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 2009 has decreased since FY 2008. Narrative changes include
updates on progress made and expansion of activities.
Centers for Disease Control and Prevention (CDC)-Zambia will continue providing technical assistance to
the Ministry of Health (MOH), the National HIV/AIDS/STI/TB Council (NAC), and implementing partners in
the continued expansion of prevention of mother to child transmission of HIV (PMTCT) services nationally.
In FY 2006, direct support was provided in terms of educational materials for the national program, job aids
for health workers, an assessment on infant and young child feeding in the context of HIV/AIDS, and
national dissemination meetings for both national and international technical updates, an activity that CDC
will continue in FY 2009 as the area of materials development such as job aids tends to have gaps. Since
FY 2007, CDC-Zambia has continuously assisted the MOH to strengthen the monitoring and data system
from facility to national-level reporting using the CDC developed PMTCT monitoring system and the
SmartCare.
In an effort to improve the national PMTCT program and provide HIV treatment to children before they
become symptomatic, the United States Government (USG) has supported the Government of the Republic
of Zambia since FY 2006 to evaluate an inexpensive and less complex approach for use in the diagnosis of
infant HIV-1 infection in Zambia. Using FY 2005 funds, equipment for two different methods of infant HIV
diagnosis has been installed by CDC at the National Infant Diagnosis Reference Laboratory at the
University Teaching Hospital (UTH) in Lusaka. These methods include the regular Roche Amplicor 1.5
deoxyribonucleic acid (DNA) Polymerase Chain Reaction (PCR) assay and the Total nucleic assay (TNA)
assay which detects both ribonucleic acid (RNA) and DNA. Both techniques have performed very well in
quality assurance and quality control evaluations at the laboratory, including on dried blood spots collected
from infant heel sticks at University Teaching Hospital (UTH). A third DNA-PCR lab has been established
with USG support at the Arthur Davidson Pediatric Hospital in the Copperbelt Province and provides
services for the northern half of the country. By June 2007, a number of PMTCT sites across the country
had started sending infant dried blood spots routinely to the National Infant Diagnosis Reference Laboratory
in Lusaka. Early results showed that it is feasible to provide early infant testing facilities at both rural and
urban sites. In FY 2008, in collaboration with Clinton Foundation, PCR testing on infant dried blood spots
was rolled-out and implemented nationwide based on the courier systems linked to the three PCR reference
laboratories. In FY 2009, CDC will strengthen the linkages with the Pediatric Care and Support program to
ensure that there is continuity of care of the exposed infant through the integration of dried blood spots
(DBS) in routine maternal, neonatal and child health services.
In FY 2009, as in previous years, the USG will continue strengthening the national PMTCT program through
the procurement of back-up (buffer) supplies in-line with the U.S. Five-Year Global HIV/AIDS Strategy. As
part of this activity, the USG will procure supplies that are vital in the provision of the national minimum
package of PMTCT to avoid national stock-outs that would disrupt provision of services. CDC will support
the national PMTCT program with technical assistance and support for study tours and other relevant
programmatic reviews.
Lack of well defined male involvement activities in PMTCT has been cited as one of the compounding
factors that impact on the program significantly. Anecdotal evidence has attributed the lack of male
involvement to low levels of disclosure of HIV results of pregnant women to their husbands which lead to a
low uptake of both mother-infant ARV prophylaxes, few HIV positive women accessing care and treatment
services and inadequate support of infant feeding choices. In FY 2009, CDC in collaboration with USG
partners and the MOH will pilot a male involvement intervention that is community-based and that engages
pregnant women's partners in access to antenatal clinic (ANC) services. The pilot will offer prenatal
education, couple counseling and address male norms that act as barriers in male's participation in health
seeking behaviors in reproductive health. The objective of this pilot is to develop new interventions that
directly encourage men to participate in the birth preparedness of their children whilst challenging widely-
held male norms. This activity will also be linked with work being conducted by USG partners currently
working in the area of couple counseling. Secondly, CDC will partner with PMTCT implementing partners to
pilot an infant feeding intervention that explores and addresses infant feeding practices in the context of
HIV/AIDS. Activities that address: abrupt weaning, safe transition period during weaning, exclusive
breastfeeding and complementary feeding will be explored. Based on the results of the two pilots, full public
health evaluation protocols will be developed.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15588
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15588 3574.08 HHS/Centers for US Centers for 7192 3013.08 CDC Technical $375,000
Disease Control & Disease Control Assistance
Prevention and Prevention (GHAI)
9019 3574.07 HHS/Centers for US Centers for 5016 3013.07 CDC Technical $125,000
3574 3574.06 HHS/Centers for US Centers for 3013 3013.06 Technical $225,000
Prevention and Prevention
Emphasis Areas
Gender
* Addressing male norms and behaviors
Human Capacity Development
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 to all prevention narratives, Abstinence and Being Faithful, Other Prevention including
Male Circumcision (MC) and all counseling and testing (CT) activities. It is also linked to antiretroviral (ART)
treatment section addressing prevention with positives as well counseling and testing. In FY 2009, the
focus will be providing technical assistance (TA) in working with communities and various points of care to
integrate prevention and to link to those who are negative and positive to the various community groups.
The TA will be provided to partners to implement the new prevention strategy expected to available in 2009.
