PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
The funding level for this activity in FY 2008 will remain the same as in FY 2007. Only minor narrative
updates have been made to highlight progress and achievements.
The funding level for this activity in FY 2009 will remain the same as in FY 2008. Only minor narrative
updates have been made to highlight progress and achievement.
This activity relates to activities in mother-to-child transmission (MTCT) (#9734) Center for Infectious
Disease Research Zambia, CARE International (#8818) and Catholic Relief Services (NEW).
The Eastern province has eight districts all of which have prevention of mother- to- child transmission of HIV
(PMTCT) services supported by the Center for Infectious Disease Research Zambia (CIDRZ) and CARE
International. Not all the sites that provide PMTCT provide antiretroviral treatment (ART), tuberculosis (TB),
and palliative care services which pose challenges in referring and linking women to treatment and care
services. As of March 2006, CIDRZ and CARE International had trained 40 healthcare providers in the
minimum package of PMTCT services and instituted 30 PMTCT sites.
In FY 2007, in joint collaboration with CIDRZ and CARE International, Eastern Provincial Health Office
(EPHO) spearheaded the scale-up of PMTCT services in Eastern province in line with the National PMTCT
expansion plan. This support enabled key technical staff from EPHO to coordinate, plan and integrate
services with CIDRZ, CARE international, and the Churches Health Association of Zambia (CHAZ). In
addition activities included expanding and mapping of services with other HIV services in all districts of
province through mapping of services during the performance audits conducted by the Provincial Health
Office (PHO) every quarter.
In an effort to support the Zambia national framework and build capacity of the national system to provide
sustainable HIV/AIDS services, the United States Government through CDC aims to provide direct support
to the EPHO to build its capacity to coordinate and oversee PMTCT services in the province, provide
training, and expand PMTCT trainings to health centers currently not covered by CIDRZ and CARE
international. CIDRZ and CARE international will continue to provide PMTCT services in the districts where
they currently work but with coordination and leadership of the EPHO to ensure uniformity and
standardization to the PMTCT services. In order to create a sustainable PMTCT program, the PHO will play
a key role in ensuring that supportive supervision is provided to these districts and will coordinate all
PMTCT services and implementing partners (CIDRZ and CARE International) to ensure optimal resource
utilization.
In FY 2008, this activity supplemented the PMTCT training in Chama, Mambwe, Nyimba, and Chadiza
districts that had not yet initiated PMTCT, and supplemented training in the other districts with few trained
providers in PMTCT service delivery. A total of 75 healthcare providers were trained through this funding.
The PHO worked in collaboration with CIDRZ and CARE International and ensured that through the
provision of technical assistance that more sites in the province establish the PMTCT service delivery. To
avoid double counting of targets, the targets on the number of women accessing counseling and testing,
and ARV prophylaxis reporting was done by the implementing partner working in each respective district.
The PHO reported on the number of health workers trained from their funding. Other activities implemented
included monitoring visits, training of program managers in the implementation and monitoring of the
PMTCT service, dissemination of national policy and guidelines on PMTCT, and the standardization of
PMTCT services provided in the province across all implementing partners. The EPHO involvement in the
coordination of the program ensured geographical coverage and facilitated planning among the districts for
the integration of PMTCT services into routine maternal, neonatal and child health units which lead to the
development of a sustainable model where Government of the Republic of Zambia plays an active role in
the continued delivery of PMTCT services.
The plus-up funds were used to strengthen the PMTCT services in the province through improving
coverage of counseling and testing amongst pregnant women, improving uptake of prophylaxis among HIV+
pregnant women identified through adequately training and mentoring of health workers and community
health workers. The EPHO was pivotal in the provision of training and supervision of PMTCT services
through the integration of PMTCT services at planning meetings from facility to district-levels, integration
and strengthening of PMTCT into maternal, neonatal and child health services. These funds were used to
establish support systems that ensure sustainability of PMTCT scale-up such as improved PMTCT supply
chain management, improving the monitoring and reporting system, and strengthening the linkage to ART.
In FY 2009, this activity will continue to supplement the efforts of the partners in working in all districts of the
province. The districts will provide comprehensive PMTCT through an integrated approach with other
services. The districts will be supported through integrated technical support and on-site training will be
provided to the health workers. This funding will also support community activities that create awareness
and solicit for support from the local and traditional leadership by holding orientation sessions of local
leaders on PMTCT and focused antenatal care. All health facilities will be supported to form and establish
safe motherhood action groups and support groups in PMTCT. Formation of these support groups will play
a major role in drug adherence and compliance to treatment and will also strengthen the feeding options
that clients will choose. These funds will contribute to conducting refresher courses for 25 health workers in
PMTCT and focused ANC. Fifty program managers will be oriented in program implementation and
monitoring of PMTCT services and focused antenatal care, this will ensure a minimum standard of quality of
services are maintained. These managers will adopt a supervisory role at district-level to ensure effective
implementation of activities which will include linkages with the EID program. The funds will also facilitate
the purchase of PMTCT training material and supplies for the training program to run smoothly and to
initiate the PMTCT services in the facilities. Furthermore the EPHO will ensure that the mentorship exercise
for newly trained health workers in PMTCT is in place. Each team will receive two weeks of mentorship
from their trainers. Ideally this will be demonstrated at a center where the PMTCT program has not yet
been established.
In addition the women on PMTCT will be supported to form infant feeding and positive living groups where
Activity Narrative: experiences and sharing of information will be done. Women will support each other to choose the right type
of infant feeding and support one another to adhere to treatment. This will be implemented at all centers
where PMTCT program is established. Traditional birth attendants (TBAs) will be enrolled in the program to
reinforce referral of pregnant women to the center for antenatal clinic (ANC) and delivery especially the
positive. This activity will build on CARE International activities in the orientation of TBAs in basic PMTCT
focusing on referrals, importance of PMTCT and health facility delivery.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15543
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15543 9736.08 HHS/Centers for Provincial Health 7179 2988.08 EPHO - 1 U2G $225,000
Disease Control & Office - Eastern PS000641
Prevention Province
9736 9736.07 HHS/Centers for Provincial Health 5008 2988.07 EPHO - 1 U2G $225,000
Emphasis Areas
Health-related Wraparound Programs
* Child Survival Activities
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $50,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
This activity is linked with the Eastern Province Health Office (EPHO) counseling and testing (CT) (#9005)
and the CDC EPHO ARV services (#9951), SOM (#17574) and IntraHealth (NEW)
THIS ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
Activities will be designed to address the prevention areas identified through the youth prevention needs
survey conducted in 2008.
Provide training to community and religious leaders to incorporate prevention messages and activities at
their functions
Actively work with health centers to integrate prevention in other aspects of care such as Counseling and
testing (CT), prevention of mother to child (PMTCT), tuberculosis treatment, and antiretroviral therapy
(ART).
Increase treatment of sexually transmitted infections (STIs) at all districts and health centers.
A radio program will be implemented to create more community awareness.
Chipata District in Eastern Province has a very high HIV prevalence of 25.9% and syphilis prevalence of
8.8% (Antenatal Clinic sentinel surveillance, 2004) among pregnant women aged 15-44 years. Adolescents
contribute considerably to the high prevalence of HIV with 16.2% of women in Chipata aged 15-19 years
testing HIV positive during the 2004 antenatal clinic (ANC) sentinel surveillance. Special reproductive
health services focusing on youth is a key activity to reduce STIs and HIV transmission among adolescents.
In FY 2007, Chipata District Health Management Teams (DHMT) strengthened the Youth Friendly Corner
services at only 30 of the 39 sites, creating a gap of nine sites still to be strengthened. Prevention and
counseling and testing (CT) services are now available at the 30 Youth Friendly Corners in urban and peri-
urban health centers. To ensure the youths are reached with HIV prevention messages and linked to the
services available in their communities, outreach services were conducted. In FY 2008, the EPHO
conducted a short survey one in rural and one in urban setting to access the needs of out of school youth
and to have a better understanding on where and how they can effectively be reached.
