This activity links with the Project Concern International (PCI) and JHPIEGO's assistance to the Zambia

Defense Force (ZDF) comprehensive HIV/AIDS care and treatment programs including Palliative Care

TB/HIV and ART programs. The administration of this will be done by the DOD PEPFAR office in Lusaka.

Since the establishment of the office, the DOD PEPFAR program has been actively engaged in supporting

ZDF 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 the Medical

Services as well as the ZDF medical staff. Based on this strong relationship and previous supports, in FY

2008, 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 and the USG mission and

assisting the DFMS HIV/AIDS coordinator's office with strengthening their capacity in program development

while emphasizing the ZDF's ownership in their HIV/AIDS program. This has also involved partnering with

other international institutions. The principal international partner for the ZDF will be the Naval Medical

Center—San Diego (NMCSD). In FY05, FY06 and FY07, ZDF physicians participated in the NMCSD "mini-

residency" in ARV services; follow-on reciprocal twinning visits resulted in improved clinical services at the

main referral hospital, Maina Soko Military Hospital (MSMH), 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 FY08 include the following:

1.Family Support Unit: ZDF has received PEPFAR funding and has requested assistance in the creation of

a multidisciplinary clinic to include the disciplines/programs in opportunistic infection

management/prevention, palliative care, and post exposure prophylaxis programs, among others. Using

funds from this activity, health care providers from the DOD and San Diego civilian sector will offer technical

assistance, train providers, and mentor/twin with ZDF counterparts at MSMH, to develop a joint ARV

services/FSU multidisciplinary clinic for their 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

delivered at MSMH, with the ultimate intent that MSMH will become the premier military academic medical

site in Zambia.

2.Positive living/Prevention for Positives workshops: Guidelines and materials for positive living and

Prevention for Positives workshops were developed with the assistance of NMCSD. In FY06 and FY07,

workshops were conducted to disseminate this information. In FY08, these workshops will continue, in

conjunction with PCI's palliative Care activity.

3. Zambian Defense Force School of Health Sciences. Strengthening the ZDF School of Health Sciences

by providing technical assistance will be one of the activities in FY2008. 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 capability of the ZDF medical staff is beneficial to the entire nation.

4.As one component, to address the crippling lack of nursing resources in the ZDF as well as augment

civilian care in Zambia, DoD/SD civilian sector nurses will work with and mentor nursing students at the

college and train them in basics of palliative care and community health for persons with HIV/AIDS.

Additional technical/programmatic assistance may be offered by the Naval School of Health Sciences, San

Diego.

5.Infectious Diseases Institute: the DOD has negotiated an opportunity to send nurses and clinical officers

for two week trainings at the IDI at 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 05, FY 06 and FY 07, 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 08, clinical

officers and nurses from the final model sites will be sent to this 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. In addition, laboratory personnel may receive laboratory training at IDI or one of the DoD Naval

Medical Research Units. 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.

6.Mobile VCT unit: PCI is continuing its support of mobile VCT services for the ZDF. This activity will link

with PCI and SD health care workers, case managers in providing technical assistance to expand the range

and improve the quality of testing and counseling services and referral linkages to treatment and care.

Other activities will be maintaining direct partnerships with NMCSD. The United States Navy has worked in

conjunction with the University of California San Diego (UCSD) in training foreign military physicians on

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..

Physicians from NMCSD have visited the main military hospital in Zambia and have identified areas where

NMCSD can provide assistance. In FY 2008, DoD/SD civilian health care providers will expand their

trainings to ZDF clinics outside of Lusaka. 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 ZDF.

In FY 2005, Department of Defense (DOD) created two positions to be responsible for all DoD funded

PEPFAR activities at Embassy Lusaka. The DOD PEPFAR program manager oversees all DOD PEPFAR

funded activities in the country. The current HIV/AIDS program covers activities in almost all program

areas. The major duties of the manager include serving as the Defense Attaché Office's (DAO) principal

advisor on HIV/AIDS in Zambia, providing support for Post's PPEPFAR Committee and Post's PEPFAR

advisory group, representing DOD PEPFAR programs and liaising with the Government of Zambia, other

donors and USG implementing partners for coordination, information sharing and other issues. This

position supervises the DAO PEPFAR Program Coordinator and Program Officer. The Manager is also

responsible for overseeing partners working with the Defence Force Medical Services (DFMS) and these

are Project Concern International (PCI), American International Health Alliance (AIHA) and JHPIEGO.

The coordinator is responsible for logistics and administrative support as well as contribution to

assessment, planning and monitoring of the DOD programs. The coordinator also acts as a primary contact

for DOD funded infrastructure development programs planned and coordinates with contracting officers

including RPSO and oversees Ministry of Works and Supplies (MOWS) as well as facilitate the procurement

of medical equipments. The funds also cover per-diem and other logistical supports for the MOWS and the

coordinator in a process of assessment, reviewing, M&E, and quality assurance of the construction sites;

use of the MOWS enables a substantial cost savings in comparison with using contracted or USG labor.

In FY06, due to an increase of activities, it became extremely necessary to hire a third member of staff, who

would serve as an additional M&E support and would be called the Program Officer. There would be a

separation of duties with the coordinator, who would be covering more site visits as the construction sites

spread out geographically. The Program Officer would be responsible for financial management and

monitoring as well as contribution to assessment, planning and monitoring and evaluation (M&E) of the

DOD program. M&E support would also be spent on accessing tools that partners are using in collecting

data. There would be collaboration with other USG agencies to ensure standardized reporting. Hiring a

third staff person will facilitate visits to the isolated rural sites within the DFMS network of clinics.

The management budget will mainly cover salaries, administrative costs such as communication, printing

and other material costs, and the maintenance of a vehicle and office equipments, as well as travel costs

including international travel (for training, meetings and conferences), Core Team travel, and local travel

(assessment, M&E and supervisory visits).

The FY08 budget would go towards continuing to support the above mentioned program and office

structure.