This activity links directly with JHPIEGO, Population Services International/Society for Family Health

(PSI/SFH), and indirectly with USAID | DELIVER PROJECT's ARV Drug activity, the Partnership for Supply

Chain Management Systems' (SCMS) activities in Laboratory Strengthening, and Policy Analysis/Systems

Strengthening.

For FY 2007 Plus-Up funds were used to serve as a bridging activity in the area of supply chain support for

the implementation of a national program to support male circumcision (MC) as part of the prevention of

HIV/AIDS. Through SCMS, Plus-Up funds assisted US Government (USG) projects and the Ministry of

Health (MOH) ensure that the necessary MC kits were available at chosen sites. Previously SFH and

JHPIEGO were procuring the different commodities needed to make up an MC kit in limited quantities.

These kits were provided to the chosen facilities.

The key activities during the bridging activity in FY 2007 included sending staff to the different national

meetings focused on MC to ensure that supply chain issues are addressed as the program expanded. A

national quantification exercise was conducted to determine the commodity quantity needs and costs.

SCMS staff monitored the supply situation of MC kit products at the Ministry of Health's (MOH) central

medical stores, Medical Stores Limited (MSL), and reported back to the different partners on product

availability.

Quantification of both the MC needs for these products and the general health needs will continue to be a

challenge in FY 2008. It will also be important to determine if there are ample supplies of kit commodities to

supply health facilities on a timely basis using the existing MSL managed distribution system. For most

MOH sites, the commodities that would make up an MC kit would be ordered from Medical Stores Limited

as part of their essential drug order. However, as with essential drugs, the system in place suffers from a

lack of sufficient funding and the lack of effective information and inventory control systems to manage the

actual needs of the health sites.

With FY 2008 funding, SCMS will review the pricing of the different products in a kit and determine the most

cost efficient manner to procure these products as the scale-up of the national program warrants larger

USG support for commodity purchases. In FY 2008 there will also be the need to conduct more field visits

to ascertain the stock situation at the facilities. Another key activity will be to develop a national logistics

strategic plan for the support of MC activities. This plan will become more important as more organizations

begin supporting MC activities throughout the nation.

Of the $9 million Plus-Up funding allotted to Zambia in August 2007, this activity will receive an additional

$1.4 million for the procurement of sexual transmitted infection (STI) drugs to treat herpes, syphilis,

gonorrhea, and chlamydia, which are the most common STIs in Zambia, and the most critical to treat for

HIV/AIDS prevention. Possible drugs to be procured include: Ciprofloxacin, Acyclovir, Erythromycin,

Doxycycline, Benzathine penicillin, and others pending final discussion with partners and the MOH.

All FY 2008 targets will be reached by September 30, 2009.

This activity links directly with USAID | DELIVER PROJECT's ARV Drug activity, the Partnership for Supply

Chain Management Systems' (SCMS) activities in Counseling and Testing (CT), Laboratory Strengthening,

and Policy Analysis/Systems Strengthening, Center for Infectious Diseases Research in Zambia, Catholic

Relief Services/AIDS Relief, Churches Health Association of Zambia (CHAZ), University Teaching Hospital

(UTH), Zambia Prevention, Care, and Treatment Partnership (ZPCT), Global Fund for AIDS, Tuberculosis

and Malaria (GFATM), the Clinton Foundation HIV/AIDS Initiative, and UNITAID.

The purpose of this activity is to develop a national forecast and procurement plan and to procure Co-

trimoxazole drugs in support of the Government of the Republic of Zambia's (GRZ) national ART program:

cotrimoxazole is used both as a prophylaxis and as a treatment for opportunistic infections. Following WHO

recommended guidelines, Zambia has adopted the policy of adding cotrimoxazole to the new national ART

guidelines which have been disseminated by the National HIV/AIDS/STI/TB Council (NAC). This

commodity will be added to the national ARV ordering and reporting system to better ensure its availability

for ART patients. In FY 2008, roughly 52,000 adult patients will receive cotrimoxazole (pediatric

cotrimoxazole is being provided by the Clinton Foundation with UNITAID funding).

Finally, it should be noted that as with USG-funded ARV drugs, the cotrimoxazole will be placed in the

GRZ's central warehouse, Medical Stores Limited (MSL), where all public sector and accredited

NGO/FBO/CBO/work-place/private sector ART programs will have access to these critical supplies. All

PEPFAR partners are connected to the national ARV logistics system.

All FY 2008 results will be achieved by September 30, 2009.