Other activities carried out in FY 2008, included counseling, community mobilization through drama, focus
group discussions, door-to-door campaigns on creating confidence in the youths for the youth to come to
the center mainly in the area of confidentiality concerning STIs, HIV/AIDS, health education talks, and
recreational activities (sporting activities and educational modeling). The corners also provided an
opportunity for dissemination of information on condoms to sexually active mature youth when appropriate
as well as other prevention services. Information on counseling and testing and the value of knowing one's
status was provided and youths who expressed interest in being tested for HIV were referred to the nearest
clinic where they received counseling and testing for HIV and referral for care.
To ensure quality services for the youth, a trained health worker at each Youth Friendly Corner with a
sincere desire to work with youth provides knowledge and skills to them. The program relies heavily on
youth volunteers and turnover rate is high as the youth access further training or become employed. The
promising youths that have been trained at each health facility will be hired on yearly contracts to provide
mentorship to other youths and will be given a monthly subsistence allowance. To ensure that there is
sustainability of the program the youths will be engaged in income generating activities (IGAs). To ensure
adequate numbers of peer counselors and peer educators, new peer counselors and educators are
required.
In FY 2008, 40 new staff and 40 youths were trained to provide HIV /AIDS prevention programs such as
correct use of both male and female condoms, family planning, PMTCT, counseling and testing, screening
for TB in HIV positive clients, screening for STIs and referrals to appropriate levels, that were not
exclusively focused on abstinence and/or being faithful. In 2008, 1000 individuals at each health facility
were reached through community outreach HIV/AIDS prevention programs.
In FY 2008, EPHO implemented prevention for positive component to working with both youths and adults.
EPHO worked with the University of Zambia (UNZA) School of Medicine (SOM) were funded to build the
provincial health facilities' capacity to deliver prevention for positives and negatives program and integrate
prevention to CT, PMTCT, TB, and ART that refer those who are positive and negative to prevention
workshops. Funds for 2008 were used to build the PHOs and DHMTs capacity to implement prevention for
positive program: hiring a prevention positives coordinator, train the coordinator, develop materials and
implement program in at least two districts, reaching 200 adults with prevention for positives messages.
In FY 2009, integration of prevention into other aspects of health care will be key. The monitoring
component will be initiated to track program outcome. Part of FY 2009 funding will be used to scale-up
prevention for positives component to additional six districts in the province. About 2,400 adults will be
reached through these workshops in 2009.
In FY 2009, information gathered from the surveys in 2008 will be employed to guide implementation of
activities for youths. One day review meeting on the progress on activities undertaken in FY 2008 will be
held for 40 youths, one from each health center. Youth friendly services, VCT services, correct use of
condoms and where to access condoms if they can not abstain will also be discussed. Abstinence for
younger youths will be included in the training package. A two day re-orientation of 40 health workers in
youth friendly health services will be held. Recreation activities including sports such as soccer, netball,
and volley ball will be held and before and after these games topics such as such as HIV prevention,
TB/HIV, PMTCT, and CT will be discussed. Banners carrying health prevention messages will be on
display in the grounds during the games. The district will use the funds to work with and solicit for support
from the local leadership, chiefs, headmen to orient them in issues of prevention on TB, HIV/AIDS, PMTCT,
and CT. This will be affected through quarterly meetings. This means of using the banners to sensitize the
public with health messages is commonly used during other national commemoration events such World
AIDS Day, Youth Day and World TB Days. Health modeling with health prevention messages on sashes
will be worn by both male and female youths (models) during youth festivals.
Activity Narrative: To reach the out of school youths and adults, 12 sensitization and preventive radio programs for youths on
TB/HIV/AIDS/STIs will be aired. The media will provide a forum to educate the community on STIs and
HIV/TB and where to find relevant health services. Topics to be covered will include the following:
Importance of VCT, Couples VCT, PMTCT, Youths and CT and prevention, Prevention for positives and
negatives, Adherence including nutrition, Alcohol and HIV, STIs, HIV and TB, domestic violence, male
circumcision, and child sexual abuse. These topics will be addressed in relation to risk behavior and
behavior change. The EPHO in collaboration with the provincial prevention technical working group will
identify experts in the areas above to lead the discussions. The youths will participate in national health
events (National VCT Day, World AIDS day, TB World Day and World Health Day) to continue creating
awareness and give out prevention messages to larger masses. Outreach activities will be conducted to
reach 1,000 youths at each health facility in the district. Supervision of youth friendly services will be
conducted by the Chipata DHO to the health facilities.
Most important, in FY 2009, the EPHO will work with the community, parents, and guardians through the
local leadership, chiefs and headmen to train and equip them with skills on how to initiate communications
with their children on issues of sexuality and prevention and be their mentors. The community leaders will
also play a major role in encouraging couples to test. STI information will be included in counseling and
testing sessions. EPHO will work with other partners to provide training, guidance, and monitor program
implementation. The local churches will be involved to develop youth empowerment programs in that they
are important to building self esteem, greater value of one self worth that will lead them to want to protect
themselves from infection. These activities will be integrated into PMTCT, TB/HIV/STI, and CT as they also
focus on prevention in their programs. In the future programs the EPHO will conduct a survey on
prevention services and at the same time evaluate the impact of the radio programs.
In FY 2009, EPHO will work with Intrahealth and UNZA SOM who are funded to build provincial health
facilities' capacity to deliver prevention for positives and negatives program to an additional five districts in
the province as well as integrate prevention into other aspects of health care. Intrahealth with continue to
provide supportive supervision. A monitoring component will be initiated to track program outcome. Part of
FY 2009 funding will be used to scale-up prevention for positives component to additional five districts in the
province including training community leaders. About 2,400 adults will be reached through these
workshops in 2009. The EPHO will hire two staff reinforce the running of the program which will cover
couple counseling in all program areas. The tested client will be encouraged to bring their partners to be
counseled and tested as well. The media will play a major role in encouraging couples to be counseled and
tested. A model couple or couples will be encouraged to encourage other couples to do the same through
meetings and through the media.
Continuing Activity: 15544
15544 9647.08 HHS/Centers for Provincial Health 7179 2988.08 EPHO - 1 U2G $90,000
9647 9647.07 HHS/Centers for Provincial Health 5008 2988.07 EPHO - 1 U2G $50,000
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* TB
Estimated amount of funding that is planned for Human Capacity Development $75,000
Estimated amount of funding that is planned for Education $15,000
Table 3.3.03:
THIS IS A NEW ACTIVITY:
•Increased access to Male Circumcision (MC) services
This activity will be linked to the TBD (former JHPIEGO) and University of Zambia School of Zambia
(UNZA) School of Medicine SOM (MC training center activity) CDC activity.
From FY 2007 to FY 2009, JHPIEGO have trained provincial health offices to build their capacity to provide
safe, quality, and effective MC services. The expectation is that after training the provincial health offices
will take the lead in scaling-up MC services at their district health facilities. In each district two health care
providers and two counselors will be trained. At the Eastern Provincial Health Office (EPHO) two people
will also be trained. The trained staff in the districts will be trainers of other staff in the remaining three
districts with support from one person from the center. The districts to be selected are those that have well
functioning operating theaters. These are theaters that will be used for practices to ensure quality training.
This funding is for the EPHO to expand provision of MC services in at least five of the district health offices.
The funds will be used to duplicate MC materials, build the capacity for an MC team at each of the five
selected district facilities to provide MC services, as well as to renovate space for MC, translate, and print
MC information, education and communication (IEC) materials, and to procure necessary equipment. We
will work with TBD and the UNZA SOM in site selection and supportive supervision. Training in some of the
five districts will be conducted in conjunction with TBD who will be funded to do training and provide
supportive supervision until the province is confident to take over such role.