Provincial meetings will he held with partners on the national strategy to build capacity of local Ministry of
Health (MOH) staff to take leadership in promoting comprehensive and effective prevention for
sustainability.
Zambia has a population of approximately 10 million citizens (US Department of State, 2006), and overall
HIV prevalence is still 14.3% among the general population and 13% among men (Zambia Demographic
Health Survey, 2002). While it is evident through the DHS survey that many Zambians know about
HIV/AIDS and its modes of transmission, there has been minimal reduction in HIV prevalence in Zambia in
the last few years, a clear indication that knowledge is not translating into behavior change as expected.
This
activity will work with the government, other donors, and experts from other PEPFAR countries to share
lessons learned and redirect prevention strategies in Zambia.
This activity will provide technical guidance in the implementation of PEPFAR activities in relation to care,
treatment, and prevention. This activity will be carried in close collaboration with Zambian partners and
USG agency technical specialists. In addition, the activity will provide oversight to ensure that PEPFAR
funded activities are programmatically sound and consistent with the Zambian National Health Strategic
Plan; train technical officers in relevant behavioral science to build local capacity; develop evaluation and
assessments to measure impact and programmatic effectiveness of interventions; recommend best
practices; participate in design of programs and represent the USG in national planning and technical
committees.
Funding for this activity will provide support for national/MOH sexually transmitted infections (STI) meetings
and prevention meetings as well as travel to the field to monitor implementation of prevention and CT
programs. Funds will also support international travel to, male circumcision (MC), counseling and testing
(CT), sexually transmitted infections (STI), and prevention conferences.
Continuing Activity: 19499
19499 19499.08 HHS/Centers for US Centers for 7192 3013.08 CDC Technical $90,000
Table 3.3.03:
FUNDING FOR THIS ACTIVITY HAS BEEN REDUCED FROM FY 2008.
In fiscal year FY 2008 funds under this activity were reprogrammed directly to the partner to support
purchase of a mobile Pediatric ART unit. FY 2009 funds are requested to provide technical assistance (TA)
in the area of care and support for both adults and children. The TA visits will focus on clinical care,
psychological care, spiritual care, social care, and prevention services and will often be combined with other
program area reviews around adult and pediatric treatment including wrap around activities. In addition
these funds will allow for one international travel to attend a relevant training, workshop, or symposium.
Continuing Activity: 15590
15590 9770.08 HHS/Centers for US Centers for 7192 3013.08 CDC Technical $30,000
9770 9770.07 HHS/Centers for US Centers for 5016 3013.07 CDC Technical $0
Table 3.3.08:
ACTIVITY UNCHANGED FROM FY2008
The funding level for this activity in fiscal year (FY) 2009 has decreased since FY 2008 to support
implementing partner activities. Only minor narrative updates have been made to highlight progress and
achievements. This activity links to all antiretroviral therapy (ART) activities.
Implementation of the surveillance for antiretroviral (ARV) drug resistance is in process and technical
assistance for the development of surveillance for HIV-1 antiretroviral drug mutations has been provided by
the United States Government (USG).
The USG, through the Centers for Disease Control and Prevention (CDC), plans to continue providing
technical assistance to the Government of the Republic of Zambia on: 1) surveillance of antiretroviral (ARV)
drug resistance; 2) supervisory visits to project sites in four provinces to evaluate antiretroviral therapy
(ART) service delivery and quality improvement; 3) collaboration with MOH and the World Health
Organization (WHO) on ARV drug resistance surveillance; and 5) critical electronic medical record systems.
With the increased, widespread availability of ARV treatment in the public health sector, it is expected that
with time the numbers of drug resistance cases will increase. In FY 2005, in response to a specific request
from the Ministry of Health (MOH), the USG provided technical assistance to the national ART program in
developing a national plan for surveillance for HIV-1 antiretroviral drug mutations. In FY 2006 and 2007,
the USG provided support for the procurement of equipment and supplies, as well as training for laboratory
staff in testing for ARV drug resistance, in collaboration with Japan International Cooperation Agency, the
University of Nebraska-Lincoln, and the University of Alabama-Birmingham.
In FY 2008, the USG continued providing technical assistance to key sites to ensure ongoing monitoring of
drug resistance nationally, in close collaboration with the WHO, MOH, and all cooperating partners in
provision of ART services.
In FY 2008 funds supported technical assistance from CDC care and treatment and strategic information
(SI) teams to the national program focusing on a quality improvement initiative in coordination with SI
activities such as the expansion of the SmartCare Electronic Health Record system and an ART cluster
evaluation. SmartCare was identified as the national electronic medical record system for ART and is to be
used in all sites where a computer is used.
In FY 2009, ARV drug resistance testing will be scaled-up and also become part of HIV care among
children who maintain high viral loads despite ongoing treatment at the USG-supported Center of Excllence
for Pediatric and Family HIV Care at the University Teaching Hospital Department of Pediatrics. CDC will
continue providing technical support to the national ART program and its coordinator including quality
improvement, monitoring and evaluation, and health management information systems. In FY 2009, funds
will continue supporting technical assistance from CDC care and treatment and strategic information (SI)
teams to the national program focusing on a quality improvement initiative in coordination with SI activities
such as the expansion of the SmartCare Electronic Health Record system and an ART cluster evaluation.