This activity links directly with all other Partnership for Supply Chain Management System activities; as well

as: The USAID | DELIVER PROJECT; Center for Infectious Disease Research in Zambia (CIDRZ); Catholic

Relief Services/AIDS Relief; Churches Health Association of Zambia; University Teaching Hospital; Zambia

Prevention, Care and Treatment Partnership (ZPCT); Population Services International/Society for Family

Health (SFH); Catholic Relief Services/SUCCESS; Zambia VCT Services; Global Fund for AIDS,

Tuberculosis and Malaria (GFATM); UNITAID; and the Clinton Foundation HIV/AIDS Initiative.

The purpose of this activity is to procure HIV test kits in support of the Government of the Republic of

Zambia's (GRZ) counseling and testing (CT), prevention of mother to child transmission (PMTCT), and

diagnostic testing programs. In FY 2007, the USAID | DELIVER Project provided support in strengthening

the national HIV test kit forecasting, quantification, and procurement systems, while the U.S. Government

(USG) through SCMS purchased $4 million worth of HIV test kits for the national program in accordance

with GRZ and USG rules and regulations.

In FY 2008, USG will continue its strong collaboration with GRZ, GFATM, Japan International Cooperative

Agency (JICA), and the Clinton Foundation/UNITAID to assist the national HIV testing programs in fulfilling

demand for these services. On behalf of the USG, SCMS will purchase three types of test kits for various

testing procedures based on the GRZ's 2006 revised HIV testing algorithm: screening (Determine),

confirmatory (Unigold), and tie-breaker (Bioline). All three tests are non-cold chain HIV rapid tests that

enhance the overall accessibility and availability of HIV testing in Zambia.

Furthermore, USG-funded HIV test kits will be placed in the GRZ's central warehouse, Medical Stores

Limited (MSL), where all the public sector and accredited NGO/FBO/CBO HIV testing programs will have

access to these critical supplies. It is anticipated that over 1,200 testing sites will be accessing these

donated supplies in 2008 and 2009. In 2009, USG's HIV test kit contribution will allow for approximately

1,800,000 tests or 70 percent of all HIV tests conducted. In collaboration with the aforementioned partners,

approximately 1,000,000 persons will be tested nationally in FY 2008.

All FY 2008 targets will be reached by September 30, 2009.

This activity links directly with Project USAID | DELIVER PROJECT's ARV Drug activity, the Partnership for

Supply Chain Management Systems' (SCMS) activities in Counseling and Testing (CT), Laboratory

Strengthening, and Policy Analysis/Systems Strengthening, Center for Infectious Diseases Research in

Zambia, Catholic Relief Services/AIDS Relief, Churches Health Association of Zambia (CHAZ), University

Teaching Hospital (UTH), Zambia Prevention, Care and Treatment Partnership (ZPCT), Global Fund for

AIDS, Tuberculosis and Malaria (GFATM), UNITAID and the Clinton Foundation HIV/AIDS Initiative.

The purpose of this activity is to procure ARV drugs in support of the Government of the Republic of

Zambia's (GRZ) national ART program. In FY 2007, USAID | DELIVER PROJECT provided assistance in

strengthening the national ARV drug forecasting, quantification, and procurement systems. With their

support, the US Government (USG) purchased $19 million worth of ARV drugs for the national program in

accordance with GRZ and USG rules and regulations.

In FY 2008, the USG will continue its strong collaboration with GRZ, GFATM, UNITAID and the Clinton

Foundation to assist the national ART programs in fulfilling demand for ART services. On behalf of the

USG, SCMS will purchase the following drugs: lamivudine (3TC), zidovudine (AZT) 100mg, AZT/3TC,

didanosine (ddI) 100mg, efavirenz (EFV) 200mg, EFV 600mg, nelfinavir (NFV) 250mg, NLF LPV/r133/33

caps, nevirapine 200mg, Tenofovir, Tenofovir/Emtricitabine and Tenofovir/Lamivudine; pediatric specific

drugs will include LPV/r syrup, and ddI 50mg.

Purchases will change as: 1) additional ARV drugs are approved by the Food and Drug Administration

(FDA) and registered in Zambia; 2) the GFATM and Clinton Foundation ARV drug donations become

solidified; and, 3) the GRZ makes changes to the national ARV treatment protocols. It is estimated that

approximately two percent of the total budget will be used to procure pediatric ARV drugs; this figure is

based on the UNITAID/Clinton Foundation's commitment to provide all required pediatric first line

formulations during this time period. An estimated three percent will be used to support PMTCT programs;

however, this figure is difficult to fix as PMTCT drugs are used in general ART.

