Zambia has a population of approximately 11.5 million citizens (US Department of State, 2007), and overall

HIV prevalence is nearly 16% among the general population and 13% among men (Zambia Demographic

Health Survey, 2002). Currently, there is very limited prevention for positives activities implemented by any

of our partners specifically targeting positives, negatives and out of school. It is apparent that as the

populations if PLWAs increase with availability of drugs those programs also incorporate prevention for

positives programs with proven success.

Funds will be used to run intensive prevention programs for negatives and positives including adult out of

school youth. Funds will be used to hire additional youth staff, provide mobility to underserved areas in

Livingstone and Lusaka, implement youth program in Siavonga in collaboration with other partners, do

community mobilization, obtain the necessary supplies and hire additional staff to carry out the work.

The following activity is newly proposed for FY 2008.This activity links with the Zambia Prevention, Care,

and Treatment Partnership PMTCT, ART, Counseling and Testing (CT), TB/HIV, and Laboratory Support

activities as well as with the Government of the Republic of Zambia (GRZ) and other US Government

(USG) partners.

Though AIDSRelief Project is primarily a provider of antiretroviral therapy (ART) services, this involves

treatment of Opportunistic Infections (OIs) including TB, STIs and others, as well as pain and symptom

management, and clinical care for severe malnutrition. This activity will strengthen and expand clinical

palliative care services in seven provinces. AIDSRelief Project will support 15 districts. AIDSRelief Zambia

has incorporated a Family Center Care Health approach to addressing the needs of Palliative Care in the

area of basic health care and support. Our Family Centered Care team has focused on trainings that are

designed to incorporate the entire family unit into the health care facility model. This approach develops

sustainable care as the family unit assumes greater health care support and responsibility for itself. This

approach has had impact on reducing stigma, encouraging more consistent follow-up, increased testing of

family members, and greater adherence among individual family members. As part of our comprehensive

care and treatment plan, the palliative care includes management of all OIs and follow-up of patients at

community level. Training and on-site mentoring on pain management has taken place and has been a

critical component of AIDSRelief program.

In FY 2007, AIDSRelief reached 41,000 clients with clinical palliative care services through support to 16

facilities in the 15 districts. In FY 2007, AIDSRelief trained 200 health professionals (doctors, nurses,

clinical officers) in ART/OI/Sexually Transmitted Infections (STI)/Pain management through full and

refresher curriculum. AIDSRelief follows the National Standards for ART and OIs. In addition, specific on-

site mentoring is conducted by the family-centered AIDS resident team.

In FY 2008, AIDSRelief will train 288 Health professionals in initial ART/OI management curriculum. In

addition, AIDSRelief Project will conduct specific customized training which will respond to the needs of the

treatment facilities based on the results of the Quality Assurance and Quality Improvement process.

In FY 2008, 48,000 clients will receive clinical palliative care services in 16 supported facilities. During FY

2008, AIDSRelief will consolidate on FY 2007 efforts by providing technical support to ensure quality

services and build capacity to manage clinical palliative care services. AIDSRelief Zambia will continue to

work with its national partner Churches Association of Zambia (CHAZ) as part of its sustainability plan. Key

elements of the work plan include transferring technical, managerial and financial skills to CHAZ and

secondment of technical staff for clinical and M&E direct support. In the same line with this plan, AIDSRelief

Zambia plans to initiate the development of HIV Residency for Zambian nationals to become expert in

clinical HIV including clinical palliative care.

Clinical palliative care activities will include these components: 1) strengthening palliative care services in

health facilities; 2) increasing referral linkages within and between ART facilities and community HBC and

hospice care; 3) participating in and assisting the MOH, the National AIDS Council to develop a strategy,

guidelines, and standard operating procedures for provision of quality clinical palliative care in ART sites

and services; and 4) increasing program sustainability with the GRZ.

