This ongoing PMTCT activity began in FY 2007 with Plus Up funds and links to other USG supported

PMTCT services,. COP 08 reprogramming in August 2008 will reduce funding for this activity by $750,000

due to a shift from Field Support to PATH as the primary mechanism, to a Mission bilateral Nutrition RFA.

PATH IYCN is expected to continue its work in COP 08 until it has expended all remaining funds. PATH

IYCN should also help USAID plan for a smooth transition for Infant and Young Child Feeding activities

funded by Field Support to a Mission bilateral mechanism once an award has been made. The shift in

funding results from the need to establish a multi-year bilateral mechanism, and the absence of other funds

to establish the mechanism.

IYCN will continue to support local partners through appropriate in-country staffing approved by USAID

while funding lasts. USAID Zambia will continue to consider the need for Technical Assistance from PATH

IYCN project, and may invest again in PATH IYCN via Field Support if additional funds become available. In

addition, USAID Zambia and other USG Zambia agencies will examine existing COP 08 Food and Nutrition

funding allocated to other partners to determine if any of the funding should be re-allocated to the Mission

bilateral Nutrition RFA or to IYCN via Field Support.

IYCN will continue to link Infant and Young Child Nutrition to existing OVC, HBC, and PMTCT activities, and

to provide nutritional support and counseling to benefit HIV positive pregnant women and their exposed

infants to minimize HIV transmission. IYCN will take the USG lead in Zambia on promotion of improved

nutrition for HIV positive (or exposed) women and infants, including community-based promotion of

exclusive breast-feeding up to six months, as well as timely introduction of appropriate weaning and

complementary foods. IYCN will assist USG with assessment and design issues.

In addition, USAID has underscored that IYCN will collaborate actively and openly with the FANTA II

activity, and vice versa, to ensure optimal provision of TA and training to USG partners and GRZ. In order

to establish sites and services with the reduced funds, IYCN will maintain a partner-friendly and client-

oriented approach. IYCN will consciously minimize the demands on overstretched clinical staff and

community caregivers, while empowering them with skills and materials for clinical and community

nutritional care and support. IYCN will also design services and referrals to simplify and facilitate client

continuity of care in clinic and community settings, and in-between.

The objectives of this activity remain to integrate nutritional assessments, counseling, and appropriate, cost-

effective, targeted nutritional supplementation, into PMTCT services to reduce post-partum HIV

transmission and mortality among exposed infants. This activity will provide strong community outreach to:

promote six months of exclusive breastfeeding for HIV-exposed newborns (mixed feeding increases the risk

of HIV transmission); integrate nutritional screening and targeted nutritional supplements into PMTCT

services for HIV+ pregnant and lactating women, especially those with low CD 4 counts; and support

appropriate weaning of HIV exposed and HIV+ infants through nutritional counseling, as well as timely and

targeted provision of appropriate weaning and complementary foods.

This activity focuses primarily on the post-partum period and has a strong clinic-community linkage

component. The community linkage will come through directly linking PMTCT clients to existing cadres of

thousands of home-based care and OVC volunteer caregivers, who will be trained to support exclusive

breast feeding until six months and appropriate weaning and complementary feeding practices thereafter.

This activity will build on existing and planned PMTCT services. By providing support for safer feeding

practices and preventing/treating malnutrition, it will help ensure that women and children are protected

against post-partum transmission. In addition, this activity will help increase PMTCT uptake by offering a

more comprehensive PMTCT package to HIV positive pregnant and lactating women and their infants,

including nutritional assessment, counseling, and, where needed, nutritional supplements. This, combined

with expanded ART access, will constitute a very attractive PMTCT package for many eligible women.