In order to ensure sustainability of the program and to promote lasting behavior change, MC services will be
integrated as part of regular health service provided by the district health offices. Community leaders will be
engaged and educated to conduct community mobilization for the MC services. These will be very
paramount and influential especially in EPHO where MC is not traditionally done. Clients who want MC
done on them individually go to the hospital to access the service. The District Health Management Teams
will organize monthly sensitizations meetings with chiefs and headmen in their chiefdoms. Community
health workers currently covering counseling and testing, prevention of mother to child, TB and Malarial
message in each districts selected will be further trained to include MC message in their package of
community health education.
The key with MC interventions will be to integrate strong prevention messages. The expected outcome of
prevention will be clearly made to ensure each person circumcised understands their role in prevention and
the need to not see MC as a magic bullet but a step that must be accompanied with strong consistent use of
condoms, being faithful, and abstaining from high-risk sexual interactions. Significant sensitization will have
to be done to create awareness on the importance of MC in the prevention of infections. Sensitization will
be done through the media, youth friendly corners, during counseling sessions, and screening for sexually
transmitted infections. Five hundred males will be reached through this activity.
Targets set for this activity cover a period ending September 30, 2009.
New/Continuing Activity: New Activity
Continuing Activity:
Construction/Renovation
Estimated amount of funding that is planned for Human Capacity Development $20,000
Program Budget Code: 08 - HBHC Care: Adult Care and Support
Total Planned Funding for Program Budget Code: $16,385,479
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Following new COP 09 Guidance, this is the first Program Area Summary for the new Adult Care and Support Program Area,
comprising Adult Care and Support (HBHC) as well as Adult Treatment (HTXS). The combination of these two previously
separate program area narratives signals a greater integration of clinical and community service delivery efforts by U.S. Mission
agencies and partners.
Zambia Adult Care and Treatment comprises facility-based and home/community-based activities for HIV-infected adults and their
families. It extends and optimizes quality of life for HIV-infected individuals from diagnosis throughout the continuum of illness, and
provides clinical, psychological, social, spiritual, and prevention services. Clinical services include antiretroviral therapy (ART),
prevention and treatment of Opportunistic Infections (excluding TB), and preventative care packages. They also address malaria
and diarrhea using commodities such as pharmaceuticals, insecticide treated nets, safe water interventions and related laboratory
services), pain and symptom relief, and nutritional assessment and support.
Psychological and spiritual support includes group and individual counseling and appropriate end-of-life services. Social support
includes a limited vocational training, income-generating activities, legal protection, and training and support of caregivers.
Prevention services include "prevention for positives," behavior change counseling, and counseling and testing of family
members. Adult Care and Treatment also includes the purchase, distribution, and management of OI drugs, excluding TB drugs.
The Government of the Republic of Zambia (GRZ) aims to expand adult ART to 228,000 clients by the end of 2009. The GRZ
policy of free ART services has greatly increased access to ART. As of the first quarter of 2008, over 180,000 patients were on
ART, of these, 160,000 (90%) were adults. The U.S. Mission in Zambia helps to achieve national ART goals and will continue to
help expand, consolidate, and sustain adult ART services.
As of October 2008, U.S. Mission in Zambia is not yet able to provide country level information on detailed, specific ART outcome
statistics, such as proportions of ART clients still alive or on ART after 12 months, mortality or transfers. The GRZ with support
from the U.S. Mission in Zambia has rolled out SmartCare, a standard medical record system. U.S. Mission in Zambia believes
that by early 2009 the standard medical record system will be able to generate detailed country level information.
Unlike ART, the GRZ does not have a national target for Adult Care and Support. However, the National Strategic Framework for
HIV/AIDS includes Care and Support. The National HIV/AIDS/STI/TB Council (NAC) Treatment Care and Support Technical
Working Group (TWG) coordinates these activities. The Ministry of Health (MOH) has accepted a full-time Palliative Care Advisor
from a USAID-funded project, beginning in early FY 2009; this is expected to result in greater MOH capacity and leadership in
terms of HIV care and support policy, standards, accreditation, advocacy, and services.
U.S. Mission in Zambia counts as unique adult care clients those who receive holistic and comprehensive adult care and support
services during the reporting period. Most Care clients carry over from the previous reporting period unless they die, move out of
a service area, discontinue care, or are otherwise lost to follow up.
In 2009, U.S. Mission in Zambia and its partners will link ART more closely to community-based services such as OVC and
Palliative Care and Support, which work with large numbers of Stage II-III HIV positive ("Pre-ART") adults. This will facilitate the
timely initiation of, and adherence to, ART. Community-based programs like OVC and Care and Support have tens of thousands
of trained volunteer community caregivers who can be trained to refer their clients to ART. The volunteers can also help "Pre-
ART" clients overcome self-stigma that might otherwise discourage them from seeking VCT and ART in a timely way.
The supply chain for HIV care-and treatment related commodities is managed through a variety of channels. The GRZ provides
Cotrimoxazole and TB drugs through Central Medical Stores, with support from the JSI DELIVER and Supply Chain Management
Services projects. The GRZ does not provide home based care kits to volunteer caregivers. Pain management drugs lack
effective supply chain management; their use is restricted, and they are not yet widely available. U.S. partners use various
approaches, such as donation or private funds, to procure commodities such as care kits and basic drugs, though a few use
PEPFAR funds to buy kits.
U.S. partners now provide differentiated Adult Care and Support services, including hospice and "traditional" home-based care for
Stage III-IV clients, early-initiation care/support packages (positive living groups, nutrition counseling, prevention for positives) for
asymptomatic new clients just identified via counseling and testing; and "maintenance" care services for ART clients who have
regained good health (adherence support, positive living). Early identification of new clients, through mobile CT in the community
or home, with immediate referral to services, is part of the U.S. Mission in Zambia strategy to identify PLWHA early in their HIV-
infection.
The U.S. Mission in Zambia and its partners have continued to work with other donors assisting the national ART program as well
as Adult Care and Support. Coordinating partners for ART include: the Global Fund to Fight AIDS, Tuberculosis, and Malaria
(Global Fund), World Bank, World Health Organization, United Nations, the Clinton Foundation, Swedish International
Development Agency, Japan International Cooperation Agency, European Union, U.K. Department for International Development.
Global Fund support from Rounds 1 and 4 have leveraged U.S. investment, particularly in Adult ART services by supporting the
purchase of first line drugs and supporting ART service delivery by the GRZ as well as the Church Health Association of Zambia
(CHAZ). Few donors fund Adult Care and Support. The U.S. Mission in Zambia is the largest donor, joined by the Global Fund,
UNAIDS, World Bank, Ireland, Netherlands, and Germany.
In terms of adult ART, Zambia had 316 ART centers as of March 2008 receiving U.S. support, including technical assistance, or
ARV drugs and system strengthening activities. In terms of Adult Care and Support, as of March 2008, the U.S. Mission in
Zambia supported 211,739 clients (on track to reach the Zambia target for 2008) at 651 service sites operating in all nine
provinces. Of these clients, 57% were women and 43% were men, reflecting the fact that far more women than men access care
and support in Zambia. Efforts to increase access for men are underway.
In FYs 2007 and 2008, the U.S. Mission in Zambia Adult ART priorities, in partnership with the GRZ, were to expand the number
of sites providing ART, improve quality of care, and increase ART uptake, including among children and their families.
The Adult ART scale-up includes public, private, and NGO/CBO/FBO facilities in all nine provinces. This rapid scale-up of
HIV/AIDS treatment services has been successful, with good clinical outcomes in urban, peri-urban, and rural primary care
settings. Progress continues in increasing access to ART at rural public and faith-based health care facilities. To address the
challenge of remote, sparsely populated areas, the U.S. Mission in Zambia supports development of a national network of ART
outreach sites. Doctors, trained in ART case management, travel to remote health centers on selected days with mini-labs, train
facility staff, and provide ART services.