In the first component, strengthening palliative care services within health facilities, AIDSRelief will continue

to support 16 ART facilities in 15 districts. In addition to the ART/OI/STI/TB training mentioned above,

health professionals will also be trained, using GRZ-approved curriculum, to provide cotrimoxazole

prophylaxis, symptom and pain assessment and management, patient and family education and counseling,

management of adult and pediatric HIV in the home setting, and provision of basic nursing services in clinic

settings as part of the overall package of clinical palliative care services. Pharmacy staff will be trained in

data collection/reporting and ordering, tracking, and forecasting HIV-related commodities to ensure

availability of critical medical supplies and drugs. AIDS Relief will also liaise closely with the USAID/Deliver

Project and Partnership for Supply Chain Management Systems (SCMS) on forecasting drug supply

requirements.

In the second component, increasing referral linkages within and between health facilities and communities,

AIDSRelief will build on Zambia's long history of working with Faith-Based Organizations (FBOs) and

Community-Based Organizations (CBOs) that provide home-based care for people living with HIV/AIDS

(PLWHAs). These organizations serve as critical partners for facility-based programs supported by GRZ

and USG. Therefore, as in FY 2007, AIDSRelief will work closely with these established entities to

strengthen referral networks linking clinical palliative care services with community-based programs. For

example, AIDS Relief will continue the implementation of the linkages and integration work plan with

Catholic Relief Services/SUCCESS RTL and RAPIDS to better link clinical services to related community

programs.

In the third component, AIDSRelief will continue its participation in and provision of assistance to the USG

Palliative Care Forum as well as coordinate with the Palliative Care Association of Zambia to develop a

national palliative care strategy, guidelines, and standard operating procedures. Through these efforts,

AIDSRelief aims to improve access to quality clinical palliative care services promote use of evidence-

based practices, share lessons learned in project implementation, and support the revision of national

palliative care guidelines and protocols in accordance with GRZ policies.

In the final component, increasing program sustainability with the GRZ, AIDSRelief will continue to work

with CHAZ to build on the quality assurance activities started in FY 2005. In FY 2008, in collaboration with

the GRZ and CHAZ, the AIDSRelief-supported sites will receive direct support from CHAZ to guarantee

consistent quality clinical palliative care services

The funding level for this activity in FY 2008 has increased from that of FY 2007. Only minor narrative

updates have been made to highlight progress and achievements.

Tuberculosis (TB) is a major cause of morbidity and mortality in people living with HIV and needs specific

attention. Routine quality testing of TB patients for HIV is an efficient means of identifying HIV in the

community. The major emphasis of this activity will be on Health Care Financing and Quality Assurance

and Supportive Supervision. Other emphases will include training, community mobilization/participation,

strengthening of networks and referral linkages, and activities that will contribute to infection control.

The following populations are targeted: health care providers (including Community Health Workers), faith-

based organizations, community-based organizations, and all persons affected by HIV and AIDS.

Based on the principle that all HIV positive persons in the CRS AIDSRelief program are screened for TB

based on symptoms and exposure history, and all patients being prepared for ARV drugs receive TB

screening, this activity will be implemented in the following components:

(1) Enhancing laboratory capacity to diagnose TB accurately;

(2) Establish and strengthen referral linkages between CRS AIDSRelief facilities and the Zambian

government TB directly observed treatment strategy (DOTS) sites to ensure timely diagnosis and treatment;

(3) Ensure accessibility to information, education, and communication (IEC) materials on the relationship

between TB and HIV at health facilities as well as surrounding communities;

(4) Enhance the capacity for the diagnosis of smear negative and extra-pulmonary TB based on national

program recommendations.

(5) Reduce the potential risk of nosocomial transmission among patients.

To ensure routine screening and accurate diagnosis of TB in all patients enrolled for HIV care at all 16 AIDS

Relief health facilities and four (4) CHAZ supported Health Facilities, this activity will involve building acid-

fast bacilli laboratory capacity and providing access to chest X-ray to diagnose sputum-negative cases of

TB. A few sites will benefit from small renovations as additional safety measures for lab workers. Additional

training to prepare providers to recognize extra-pulmonary TB in HIV+ individuals will also be conducted.