CDC-Zambia staff will continue engaging with the WHO on ART quality and guideline updates for pediatric
and adult ART as well as medical information data standards. Occasional travel and local meetings are
required on these tasks. In addition, funds within this activity will also be used for staffing costs needed to
monitor the scale-up of ARV services and infrastructure rehabilitation.
Continuing Activity: 15593
15593 3846.08 HHS/Centers for US Centers for 7192 3013.08 CDC Technical $278,000
9026 3846.07 HHS/Centers for US Centers for 5016 3013.07 CDC Technical $648,000
3846 3846.06 HHS/Centers for US Centers for 3013 3013.06 Technical $350,000
Table 3.3.09:
This PHE activity, "The role of supportive services in the provision of ART", was approved for inclusion in
the COP. The PHE tracking ID associated with this activity is ZM.07.0196.
Continuing Activity: 17704
17704 17704.08 HHS/Centers for US Centers for 7192 3013.08 CDC Technical $70,000
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 achievements
This activity relates to activities in counseling and testing (CT), laboratory infrastructure and support,
HIV/AIDS treatment services for adults and pediatrics.
This activity relates to activities in counseling and testing, laboratory infrastructure, palliative care: basic
health support activity, and HVTB (#9032, #9017, #8819, #8992, #9037, #9006, #9046, and #9010).
Provision for the following activities in support of the national implementation of TB/HIV activities is being
requested: 1) technical assistance for evaluation of surveillance system for TB/HIV implementation; 2.)
Provide supportive technical supervision to the Southern, Western, Eastern, and Lusaka provinces and 3)
inclusion of TB/HIV data elements in the SmartCare Electronic Health Records to improve patient care,
In FY 2007, the US Government (USG) provided support to the Ministry of Health (MOH) in the national
integration of Tuberculosis (TB) and HIV services by providing support to a variety of areas at the national
and local level, including support of TB policy processes, adaptation of guidelines and materials, and
preparation of TB clinical decision support systems. A National level TB/HIV coordinating body within the
MOH with the following membership; staff from the TB, HIV, CT units in MOH; multilateral organizations;
research groups; faith-based organizations; non-governmental organizations; and community
representatives.
This body was tasked with developing and implementing a single, coherent TB/HIV strategy, policy, and
communication message based on the best existing evidence. As a result national guidelines for the
implementation of TB/HIV activities were developed based on the World Health Organization (WHO) Interim
Guidelines for TB/HIV collaboration. Additional support was provided for the revision of TB data collection
forms and registers, based on WHO forms that incorporate the collection of HIV data. The USG produced
the revised patient treatment form, identification card, and registers that have been distributed to all
provinces and districts. Technical support was provided for the orientation of health staff in the new forms.
In addition the USG co-funded, with the MOH, WHO, and Jhpiego, a training of trainers session for an initial
group of 25 trainers in diagnostic counseling and testing using the national training module adapted by
JHPIEGO (#9032).
In FY 2007, the USG provided technical support to the MOH for the evaluation of surveillance systems for
TB/HIV implementation. A pilot evaluation of the revised TB/HIV reporting and recording systems in
Southern (21 health facilities) and Copperbelt provinces (17 health facilities) were sampled. The findings
showed that the recording and reporting systems needed strengthening and there was need to conduct a
country wide evaluation. In addition the evaluation identified weaknesses in the supervision of the health
facilities and in response the MOH has developed a supervisory tool that will be used by all TB officers and
allow for comparison of performance at different time points.
In FY 2008, the USG working in collaboration with the MOH and other partners conducted a similar
evaluation in Lusaka Province. The evaluation was done in Lusaka District, Kafue and Chongwe districts.
The evaluation brought out the strengths and weaknesses of the program which facilitated program
planning.
In FY 2008 the USG directly funded the NTP to repeat the evaluation of the national TB/HIV surveillance
system in all the remaining six provinces. The findings of this national evaluation will provide information on
how well the program is performing and will facilitate planning to make the NTP achieve better out comes in
TB/HIV activities. Technical assistance for this evaluation would be provided for by the USG in conjunction
with other members of the National TB/HIV coordinating Committee.
In FY 2008 the USG provided supportive technical assistance to the NTP through supervision to the
provinces, districts and health facilities in Southern, Western, Eastern, and Lusaka provinces. During these
visits, on the job training to over 100 health care workers was provided. The supervision team combined
with the National TB program staff and other partners in TB and HIV control Programs.
In FY 2009, the USG will continue to provide technical supportive supervision to the four provinces.
Program coordinators at provincial, District and health facility levels and community volunteers will receive
on the job training. It is expected that 120 health care providers will be reached during this period.
This activity is related to activity #9023. To sustain policy and clinical decision-making for future expansion
of national TB activities, CDC has assisted the MOH in establishing an Electronic Medical Health Record
(EMR) standard that now includes TB data as well as HIV and other opportunistic infections (OI's) data. In
the last year, this EMR, now called SmartCare (previously called CCPTS), was established as the national
standard software for use in any clinic that could support a computer. This remarkable consensus
achievement by the MOH is being followed by national training and deployment at the same time as there is
ongoing development of the out patient department (OPD) module that will include TB care planned for
release in 2007. The SmartCare already addresses TB care in the context of antiretroviral (ART) services,
but the pending OPD module will establish a bidirectional link between OPD TB services and ART TB
services provided either by a patient-carried smart card or via a periodic facility-by-facility database ‘merge'.
