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 with MOH and EGPAF/CIDRZ.

In an effort to support the Zambia national framework and build capacity of the national system to provide

sustainable HIV/AIDS services, the United States Government through Centers for Disease Control and

Prevention (CDC) aims to provide direct support to Western Provincial Health Office (WPHO) to build its

capacity to coordinate and oversee prevention of mother to child transmission of HIV (PMTCT) services in

the province, provide training, and expand PMTCT trainings to health centers currently not covered by

Center for Infectious Disease Research Zambia (CIDRZ). CIDRZ will continue to provide PMTCT services

in districts where they currently work but with the coordination and leadership of the WPHO to ensure

uniformity and standardization to the PMTCT services being provided in the province. In order to create a

sustainable PMTCT program, the provincial health office (PHO) will take a key role in ensuring that

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

implementing partners (CIDRZ) to ensure maximal resource utilization.

Western Province has seven districts of which four currently have PMTCT services provided through

CIDRZ. The sites that provide PMTCT also provide antiretroviral therapy (ART), tuberculosis (TB), and

palliative care services to which the women are referred. By March of FY 2007, WPHO had trained 82

health care providers in the minimum package of PMTCT services and indirectly supported 42 PMTCT sites

in additional to 50 health workers trained by CIDRZ.

In FY 2008, this activity will supplement PMTCT training in Shang'ombo, Lukulu, and Kalabo districts that

have not initiated PMTCT and will supplement training in the other districts with few trained providers. An

additional 100 health providers will be trained. WPHO and CIDRZ working in collaboration will ensure

through the provision of technical assistance that additional sites establish the PMTCT services and the

targets on the number of women accessing counseling and testing and ARV prophylaxis will be reported by

CIDRZ to avoid double counting. However, the WPHO will report only on the number of health workers

trained from their funding. In addition, other activities to be implemented will include monitoring visits,

training of program managers in the implementation and monitoring of the PMTCT service, dissemination of

national policy and guidelines on PMTCT and standardization of PMTCT services provided in the province

across all implementing partners. The PHO'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 (MCH) units which should lead to the development of a sustainable model

where Government of the Republic of Zambia plays an active role in the continued delivery of PMTCT

services.

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

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

WPHO to coordinate, plan, and integrate services with CIDRZ. In addition, other activities will include

expanding and linking PMTCT services with other HIV services in target districts throughout the province.

This will be achieved through the mapping of services during the services performance audits led by the

PHO every quarter.

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

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

strengthening of PMTCT into maternal and child health. Support systems established in FY 2007 to ensure

sustainability of the PMTCT scale-up such as improved PMTCT supply chain management, improving the

monitoring and reporting system and strengthening the linkage to ART will be further strengthened in FY

2008. An additional activity will be development and strengthening of follow up of HIV-exposed infants by

linking this activity to Integrated Manangement of Childhood Illnesses and community based village

registers and records.

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

monthly planning review meetings with MCH coordinators. Strategic information will be collected,

aggregated, and analyzed for M&E purposes. It is the responsibility of each District Health Management

Teams to submit this information to the WPHO through the Data Management Specialist. To ease this

process, the WPHO will continue to support one data associate at each District Health Office and one

based at Provincial Health Office to ensure smooth data collection, compilation, and submission.

Direct funding for PMTCT service delivery in line with the national PMTCT protocol guidelines and technical

assistance at the provincial level will complement and enhance referrals to other services such as ART,

TB/HIV, and palliative care.

The plus-up funds received in FY 07 will be used to strengthen PMTCT services in the Western province

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

prophylaxis among HIV+ pregnant women identified through adequately training and mentoring of health

workers and community health workers. The Western Provincial Health Office will also coordinate training

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

and strengthening of PMTCT into maternal and child health. These funds will also be used to establish

support systems that ensure sustainability of the PMTCT scale-up such as improved PMTCT supply chain

management, improving the monitoring and reporting system, and strengthening the linkage to ART.