All laboratories will be equipped to perform sputum smear to detect acid fast bacilli and will be engaged in

quality assurance and quality improvement activities with nearby reference laboratories. Specifically, funds

will be used to strengthen laboratory infrastructure at AIDSRelief facilities to conduct TB diagnostic tests, to

ensure that chest X-ray is available for all sputum-negative individuals, especially those who qualify to

commence antiretroviral therapy, and to provide training and ongoing technical assistance to laboratory staff

in sputum diagnosis of TB, training all cadre of staff to identify potential TB cases and to make the diagnosis

(counselors, nurses, community health workers, treatment support specialists, etc). In addition, patients with

smear negative specimens but suggestive clinical signs will have their specimens referred to an outside

laboratory for culture.

Ensuring that patients diagnosed with TB at CRS AIDSRelief facilities have access to quality care involves

strengthening the capacity of the facilities to meet the special needs of persons living with HIV/AIDS and

TB. Special attention will be placed on patients who are on ARVs and anti-TB treatment simultaneously.

Funding towards this component will go to supporting training of all cadres of clinical staff (doctors, nurses,

counselors, treatment support specialists, and community health workers, etc.) on TB management

especially as it relates to the HIV positive patient, establishment of referral linkages for HIV patients

diagnosed with TB at CRS AIDSRelief sites on TB DOTS for community-level follow-up for care and

support, and developing and implementing joint strategies to assist with patient adherence to ARVs and anti

-TB drugs by utilizing community health workers, treatment support specialists and other community support

groups. It is further planned to strengthen the dual referral system between AIDSRelief facilities with HBC

for patients co-infected with HIV and TB. This will improve the linkages with other USG supported programs

like SUCCESS-RAPIDS. Additionally targeted co-infected TB/HIV patients will be linked with SUCCESS for

the provision of Ready to Use Therapeutic Food (RUTF) and complementary food.

Up to 60 health workers will receive specific training on TB/HIV as it relates to their job responsibilities. It is

estimated that a total of 4,000 persons living with HIV/AIDS will be treated for TB under CRS AIDSRelief

using drugs obtained through the National TB program and is not included in the budget. All patients who

are diagnosed and treated for TB under CRS AIDSRelief will be entered in the Zambian Government's

register with appropriate linkage of medical records between TB and HIV. Funds under the Strategic

Information activity will be used to implement the use of TB registers in all CRS AIDSRelief facilities, train

medical records staff, laboratory staff and clinicians on entering information on suspected cases, TB

screening, diagnosis, treatment, and follow-up laboratory tests for patients seen at the health facility.

The education and sensitization component under this activity will include the development of a

communication strategy to sensitize the communities served by CRS AIDSRelief on the linkage between TB

and HIV. Funds will be directed at working with local organizations to develop, print and distribute IEC

materials related to TB/HIV issues to communities and health facilities, conducting educational sessions at

support groups and other community-based groups, training in voluntary counseling and testing (VCT) and

other counselors to provide information on TB/HIV to their clients during counseling sessions. All sixteen

CRS AIDSRelief health facilities and four CHAZ supported facilities and surrounding communities will

benefit from having IEC materials available.

Funds will be used for infrastructure improvement at outpatient clinics (OPD) in five (5) CRS

AIDSRElief/CHAZ sites in order to reduce the risk of nosocomial transmissions among patients due to

congestion as a result of scale up.

The training of health staff and community volunteers providing care in both urban rural mission health

facilities will ensure sustainability of the program.

With the extra funding of $ 150,000 AIDSRElief will increase the capacity in three (2) CHAZ supported sites

and upgrade one (1) AIDSRelief site to conduct sputum investigations. 750 patients will be targeted.

Activity Narrative:

Patient care will include ensuring routine screening and accurate diagnosis of TB in all patients enrolled for

HIV care at the three (3) CHAZ supported Health Facilities, this activity will involve building acid-fast bacilli

laboratory capacity and providing access to chest X-ray to diagnose sputum-negative cases of TB. Three

(3) sites will benefit from small renovations as additional safety measures for lab workers and infection

control in the outpatient departments.

Specifically, funds will be used to strengthen laboratory infrastructure to conduct TB diagnostic tests, to

ensure that chest X-ray is available for all sputum-negative individuals, especially those who qualify to

commence antiretroviral therapy, and to provide training and ongoing technical assistance to laboratory staff

in sputum diagnosis of TB, training of staff to identify potential TB cases and to make the diagnosis

(counselors, nurses, community health workers, treatment support specialists, etc). In addition, patients with

smear negative specimens but suggestive clinical signs will have their specimens referred to an outside

laboratory for culture.