The EMR system and SmartCard carries a longitudinal record of a client's medical history, including prior
illness, physical findings, lab results, symptoms, problem list with diagnoses, and treatment plan for all
these services. A paper and electronic copy of patient information is maintained at all clinics visited, and
paper records are still used for primary data capture in most settings. Accessible and integrated information
provides one basis for improved TB care, and this will become available in the higher density settings in
2007. As the core element of the SmartCare system, the electronic record provides: 1) more fully informed
local decision support; 2) reminder reports to staff to help keep patients from "falling through the cracks" (to
assure adherence and minimize resistance); and 3) improved management of general facility operations
(such as drug utilization) by automating key management elements of local monitoring and evaluation and
Activity Narrative: logistics support.
During May and June 2007, with strong USG support, the MOH held a series of three national trainings for
180 district and provincial leaders from all 72 provinces, as part of scaling up the SmartCare deployment.
In FY 2008, emphases will be on refinement of the TB service within the OPD module, addition of suitable
decision support cross-referencing other health conditions and potentially interacting medications, and
primarily scaling-up of this service increasing numbers of clinics nationwide. Building on previous year's
successes in HIV and antenatal clinic/prevention of mother to child transmission/CT services, SmartCare is
now supporting around 90,000 PLWHA. This year's funding will increasingly focus on building the capacity
of the MOH and collaborators within Zambia to implement and scale-up the TB/HIV module of the
SmartCare for purposes of sustainability, and to operationalize automatic links between increasing numbers
of SmartCare service modules in order to better care for TB-HIV patients with these concurrent illnesses
and OI's. Together with the related activities, these funds help assure that the OPD TB to HIV services link
spreads throughout the country with this same deployment effort.
The USG has provided direct funding to the MOH through a co-operative agreement since 2004 (activity
9008) for activities related to strategic information and more specifically to Information Technology (IT) such
as setting up a local area network at the headquarters and IT supervisory support to the provinces and
districts around the country. Since FY 2007 the USG increased the level of funding and scope of activities
supported through this mechanism to include other program areas such as PMTCT (ref 9737), TB (ref
12445), ARV services (ref 9754), and laboratory (ref 8991). The funding provided through this mechanism
enabled the MOH technical program officers to coordinate national level activities and enhance their
capacity for supervision and technical support to the lower levels of the health system. The increase in
funding and scope of activities brought with it added challenges in assuring that activities are conducted as
planned and that the reporting of the activities is coordinated.
Targets set for this activity cover a period ending September 30, 2010.
Continuing Activity: 15592
15592 3645.08 HHS/Centers for US Centers for 7192 3013.08 CDC Technical $200,000
9021 3645.07 HHS/Centers for US Centers for 5016 3013.07 CDC Technical $171,000
3645 3645.06 HHS/Centers for US Centers for 3013 3013.06 Technical $376,000
Health-related Wraparound Programs
* TB
Estimated amount of funding that is planned for Human Capacity Development $100,000
Table 3.3.12:
The funding level for this activity in fiscal year (FY) 2009 will remain the same as in FY 2008. Only minor
narrative updates have been made to highlight progress and achievements.
Activity Narrative:
This activity relates to activities in counseling and testing, laboratory infrastructure, palliative care, and basic
health support activities.
The following activities are being requested:
1) Printing of the participant's manual for training tuberculosis (TB)/HIV treatment supporters. 2) Printing of
TB/HIV news letter. 3) Program evaluation of the use of cotrimoxazole for HIV-positive TB patients in TB
clinical settings.
TB remains a major health problem in the health care delivery in Zambia. The incidence and prevalence
rates continue to increase from 1985 due to HIV/AIDS. The burden of TB has risen more than five-fold since
HIV/AIDS was first diagnosed in Zambia. It is estimated that 50-70% of all TB patients are co-infected with
HIV. The increase in the number of HIV/AIDS related diseases has made it difficult for the health care
system to accommodate all the chronically sick and TB patients in hospital wards. Many of these patients
are therefore discharged or referred to be managed in their homes by the community health care providers
with technical support from the trained health staff. The Ministry of Health (MOH) has also been highly
burdened by the attrition of trained health staff through resignations, deaths, retirements and other reasons.
Many health centers are managed by one or two trained staff. Others are managed by non health trained
staff.
Community initiatives implemented in Ndola by World Health Organization (WHO) in 1998 and Monze by
the Catholic Church showed better results in terms of case holding and better TB out comes. These
community initiatives demonstrated that effective community participation is key for successful Stop TB
strategy.
The Ministry of Health (MOH) through Central Board of Health endorsed the integrated community based
DOTS approach in order to strengthen TB control in the district hospitals and health centers. This new
approach aims to provide a quality integrated TB services to the people by means of standardized
diagnosis, care, support and community based treatment.
In Zambia there are three Directly Observed Treatment (DOT) Plans that are used for TB patients. Two of
these DOT plans are implemented at community level. The DOT Plan V (Volunteer) is where the TB
patients are being directly supervised and observed as they swallow the anti TB drugs by the community
volunteer on daily basis. DOT Plan R (Relative) is when the patient is supervised and observed as they
swallow anti TB drugs by the relatives daily. In both plans it entails providing health education to the patient
and the family, to observe for side effects, document the drugs intake after every dose and refer patients to
health facilities for review among other functions at community level.