In FY 2007, the MOH and the NAC revised the adult ART treatment guidelines with support from U.S. Mission in Zambia and its
partners. The revisions include change of first line ART regimen from Stavudine or Zidovudine based to Tenofovir based
combinations. The new guidelines were implemented in FY 2008. In FY 2008 the U.S. Mission in Zambia developed a public
health evaluation (PHE) to assess the cost effectiveness of Tenofovir based ART combination; this PHE will be carried out in FY
2009.
These guidelines are in use in ART provision in sites nationwide. The U.S. Mission in Zambia also assists the ART site
accreditation system to assess institutional capacity to deliver ART according to national guidelines and standards. U.S. Mission
in Zambia partners have assisted in the development of national policies, plans, and guidelines for the scale-up of ART services.
The U.S. Mission in Zambia will continue to provide technical assistance to the national ART program for development of training
materials and protocols, and for the dissemination of these materials.
As adult ART provision expands further, the GRZ is prioritizing pharmacovigilance in ART sites for providers to recognize, track
adverse events, side effects and monitor the efficacy of ARVs. Using the MOH guidelines on reporting adverse events and
treatment failure, ART sites will provide timely information to the Pharmaceutical Board of Zambia on development of these
events.
The U.S. Mission in Zambia continues to promote comprehensive adult Care and Support, including pain management, as well as
preventive HBHC services, such as routine provision of low-cost, safe water treatment ("Clorin"), bed-nets to prevent malaria, and
Cotrimoxazole to reduce OIs. U.S. partners emphasize quality care, and document the various quality checklists, other quality
tools, and indicators they use to promote and monitor quality. U.S. partners follow Zambian national minimum standards for home
based care. National standards for hospice care are in the final stages of development. U.S. partners have supportive
supervision structures and personnel and undertake other efforts to improve quality.
The U.S. Mission in Zambia has supported significant shifts in adult Care and Support, including: 1) a paradigm shift from care
that began near the end-of life (HIV Stage III-IV), to adult care initiated at the time of HIV diagnosis (through Counseling and
Testing), and preventive care that extends and improves quality of life; 2) establishment of stronger linkages between Care and
Support and Adult ART; and 3) increased collaboration with the GRZ on policy and guidelines, including those for pain
management and prophylactic use of Cotrimoxazole (CTX). As a result, the MOH agreed in 2008, for the first time, to allow
designated hospices to stock and dispense pain drugs (oral morphine) under the guidance of a full-time qualified pharmacist.
In FY 2009, U.S. procurement of ARV drugs is covered in the HTXD program narrative. The U.S. Mission in Zambia has
supported integration of ART services with other Adult Care and Support and other clinical care services. The U.S. Mission in
Zambia supported integration of TB/HIV services and diagnostic counseling and testing for TB and hospitalized patients. A
national ARV drug resistance monitoring strategic plan was implemented in FY 2008. By end of 2008, the first group of monitors
will receive training in HIV drug resistance monitoring, and they will complete assessment of the first two sites.
The U.S. Mission in Zambia will continue to strengthen evaluation of the impact of ART and quality of services as well as
laboratory capacity to diagnose and monitor patients on ART in Zambia, and to provide support for CD4 count, liver and renal
function tests.
The U.S. Mission in Zambia will continue to help the GRZ standardize Adult Care and Support training, improve national Care
policies and protocols, strengthen infrastructure (e.g. hospices), establish a national hospice accreditation system, implement
facility-based quality assurance/ improvement programs, and develop and strengthen Care and Support information. The U.S.
Mission in Zambia will continue to strengthen the Palliative Care Association of Zambia (PCAZ). Continued capacity building of
Zambia's faith-based and community-based providers will include fund-raising and improved financial management capabilities to
ensure sustained continuation of Care after PEPFAR ends.
Embassy Lusaka and partners adhere to OGAC Food and Nutrition guidelines. The U.S. Mission in Zambia allocates around 2%
of its PEPFAR funds for targeted food and nutrition support. This package includes therapeutic and/or supplementary foods for
vulnerable groups identified by OGAC, as well as nutrition assessment and counseling. The U.S. Mission in Zambia used FYs
2007 and 2008 funds to support GRZ efforts to establish national therapeutic feeding guidelines, to launch the production of high
quality, affordable therapeutic and supplementary foods, as well as to target PMTCT clients and their infants for nutrition
assessment, counseling and nutrition support. Selected U.S. partners will continue to target HIV positive children with
micronutrient supplements.
Also new in FYs 2007 and 2008 was a focus on better management of HIV-related cancers, e.g., lymphoma and Kaposi's
sarcoma (KS), especially at the new Cancer Center in Lusaka. This facility is now operational and cares for people with various
cancers, such as the HIV related ones above.
In 2008, the U.S. Mission in Zambia began to support "Positive Prevention" to protect the health of PLWHA and prevent the
spread of HIV to sex partners. This support will expand in FY 2009. The rapid scale-up of care and treatment has enabled the
U.S. Mission in Zambia to reach PLWHA with clinic- and community-based prevention. Counseling on ARV adherence and
alcohol use will continue in FY 2009.
The U.S. Mission in Zambia and partners foster Zambian ownership of the Adult Care and ART programs to increase acceptance
and uptake of ART services by communities. To enhance sustainability, the U.S. Mission in Zambia supports the MOH, Provincial
Health Offices, and District Health Management Teams, along with U.S. partners, to lead increased access of ART. Improved
linkages and well-functioning referral systems among tuberculosis, PMTCT, antenatal care, STI, ART, and Adult CS services have
facilitated rapid scale-up of ART and adult care.
The U.S. Mission in Zambia will continue to build the Adult Care and Support capacity of the MOH, NAC, Provincial and District
Health Offices and Task Forces, and faith- and community-based organizations. Significant private support will also help leverage
and boost U.S. funded efforts. FY 2007 donations by private U.S.-based corporations, OGAC and PMI resulted in the distribution
of 500,000 insecticide treated bed nets, targeted at PLWHA and others at-risk. By 2008, these nets had helped to decrease
malaria case rates and deaths significantly.
Table 3.3.08:
ACTIVITY HAS BEEN MODIFIED IN FOLLOWING WAYS;
•Have included a prevention for positives activity in the antiretroviral therapy program (ART)
Activity Narrative:
Related activities: This activity links to AGPAF (#9000, #9003) and CRS (#8827, 8829).
The Eastern Provincial Health Office (EPHO) intends to scale-up and consolidate the provision of
antiretroviral therapy (ART) services in close linkage with Catholic Relief Services (CRS) and the Center for
Infectious Disease Research in Zambia (CIDRZ). The Eastern Province, with a population of 1.6 million
people has an HIV seroprevalence of 10.2% among the general population between 15- 49 years (DHS
2007). The province has eight districts and is primarily a rural province. Currently there are 13 sites
offering ART in the province, based primarily at the district hospitals, with the exception of Chadiza district
which does not have a district hospital and services are provided at the health center. The capital of the
province, Chipata, has five sites offering ART. A total of 16,650 clients (against a set target of 12,000) in
Eastern Province were receiving ART in the government program as of November, 2007.
Due to the large distance and poor road networks and transportation system in the province the cost of
providing care is high and access to ART is limited to those without means of transportation. In order to
increase access to ART for a larger section of the population, the PHO would like to expand the number of
service delivery points in five of the districts by an additional two sites per district. The EPHO plans to
expand ART services to the hard to reach areas of the province and will develop mobile ART clinics to
provide care to some of these areas. The EPHO will liaise with CIDRZ and CRS in the selection of sites to
avoid duplication and to increase geographical coverage of the province with ART services. The EPHO has
the advantage of having a presence and basic infrastructures in almost all corners of the province through
which ART services will be provided, although additional and rehabilitation of the existing infrastructures
may be required in some parts of the province.