Furthermore, USG-funded ARV drugs will be placed in the GRZ's central warehouse, Medical Stores

Limited, where all public sector and accredited NGO/FBO/CBO/work-place/private sector ART programs will

have access to these critical supplies. It is estimated that USG procurements, in combination with GFATM

and Clinton Foundation purchases, will enable Zambia to place 230,000 patients on ART by the end of

2009. The cost per patient is estimated at $36/month based on the new national treatment protocols

enacted at the end of 2007.

All FY 2008 results will be reached by September 30, 2009.

This activity links with the Partnership for Supply Chain Management System's (SCMS) activities in ARV

Drug procurement, Counseling and Testing (CT), and Policy Analysis/Systems Strengthening; USAID |

DELIVER PROJECT activities in ARV Drugs and CT; the Centers for Disease Control and Prevention;

Center for Infectious Diseases Research in Zambia ; Catholic Relief Services/AIDS Relief; Churches Health

Association of Zambia; Zambia Prevention, Care and Treatment Partnership; the Government of the

Republic of Zambia (GRZ); the Global Fund for AIDS, Tuberculosis and Malaria (GFATM); UNITAID; and

the Clinton Foundation.

The purpose of this activity is to procure essential HIV/AIDS laboratory commodities in support of the

national ART program and to ensure that US Government (USG), GFATM, GRZ, and other partners'

HIV/AIDS laboratory commodity procurements are in sufficient supply and available at service delivery sites

through an efficient and accountable HIV/AIDS laboratory logistics and supply chain system.

In FY 2007, the USG, the World Bank, UNITAID, and GRZ provided funding for the procurement of

laboratory reagents to support the rapid scale-up of treatment and care for persons living with HIV/AIDS in

Zambia. Beginning in FY 2007 and continuing into FY 2008, the USG through SCMS, procured the

following items: CD4 reagents (Beckman Coulter Epics XL, Becton Dickinson FACSCalibur, Becton

Dickinson FACSCount, Guava Easy CD4 System (PCA)); hematology reagents (ABX Pentra 60C+, ABX

Micros 60, Sysmex pocH-100i); chemistry reagents (Cobas Integra 400, Ortho Vitros DT60, Olympus

AU400, Human Humalyzer 2000, Nova Biomedical Stat Profile pHOx Plus); and various consumables (e.g.,

Ethelyne Diamine Tetra Acetic Acid, vacutainer tubes, needles, disposable gloves and pipette tips).

To better ensure that these valuable commodities will be available in the correct condition, quantity, location

and time; SCMS has been working to improve the national HIV/AIDS laboratory logistics system through

technical assistance. A key component of this assistance was a series of workshops that led up to the

design of the new lab logistics system. The new system is a manual system that was implemented through

nationwide training. Both central level and service delivery site computer software logistics management

information systems and a central management information system that was installed at the Ministry of

Health (MOH) Logistics Management Unit.

In FY 2008, SCMS will continue to procure laboratory commodities in bulk. SCMS will procure 50% of the

national quantification for laboratory commodities; which will support the 2009 ART target of 230,000

patients. SCMS will also continue to strengthen and expand the national HIV/AIDS laboratory logistics

system through the following activities:

1) SCMS will quantify and procure USG-funded HIV/AIDS laboratory commodities consistent with

resources and policies for rapidly scaling-up HIV/AIDS clinical services;

2) SCMS will coordinate HIV/AIDS laboratory commodity forecasting efforts and will develop procurement

planning capacity within the MOH and with other key national stakeholders;

3) SCMS will standardize the HIV/AIDS laboratory commodity inventory control procedures at central,

district, and service delivery levels;

4) SCMS will implement a computerized HIV/AIDS laboratory logistics management information system

(LMIS) in at least 80 service delivery sites. For sites that are laboratories, the software development will be

in conjunction with ZPCT, the Centers for Disease Control (CDC), and the USAID | DELIVER PROJECT,

and its related mandate to improve HIV Test Logistics System;

5) SCMS will provide technical assistance and funding support for the creation of service and maintenance

contracts for laboratory equipment; which has been identified as a vital need by all stakeholders;

6) SCMS will develop and maintain a system for monitoring the function and condition of laboratory

equipment, providing an early warning system for the MOH when repairs or replacements are needed;

7) SCMS will develop and implement a specialized supply chain system for commodities with short shelf

lives; and

8) SCMS will monitor and evaluate the HIV/AIDS laboratory supply chain as a whole, and will make

improvements and recommendations to the USG as needed.

To complete these activities, SCMS will collaborate with GRZ, GFATM Principal Recipients, and other

partners, to train up to 150 key personnel in the newly computerized national HIV/AIDS laboratory logistics

management system. Moreover, at the central level, SCMS will coordinate multi-year national HIV/AIDS

laboratory commodity forecasts and procurement plans with all key partners, including GRZ and donors.

SCMS will also be a key member of related national technical working groups, such as the Ministry of

Health's Procurement Technical Working Group and the HIV/AIDS Laboratory Committee.

Finally, in order to create a more sustainable HIV/AIDS laboratory commodity logistics system, SCMS will

continue to improve national capacity through training and skills transfer programming that is consistent with

the GRZ's vision of a fully-functioning national HIV/AIDS laboratory system.

All FY 2008 targets will be reached by September 30, 2009.

This activity links with USAID | DELIVER PROJECT's activities in Counseling and Testing (CT) and ARV

Drugs; the Partnership for Supply Chain Management Systems' (SCMS) activities in CT, ARV Drug, and

Laboratory Strengthening; the Centre for Infectious Disease Research in Zambia (CIDRZ); Catholic Relief

Services/AIDS Relief; Churches Health Association of Zambia (CHAZ); University Teaching Hospital (UTH);

Zambia Prevention, Care and Treatment Partnership (ZPCT); Government of the Republic of Zambia

(GRZ); Global Fund of AIDS, Tuberculosis and Malaria (GFATM); and the Clinton Foundation.

The purpose of this activity is to provide support to GRZ policy makers, the National HIV/AIDS/STI/TB

Council (NAC), the Ministry of Health (MOH), the Ministry of Finance and National Planning (MOFNP), and

other relevant stakeholders to implement the HIV/AIDS Commodity Security Strategy which has recently

been developed with assistance from SCMS and the USAID | DELIVER PROJECT.

The development and beginning implementation of a national HIV/AIDS Commodity Security Strategy was

based on a comprehensive HIV/AIDS Commodity Security (HACS) needs assessment conducted in

consultation with key MOH managers, policy makers, and cooperating partners. The process has provided

GRZ policy makers, NAC, donors, and other partners with a strategic plan detailing priority interventions to

better ensure a sustained, appropriate supply of essential HIV/AIDS commodities required for the

continuation of the national HIV/AIDS program following intensive PEPFAR support.

In FY 2007, the US Government (USG) authorized SCMS project core funds for the needs assessment and

the development of a national HIV/AIDS Commodity Security Strategic Plan. This strategy was developed

in close collaboration with GRZ, NAC, MOH, and other key stakeholders, such as CHAZ and the Clinton

Foundation. The first step in the process was to conduct an analysis of existing policies, procedures,

guidelines, and programs to identify commodity security issues that must be addressed in order to better

ensure the availability of key HIV/AIDS commodities (e.g., HIV test kits, ARV drugs, and laboratory

reagents), and a series of stakeholder meetings were held to seek support for the way forward. In FY 2007,

an implementation plan for the HIV/AIDS Commodity Security Strategic Plan was developed to foster local

ownership and to provide monitoring and evaluation of progress towards commodity security. Furthermore,

the newly formed national HIV/AIDS Commodity Security Working Group, representing 20 organizations,

was formed to ensure that activities are institutionalized and in accordance with the GRZ policies and

procedures.

In FY 2008, SCMS will continue working with the HIV/AIDS Commodity Security Working Group and the 20

member organizations. In order to support the national HIV/AIDS Commodity Security Working Group,

formed under the MOH's leadership, and its implementation of the national strategy, SCMS will provide the

following assistance in FY 2008: 1) full-time support to the working group to ensure that the group remains a

viable entity; 2) continuous review, monitoring, and updating of the implementation of the HIV/AIDS

Commodity Security Strategy; 3) advocacy for HIV/AIDS Commodity Security at all levels of the health care

system (e.g., national, provincial, district, and community); 4) facilitate GRZ and donor coordination to

analyze and make recommendations to harmonize various inputs into the national HIV/AIDS procurement

systems; 5) enhance GRZ's commitment to provision of these essential commodities through increased

budgetary support; and 6) conduct a supplementary analysis identified in the strategy such as market

segmentation, ability to pay, and diversifying the funding base which would inform a longer term national

sustainability strategy that could be less dependent on donors for vital HIV/AIDS commodities.

The USG, GRZ, GFATM, Clinton Foundation, and other partners are committed to creating an environment

that will allow for the sustained availability of these critical supplies; long-term implementation of the

HIV/AIDS Commodity Security Strategic Plan will greatly assist in achieving this goal.

All FY 2008 targets will be reached by September 30, 2009.