activity cover a period ending September 30, 2009.

The funding level for this activity in FY 2008 will remain the same as in FY 2007. Only minor narrative

updates have been made to highlight progress and achievements.

This activity is linked to the TB/HIV activity in SPHO, and the Comforce, CDL, and UTH Virology within the

Lab section.

This activity will provide local support to the Southern Province Health Office for implementation of Quality

Assurance/Quality Control (QA/QC) programs in Prevention of Mother to Child Transmission of HIV

(PMTCT), counseling and testing (CT), diagnostic counseling and testing (DCT), tuberculosis (TB)/HIV and

antiretroviral therapy (ART) services. This will be done in collaboration with the University Teaching Hospital

(UTH) and National TB Chest Diseases Laboratory (CDL). The goal of this activity is to build capacity and

sustainability at the local level by transferring skills for equipment procurement, maintenance, sample

transport, and quality systems training for QA/QC activities and routine maintenance of biomedical

equipment to be conducted within the province. In FY 2007, the goal was to reach ten laboratories within

Southern Province. In 2008, the goal will be to increase laboratory support to 19 laboratories in the

Southern Province. Southern Province is about 500km from Lusaka where the UTH, CDC, and Ministry of

Health (MOH) laboratory experts are located, therefore, supervisory travel visits must be divided by the time

and number of technical experts and resources available.

Southern Province has an HIV prevalence of 16.2% and a reported TB incidence rate of 415/100,000 as of

the end of 2005. This ranks Southern Province third behind Lusaka and the Copperbelt provinces in terms

of HIV and TB burden in Zambia. Livingstone District, the provincial capital, reports extremely high HIV

prevalence (30.8%) and the TB notification rates were at 5,941/100,000 in 2005. The smear positive rate is

reported at 25.8% with a cure rate of 85% for 2007.

Availability of laboratory services in most of the more rural districts is limited, due to several factors

including human resources, geographical location, lack of suitable infrastructure for laboratory testing

equipment, and services such as a source of power and the increasing demand for specialized laboratory

investigations. Antiretroviral laboratory care and treatment services are limited. Sample preparation and

transport support in some site where human resources are limited will alleviate the lack of services due to

laboratory infrastructure and technical limitations. In FY 2008, onsite training and technical support for

existing personnel in basic laboratory testing and transport will be assessed and provided. Laboratory

quality assurance programs for rapid HIV testing currently performed in the CT, DCT, and PMTCT will be

supervised and supported by the National HIV Reference Laboratory (UTH), CDC laboratory staff, provincial

and district laboratory coordinating committee. An integrated program to include, laboratory data

management, onsite quality assurance will assist in improving and standardizing antiretroviral therapy

laboratory services. Support will be provided for basic infrastructure improvements such as the installation

of air conditioners and eight back-up generators in Mazabuka, Gwembe, Choma, Maamba, Siavonga, Itezhi

-Itezhi, Kafue Gorge and Namwala hospitals. In FY 2008, the SPHO will procure CD4 automated chemistry

and hematology machines to improve sites where this capacity is lacking. Additional support for alternative

water and power sources for proper equipment operation at all laboratories currently lacking this

infrastructure will be evaluated and provided.

The following activity is newly proposed for FY 2008.

This activity relates to Ministry of Health (MOH), and Technical Assistance/Centers for Disease Control and

Prevention (CDC)

Proposed funding will support (Very Small Aperture Terminal) VSAT internet connection for the province

through the Provincial Health Office (PHO) in Livingstone to improve strategic information activities.

Improving internet service and email communication will reduce the isolation through increased access to

information. Communication flow between central level and the province will be enhanced with this service

and help link the PHO and the District Health Offices. It is assumed that the availability of good internet

access will also be an important motivator to retain staff as it offers them an opportunity to participate in

distant learning programs and conduct research projects. Such investment in technology is a sustainable

contribution to essential communications infrastructure for many years ahead.

In addition, FY 2008 funding will help support other activities involved in the the implementation and roll-out

of the SmartCare system within the province. At the provincial level, support will be required for the

provision of supervisory visits to districts, further training for staff in new facilities, and also maintenance and

support for deployed sites through the continuous supply of printing and other consumables required to

keep the systems running and also to ensure that there is seamless flow of data from SmartCare at facility

level to the provincial level. The province will, in addition to providing this support, disseminate and

supervise upgrades and other enhancements to SmartCare periodically when changes are made to the

system

Targets set for this activity cover a period ending September 30, 2009.