In ongoing efforts to support national efforts, United States Government (USG), through Health and Human
Services (HHS)/ CDC provided direct support to EPHO for supportive supervision by provincial teams of
ART service delivery in districts and enabled improved linkages with the national ART program in fiscal
year (FY) 2007.Activities accomplished included monitoring visits to eight districts, training, policy and
guideline dissemination, participation in national quality improvement efforts, and integration and scale-up of
the national ART information system and the Continuity of Care: Patient Tracking System (CC: PTS).
In FY 2007, Elizabeth Glaser Pediatric AIDS Foundation - CIDRZ scaled-up support in Chipata and other
sites in Eastern Province. This support enabled key technical staff from EPHO to plan and integrate
services with CIDRZ and expanded and linked ART services in targeted and harder to reach districts
throughout the province. This resulted in improved HIV/AIDS linkages, joint monitoring of activities by
partners and programme management
In FY 2008 direct funding for ART service delivery and technical assistance complemented other support to
the province such as in TB/HIV and CT. The EPHO also trained 50 health workers in pediatric ART
management and 80 community members in ART adherence with support from the USG funds. Technical
support in recording, reporting, and monitoring ART services was provided together with assessment of
potential ART sites of which three sites were identified. This was done in collaboration with CARE
International, CIDRZ, and HSSP. To ensure comprehensive care for people living with HIV/AIDS and
adherence to treatment, Community Drug and Therapeutic committees were established in the four
districts. The funds were also used for salary support to the ART Focal point person.
In FY 2008, EPHO worked with Churches Health Association of Zambia (CHAZ), CIDRZ and CRS and
scaled-up support in ART services in Eastern Province.
The USG funds in 2008 supported the training of 50 additional staff using the national pediatric ART training
modules. Five staff were trained per site, to provide multidisciplinary team. This increased the number of
staff trained in ART in the province to 179. The bulk of the people trained were clinical officers (COs) and
nurses who have proved to be a reliable and effective group of workers in provision of ART in a resource
limited set up. The few ART trained physicians at the Provincial and District Hospitals in the province
provided supervision to the COs and nurses. Training included adherence and counseling. The additional
treatment sites resulted in an additional 2,000 persons that have received ART. Funds were also used for
infrastructure renovations and enhancements, such as remodeling, painting and procurement of basic
furniture for the existing ART sites and this helped to provide confidential service for the ART patients.
In FY 2009, emphasis will be placed in strengthening current sites, including comprehensive pediatric ART
and mobile ART services through technical support visits.
To improve the quality and care in the ART program, Clinical Care Teams (consisting of medical officer,
clinical officer and a nurse) will been formed in all the eight districts and will be mentored quarterly by our
two second level hospitals (St Francis and Chipata General Hospitals) under the leadership of the PHO .
The EPHO will also purchase a vehicle for Mambwe district to improve transport system and thereby
strengthen TB/HIV/PMTCT/ART and CT services. Mambwe is hard hit with transport.
In FY 2009 the EPHO will collaborate with ART treatment department to integrate behavior change through
prevention with positives. Three approaches will be used 1) asking clients if their partners have tested and
if not, they will be encouraged to bring them to test. The emphasis will be in the importance of a couple
knowing their status together 2) couples will be enrolled and engaged in discussions two hours once a week
for four weeks exploring HIV/STI/TB prevention and to come up with ways to limit new infections 3) after the
four sessions, couples/individuals will be referred to community support /discussion groups formed and with
people trained to promote prevention. Community groups will be led by community leaders trained in
prevention and behavior change using participatory learning activities. EPHO being predominantly rural
Activity Narrative: creating awareness in the male population will be paramount. Therefore sensitization messages targeting
males will be employed through the media, using the traditional and local leadership and using information,
education and communication (IEC) messages on posters written in both English and local languages.
Of the funds under this activity, $85,000 will be dedicated to support prevention for positives activity. The
funds will be used to hire prevention for positives coordinator and deputy to be based at the EPHO,
additional counseling staff to engage patients into longer counseling sessions that address prevention,
alcohol abuse and adherence, staff to run the discussion groups and train community leaders in prevention
will be based in the selected districts. Funds will also be used to provide transportation (Bicycles) for
community leaders for follow up with community discussion groups both at community and district levels
(Motorcycles). Funds will also be used to develop materials and implement the program in at least six
districts sites in the province.
The PWP program will integrate with CT and OP programs. In this regard there will be need to create
space and provide furniture and other essential supplies and equipment(computers, printer, a laptop, office
furniture) for use by the program coordinators and other staff in the districts
EPHO will work with Intrahealth and school of medicine (SOM) who are funded to build provincial health
facilities' capacity to deliver prevention for positives and negatives program to the six districts in the
province as well as integrate prevention into other aspects of health care. Intrahealth will continue to
provide supportive supervision on quarterly basis initially and then bi-annually. The EPHO will provide
technical support supervision to the districts on quarterly basis and the districts to the health facilities on
monthly basis. A monitoring component will be initiated to tract program outcome.
Continuing Activity: 15547
15547 9751.08 HHS/Centers for Provincial Health 7179 2988.08 EPHO - 1 U2G $200,000
9751 9751.07 HHS/Centers for Provincial Health 5008 2988.07 EPHO - 1 U2G $200,000
Estimated amount of funding that is planned for Human Capacity Development $140,000
Table 3.3.09:
THIS ACTIVITY IS A CONTINUATION OF 2008 TREATMENT PROGRAM. A SEPERATE NARRATIVE
HAS BEEN INCLUDED FOR PEDAITRICS IN THIS SECTION FOR FY 09
Related activities: This is a new activity for FY 2009 funding. This activity links to EGPAF (#9000, #9003)
and CRS (#8827, 8829), PMTCT activities under EPHO and CHAZ (#9736.08 and 9734.08), and EGPAF
pediatric treatment program (# NEW PDTX).
The Eastern Provincial Health Office (EPHO) intends to scale-up and consolidate provision of the
antiretroviral therapy (ART) services in close linkage with Catholic Relief Services (CRS) and Center for
Infectious Disease Research in Zambia (CIDRZ). Eastern Province, with a population of 1.6 million people
has an HIV seroprevalence of 10.2% among the general population between 15- 49 years (Demographic
Health Survey 2002). The province has eight districts and is primarily a rural province. Currently there are
13 sites offering ART in the province, based primarily at the district hospitals, with the exception of the
Chadiza district which does not have a district hospital and services are provided at the health center. The
capital of the province, Chipata, has two sites offering ART. Of 16,650 people on ART less than six percent
are children. The programme to reach children is recent and has had setbacks in the past due to lack of
diagnostic guidelines, few staff were trained in paediatric ART management and also pediatrics ART
formulations were not available.
In FY 2007, Elizabeth Glaser Pediatric AIDS Foundation and its sub-partner ,CIDRZ, scaled-up support in
Chipata and other sites in Eastern Province. This support enabled key technical staff from EPHO to plan
and integrate services with CIDRZ and expanded and linked ART services in targeted and harder to reach
districts throughout the province.
In FY 2008 direct funding for ART service delivery and technical assistance from CDC contributed in the
following areas to scale-up pediatric treatment: training in child counselling and testing, provider initiated
approach to testing children in health settings, training of health care workers in management of HIV
infected children, management of opportunistic infections and training in use of dried blood spots for infants
(DBS). Other areas of support included infrastructure renovations and enhancements, such as remodeling,
painting and procurement of basic furniture for the existing ART sites in order to provide confidential service
for the ART patients, including children.
Strategies to increase uptake of children on the program in FY 2009 will include:
•Intensifying enrolment of children in all the current 18 ART sites, including co-trimoxazole prophylaxis and
management of opportunistic infections
•Supporting four districts not adequately covered by partners like CIDRZ and CHAZ
•Rolling out the provider initiated counseling and testing approach
•Increasing access and strengthening systems for early infant diagnosis, including courier system for
transport of DBS samples.