It is further planned to strengthen the dual referral system between AIDSRelief facilities with HBC for

patients co-infected with HIV and TB. This will improve the linkages with other USG supported programs

like SUCCESS-RAPIDS. Additionally targeted co-infected TB/HIV patients will be linked with SUCCESS for

the provision of Ready to Use Therapeutic Food (RUTF) and complementary food.

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 also relates to activities in HBHC SUCCESS II, CRS HVTB, HTXS (track

1.0), CRS HTXS, CRS HKID and HLAB.

Based on the Zambian national HIV/AIDS strategic plan, there has been a low uptake of counseling and

testing (VCT). In FY 2008, AIDSRelief will aim to improve uptake of CT by increasing the availability of

counseling and testing in health facilities and through community outreach, through training of staff and

strengthening linkages with other services. This activity will be conducted in different clinical settings

including adult and pediatric antiretroviral therapy (ART), prevention of mother to child transmission

(PMTCT) and tuberculosis (TB), and sexually transmitted infection (STI) clinics. The suggested form of

testing would be as diagnostic routine testing with the option to opt-out. This is in conjunction with the

Government of the Republic of Zambia (GRZ) plans of introducing a more comprehensive approach and

increasing the number of people receiving CT services. Most of the rural mission hospital AIDSRelief sites

where AIDSRelief is currently working have TB or STI clinics where these activities will be implemented.

This activity will target persons affected by HIV/AIDS, faith-based organizations (FBOs), and community

health care providers. There are three main components to this activity: 1) provision of comprehensive CT

services within hospital settings and in the surrounding communities; 2) training of staff to provide CT

services; and 3) the strengthening and expansion of linkages to ensure continuity of care for persons who

test HIV positive.

The first component of this activity is to provide comprehensive CT through integrated VCT services within

hospital settings and in the surrounding communities, which will involve supporting 16 hospitals to provide

CT for diagnostic purposes for persons attending in-patient and out-patient services. Routine CT will be

offered to the following principal target populations: pregnant women, patients diagnosed with STIs, and TB

patients, as well as family members of persons living with HIV/AIDS (PLWHA) and self-referred members of

the general public. To enhance patient uptake, VCT services will be offered at community outreach

activities in the surrounding communities, and home testing for families of PLWHA. Community outreach is

carried out during the important health calendar days. A full package is delivered by the clinical team

including community mobilization, drama show focused on access to treatment and care. Those positives

would be referred on site for continued care and ART services. Besides the clinical component, they are

linked to the support system within the community..

The program will continue to use rapid test with same day results. Funding under this activity will

specifically go to support the procurement of test kits for sites not linked with the government pipeline of

supplies and the cost to conduct community-level testing. Through this component support will be provided

to 16 service outlets to train 64 individuals in CT, conduct and provide CT services to an estimated 28,000

individuals.

The second component of this activity is the training of staff at the hospitals to provide CT and the training

of supervisory staff at the hospital to ensure that minimum quality standard of services are met.

Counselors, laboratory staff, and VCT counselors will be trained on how to conduct pre-test and post-test

counseling, on the correct use of the HIV rapid test kits, on providing full and accurate information on HIV

prevention, and also on how to make the appropriate referrals for patients and their families who test either

positive or negative. The training of trainer concept will be used for persons involved in workshops. This

component of the activity will work to train 64 individuals in CT. All VCT training activities will use the

standard Zambian VCT guidelines and testing protocols.

The final component is strengthening and expanding linkages to ensure continuity of care for all persons

accessing CT through AIDSRelief. Strong linkages will be formed with other CRS HIV-related activities

including palliative care provided by the SUCCESS and RAPIDS projects, as well as other CRS orphans

and vulnerable children projects conducted by the CHAMP and RAPIDS projects (HKID activity #8947).

AIDSRelief will also work to establish linkages with other community groups to ensure social, psychological,

legal support, and income generation activity which is available for all patients who test positive for HIV.