In order to expand the community based Stop TB strategy, health workers, and community volunteers need
standardized knowledge and skills.
In 2005, the USG directly supported the development and printing of a facilitators manual for training TB
treatment supporters. This manual was developed in collaboration with the Ministry of Health, the USG,
various community based organizations and the TB committee of Care and Treatment working Group. This
manual is widely used by the MOH institutions, Non governmental organizations, community based
organizations and faith based organizations when training the TB treatment supporters.
By the end of FY 2008, the facilitator's manual would have been updated to include new treatment
guidelines of the four fixed drug combination and TB/HIV information. After the revision and updates, this
manual would have been printed and distributed to all the Provinces to facilitate quality knowledge and skills
to the facilitators. One-thousand (1,000) copies were produced and distributed to users.
In FY 2009, due to the demand for this manual by trainers in government health institutions, community
based organizations, faith based organizations, and other users, an additional 1000 copies will be
produced. Despite the availability of this facilitators manual for training TB treatment supporters, a gap still
exist in terms of material for the community volunteers to refer to after the training.
By the end of FY 2008, the USG would have developed and produced a reference hand-book for the
treatment supporters. This hand book will be in line with the materials in the Facilitators manual for the
training of TB treatment supporters. It is hoped that 65-70% of volunteers to be trained in the country would
be given a copy of the Participant's hand book for training TB/HIV treatment supporters. A total of 3000
copies were produced and distributed to community volunteers.
In FY 2009, due to the high number of community TB treatment supporters in the country, another 2,000
copies will be produced to facilitate each trained community volunteer to be in possession of the
participant's manual.
TB/HIV co-infection has presented a lot of challenges in the management of these diseases such as; the
diagnosis, care, support and treatment (fixed TB drug combination and the co-treatment with ART),
mobilization of communities, incentives for the volunteers and patient involvement; screening, counseling
and testing of TB patients for HIV; and screening of HIV infected patients for TB. Other issues include
development of linkages and referral of patients between the\ different service areas; the recording and
reporting of TB/HIV information on the data collecting and reporting tools and challenges to do with infection
control in TB/HIV settings, patient, family and community education.
Some of these challenges are handled some what different from place to place depending upon the
knowledge and skills the health care workers and the community volunteers have and the different
administrative support given. There is therefore a need to ensure that experiences in implementation of
Activity Narrative: TB/HIV activities indifferent provinces and districts are shared.
In FY 2008, the USG closely collaborated with the MOH National TB program to solicit for articles on
TB/HIV from the Provincial Health Offices, districts and the communities and other partners in order to
share knowledge, skills and other experiences in the management of the challenges in TB/HIV
programming. Using these materials a TB/HIV newsletter was produced and distributed to stakeholders. A
total of 5,000 copies were printed and distributed to the TB and HIV program implementers and other
interested parties. It is hoped that this newsletter will go a long way in providing technical support to the
different players in TB/HIV by applying positive strategies used else where to implement activities which
were challenging.
In FY 2009, the production of this newsletter will continue and be produced bi-annually. Each publication will
produce 5,000 copies for distribution to stakeholders.
The provision of cotrimoxazole (CTX) prophylaxis for HIV positive TB patients has been included in the
national TB/HIV Guidelines adapted by the MOH. However the provision of CTX to the HIV-infected TB
patients has primarily occurred within the ART clinics and not in the TB clinics due to a concern that adding
CTX to the duties of the TB staff would overload them and compromise the TB care provided. Whilst all HIV
positive TB patients are referred for HIV care and treatment to the HIV clinics, which tend not to be co-
located in the same clinic as the TB services, it is recognized that this does result in some TB patients not
accessing HIV care for a variety of reasons. These include not reaching the HIV clinic or not being attended
to in a timely fashion due to the large number of patients attending these clinics coupled with health workers
shortages. A recent evaluation of the TB surveillance system revealed that less than 20% HIV-infected TB
patients have documented evidence that they were receiving CTX. In 2009 the USG will work with the
MOH and other partners to develop a pilot program to provide CTX in three TB clinics in two provinces
(Eastern and Western). The program will be evaluated in order to determine whether provision of CTX in
the TB clinic is feasible within the Zambian context and provide information to the MOH on how CTX
prophylaxis can be widely implemented in TB clinical settings. The program will also provide information on
how referrals between TB and HIV clinics can be improved.
Continuing Activity: 15601
15601 3884.08 HHS/Centers for US Centers for 7192 3013.08 CDC Technical $124,000
9010 3884.07 HHS/Centers for US Centers for 5010 3104.07 CDC (Base) $124,000
Disease Control & Disease Control
3884 3884.06 HHS/Centers for US Centers for 3104 3104.06 $124,000
Estimated amount of funding that is planned for Human Capacity Development $124,000
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
April 2009 Reprogramming: Reduction in overall amount of funds; $600,000 total has been reprogrammed
to 3 implementing partners.
To strengthen national laboratory quality assurance programs, strengthen laboratory infrastructure and
facilities, build local human capacity, and to provide technical assistance.
