The funding level for this activity in FY 2008 has changed in two ways since FY 2007: 1) Track 1.0 funding

from ARV Drugs has been moved to this activity since all AIDSRelief sites are now ARV Drug accredited

and can receive drug supplies through the government system; and 2) Reduction by 1/12th of overall

AIDSRelief funding due to the request from CDC/GAP to move 1/12th funding to ‘PEPFAR II Track 1.0 ART

AIDSRelief' to ensure that funds are available for ART services during the one month lag between when

Track 1 PEPFAR 1 funds are due to end and when funding will be available under the next congressional

notification. This funding has been moved to ‘PEPFAR II Track 1.0 ART AIDSRelief' mechanism to assure

that persons receive services during the first month of PEPFAR II.

This activity relates to CRS SUCCESS Project. 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. 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. AIDSRelief also participates in the JHPIEGO-led ART Quality Improvement Program (AQIP).

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 Sample (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

Activity Narrative: 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

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.

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 remained the same as in FY 2007.

This activity relates to: CRS SI, EGPAF SI, JHPIEGO SI, Ministry of Health (MOH), Technical Assistance -

Centers for Disease Control and Prevention (CDC), and SmartCare COMFORCE.

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

AIDSRelief Zambia. 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.

With the activity under SI and in line with AIDSRelief sustainability workplan, Constella Futures will embark

on sustainability activities which will include targeted on site support to train individual LPTFs in data

management. The targeted on site support will include Analyses in software applications such as Epi Info,

SPSS, MS Excel and Access available at the sites; this will ensure that LPTFs are up dated in skills to carry

out independent analysis for adaptive management and use data to external partners for purposes of

demonstrating program benefits and sourcing of additional funds for the benefit of the LPTfs and clients.

The LPTFs will also be trained in managing data for in house activities such as QA/QI, QLA and LTA. The

targeted on site support will involve spending two to three weeks at each of the 20 LPTFs including and an

additional 8 CHAZ supported sites for sustainability.

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