The following activity is newly proposed ¬ for FY 2008.

This activity is linked to all prevention narratives, AB, Other Prevention including Male Circumcision. It is

also linked to Counseling and Testing and treatment as we would like appropriate prevention to clearly link

to those who are negative and positive. The goals are to work in support of national strategy to build

capacity of local USG staff to take leadership in promoting comprehensive and effective prevention for

sustainability.

Zambia has a population of approximately 10 million citizens (US Department of State, 2006), and overall

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

Health Survey, 2002). While it is evident through the DHS survey that many Zambians know about

HIV/AIDS and its modes of transmission, there has been no reduction in HIV prevalence in Zambia in the

last few years. A clear indication that knowledge is not translating into behavior change as expected. This

activity will work with the government, other donors and experts from other PEPFAR countries to share

lessons learned and revitalize prevention strategies in Zambia.

Funding for this activity will provide behavioral science support for care and treatment and prevention

services to people living with HIV/AIDS and other opportunistic infections while developing leadership in the

behavioral science arena. This activity will provide technical guidance in the implementation of PEPFAR

activities in relation to care, treatment and prevention. This activity will be carried in close collaboration with

Zambian partners and USG technical specialists. In addition, the activity will provide oversight to ensure

that PEPFAR funded activities are programmatically sound and consistent with the Zambian National Health

Strategic Plan; train technical officers in relevant behavioral science to build local capacity; develop

evaluation and assessments to measure impact and programmatic effectiveness of interventions;

recommend best practices; participate in design of programs and represent the USG in national planning

and technical committees.

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.

A senior level international TB expert with both management and technical expertise in all levels of

mycobacteriology was requested in FY2007 to augment the existing MoH leadership in order to secure and

sustain accreditation for the Chest Diseases National TB Laboratory. This person will work full time onsite in

the National TB Laboratory for a minimum of one year working with MoH, USG and other TB laboratory

partners to maximize efficiency in training efficiency and human resources. A strong internal and external

quality assurance program in all areas of TB laboratory activities will be developed for TB smear

microscopy, culture, isolate identification and drug susceptibility testing which include both first and second

line testing to detect multiple drug resistant (MDR) and XDR tuberculosis.

The person will work with MoH to strengthen operational and administrative systems. Support will be

provided to the national TB national quality assurance technologist on sample transport for data

management, documentation, test result feedback and customer services in smear microscopy, rapid

culture, drug susceptibility testing and health and safety issues in providing services from rural and urban

health care centers to sustain international accreditation standards for the national laboratory.

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

The following activity is newly proposed for FY 2008.

Related activities: EPHO HVCT, SoPHO HVCT, and WPHO HVCT and all other VCT activities.

Funding in FY 2008 is requested to provide technical assistance (TA) the scale-up of voluntary counseling

and testing (VCT) access for rural disadvantaged communities, migrant populations, and general population

in Zambia. VCT is scaling-up fast in Zambia and extending access to many rural areas hence increasing

the need for oversight and monitoring to ensure quality of services. The TA will make certain training

provided for capacity building is focused on the new Zambian testing protocols, data management and

quality assurance and that appropriate data is being captured at all sites and reporting accordingly.

The TA will also ensure the VCT programs are all working in collaboration with government under the MOH

and works within the confines of government health guidelines and strives to establish a sustainable

programs through training of health care workers, developing standard testing protocols, strengthening

physical and equipment infrastructures, implementing facility level quality assurance/quality improvement

program, improving laboratory equipment and systems and development, and strengthening health

information systems.

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 CDC Lab TA, CDL and TDRC.

This activity allows international laboratory experts to spend extended periods of time in Zambia working

side-by-side with Zambian nationals to transfer laboratory technical skills on-site rather than sending

laboratory technicians to the United States or other countries for training. By having experts based in

Zambia, a greater number of local laboratory technicians are able to benefit from their skills. As the

international experts work in Zambia the understanding in regard to the environment and conditions met on

a daily basis within the country is drastically improved. This model has proven to be the most effective way

to identify and implement practical laboratory technique solutions within the Zambian context.