This activity is linked to VCT (#9714), PMTCT (# 0631), TB/HIV (#0724), pediatric and adult care and
treatment and strategic information (SI #3714) program areas and to all activities in the laboratory
infrastructure section (#3701, 3702, 3703, 3704, 3754, 9794, 9795, 9796, 9797, 9798, 9799, 16956, 9524,
3541, 9524, 16420).
Technical expertise, material support, and human resource capacity strengthening are critical for building a
sustainable laboratory program for diagnosing and managing treatment of HIV/AIDS, TB, and other
opportunistic infections. In FY 2005-2008, the Laboratory Infrastructure and Support Branch of CDC
Zambia has made significant progress to support laboratories throughout the four provinces (Lusaka,
Southern, Western and Eastern) to provide laboratory services to care and treat people living with HIV/AIDS
(PLWHA). Diagnostic capacity for TB and bacterial infections in Zambia is in an advanced stage, more so
than many other PEPFAR countries. Automated laboratory equipment (including but not limited to CD4,
hematology, chemistry) were procured, installed and maintained. Local staff received training and
supervision. Strategic laboratory reagents and consumable acquisitions with national maintenance and
service agreements for automated systems were provided.
In FY 2008, this activity supported: 1) expansion of laboratory technical expertise through training and
quality assurance (QA) to the Ministry of Health (MOH) laboratories, national reference laboratories,
provincial, district, urban and rural health centers and included University Teaching Hospital ; 2) continued
to develop, renovate, and expand the pre-service laboratory training center at Chainama College in Lusaka
in support for HIV rapid testing, TB AFB smear microscopy, CD4 staging, liver and kidney function testing,
and treatment services; 3) implementation and monitoring of a laboratory information system for data
management to improve the documentation of patient test results, tracking of reagent procurement and
consumption, and QA efforts; 4) strengthen the palliative care system by improving detection and treatment
of opportunistic infections commonly associated with HIV/AIDS; 5) provide technical support for infant HIV
diagnosis with dried blood spot analysis in children at the Arthur Davison Children's Hospital in Ndola and in
Lusaka Zambia; 6) support much needed renovations and improvements in laboratory infrastructure at key
district-level health facilities in Eastern, Lusaka, Southern, and Western Provinces; 7) provide travel support
for Zambia CDC laboratory staff for on-site QA/quality control (QC) supervisory training and visits to testing
sites throughout the country to ensure proper equipment operations, provide feedback, troubleshoot, and
reinforce systems strengthening; and, 8) coordinate with the MOH, UTH, and other partners to develop a
national training curriculum for HIV rapid testing and trainer of trainers.
In FY 2009, CDC will focus on strengthening the national QA program for rapid HIV testing in Zambia. In
this regard, CDC will conduct the following activities: 1) co-ordinate and provide technical support the MOH,
UTH Virology (UTH-VL), and other partners to implement the national QA program for rapid HIV testing
according to the national guidelines for HIV counseling and testing; 2) co-ordinate a course for HIV rapid
test training of trainers. This will include partners' laboratory staff as well as CDC Zambian laboratory
specialists. A national laboratory training team will be formed; 3) co-ordinate roll out training of the national
algorithm that includes the component of quality assurance and quality control for HIV rapid testing to both
technical and non-technical laboratory persons in VCT, PMTCT, and integrated HIV/TB programs within the
four provinces named above; 4) support CDC laboratory staff to travel within the country to perform on-site
training, supervisory visits and re-testing to healthcare facilities within the four provinces that conduct rapid
HIV testing. Four CDC local laboratory staff will be assigned as CDC regional laboratory points of contact
and be responsible for the QA program of each province. They will work and coordinate closely with the
MOH, UTH, and the provincial laboratory personnel to ensure timely feedback and troubleshooting; 5) co-
ordinate with Zambian Provincial Care and Treatment program (ZPCT) staff to train and develop skill
capacity to standardize the quality of HIV rapid testing in the rest of the country (Central, North, Northeast
and North-Western regions where ZPCT is providing technical assistance; 6) co-ordinate and support
quality assurance and quality control workshops for rapid HIV testing, TB acid fast bacilli (AFB) smear
microscopy, CD4, hematology, and chemistry; 7) provide technical assistance to the MOH and UTH staff to
establish a functional national external quality assurance scheme (EQAS) for HIV rapid testing in order to
assess the quality and accuracy of sites performing rapid HIV testing. Skill and technology will be
transferred to the MOH and UTH staff to generate panels of dried tube specimens consisting of HIV positive
and negative samples. The panels will be distributed to sites throughout the country; 8) assist the MOH and
UTH staff to collect and analyze data at the MOH central collection point, and disseminate the national
EQAS data through workshops, scientific meetings and/or conferences; 9) provide technical assistance to
healthcare personnel at sites to follow up on the results, delivery and outcome of the EQAS as well as to
troubleshoot and provide technical guidance for corrective action and 10) provide technical assistance to
USG SI team and its partners (TDRC and UTH Virology) on laboratory testing related to surveillance
activities in Zambia supported by PEPFAR.