IYCN will work jointly with USG Zambia funded partner(s) including FANTA II, and the GRZ, to provide

technical assistance, offer training technical advice and materials (though it will not fund all training costs),

and other inputs to support nutritional assessment, counseling, and supplements at various clinical

locations. This will ensure that approaches recommended at the clinic level are supported thereafter by

community-based caregivers. Antenatal clinics and PMTCT sites will first identify high-risk women (low

CD4 counts and/or malnourished) and "prescribe" and "dispense" appropriate, cost-effective maternal

nutritional supplements to support the health of the mother and reduce the risk of low birth weight infants.

These same women and their infants would then benefit from the standard PMTCT services, reducing the

risk of transmission.

After the birth of the child, IYCN-supported training and TA will ensure ongoing clinical assessment and

nutritional counseling at clinical sites, such as well-child/maternal-childhood health (MCH) clinics, which will

advise on exclusive breastfeeding (EBF) and Acceptable, feasible, affordable, sustainable and safe

(AFASS) practices up to six months and on how to introduce appropriate weaning and complementary

foods thereafter. Selected clinic sites will also "prescribe" and "dispense" nutritious weaning and

complimentary foods for infants who are deemed to need them, and to mothers who present with low CD4

counts and/or signs of serious malnutrition.

USAID and CDC PMTCT projects will work with IYCN to select five or more "demonstration sites" based on

such criteria as HIV prevalence, client load, malnutrition rates, facility-perceived need, capacity, and

willingness each in the Northern and Southern half of Zambia. The catchment areas for each site will

include ART and PMTCT clinical services, and community support services (HBC and/or OVC caregivers),

as well as well-child/MCH/under-five clinical care. The combination of these services will allow a complete,

integrated PMTCT-HBC-ART network to function.

The prime partner is the PATH through their Infant and Young Child Network (IYCN). IYCN will provide

technical assistance, training, and materials to existing USG PMTCT partners on Infant and Young Child

Feeding (IYCF). This will include training, technical advice, and materials, and equipping PMTCT

partners/sites for nutritional assessment and counseling, as well as prescription and monitoring of food

supplements.

Activity Narrative: Recent research has confirmed the value of exclusive breast feeding for PMTCT clients and their infants.

This approach will afford PMTCT partners (ZPCT and ZEBS) an option to improve maternal and infant

survival and mortality, through strengthened nutritional assessment, counseling, and support, beyond the

first six months of life. It would also help determine the value of community-based promotion of EBF and

appropriate weaning and feeding practices linked to a network of clinical PMTCT and ART services.

IYCN will assist USAID Zambia to adapt or adopt the USAID Kenya "Food by Prescription" model, as well

as other experience with nutrition assessment and supplementation in Zambia (i.e., CIDRZ, SUCCESS).

The models offer opportunities for replication and expansion. Based on a detailed assessment of local food

processing capacity, IYCN will assist USAID to make best use of existing private producers to cost-

effectively produce (and/or procure) and distribute appropriate food and nutrition support products.

It is anticipated that through technical and training assistance, and design of materials and products, IYCN

will be able to support a full range of services including nutritional assessment and counseling and, as

required, nutritional supplements to approximately 5,000-10,000 HIV positive women and infants at 5-10

carefully selected sites. This assumes that the women and children will benefit from supplements on

average for three-six months.

This activity has a strong capacity building aspect for both clinical sites (PMTCT, ART, and well-child/MCH

clinics) and the OVC and HBC community caregivers, who will acquire and make use of valuable nutritional

assessment and counseling skills.

The initial investment in production and distribution of appropriate food supplements for mothers and

weaning foods for infants will stimulate the private sector investment in appropriate food supplements, as

well as attract wrap-around funding, such as income-generation, other appropriate forms of food aid for

malnourished PLWHA and their infants, or support to increase agricultural yields.

If successful, the model can be replicated/expanded to serve more sites and all under-five children of HIV

positive mothers through better nutrition guidelines and training in nutritional assessment and counseling for

clinical and community based caregivers. This will depend on funding availability. Demonstration of the

effectiveness of this approach may facilitate future access to further funding from a variety of sources.

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