Non disclosure makes it very difficult for referrals to other services. The programs plan to intensify

disclosure counseling including couple counseling. Assessment of the social status of clients will be done to

determine the barriers to disclosure. The program will continue to provide Information during group

education sessions on the benefits of disclosure. One on one counseling session will be specially initiated

for clients in need. Special emphasis on spouse notification will be encouraged.

Funds for this component will be used to establish and strengthen referral networks between community

groups and social service providers, as well as with other related projects conducted by CRS and other

USG partners.

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

Related activities: This activity links to AIDSRelief-Zambia .

The funding level for this activity in FY 2008 will decrease since FY 2007 this is due to the recent drug

accreditation of all AIDSRelief sites that can now access ARV Drugs through the government system.

AIDSRelief provides HIV care and services, including antiretroviral therapy (ART), primarily to the most

marginalized populations through faith based organizations in rural areas. AIDSRelief works through the

local partner treatment facility (LPTF) to provide treatment and care and builds the capacity of the treatment

facility to provide this care as a means of building a sustainable care system. In the initial phases of the

program, the antiretroviral drugs were purchased directly by AIDSRelief, in a system parallel to the Ministry

of Health (MOH). However in the spirit of supporting the Three Ones principle and in order to ensure the

development of a sustainable system, beginning in FY 2006, AIDSRelief agreed with the MOH that new

patients initiated on treatment in the AIDSRelief-supported sites would receive first-line and second-line

generic drugs through the Central Medical Stores logistics supply system. The U.S. Government through

JSI Deliver has strengthened the central logistics procurement and supply of antiretroviral medications.

In FY 2008, all AIDSRelief supported sites will have access to government supply pipeline of drugs.

AIDSRelief will keep $212 000 for ART drug supply as a buffer stock. This backup is intended to help

avoid emergency stock-outs as the Government of the Republic of Zambia stock reporting and drug

forecasting systems are being strengthened. As of June 2007, approximately 2,412 patients (adult and

pediatric) were on second-line and/or drug combinations containing second-line antiretroviral treatment.

Churches Health Association of Zambia will continue to store the buffer stock and will also distribute drugs

to AIDSRelief facilities, in support of the Central Medical Stores logistics supply system.

In FY 2008, AIDSRelief will provide ART for 21,000 patients at 16 faith-based hospitals and other clinics,

including the maintenance of 15,000 patients from 2007 and the expansion of ART to an additional 6,000

patients in 2008-2009.

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. Funding from ARV Drugs has

been moved to this activity since all AIDSRelief sites are now ARV Drug accredited and can receive

supplies from the government system.

This activity relates to CRS SUCCESS Project. Funding supports scaled up activities from track 1.0.

AIDSRelief has continued to contribute to the United States Government's HIV/AIDS strategy in Zambia by

activating and supporting 16 local partner treatment facilities (LPTFs) and additional satellite facilities to

provide antiretroviral therapy (ART), as well as HIV care and services in remote areas. As of July 2007,

AIDSRelief had 13,880 patients actively on ART out of which 895 were children and 31,583 patients were

receiving basic care and support.

AIDSRelief continues to support the Zambian government's HIV strategy and participates in multiple

technical working groups and technical committees, including: the ART National Guidelines Working Group;

National AIDS Council Resistance Surveillance Working Group; the Medical Council Site Accreditation and

Provider Certification Group; the National Laboratory Instrumentation Working Group; the National Pediatric

ART Regimen Choice Committee; the National Pediatric ART/OI Training Curriculum Development Group.

In keeping with its commitment to ensure that care and services continue to be delivered at a high standard,

AIDSRelief has implemented a Quality Assurance/Quality Improvement (QA/QI) program at its LPTFs.

AIDSRelief also participates in the JHPIEGO-led ART Quality Improvement Program (AQIP). This included

conducting formal chart reviews at facilities that were activated in FY 2004 and performing viral load

measurements on 10% of patients who had been on treatment for more than nine months. Analysis of the

data showed a viral load suppression of 88 %. In addition, by using the pharmacy database, partners have

been able to track would-be defaulters easily and implement early interventions such as home visits and

counseling. By keeping track of the attrition rates, AIDSRelief and their partners have been able to

implement timely interventions at LPTFs, such as community mobilization and revision of adherence

strategies.