In addition, in FY 2009, CDC will focus on providing technical assistance to the MOH through coordination
with partners to support the following activities: 1) develop an integrated national QA program for laboratory
testing including rapid HIV testing, CD4, early infant diagnosis using PCR, TB smear, and malaria
diagnosis. The latter activity will be performed in collaboration with President's Malaria Initiative (PMI) staff
in Zambia; 2) develop a Laboratory Information System in collaboration with other partners; 3) to assess the
electrical supply situation at various laboratories in the health centers in remote areas where interruptions
are common and assist in developing a sustainable continuous electrical supply; 4) to review the five year
national laboratory strategic plan; 5) assist the MOH to review national curriculum for laboratory technologist
schools when need arises. Currently, the MOH with support from the Clinton Foundation has started a
process to revise the curriculum. The MOH will call upon assistance from CDC when the draft is ready for
Activity Narrative: revision; and 6) provide technical assistance to the MOH such as reviewing its documents (the national
medical laboratories policy, the national laboratory safety manual), attending meetings organized by the
MOH as well as support the MOH laboratory-related activities when call upon.
Furthermore, in FY 2009, the funds will be used to support the following activities: 1) coordination with
donors such as the Global Fund, World Health Organization (WHO), PMI, USAID, and Japanese
International Cooperative Agency (JICA) to ensure harmonization and to avoid duplication of funds and
technical support; 2) training of provincial laboratory personnel and CDC Zambian laboratory specialists to
be diverse in all laboratory testing procedures conducted in clinical laboratories at all levels including
laboratory management and QA/QC for supervision purposes; 3) coordination and support to lab-related
workshops; 4) continuation of provision of technical assistance and QA through CDC regional laboratory
points of contact to laboratories, to ensure the quality of its services for PLWHA is maintained; 5) the
national TB laboratory network, the TB AFB QA/QC program, TB culture and drug susceptibility testing for
rapid detection of multiple and extreme resistant cases of tuberculosis; 6) continue to support bacteriology
laboratories at UTH and provincial general hospitals for diagnosis of HIV-related opportunistic infections; 7)
provide technical support and training for the expansion of infant diagnosis utilizing PCR techniques at
Maina Soko Military Hospital and Livingstone General Hospital; 8) provide technical assistance to DOD for
the expansion of the military clinical and laboratory services in Zambia; and 9) provide technical assistance
to other PEPFAR program areas including Biomedical Injection and Blood Safety.
In summary, in FY 2009, CDC will continue to provide support to all the above listed activities to improve
and build sustainable laboratory systems in Zambia by strengthening the national QA program and
laboratory infrastructure, through provision of technical assistance to support continuous professional
development of laboratory personnel by pre- and in-service training; and through coordination.
Continuing Activity: 15594
15594 3706.08 HHS/Centers for US Centers for 7192 3013.08 CDC Technical $1,249,900
9022 3706.07 HHS/Centers for US Centers for 5016 3013.07 CDC Technical $890,001
3706 3706.06 HHS/Centers for US Centers for 3013 3013.06 Technical $1,162,676
Workplace Programs
Estimated amount of funding that is planned for Human Capacity Development $400,000
Table 3.3.16:
ACTIVITY HAS BEEN MODIFIED IN TE FOLLOWING WAYS:
Support to MOH staff in analytic skills training is added.
This activity relates to Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) Strategic Information (SI)
(#3709.08), JHPIEGO SI (#3710.08), AIDSRelief - Catholic Relief Services (CRS) (#3711.08), Ministry of
Health (MOH) (#3713.08), National HIV/AIDS/STI/TB Council (NAC) (#3716.08), SI Central Statistical
Office (CSO) (#3717.08), Tropical Diseases Research Centre (TDRC) (#3718.08), Eastern Provincial
Health Office (EPHO) (#9693.08), Western Provincial Health Office (WPHO) (#9696.08), Zambia National
Blood Transfusion Service (ZNBTS) (#9698.08), and SmartCare COMFORCE (#9692.08).
Continuing work from FY 2008 CDC's SI activities provide critical support to information systems, building
sustainable monitoring and evaluation (M&E) capacity, and ensuring that essential information from sentinel
surveillance, national health surveys, clinical information systems, and targeted evaluations is obtained and
used to improve quality of care. Core systems must be institutionalized to sustain improved quality of care,
decision-making about resources, and improved service delivery mechanisms. CDC provides technical and
financial support to the MOH and the NAC at central, provincial, district levels, the CSO, TDRC, the
University of Zambia (UNZA) School of Medicine (SOM), and a number of other partners. Built around the
SmartCare the anchor information system project is formerly known as the Continuity of Care and Patient
Tracking System (CCPTS). This information system has been adopted by the MOH as a national standard;
in the next funding cycle, there will be an evaluation of the SmartCare program. CDC Zambia is continuing
to help institute durable systems for quality health services, disease surveillance, and M&E.
The first component relates to direct support to the official CDC office locations and collocated partners
which require one-time and on-going improvements to their information systems infrastructure. These office
locations are at the U.S. Embassy, University Teaching Hospital (UTH) Pediatric Center of Excellence,
Chest Diseases Laboratory (CDL), Intercontinental Hotel in Lusaka, and a growing number of offices based
at the Provincial Health Offices, such as in Livingstone in Southern Province, Chipata in Eastern Province
and Mongu in Western Province. This activity will fund the following: (1) continued procurement,
maintenance, and replacement of IT equipment for the new Pediatric and Family Center of Excellence at
UTH such as computers, consumables and other related equipment for the offices, communications
systems, equipment for training and conference facilities, integrate power supply systems for server and
core equipment; (2) maintenance contracts for printers & computers, continued network operability for
remote sites, VSAT and terrestrial communication links, and network hardware; (3) training for CDC and
partner IT staff in networking and server administration; (4)Continued support to the ZNBTS on linking
SmartCare to the national donor retention database and continued salary support for CDC staff.