•Zambia has adopted the new WHO guidance to treat all infants below 12 months who have a confirmed
HIV test result.
•Scaling up and buy into existing mobile clinic initiative and ensuring this includes enrollment of children into
care and treatment.
•Increasing stakeholder partnering through consultative meetings to support supervision monitoring and
evaluation, DBS transport and Pediatric ART trainings to maximize output. Currently there are at least 15
key partners working in various HIV and related fields in the province.
•Supporting monthly meetings and clinical symposia at district level to discuss advances in HIV.
•Linking up with other wraparound programs to ensure prevention and treatment of malaria (Presidents
Malaria Initiative), safe water using chlorine, nutritional assessment and management of malnutrition
(support the development and implementation of a USG Zambia food and nutrition strategy, as well as to
consider adopting a common technical approach to food and nutrition support), pain management and
expanded program for immunizations.
•Strengthening links between PMTCT and pediatric ART programs, including issues around infant feeding.
•Increasing community participation through awareness campaigns, use of community adherence
supporters and regular community level meetings
At the end of FY 2009, it is anticipated that an additional 300 HIV-infected children will be initiated on ART,
training of 50 health care workers in comprehensive pediatric ART (management of OI's, DBS, adherence,
disclosure etc).
Sustainability of the program will be ensured through capacity building at all levels of service delivery.
EPHO and the Districts must own this program and incorporate it in their action plan. Activities will be
implemented by the districts and the EPHO will take a monitoring role. Community empowerment is very
cardinal to ensure success of the program.
* Malaria (PMI)
Estimated amount of funding that is planned for Human Capacity Development $40,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $5,000
and Service Delivery
Table 3.3.11:
The funding level for this activity in FY 2009 will remain the same as in FY 2008. Narrative changes include
updates on the progress made and expansion of activities.
Activity Narrative
This activity relates to activities in counseling and testing (CT), laboratory infrastructure, palliative care, and
basic health support activities.
Eastern Province includes eight (8) districts, which predominately are rural with an overall HIV prevalence of
10.2% and notified 3171 tuberculosis (TB) cases in 2007. Outside of Chipata, the provincial head quarters,
access to health-care facilities and services are limited. TB/HIV integration activities were initiated by
CARE International using USG funds in FY 2005 and 93 health- workers, from the 3 highest population
districts (Chipata, Katete, and Petauke) were provided with some level of TB/HIV integration training. The
largest barriers to implementing and maintaining TB/HIV integration were due to limited human resources,
coupled with an expected increase in patient-load.
In FY 2006, the United States Government (USG) provided funding to the Eastern Provincial Health Office
(EPHO) to support four disadvantaged districts namely Chadiza, Chama, Mambwe, and Nyimba. This
support enabled the province to train 19 health workers from TB diagnostic centers in TB/HIV integration.
To address the staffing issues, by the end of budget period 2006, the USG supported the Provincial Health
Office (PHO) to employ a TB/HIV focal point person who is based in the Provincial Health Office and is
responsible for coordinating TB/HIV activities such as supervision, training, surveillance, program
monitoring and evaluation. The TB/HIV focal point person has been working closely with the Provincial
TB/HIV committee in coordinating activities in the province and providing joint supportive supervision. Three
laptops were procured for easy storage, analysis and reporting of data.
Other than the USG support, the districts have been receiving support from Global Funds to scale -up TB
control by strengthening directly observed treatment strategy (DOTS). Another key partner is CARE
International (#8819), which also previously supported TB control activities in the area for the past three
years. Due to the limited access to health care facilities and acute shortage of facility-based health care
staff in Eastern Province, special emphasis was placed on the development and support of community
volunteers to provide TB/HIV integrated care.
In FY 2007, the following activities were undertaken with support from USG:
Chadiza, Chama, Mambwe, and Nyimba districts trained a total of 88 health staff in TB/HIV integration, 124
health staff trained in provider initiated counseling and testing (PICT) and 120 lay counselors from the
community were trained in TB/HIV collaborative activities to strengthen community support and awareness.
Monthly community sensitization meetings with the neighborhood Health Committees, Churches and other
community leaders were held. Monthly and quarterly supportive technical supervision to the sites was
provided by the districts and the province respectively. Quarterly provincial TB/HIV meetings were held to
monitor program activities at the district, health centre and community levels. To increase TB/HIV
awareness to the community, all four districts participated in the World TB day commemoration. Linkages
between the TB program and other USG funded home-based care programs were strengthened through
meetings and supervision to ensure continuum of care for HIV infected TB patients.
In FY 2007 an assessment of infrastructure was carried out to identify sites that required minor renovations
and refurbishment in order to ensure the availability of appropriate infrastructure to provide the counseling
and testing for TB patients and reduce transmission of TB in clinic settings. One counseling, testing and,
care (CTC) room in Nyimba at Chipembe RHC has been completed and is in use. The other CTC room in
Chama has delayed because the district bought building materials for a new building instead of materials for
renovations. However the district has made arrangements with the MOH for top up funds to start
construction of the building.
To enhance equity in coverage and ensure standardization of TB/HIV services CIDRZ, CARE International
and Churches Health Association of Zambia (CHAZ) worked with PHO to provide technical assistance and
capacity building in the integration of TB/HIV care in all the districts in the province (Chadiza, Chama,
Chipata, Katete, Lundazi, Mambwe, Nyimba, and Petauke).
Additional technical support was provided by the Clinical Care Specialist under HSSP. The CDC Field
Office Manager provided technical support and ensured coordination of implementing partners was
strengthened. To reduce on the shortage of transport, EPHO procured a vehicle to support program
implementation.
In 2007 out of 52 health facilities providing TB treatment in the four districts, 12 reported HIV testing for TB
patients. This increased from 20 sites in FY 2008 to 25 in FY 2009. Of the estimated number of 678 TB
patients the EPHO reached 450 TB patients and, 70% (315) received counseling and testing for HIV and
were referred for HIV care and treatment including ART. Nine hundred HIV positive clients were diagnosed
and 40% (360) were screened for TB disease; 75% of TB patients' referred for ART services received HIV
care and support. The TB patients found eligible for ART were commenced on treatment according to the
national guidelines. A system to track the referrals and the TB patients commenced on ART has been
developed. Isoniazide preventive treatment (IPT) for HIV clients does not currently form part of the national
program guidelines for TB/HIV activities and hence were not implemented.
In FY 2008, 100 health workers received training in TB/HIV collaborative activities at health facility. The
training for the health staff focused on the provider initiated counseling and testing (PICT). Quality of care
was assured through supportive supervision to the staff and community volunteers after the training.
The EPHO and district health management team (DHMT) conducted quarterly supervision to the trained
facility staff .Community volunteers were provided with technical support monthly by the health center staff.
The DHMTs conducted quarterly TB/HIV technical review meetings for the health center staff where data
was analyzed and validated before submission to the province. Quarterly meetings took place for the
Activity Narrative: community TB/ART lay counselors and adherence treatment supporters to share experiences. Reports from
community level were submitted to the health centers. Quarterly TB/HIV technical review meetings were
organized by EPHO to analyze and validate the data from the four districts.
The EPHO strengthened the provincial TB/HIV coordinating body through meetings. Quarterly meetings
were held and focus was on the formation and integration of the program in the districts. The district TB/HIV
coordinating bodies were established in the four districts and quarterly meetings were held.
Renovations of infrastructure in four districts to create space for TB/HIV and laboratory services, to prevent
the spread of TB infection were done. Each district indentified one site to be renovated.
To enhance quality service provision, four staff will be employed in the four EPHO districts.
In addition training was conducted for staff in the provincial hospitals and district hospitals in the guidelines
on prevention of TB in health care settings under development by Jhpiego
In FY 2009, the EPHO will strengthen the already existing programs of integrated supervision and
monitoring of the program with partners to harmonize and standardize the activities. The project will conduct
a refresher course for 100 health workers and 200 community members in TB/HIV. To prevent cross
infection in ART sites, an additional four rooms will be renovated in the four districts (Chadiza, Chama,
Mambwe, and Nyimba).