Since the initiation of ART services at all our LPTFs we have installed, trained, and assisted with

maintenance of dry chemistry analyzers for Creatinine and ALT determination. Since abnormal renal

function requires dose adjustment with many ARV drugs, we have invested in this capacity since year one.

All AIDSRelief sites have been performing Creatinine values routinely and will continue with this monitoring.

Building on FY 2007, AIDSRelief will provide AIDS treatment services primarily through faith-based facilities

that typically treat the most marginalized populations and provide services in rural areas. The cost of

providing care in these areas is usually high due to poor road infrastructure that makes it difficult and costly

to transport supplies.

Although not directly funded in Zambia for PMTCT, training and integration of PMTCT programs into our

Family-centered care health strategies and emphasis on building linkages between all infant and child

services have occurred and will continue. Special link has been made with CHAZ to provide PMTCT

services at AIDS Relief supported sites. The incorporation of Dry Blood Spot (DBS) testing for infant

diagnosis has availed an opportunity to truly develop tracking systems that can monitor the impact of

PMTCT programs on transmission. Our PMTCT approach has facilitated increased enrollment of all ART

eligible pregnant women on full ART courses to be on full ART courses so as to maximize the benefit of

PMTCT while minimizing the impact of ARV drug resistance to the mother and infant.

During FY 2008, AIDSRelief will scale up in the existing sites providing ART to 21,000 patients in 16 faith-

based and non-faith based hospitals and clinics, this will include the maintenance of 15,000 patients from

FY 2007 and the expand 6,000 ART patients as an additional number. By the end of FY 2008, AIDSRelief

Zambia will have provided HIV care to a total of 48,000 individuals. CRS will use private funds and

foundation resources for infrastructure improvement to accommodate the expanded number of patients in

three (3) health facilities.

Pediatric populations and issues will continue to be addressed through focused trainings on early

identification of children at risk for HIV at the rural health MCHC sites, PMTCT programs, OPD clinics, and

in-patient pediatric wards. Trainings for medical officers, clinical officers, and nurses will be regularly

conducted that are designed to increase care management skills of non-pediatric health care providers.

These trainings will be focused on those LPTFs with reported low pediatric enrollments or had requested for

assistance. It is hoped that, with these funds AIDSRelief will reach 2100 pediatric patients expected by the

end of the fiscal year.

In FY08, AIDS Relief will continue to focus on Quality assurance at several different levels. Since durable

viral suppression and adherence to therapy are the cornerstones of successful treatment of HIV with ART,

AIDSRelief Zambia will continue to invest in extensive chart review, by conducting adherence surveys as

well as doing viral load sampling on a randomized sample of patients on ART at each site. The data is then

analyzed site by site and comparisons are made with the data from other AIDSRelief countries. Sites are

then assisted with potential areas for support and improvement. Concurrently, at the LPTF a Quality

Assurance/Quality Improvement program is developed with local ownership to assist with the identification

of site specific strengths and weakness in the multiple departments that impact care and treatment. In

conjunction with the MOH, CDC, and other implementing partners AIDSRelief Zambia a ‘best practice'

model of QA/QI programs is being developed for implementation at the national level. Currently AIDSRelief

Zambia is also implementing a wide scale laboratory quality control program to address sustainable quality

control in the rural laboratory setting

AIDSRelief will continue with CHAZ activities related to joint involvement at site level for sustainability

purposes. AIDS Relief and CHAZ will continue to implement elements of the sustainability work plan which

include transferring technical, managerial and financial skills to CHAZ and secondment of technical staff for

clinical and M&E direct support. In line with the sustainability plan, AIDSRelief in collaboration with the

Ministry of Health (MOH) and the University Teaching Hospital (UTH) plans to use the funds to develop a

residency fellowship program to prepare Zambian doctors to become HIV specialists.

Adherence to treatment will be ensured through linkages with home-based/palliative care programs

established by CRS and other partners. These linkages are critical to monitoring the treatment adherence

and preventing possible complications as a result of non-adherence. The treatment support specialist at the

clinical level will be working with community health workers and volunteers from the existing palliative care

programs to ensure the proper treatment monitoring as well as the ART education of patients and their

buddies. Creating satellite point of service will help further expand the reach to patients in remote and rural

Activity Narrative: areas of Zambia. ART services will continue to be enhanced by twinning sites from different geographical

areas. This will ensure sharing experiences and lessons learned and will enable further capacity building of

LPTFS. Training centers will continue to serve as resource centers for building the capacity of medical staff

from other LPTFS as well as other ART providers in country offering more sophisticated services to patients

on treatment. In FY 2007, AIDSRelief had four ART sites accredited by the Medical Council of Zambia and

will therefore receive ARV drugs from the Ministry of Health supply. Therefore $ 1,615,895 meant for ARV

drugs has been moved to scale up ART services in the 16 sites AIDSRelief is supporting.

Traditionally HIV prevention efforts have focused on HIV-negative individuals. "Positive Prevention" aims to

protect the health of HIV-infected individuals and prevent the spread of HIV to sex partners. The rapid scale

-up of care and treatment has created an important opportunity to reach many HIV-infected individuals and

clinic-based prevention interventions aimed at people infected with HIV will be included together with

counseling on ARV adherence and alcohol use.

In FY 2008, the data migration from CAREWare to government SmartCare system would by then complete

and all AIDSRelief supported sites will use SmartCare.

These services are critical to providing quality HIV care and treatment, and have been an integral part of the

AIDSRelief program since its inception. This proposal is also contingent upon continued central funding

through HRSA at existing levels.

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: EGPAF SI, JHPIEGO SI,

Ministry of Health (MOH), Technical Assistance - Centers for Disease Control and Prevention (CDC), and

COMFORCE

Constella Futures leads the monitoring and evaluation (M&E) component for Catholic Relief Services (CRS)

AIDSRelief Zambia. Using in-country networks and available technology, Constella Futures is building

strong patient monitoring and management systems that are used to collect data and track strategic

information from the Points of Service (POS). Strategic information includes indicators from the President's

Emergency Plan for AIDS Relief (PEPFAR), other United States Government (USG) agencies in

conjunction with the Ministry of Health (MOH), and AIDSRelief specific project indicators. This collective

information supports the provision of high quality HIV/AIDS care and treatment, ensures drug availability,

tracks patient and program progress, and provides accuracy in reporting to both the USG and NMOH

(former Central Board of Health). While reporting on indicators to donors and governments is an essential

secondary objective, the primary aim of collecting strategic information (SI) is to assist clinicians and clinic

managers to provide high quality HIV/AIDS care and treatment, assist in chronic disease management,

monitor viral resistance, and ensure durable viral suppression.

With the MOH establishing the SmartCare electronic medical record (EMR) application as the national

standard, all AIDSRelief supported sites will convert to SmartCare.

The program will hire temporary staff to enter data into the new SmartCare in case some date fields from

CAREWare has not been properly migrated.

In FY 2008 the SI team will focus their efforts on maintaining the standardized national M&E systems that

will be used across all AIDSRelief sites. This will include the mentoring of already trained as well as training

of new facilities in using the forms and software adopted at national level.

Constella Futures provides training and on-site technical assistance to local partner treatment facilities

(LPTFs) in order to build in-country capacity and enhance paper-based and automated HMIS. Focusing

efforts on capacity building activities will ensure that LPTFs are skilled in comprehensive data management,

including data collection, validation, analysis, and reporting. LPTFs will also develop an understanding of

the minimum data requirements for donor purposes and high-quality clinical management. It is Constella

Futures's intent to ensure that accuracy in data management is understood at all levels at the LPTFs

because it is an essential component of monitoring patient progress and ensuring accuracy in reporting.

In year 2008/9 Constella Futures will carry out a program evaluation, which will cover program

implementation, outcome and impact assessments. The evaluation will incorporate the findings from Quality

Assessment/Improvement (QA/QI), Quality of Life Analysis (QLA) and Life Table Analysis (LTA).