The funding level for this activity in FY 2008 will increase from FY 2007 due to plus-up funding to support

additional training.

Most new HIV infections in Africa occur in cohabiting couples. Abstinence is not an appropriate message for

these couples, and faithfulness is not effective in the 15-20% of couples who have one HIV positive and one

HIV negative partner (‘discordant couples'). Joint testing and counseling decreases transmission of HIV in

discordant couples, and reduces sexually transmitted infections and unplanned pregnancies in all couples.

Testing only one partner in a couple does not result in decreased HIV risk.

The Zambia Emory HIV/AIDS Research Project (ZEHRP) was established in 1994 in Lusaka. ZEHRP

counselors have provided couples' voluntary counseling and testing (CVCT) to more than 23,500 Zambian

couples. In 2005 alone, ZEHRP's three CVCT centers in Lusaka tested over 4,300 couples. Over 1,300 HIV

positive individuals were referred to district clinics for evaluation for antiretrovirals (ARVs), 805 were treated

for syphilis, and 174 pregnant women were referred for prevention of mother to child transmission (PMTCT).

Translation of research findings into public health practice is a primary goal of ZEHRP. Counselors from

ZEHRP, along with their counterparts in Kigali, Rwanda, and partners at Emory University in Atlanta, GA,

collaborated with CDC-Atlanta and the Liverpool School of Tropical Medicine to produce a procedure

manual for CVCT. CDC has since used this manual in regional trainings in Southern and Eastern Africa.

ZEHRP Lusaka's three CVCT centers and contributions to the CDC-CVCT procedure manual have been

funded by a research grant from the United States National Institutes of Mental Health (NIMH). The goals of

this grant were to establish sustainable CVCT in Zambia and Rwanda through: 1) Advocacy with

government leaders, funding agency representatives, service providers, and community leaders; 2)

Development of standardized procedures for CVCT; and 3) Operations research to identify the best ways to

promote and provide CVCT.

These goals have largely been achieved in both target countries. Existing NIMH funding for ZEHRP's three

CVCT centers in Lusaka ended in mid-2006. The NIMH grant requires that funding be transitioned from

research to the health and development sector. In FY 2006 the USG provided funds to ZEHRP in order to

provide for provision of couples counseling and testing as a routine service. Funding for this became

available in September 2006 and was earmarked to continue activities in the current three sites in Lusaka

and set up a new site in Mazabuka, Southern Province.

From September 2006 to date, ZEHRP has tested 1,001 couples in Lusaka and referred 803 individuals for

ARV treatment. The Lusaka sites operate Friday to Sunday each week. CVCT services in Mazabuka were

established in June, 2007.

Goals for Zambia for fiscal year 2008 through the President's Emergency Plan for AIDS Relief funds are:

1) Continue to offer CVCT three days per week in three existing centers of excellence in Lusaka

2) Provide didactic and practical training in CVCT promotion and Couples counseling procedures through

these centers

3) Refer for care and treatment all HIV-positive individuals and all syphilis positive individuals

4) Integrate weekend CVCT into existing voluntary counseling and testing (VCT) programs in Lusaka,

primarily in the district clinics. Most couples find it hard to come together during regular hours during the

week as one or both are in gainful employment. This activity will include providing training and support to

existing VCT counselors so that they can counsel couples using the standard Zambia National VCT

Guidelines, providing logistical and financial support to promotion of weekend CVCT at existing VCT

centers and providing funds for overtime salary for trained staff at existing VCT centers.

5) Continue expansion of CVCT services outside Lusaka by continuing services in Mazabuka.

Goals for the Zambia COP FY08 budget plus 50% will include all of the above-mentioned projects plus the

following:

1) Expansion of CVCT to Monze, operating three days a week.

2) Current CVCT sites in Lusaka would start operating five days a week, instead of three.

A very small percentage of Zambians attend VCT as couples. Couples counseling allows partners to

explore and address their sexuality and prevention together. ZEHRP has been instrumental in taking the

leadership in providing and expanding couples counseling in Zambia. In 2008 ZEHRP will expand on

building capacity of other provider organizations to also promote and provide CVCT. Since 2005, 48

counselors from the ministry of health have received training on couples counseling and testing.

In FY 2008 with the plus up funding, $60,000, ZEHRP will build capacity for couples counseling and testing

through providing training to 100 counselors, 10 from each province. Training in couple counseling will be

provided to trained counselors and will include 2 days of didactic and 12 days of practical training. Funding

will also be used to provide supportive supervision and follow up observation to the 100 counselors trained

to ensure they acquire adequate CVCT skills to allow them to effectively initiate and expand CVCT activities

including training within their own institutions.

FY 2008 none plus up funding will be used to support laboratory supplies, transport and logistics of running

current sites. Other costs will go towards production of IEC materials, payment of staff for overtime

weekend service, travel re-imbursement for participants and other personnel costs.

With greater emphasis on trainings and the incorporation of CVCT in routine VCT centers, plus additional

hours to cater for the working population, we hope that the program will become part of the routine

operations of the district/VCT sites. This will ensure long-term sustainability of the program even when

funding is reduced or limited.

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