Other preventive programs will be done in the district e.g. Media, Drama, post-TB support groups,
commemoration of world TB, VCT and World AIDS days in collaboration with partners like Global Fund,
CARE International, CHAZ and, Center for Infectious Diseases Research in Zambia (CIDRZ). Counseling
and testing in TB patients for HIV will continue in collaboration with other programs (PMTCT, ART, and
VCT) and also the screening of HIV positive patients for TB in HIV programs. The number of health
Facilities in the four districts has increased from 52 to 58 since the last reporting period. Therefore it is
estimated that EPHO will have 25 service outlets for TB/HIV collaborative services
In FY 2009 it is estimated that 520 TB patients will be put on treatment of which 91% (475) will be
counseled and tested for HIV. A total of 285 HIV infected individuals will receive treatment for TB
Due to shortage of staff in the health facilities EPHO will employ four more staff for districts that will be
stationed in four indentified health facilities. Renovation of the houses for the four staff will also be done.
EPHO will continue working together with partners and districts in the implementation of the TB/HIV
activities through the holding of the TB/HIV coordinating bodies, TB/HIV review and partners meetings.
Meetings will continue integrating all program areas. EPHO will also monitor the Co-trimoxazole prophylaxis
therapy which will be implemented as a pilot in Chipata district at two sites.
To ensure sustainability, the activities will be enshrined in the district health plans for the Ministry of Health.
Targets set for this activity cover a period ending September 30, 2010.
Continuing Activity: 15545
15545 3790.08 HHS/Centers for Provincial Health 7179 2988.08 EPHO - 1 U2G $315,000
9006 3790.07 HHS/Centers for Provincial Health 5008 2988.07 EPHO - 1 U2G $190,000
3790 3790.06 HHS/Centers for Provincial Health 2988 2988.06 Eastern $100,000
Disease Control & Office - Eastern Provincial
Prevention Province Health Office
Estimated amount of funding that is planned for Human Capacity Development $250,000
Table 3.3.12:
THIS IS ACTIVITY UNCHANGED FROM FY 2008. ONLY MINOR UPDATES INCLUDED
Related activities: This activity is linked to all Eastern province funded activities under TB/HIV (# 3791.08),
adult and pediatric treatment (#9751.08 and # NEW Peds) laboratory services (#9795.08) and strategic
information (#9693.08) as well as partner funded activities under counseling and testing CARE #9714.08
and AIDS Relief #9713.08.
In Eastern Province the estimated HIV prevalence rate among adults aged 15-49 years is10.2%. In 2004
the HIV prevalence rates among adults aged 15-49 years in Chipata, Katete and Petauke were 26.3%,
18.1% and 9.3% respectively as reflected in DHS 2007 report. The CT program is in four districts and the
Eastern Province Health Office (EPHO) will share sites in Chama and Chadiza to cover gaps with CARE
International. EPHO will implement continue to implement in the four districts, Chama, Chadiza, Nyimba
and Mambwe.
The provincial tuberculosis (TB) notification rate in 2004 was 263/100,000 population. The syphilis
prevalence rates among adults aged 15-49 years is estimated to be 9.3%.
In FY 2006, the United States Government (USG) supported a number of counseling and testing activities,
at the EPHO, including rehabilitation and renovation of counselling and testing rooms in the four selected
health facilities (Nyimba, Mambwe, Chama and Chadiza); training of 100 community lay counselors and 40
health care workers in adherence counseling; and setting up appropriate referrals to health centers was
conducted. In addition the district recording and reporting system was used to document counseling
activities as well as fulfill the reporting targets under President's Emergency Plan for AIDS Relief.
In FY 2007, USG continued to support the EPHO to expand the counselling and testing activities to four
additional sites within these districts for a total of eight. The recent national policy of providing routine
counseling and testing in health facilities, including all TB patients, supported the plan to train 80 health care
providers in HIV/AIDS counselling and rapid HIV testing. These trainings included appropriate referral of
HIV positive clients to PMTCT and ART services and emphasis on prevention of transmission of HIV among
those who tested positive (positive prevention as well as issues surrounding disclosure and discordance).
This training program complemented the training that was provided under activity EPHO HTXS (# 8819)
and EPHO HVTB (#9006) in HIV and ARV's and OI's; TB/HIV and STI/HIV integration. Due to the current
human resource crisis in Zambia, an additional 100 lay counselors were trained in counselling to increase
HIV awareness, care and referral of cases that needed further counselling and care to health facilities.
These counselors have helped improve adherence among patients on ART as well as patient on both TB
and HIV therapy..
During FY 2008 there were eight service outlets out of 48 representing 17% coverage. The EPHO and the
District Health Management Teams provided technical supervision to remote sites monthly. Monthly
meetings at health center level for monitoring and sharing experiences on the progress counseling and
testing in each of the four districts were held. Linkages with other USG funded programs in the area of
prevention, and those supported with the Global fund activities (TB) were strengthened through quarterly
partner meetings which were held to share experiences and avoid overlap especially during trainings.
Logistics such as HIV test kits were supported by the USG through the Central Medical Stores. The districts
held monthly meetings with organizations and community based groups implementing CT activities to report
on findings, share experiences and to identify weaknesses. The expected outcome of providing HIV testing
services to 400 STI patients and 200 HIV/AIDS patients was achieved and approximately 1,322 clients
received CT services from the CT outlets. These activities were coordinated by the EPHO and linked to the
activities to be implemented by CARE International (HVCT 9713) and resulted in a substantial increase in
access to CT in the province in all districts. Additional support for CT was provided by Faith Based
Institutions in two districts through Catholic Relief Services HVCT (#9714).
Established structures in terms of human resource, infrastructure, and resource mobilization through the
Government of the Republic of Zambia and other donors provided support to ensure sustainability of the
program. The activities also included future national health plans, which will secure national funding for the
activities. Emphasis on training and incorporation of CT in all service delivery was done and this
empowered staff and this surely ensures long term sustainability. Global Fund money was used to support
these activities as the EPHO is now integrating all programs and CT is areas that cross cuts in all programs.
By the end of FY 2008, 80 health workers were trained in counselling, and 100 lay counselors from the
community were trained to reinforce staff shortage and enhance referrals from the community to the health
facility. All participants were drawn from the EPHO four districts. The EPHO through the four districts
managed to have 4000 clients counseled and tested for HIV and received their test results including TB.
In FY 2009 this activity will cut across the other programs as a routine activity in PMTCT, TB/HIV/ART/STIs.
This will be done during trainings in counseling and testing for health care providers to provide
comprehensive counseling and testing through stand alone and integrated VCT services in health facilities
in the provision of counselling and testing for diagnostic purposes for in and out patients. The EPHO will
scale up CT services to an additional 12 sites in the four districts, giving a total of 20 supported sites. To
achieve this the EPHO will work at a five days training of 80 health workers from the two districts in
counselling and testing, appropriate referral of HIV positive clients, prevention of transmission and TB
screening using a specifically designed questionnaire in the four districts. The EPHO will work with
community leadership to promote couple counseling and testing and also work with partners to promote to
ensure CVCT and CT for prevention of positives. The EPHO will also through the districts to the community
leaders encourage couple counseling and community leaders will be taken through an orientation on how to
support this activity.
Due to shortage of human resource, the FY 2009 funds will support the strengthening and expanding
counseling and testing services by working at training an additional 100 lay community members in
Activity Narrative: counseling, a total of 50 participants in the two districts Nyimba and Mambwe will be trained in drug
adherence. This will work toward removing stigma and discrimination. The district counselors will hold
monthly meetings with the health facilities and Hospitals offering CT services. In addition to the monthly
meetings, integrated quarterly partners meetings in TB/HIV, ART, PMTCT and STI will be held. Theses are
meetings that will be attended by EPHO partners like CHAZ, CIDRZ, CARE International, Provincial AIDS
Coordinating Advisors, Corridors of Hope and many more that are in TB/HIV and Counseling programs.