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

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 Mongu 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.

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 with the other activities for the Western Province Health Office including counseling

and testing , ARV services and laboratory infrastructure and support.

Mongu District in Western Province has a very high HIV prevalence of 28.2% and syphilis prevalence of

11.7% (Antenatal Clinic ANC Sentinel Surveillance, 2004) among pregnant women aged 15-44 years.

Adolescents contribute considerably to the high prevalence and 17.0% of women in Mongu aged 15-19

years were found HIV positive during the 2004 ANC sentinel surveillance. To serve the youth better in

Mongu district, the concept of Youth Friendly Corner services is an important component. This is where a

room at a health facility is reserved specifically and conveniently for adolescent peer educators and trained

service providers in which youth friendly services are provided to adolescents. These services are a point

for access to health services, condom collection, and social activities. The centres are typically manned by

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.

Youth Friendly Corners act as the entry and exit points for all youth clients presenting with STIs, HIV, or TB

infection, and for those wanting to discuss reproductive health issues. This activity supported the Youth

Friendly Corners program of Mongu district through the Provincial Health Office (PHO) in FY 2007. The

support was utilized to strengthen the eight existing sites and allowed for expansion to eighteen additional

sites. Here, youth friendly services have been offered as well as sensitization and behavior change

sessions in high-risk areas and during events. As there has been no survey to determine what youths like

or do not like about the Youth corners, by the end of FY 2007 the WPHO will develop an exit interview

questionnaire in order to guide the future support to the centers and increase their effectiveness.

Some of the activities planned and implemented in these corners are: peer education, which involves

outreach through community sensitization by drama groups, mobile video shows, radio programs and the

peer counseling activities which includes one-to-one counseling and referring appropriate clients to trained

health workers for further management. As a result of the outreach services conducted by peer educators

during the first half of 2007, 1109 youth attended the Youth Friendly corners in 4 health facilities and of

these 843 were counseled and tested for HIV with 355 testing positive. In FY 2008 partnerships will be

created with traditional gate keepers to integrate youth friendly services during traditional ceremonies as

well as the Ministry of Youth and Sport, the Mongu Catholic Diocese to support the 3 Youth Resource

Centers in the district. The corners also provide an opportunity for dissemination of condoms to sexually

active mature youth who cannot abstain and choose to protect themselves. To achieve quality results in

these corners, trained health personnel with a sincere desire to work with youth are posted nearby the site

to provide knowledge, skills, and guidance to the youth. Youth who utilize these centres will be encouraged

to know their HIV status and referred appropriately to the nearest VCT centre, where they can receive

counseling, testing and results for HIV. Youth Friendly services are particularly popular with STI clients and

all such clients will be counseled for HIV and routinely tested.

The district has 30 health facilities and by the end of 2007 only ten will offer youth friendly services. The

main challenges that have been experienced in the implementation and expansion of services in the district

are: 1) inadequate funds to run the services; and 2) lack of transport to coordinate the activities at both the

district and health centre levels resulting in these services being confined to urban and peri-urban areas

only. There is also poor and inadequate building infrastructure at health facility levels to accommodate the

health services. There is also a lack of knowledge among youth and to some extent health facility staff

about the services available, which also contributes to sub-optimal provision of youth friendly services.

Special reproductive health services focusing on youth is a key activity to reduce STI and HIV transmission

among adolescents. Mongu district has started prevention and counseling and testing programs for this

age group. In collaboration with Adolescent Reproductive Health Advocates (ARHA), the District Health

Management Team (DHMT) has set up several Youth Friendly Corners in eight of the thirty urban and peri-

urban health centers. Mongu DHMT will strengthen the Youth Friendly Corner services as well as expand

the concept to ten additional health centers. By the end of FY 2007, 18 of the 30 health centers in Mongu

district will have established Youth Friendly Corners. To achieve this, the district will need to address the

transportation problem to facilitate the coordination. There is also a need to build capacity among the youth

and health care workers in appropriate services, to renovate existing spaces, and to procure furniture for the

youth services at health centers. Another key activity is the re-production of information, education, and

communication materials already in existence in appropriate local languages to be used for advocacy and

education among the youths and the communities.

The program relies heavily on volunteers and the turn-over rate is high as the trained youth go for further

training or become employed full-time. To ensure adequate numbers of peer counselors and peer

educators, ongoing training of new peer counselors and educators is required. In FY 2007, 40 individuals

will have been trained to provide HIV/AIDS prevention programs that are not exclusively focused on

abstinence and/or being faithful. An important component of the Youth Friendly Corner approach is

conducting sensitization sessions within certain high-risk communities. The success in use of non-

monetary incentives to reduce turn-over of volunteers will be assessed. In FY 2007, 1,500 individuals will

be reached through community outreach HIV/AIDS prevention programs that are not focused exclusively on

abstinence and/or being faithful.

Activity Narrative:

In FY 2008, with the same level of funding, all current activities with the youth will be continued and an

additional six new district sites with Youth Friendly services will be established. An additional 40 individuals

will be trained in 2008 and it is hoped that at least an additional 1500 clients will be reached during this

period.

To ensure sustainability, the Government of the Republic of Zambia through the District Health

Management Team and health centers will include the youth friendly services in the annual health plans. In

the following years the PHO plans to scale up the Youth Friendly Corner approach to the other health

centers in Mongu district and other districts in Western province.

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, laboratory services, palliative care: basic health

support activity, and TB/HIV activities.

Western province is a predominately rural province with an HIV prevalence of 13.1% and reported

tuberculosis (TB) incidence rate of 481/100,000 in 2004. Outside the provincial capital of Mongu, with an

HIV prevalence rate of 22% and TB notification of 881/100,000 in 2004, access to health care facilities and

services are limited. Many TB / HIV patients have to travel 20-25km on foot in sandy terrains to the nearest

health facility. External funding and support to this province has traditionally been low.

In FY 2008, the goal is to increase access by increasing; the number of service outlets providing treatment

for TB to HIV individuals; the number of HIV infected clients attending HIV care/treatment services that are

receiving treatment for TB disease; the number of health providers trained in providing treatment for TB to

HIV infected individuals; the number of registered TB patients who receive HIV counseling, testing and

receive results at the United States Government (USG) supported site. It is hoped that the above will both

strengthen the existing TB/HIV collaborative services and increase coverage. In order to achieve this goal

WPHO, will undertake the following activities:

In FY 2006 the plan was to scale-up to 22 (15%) new sites from the previous five (3%) sites out of the

existing 147 health facilities, and scale-up to 20 more new sites in the FY 2007 which would have resulted

in 47(32%) new sites. This will not be the case as the number of new sites increased following the training

of more staff by the program and other partners such as JHPIEGO. To this effect by the end of FY 2006

there were 77 (52.3%) sites providing TB/HIV/STI collaborative activities. By the end of 2007 the number

sites providing same will increase to 87 (59%). For the FY 2008, it is planned that 27 new sites will be

established making a total of 114 (77.5%) sites.

Available data for the first quarter 2007 indicate that, of 738 TB patients seen, 527 (71.4%) were screened

for HIV and out of these, 311(59%) were HIV positive. Of these, 120 (38.5%) were put on ART. It is

estimated that by the end of FY 2007, 3000 TB patients will be seen and out of these 2,100 will be HIV

positive. Assuming that 1,400 (70%) of these patients will be tested.

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. The national guidelines recommend the

use of Isoniazid to children under five whose mothers are sputum smear positive TB patients.

In FY 2008, it is estimated that 3,000 TB patients will be seen in the seven districts. Due to constraints such

as limitation in counseling and testing facilities, it is estimated that 70% (2400) will receive counseling and

testing over 12 months. Given that 70% HIV positive prevalence in TB patients this will result in 1,700

individuals receiving treatment for TB. Those found to be co-infected with TB/HIV will be referred for

appropriate HIV care including ART. TB screening of HIV infected patients will be a key component of these

activities and it is expected that this support will result in the routine screening for TB disease for an

estimated 1500 (50%) people accessing HIV services.

In FY 2006, 111 health workers were trained in TB/HIV activities (95 in Diagnostic Counseling and Testing,

20 in DOTs and 16 microscopists in TB slide and HIV testing). In FY 2007 an extra 240 health providers

would have been trained in TB/HIV collaborative activities (50 in TB screening, 20 in DOTs, 120 community

treatment supporters and 50 in DCT). In FY 2008, 111 health providers will be trained (45 in DCT, 20 in

DOTs, 20 in TB screening and 26 community supporters). As a result of these trainings and expansion to 27

new outlets, it is hoped that 2,400 HIV infected clients attending HIV care will receive TB treatment. The

trainings will be carried out for health providers and community volunteers in 27 new sites. In addition,

health providers in facilities providing PMTCT, VCT and ART who are not trained in TB/HIV collaborative

activities will be targets for training.

45 health providers will be reoriented in DCT in order to up date the providers in any emerging issues. The

training will include among other issues screening HIV infected persons for TB

In order to strengthen the availability of equipment, drugs and other supplies and cut down on avoidable

stock outs and wastage, 32 health providers will be trained in logistics management.

In order to strengthen monitoring of MDR and adverse reactions, 32 health providers will be trained in

pharmacovigilance.

The importance of adhering to standard infection prevention practices in health facilities and in particular

facilities providing TB/HIV collaborative activities can not be over emphasized. Generally infection control in

health facilities in the province is poor. To this effect, WPHO is planning to renovate Mongu chest clinic to

provide an enabling environment for practicing IP practices and orient health providers in infection.

With an extra $100,000 in plus-up funds WPHO will facilitate adherence to the guidelines on Prevention of

TB in Health Care settings which are currently being developed by JHPIEGO by undertaking the following

activities:

1.Renovate 4 health centers (Nanjuca, Nkeyema, Shangombo, Libonda) to which the ART services are

being scaled up to during FY 2008. These health centers are usually congested putting the HIV positive

patients at risk of getting infected with TB. Senanga and Lewanika chest clinics will also be renovated.

2.Support the dissemination of the updated national infection prevention guidelines in all the 7 districts of

the province.

3.Train and orient health providers in infection prevention.

In FY 2006, the program recruited and supported five staff (one each at PHO, Mongu Urban Health Clinic

(HC), Sikongo in Kalabo and Luvuzi and Mitete HCs in Lukulu). In FY 2007, the program would have further

recruited one additional staff for Nalwei health center and continued supporting four health providers at

Sikongo, Luvuzi, Mitete, and Mongu chest clinic. This support activity will continue in 2008. In addition, an

additional six health providers (Clinical officers/Nurses) will be recruited in five Zonal health facilities with

Activity Narrative: populations between 6,000 and 8,000 (Mbanga, Mulobezi, Mutomena, Libonda and Sihole) to boost up

staffing in two of the health facilities and in three health centers meet the human resource requirements for

establishing TB/HIV collaborative activities.

In FY 2006, supportive supervision was integrated in the PHO routine performance assessment. In FY 2007

the supportive supervision will be conducted quarterly to all the seven districts in addition to the routine

provincial and district performance assessment. During the FY 2008 the WPHO will continue providing

supportive supervision quarterly to seven districts and continue support to district health offices to carry out

supportive supervision to health facilities at least once in a quarter focusing on program activities. In

addition the WPHO will develop supportive supervision guidelines for TB/HIV collaborative activities. The

Provincial Health office will monitor performance and identify areas for capacity building in TB/HIV

collaborative activities which will also be complimented by the routine bi annual performance assessment.

. Technical supervision will be conducted quarterly to provide knowledge and skills to the health staff and

community volunteers. The province will ensure that there is uninterrupted supply of drugs, HIV test kits and

TB/HIV test reagents.

By the end of FY 2007, one provincial and seven district coordination committees will have been

established. In FY 2008, support the committees will continue meeting giving strategic direction to the

activities implementation. The WPHO will also continue coordinating activities undertaken by other partners

such as CIDRZ, CHAZ, and other Faith based organizations and others.

In FY 2006, two health facilities (Mitete and Muoyo) were renovated and extended using funds solicited by

CDC from a private foundation. By the end of FY 2007, Nalwei health center would have been renovated to

provide space for TB/HIV diagnosis and collaborative activities.

In FY 2008, four health facilities among those earmarked as new sites (Mbanga, Mulobezi, Mutomena,

Libonda and Sihole) will be renovated to facilitate the provision of TB/HIV collaborative activities. The

Provincial Health office will provide guidance to minimum requirements for infrastructure, staffing and

equipment for these facilities. The aim is to reduce the infection transmission from untreated sputum smear

positive TB patients to HIV infected patients in TB/HIV clinical care settings.

In order to increase community awareness TB/HIV collaborative activities and therefore ultimately increase

demand for the services at least one meeting in each district for sensitization of community gate keepers

(Chiefs, Indunas, headmasters etc), support 14 drama groups (two in each district) as well as developing

information, education and communication materials in the local language will be held. It is hoped that the

sensitization will be complemented by the GAMMA CHULU activities.

The activities for implementation in the FY 2008 will be included in the Provincial and District action plans

for 2008 and therefore compliment the Ministry of Health activities in Western Province.

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.

HIV counseling and testing (CT) is the entry point for antretroviral therapy (ART) services and offers an

opportunity to disseminate education and information on prevention to individuals and couples. According

to the 2002 Zambia Demographic Health Survey data, the Western Province has a HIV prevalence of

approximately 13%. The Western Provincial Health Office (WPHO) is currently collaborating with partners

that working within the Province to encourage people to know their HIV status by seeking voluntary

counselling and testing (VCT) services and also helping link people to treatment services when necessary.

In an effort to support the Zambia National Framework and build national capacity of HIV/AIDS services, the

United States Government (USG) through Centers for Disease Control and Prevention (CDC) aims to

continue to provide direct support to the WPHO to build its capacity to coordinate and oversee voluntary

counselling and testing (VCT) services in the province by providing training and hleping to expand VCT to

its district hospitals and rural clinics.

In 2007, funding was used to train 15 health workers in diagnostic counseling, 10 health workers, and 30

CDEs/CHW/TBAs trained in VCT.

In FY 2008 funding will be used to train an additional 15 health workers in diagnostic counseling, 10 health

workers, and 30 CDEs/CHW/TBAs trained in VCT to ensure that all districts have adequately trained staff to

provide VCT. Training will be conducted in collaboration with KARA counseling and in-line with the national

guidelines. An HIV/TB coordinating officer recruited for the WPHO will work closely with the CDC Field

Office Manager to initiate, supervise, support, promote, coordinate and monitor the CT services as well as

teh TB collaborative services in the districts to ensure good collaboration with other stakeholders working in

the HIV/AIDS area (CIDRZ, HCP, JPHIEGO, NZP+, Diocese of Mongu, World Vision International, CRS).

Funding will also be used to strengthen and expand the availability of CT services to 50% of the public

health facilities (in total 68 active sites, including eight new sites). Emphasis will also be placed on

prevention for those that are negative and linking HIV positive clients to appropriate treatment and care

services such as: prevention of mother to child transimission of HIV, ART, home based care programs, and

care programs for orphan and vulnerable children within the districts.

The activities under this program are all in-line with the government plan to increase the number of

individuals who know their HIV status. CT activities are a part of the annual district health plans and

through the USG support, the skills and training acquired by the staff will help empower local initiatives,

leverage additional funds, and ensure 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 Elizabeth Glaser Pediatric Foundation (GPAF) and Catholic Relief Services (CRS).

The Western Province of Zambia has an HIV sero-prevalence of 13.1% within the general population

between 15-49 years of age (Demographic Health Survey 2002). The province consists of savannah

woodlands in a sandy plateau and plains, traversed by the Zambezi River. Deep, sandy, terrain and flood

plains make communication and food production extremely difficult. Most areas of the province can only be

reached by 4x4 vehicles throughout the year and some areas only by canoes and speed boats in the rainy

season, making the logistics of service delivery challenging and the cost much higher than most provinces

in Zambia. The province has 11 hospitals and 134 rural health centers. The vastness of the province and

low population density makes it difficult to make services easily accessible to the population, which is

compounded by low staffing levels and insufficient infrastructure. Lukulu and Kalabo districts are especially

limited in their efforts to scale-up HIV and tuberculosis (TB) related services due to staff shortages.

Based on the 13.1% prevalence and with a population of 871,030, the province had an estimated 114,389

HIV/AIDS cases in 2005. By the end of 2005, only 3,213 people living with HIV/AIDS were receiving

antiretroviral therapy (ART). At present, the province has 10 antiretroviral therapy (ART) sites. All districts

have at least one site where ART services are offered. To make ART services more accessible to the

population as well as to improve the quality of the services by decongesting some of the present ART sites,

there is need to increase the number of ART sites in some of the districts.

The Western Provincial Health Office (WPHO) in FY 2007 expanded and consolidated the ART services

working closely with Center for Infectious Disease Research in Zambia, Catholic Relief Services, and other

partners providing care in the province. The WPHO targeted the expansion in areas where the partners do

not have a presence.

In order to expand and strengthen the availability of ART services in the province, in FY 2008, the WPHO

will introduce six new ART sites in Shangombo, Senanga, Mongu, Lukulu, and Kaoma districts. This will

entail training of health centers staff, using the government model of developing treatment teams in the

health centers. The centers will be supervised by ART trained physicians from the provincial and district

hospitals who will visit the center at least once a month. A referral system will be developed so that patients

with complicated conditions or complications arising from ART, that cannot be dealt with by the local staff

are referred to centers with higher ART expertise. A mobile ART clinic will be established to provide

antiretroviral services at a difficult to access rural health centre in the Lukulu district that is inaccessible for

six months due to flooding in the plains. The health center is situated on the western side of the Zambezi

River and the mobile ART clinic is expected to serve a population of over 20,000. The staff in the health

centre will be trained in counseling, testing, and care, including prevention of mother to child transmission,

TB/HIV services, as well as ART. Emphasis in FY 2008 will be scaling-up pediatric access to ART to 10%

and this will be achieved through strengthening referral systems between PMTCT and ART services and

scaling-up early infant diagnosis of HIV.

A team from the hospital consisting of a physician, nurse, counselor, and a lab/pharmacist (alternating) will

start visiting Mitete, which is an out post in the Lukulu District four times a quarter, monthly and for one

month fortnightly. Only during the month of the fortnightly visit, will new patients start ART as they need to

be reviewed after two weeks. During the floods they will use a boat provided by the District Health Office to

visit the post. Extra staff will be recruited for Mitete to ensure there is adequate capacity at the health

center to deal with the increased workload.

In order to improve the quality of service for ART and enhance adherence, the WPHO will train staff in

ART/opportunistic infections management, adherence counseling, and ART data management. Staff will

also be trained in the use of Tenofovir + FTC/3TC based ART regimen and assessment of creatinine at

baseline and during follow-up as tenofovir may cause nephrotoxicity. In addition, community members will

be trained in home based care. An additional 600 people will be commenced on ART in FY 2008 and 10%

of these will be children.

The involvement of the WPHO in expansion of ART services to the hard-to-reach areas will contribute

towards coordination, standardization, sustainability, and equitable access to ART in the Western Province

of Zambia.

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 WPHO ART, PMTCT, TB and CT activities, as well as to UTH Virology and CDL.

This activity will provide support to Western Province to implement the University Teaching Hospital (UTH)

National Prevention of Mother to Child Transmission of HIV (PMTCT) and Voluntary Counseling and

Testing (VCT) Quality Assurance (QA) Program within the districts of this province. Major limiting factors for

implementation, support, and sustainability of laboratory programs outside of the capital city are due to: 1)

travel distances; 2) lack of transport for onsite supervision and feedback; and 3) lack of funds at the

provincial and district levels. Western Province is approximately eight hours by road from Lusaka where the

UTH, CDC, and the Ministry of Health (MOH) laboratory experts are located. Supervisory travel visits to

Western and other provinces must be divided by the time and number of technical experts.

The goal of this activity is to build laboratory testing capacity, infrastructure and sustainability at the local

level by training and providing support so laboratory activities conducted by local staff within the province for

PMTCT and VCT as well as care and treatment support. It will also assist in the integration of the National

TB/HIV activities in the Province. The Provincial Laboratory will offer rapid diagnosis for opportunistic

infections (OI's) such as blood culture using the BACTEC 9050. During this first year (2007), the goal was

to reach and build capacity for ten laboratories within Western Province.

Western Province is a predominately rural province with an HIV prevalence of 13.1%. The deep sandy

terrain of this area, the poor road network, and the lack of public transport systems leave only one option for

the majority of the people who walk to the nearest health facility. Access to health care facilities and

services are limited, with an estimated 40% of the population living more than 12 kilometers from the

nearest health facility.

Availability of laboratory services in most of the districts is limited due to several factors which include

limited technical human resources, lack of suitable infrastructure and services such as electricity,

geography, and increasing numbers of persons participating in PMTCT and VCT programs at local levels.

Antiretroviral laboratory care and treatment services are limited. Sample preparation and transport support

can alleviate the lack of services due to laboratory infrastructure and technical limitations. In FY 2008,

continued onsite training and technical support for existing personnel in basic laboratory testing and

specimen transport will be assessed and provided. Laboratory QA programs for rapid HIV testing currently

performed in the VCT and PMTCT will be supervised and supported by the UTH Virology national HIV

reference laboratory. TB laboratory capacity will be strengthened in AFB smear microscopy and local

external quality assurance within the provincial laboratory from rural and district health centers. An

integrated program to include laboratory data management and onsite quality assurance will assist in

improving and equalizing antiretroviral laboratory services to people living with HIV/AIDS in these areas.

Support will be provided for basic infrastructure improvements and the provision of alternate sources of

power such as solar panels at all laboratories currently lacking this infrastructure. This activity will support

the UTH national QA program within the districts of this province to sustain quality services and build staff

capacity.

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 Ministry of Health (MOH), and Technical Assistance/Centers for Disease Control and

Prevention (CDC).

Western Province is a remote and scarcely populated province (population density: roughly seven people

per sq kilometer; surface: 126,386 sq kilometers). The province consists of savannah woodlands on a

sandy plateau and plains, traversed by the Zambezi River, which divides the Province into East and West.

Deep sandy terrain and flood plains makes communication and transport extremely difficult. Especially

Kalabo, Lukulu, and Shangombo district are affected by the terrain and are very isolated.

In FY 2007, funding supported Very Small Aperture Terminal (VSAT) internet connection for the province

through the Provincial Health Office (PHO) in Mongu and improved strategic information activities.

Improving internet service and email communication helps 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 (DHO). 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 distance learning programs and conduct research projects. Such investment in technology is a

sustainable contribution to essential communications infrastructure for many years ahead. The Government

of the Republic of Zambia's National Development Plan places improved information services as a top

priority, contributing non-United States Government efforts for sustainable use of technology of this kind into

the future.

In addition to continuing ongoing support for the communications initiatives of FY 2007, FY 2008 funding will

help support other activities involved in 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.