In FY 2007, this activity allowed international laboratory experts to work in Zambia with more than 150

laboratory technicians in five provinces. The laboratory technical experts worked in-country with one CDC-

direct hire and four Zambian public health laboratory technologists to strengthen national sustainability for

good laboratory practices (GLP), planning, and quality assurance (QA) on a daily basis for diagnosis, care,

and treatment support. Experts have also provided support to developing infant HIV polymerase chain

reaction (PCR) dried blood spot (DBS) sample collection procedures, rapid HIV quality assurance,

hematology, CD4 testing, and biochemistry procedures. Two additional high level experts with TB and HIV

testing experience will assist the national TB reference laboratory and University Teaching Hospital (UTH)

Virology laboratory in achieving international accreditation. Experts focus on skills transfer to build the

national laboratory system, working with Ministry of Health (MoH), Department of Defense (DoD), and

private health facilities in collaboration with consultants from the American Society of Microbiology and the

American Society for Clinical Pathology.

In FY 2008, this activity will support three laboratory experts to continue to work side-by-side with USG and

Zambian laboratory scientists in strengthening skills and expanding the national quality assurance (QA)

program for automated and non-automated laboratory testing procedures. One technical expert will

continue to work on national hematology, CD4, and chemistry QA for monitoring care and treatment support

to persons on antiretroviral and tuberculosis (TB) therapy. A second expert will expand national capacity for

molecular technology procedures infant HIV PCR using DBS analysis and provide selected HIV resistance

testing. Support will continue on implementation of the national laboratory information system (LIS) to

improve accuracy of patient laboratory test data collection for care and treatment, reagent procurement, and

other laboratory management support. A third technical expert will provide support to the national TB

laboratory program for rapid detection and identification of drug resistant Mycobacterium tuberculosis using

automated liquid culture systems for first and second line TB drug resistance testing and molecular

techniques. This senior level expert will work with a supranational laboratory and assist the national

laboratory program in achieving international accreditation.

In FY 2008, this activity will extend technical assistance to additional Ministry of Defense laboratory sites.

This activity provides support for lodging, consultant fees, travel, training costs, needed supplies, and other

costs related to work with the national HIV/TB program in Zambia. Trainings and target data collection for

this activity will be done in consultation with USG and other cooperating laboratory organizations. Technical

support from three international experts brings expertise and provides efficient and sustainable human

resource capacity building in local laboratory personnel. Continuous onsite in-country training and

monitoring will allow several laboratory staff to expand technical expertise as well as in management,

leadership, and problem solving skills in both provincial and districts laboratories within Zambia.

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 EGPAF SI, JHPIEGO SI, AIDSRelief - Catholic Relief Services (CRS), Ministry of

Health (MOH), and Technical Assistance/Centers for Disease Control and Prevention (CDC) and Zambia

National Blood Transfusion Service (ZNBTS).

To support the continued transition of software upgrades and development in 2008 to in-country talent, the

United States Government (USG) will continue to provide support for the ‘lead' professional

programmer/developer who is working closely with the SmartCare team on-location in Zambia to continue

bringing skill levels of the Zambian team up to the level required to maintain and adapt the software in the

future. In addition to this lead staff, the Centers for Disease Control and Prevention (CDC) strategic

information (SI) section will continue to support a national hire as an understudy. The purpose of having

these two SI staff in-house is for closer monitoring and evaluation of their capability and contribution, and to

make it easier to provide close guidance for the next phase of the project as the Ministry of Health (MOH)

assumes more leadership in a new technical area.

The intent for the ‘national hire' developer is to provide an option for a longer term and lower cost technical

bridge between the US-based technical expertise that jump-started the project, and the locally sustainable

ownership of the technology. This provides CDC an alternative method of placing essential software talent

at the disposal of the ministry; this is particularly crucial due to the recent Ministry reorganization and

technical gaps.

The high end technical professional possesses experience in developing clinical software applications,

including Electronic Health Records (EHR), and will be employed no more than two years (thired in 2007).

This lead professional works daily with Zambian colleagues to ensure transparent and shared engineering

of the system as it being deployed.

This activity provides a critical one to two year bridging capacity, while the US based developers who gave

the project its initial jump start are tapered down to small contributions and backup roles for what is

becoming the Zambian EHR (SmartCare). August 31, 2006, the Ministry held a high level meeting to

announce to all the Cooperating Partners the plan to deploy SmartCare nationwide. In August of 2007 they

announce the MOH intention to deploy the system to 900 sites in less than two years - with support from

partners, most specifically PEPFAR. They were able to announce that the latest consensus revision of the

ART software ‘forms' were entirely developed in Zambia. However there remain some challenging technical

areas yet to be mastered by the in-country team, despite the tremendous success of the project concept at

a political level and deployment level.

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