This activity is also linked to and funded by other partners like Global funds support to diagnostic counseling
and testing and MOH funds for PMTCT and Reproductive health.
Continuing Activity: 15546
15546 3669.08 HHS/Centers for Provincial Health 7179 2988.08 EPHO - 1 U2G $100,000
9005 3669.07 HHS/Centers for Provincial Health 5008 2988.07 EPHO - 1 U2G $100,000
3669 3669.06 HHS/Centers for Provincial Health 2988 2988.06 Eastern $100,000
Estimated amount of funding that is planned for Human Capacity Development $80,000
Estimated amount of funding that is planned for Education $20,000
Table 3.3.14:
April '09 Reprogramming: Increase in funding amount by $150,000 to bring total funds to $350,000.
This activity is linked to the TB/HIV (#0724), PMTCT, CT and ART in Eastern Province Health Office
(EPHO), and the Centers for Disease Control and Prevention - Technical Assistance (CDC-TA #9022),
Comforce (#3704), Chest Diseases laboratory (CDL #15510), University Teaching Hospital (UTH # 9798),
EGPAF-CIDRZ (#16956) and Supply Chain Management Systems (SCMS # 9524) within the Lab section.
An estimated 40% of the Zambian population lives a walking distance of more than 12 kilometers to the
nearest health facility. Availability of laboratory services in most of the more rural districts continues to be
limited, due to several factors including shortage of man power and lack of suitable infrastructure and a
continual source of power. However, there is still an increasing demand for specialized laboratory
investigations to initiate and monitor antiretroviral therapy (ART).
In FY 2007-2008, the United States Government provided support to EPHO for the improvement and
implementation of quality assurance/quality control (QA/QC) programs in prevention of mother to child
transmission of HIV (PMTCT), counseling and testing (CT), diagnostic counseling and testing (DCT),
tuberculosis (TB) HIV and ART laboratory services. The goal of this activity was to build capacity and
sustainability at the local level by transferring skills for equipment procurement and maintenance, sample
transport, and establish laboratory quality systems within the province by supporting training on orientation
of quality improvement on all sites. In FY 2008 in collaboration with CDC, UTH, and CDL the goal of
Eastern Province was to reach 15 laboratories.
In FY 2009, EPHO will work with MOH, CDC, and other partners to conduct the following activities: 1)
support quarterly meetings on TB and HIV/AIDS for 20 health center laboratory staff. Quarterly quality
control supervision in HIV rapid testing in 15 hospitals will be conducted by EPHO and Chipata General
Hospital staff to enhance accuracy of HIV rapid testing and reporting and TB sputum microscopy
examination.; 2) Improve TB acid fast bacilli (AFB) smear diagnosis by using LED microscopy; 3)
strengthen TB diagnosis capabilities by strengthening existing TB laboratory network within the Eastern
Province. EPHO will support external quality assurance (EQA) activities in the province by training staff and
participating the national TB EQA program using EQA Panels generated from CDL. A one day bi-annual
TB/HIV quality control review meetings at the Provincial Health Office for 10 laboratory staff will be
conducted, 3) continue to improve clinical laboratory services including CD4, blood chemistry and
hematology in support of ART patients care and treatment; 4) conduct supervisory visits to district health
centers and hospitals laboratories; 5) ensure smooth functioning of the courier system for dried blood spots
(DBS) for early infant diagnosis and sputum samples to the reference Laboratories; 6) continue to renovate
laboratory at four healthcare facilities; 7) procure laboratory equipment and supplies and equipment service
maintenance contracts; 8) hire an additional laboratory deputy coordinator (biomedical scientist) and a
laboratory technologist to assist the provincial laboratory manager to coordinate with the CDC Zambia
provincial contact for improving quality of laboratory services, training and all other lab program activities
within the Eastern province; 9) support the roll-out of laboratory QA programs for rapid HIV testing, DBS
collection, and TB in the Eastern province. Plans will be drafted to identify training sites, participants,
dates, and time. The activity funds will support and cover the cost of the training; to monitor and evaluate
the performance of staff at testing sites; to support participant transportation to training sites and training
materials to ensure smooth, effective and efficient subsequent roll out in all districts at all sites in Eastern
Province. In addition, an integrated program to include, laboratory data management, onsite quality
assurance that assist in improving and standardizing antiretroviral therapy laboratory services will continue.
Furthermore, in FY 2009, EPHO will also assist the MOH, UTH, and CDC with its national quality assurance
(QA) activities in other laboratory testing including CD4. The province will also work with the supply chain
management (SCMS) to ensure un-interrupted supply of Laboratory commodities. EPHO will also
communicate with partners involved in the laboratory program regularly, co-ordinate and support regular
meetings with CDC and other partners, to allow dissemination of activity and improve collaboration to avoid
duplication of activities and encourage feedback.
To establish a sustainable program, EPHO will work with existing clinical facilities, MOH, CDC and other
partners and strengthen their capacity to provide continual quality Lab services and programs.
The activities will compliment and support the MOH National Lab QA program, to continue to build local
capacity and sustainability.
Continuing Activity: 15548
15548 9795.08 HHS/Centers for Provincial Health 7179 2988.08 EPHO - 1 U2G $200,000
9795 9795.07 HHS/Centers for Provincial Health 5008 2988.07 EPHO - 1 U2G $300,000
Workplace Programs
Table 3.3.16:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS: Funding has been increased.
This narrative relates to Ministry of Health (MOH) (#3713.08), and Technical Assistance/ Centers for
Disease Control and Prevention (CDC) (#3714.08).
Eastern province, has eight districts, is predominantly rural with an overall HIV prevalence of 10.3 % (DHSZ
2007) and a reported tuberculosis (TB) notification of 3171 in 2007. Outside of the provincial capital of
Chipata (which has an HIV prevalence of 26.3 % and TB notification rate of 2007 of 380/100/000), access to
healthcare facilities and services are limited.
In FY 2009 proposed funding will continue with support to Very Small Aperture Terminal (VSAT) internet
connection for the Provincial Health office (PHO) and all eight districts in the province. This will continue to
aid the timely transmission and reception of information and data from the rural districts to aid timely
decision making. Improved internet services and email communication thereby reduced the isolation
through increased access to information from all locations within the province. The availability of good
internet access is also an important motivator in that it assists in retaining of staff as it offers an opportunity
to access online medical journals for such things as new best practices in health care and also allows for
participation in distant learning program. Such investment in technology is a sustainable contribution to
essential communication infrastructure. The government of the republic of Zambia's National Development
plan places improved information services as a top priority, thereby assuring sustainability of such an
investment way into the future.
The second major component will be the continued training, implementation and maintenance of the
SmartCare system throughout the province. Typical activities will be around assuring site preparedness,
training of various cadres such as facility staff, program managers, district and provincial management on
the use of the system (will be on-going due to the still high staff turnover especially at the facility level),
assuring data flow between the facilities and higher levels and regular planning and feedback meetings
between the provincial management and the district management.
In FY 2009, the EPHO will work at building capacity to 42 staff from the eight districts in use of the
SmartCare system. Quarterly SmartCare meetings will be carried out as a way of assuring holistic technical
assistance review, data sharing, compilation, and analysis. To establish a sustainable approach to
implementation and use of electronic health records systems, the EPHO will work with districts at training
eight district staff in data management and audit.
Continuing Activity: 15549
15549 9693.08 HHS/Centers for Provincial Health 7179 2988.08 EPHO - 1 U2G $100,000
9693 9693.07 HHS/Centers for Provincial Health 5008 2988.07 EPHO - 1 U2G $50,000
Table 3.3.17:
