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.

United Nations Children's Fund (UNICEF), a co-sponsor of the Joint United Nations Program on HIV/AIDS

(UNAIDS), is a lead advocate for maternal and child health (MCH). UNICEF is currently working at all

levels to improve programs addressing the prevention of mother-to-child HIV transmission (PMTCT) and

pediatric AIDS treatment and care.

UNICEF has worked in Zambia for a number of years and led the effort to: 1) initiate and implement PMTCT

demonstration projects (1999); and 2) advocate and support national level government scale-up and roll-out

of PMTCT and pediatric treatment and care programs. UNICEF has supported the Government of the

Republic of Zambia (GRZ) to develop PMTCT and Pediatric HIV/AIDS guidance documents, implemented

several child survival programs, and continues to play an important role in aiming to reach the 2015

Millennium Development Goals in MCH.

With the wealth of experience that UNICEF has, the United States Government (USG) in FY 2007 funded

UNICEF to assist in implementing important national PMTCT activities, namely, 1) the scaling-up of routine

opt-out HIV testing in PMTCT settings whereby UNICEF worked with GRZ and stakeholders to advocate for

and support routine offer of HIV testing to all pregnant women; and 2) included the routine offer of HIV

testing policy in national guidelines and incorporate training into all HIV training curricula.

UNICEF also supported GRZ and stakeholders in supporting or developing systems to identify HIV-exposed

infants and refer them for treatment, care, and support. This was achieved by: 1) standardizing the

documentation of mother's HIV status on Under Five cards in Zambia; 2) the training of health workers to

routinely review MCH cards for HIV status to provide clinical care accordingly and also supported

institutionalization of CPT for HIV exposed and infected infants; and 3) supported the institutionalization of

infant dried blood spots (DBS) for early HIV diagnosis and confirmatory testing, utilizing polymerase chain

reaction (PCR) capacity developed in Zambia with support by the CDC.

Another important achievement in FY 2007 was the support provided to the use of traditional birth

attendants (TBA). Many women in Zambia use TBAs for their prenatal care and may visit antenatal care

(ANC) only once during pregnancy. More than 50% of deliveries in Zambia are outside regular health care

facilities, with the majority occurring at home with the assistance of a TBA. Building on previous initiatives

involving TBAs, UNICEF would work with TBAs to develop their capacity to promote PMTCT in the

community and to refer pregnant women for HIV testing and counseling at antenatal clinics. TBAs will also

be empowered to follow mother-infant pairs and provide referral and support. Other community providers

will be engaged in the process as feasible.

In FY 2008, UNICEF will continue supporting the PMTCT national program through continued strengthening

and support to the above activities instituted in FY 2007. In addition, UNICEF will provide technical

expertise in the updating of national protocols to ensure that MoH adheres to current World Health

Organization's technical updates and guidelines pertaining to PMTCT and pediatric antiretroviral therapy

services through the updating of the national guidelines and training curriculum.

With USG support, UNICEF in FY 2008 will print national job aids for use by all cadres implementing the

PMTCT program, identified are the flip charts for use by lay counselors, training materials for lay counselors

and spearhead the revision of the national health worker training curriculum and printing of the training

materials for use in the 72 districts of Zambia. UNICEF will also print sufficient copies and disseminate the

updated PMTCT protocol guidelines, and procure buffer supplies to strengthen the broader MCH services.

With the FY 2008 funding, UNICEF will be the key USG partner that calls for meetings, material

development workshops and ensure that MOH rolls out the updated tools at all levels of the service

delivery.

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