FY 2009 funds will also support M&E activities to: (1) continue technical support to the national M&E
capacity and workforce building initiative in cooperation with NAC, MOH, SHARE, Peace Corps, the
University of Zambia, and National Alliance of State & Territorial AIDS Directors (NASTAD) to deliver
performance-based ongoing training, mentoring, and scholarships to partners, Provincial AIDS
Coordinators, District Planners, and District and Provincial AIDS Task Forces. USG support includes
technical assistance and support to national meetings, joint field and quality assurance monitoring; (2)
finalize and disseminate a system dynamics evaluation of antiretroviral therapy (ART) treatment success
and the role of ancillary services (approved and implemented as a PHE under HTXS in 2008). This
exercise engages stakeholders in considering various program options for national ART service delivery
sites and supportive services (e.g. food, psychosocial support). The model and its results will be
disseminated through conferences, invitational travel, and scholarly manuscripts; (3) develop appropriate
tools, manuals and quality assurance processes for SmartCare implementation; (4) Provide technical
support to Provincial Health Offices for M&E, SmartCare deployment and performance and data quality
assessments; (5) Continue to support Zambian M&E professionals to publish as well as present at regional
and international conferences on operational and evaluation research.
Lastly, FY 2009 funds will support the following HIV/AIDS surveillance activities: (1) continue technical and
material support to GRZ in its surveillance and reporting of HIV and syphilis prevalence through 27
antenatal clinic sentinel sites (ANCSS) and refugee camps; toward the end of FY 2008 preparations for
2010 round must commence. This activity is conducted in collaboration with the MOH, the CSO, UTH,
NAC, TDRC, and United Nations High Commission for Refugees (UNHCR); (2) support the GRZ in its
surveillance of HIV incidence and prevalence of other important viral infections over time, and by testing
blood specimens from the antenatal clinic sentinel surveillance (1994-2008) and the Zambia Demographic
and Health Survey using the BED-CEIA assay developed at the CDC to allow the estimation of recent HIV
infections (incidence); (3) partner with the private sector in Zambia to strengthen surveillance and reporting
of HIV prevalence and incidence among workers in the agricultural and other industries; FY 2009 funding
will allow us, together with partners, to utilize the findings and to develop the methods and tools to
strengthen the continuity of HIV care for migrant workers during the work season and to help establish
linkage to care upon their return to home regions; (4) continue to strengthen and work towards sustaining
the National Cancer Registry of Zambia and the Cancer Diseases Hospital in their surveillance and
reporting of AIDS-related malignancies through technical and material assistance. Surveillance of AIDS-
related cancers is important both for GRZ planning of cancer treatment needs and preventive interventions
in the population, and for monitoring the impact of ART scale-up on the risk of AIDS complications and
survival; (5) support the CSO to expand the Sample Vital Registration with Verbal Autopsy (SAVVY) System
in selected regions in Zambia, to validate the data capture instruments, and to evaluate the SAVVY
implementing process. This activity builds upon the Feasibility Study conducted in FY 2007 by CSO in its
surveillance and reporting of vital events in Zambia and will add coverage areas beyond the pilot sites. The
FY 2009 plan aims to strengthen and sustain the CSO office and expand expertise for vital registration in
Zambia; (6) collaborate with the World Health Organization to provide assistance to the MOH in establishing
a system to monitor the prevalence of transmitted HIV drug resistance (HIVDR) observed among young
women attending antenatal clinic. Such a system will strengthen the MOH HIVDR Working Group to
develop and implement a national strategy for HIVDR resistance monitoring, design and implementation of
appropriate study populations in which to monitor HIVDR and to collect information on behavioral and other
risk factors associated with increased risk of HIVDR development, technical support to build laboratory
Activity Narrative: capacity to perform genotypic HIV drug resistance testing, management and analysis of data on the
magnitude of HIVDR in the selected study population, and the coordination of report dissemination to the
GRZ, health professionals, the public, and the scientific literature; (7) through TDRC, support the
surveillance of HIV/AIDS in prison populations in Zambia; (8) ensure the sustainability of HIV surveillance
activities by providing expertise and coordinating training courses to increase long-term Zambian human
resource capacity in data management, statistical analysis, data use and interpretation, scientific writing,
and preparation of manuscripts for publications in scientific literature; (9) through MOH, improve Zambia's
geographic data layers and data infrastructure needed to utilize geographic information and geographic
mapping to support HIV/AIDS monitoring, evaluation, and response.
Continuing Activity: 15595
15595 3714.08 HHS/Centers for US Centers for 7192 3013.08 CDC Technical $1,949,900
9023 3714.07 HHS/Centers for US Centers for 5016 3013.07 CDC Technical $2,240,000
3714 3714.06 HHS/Centers for US Centers for 3013 3013.06 Technical $860,768
Estimated amount of funding that is planned for Human Capacity Development $75,000
Table 3.3.17:
The funding level for this activity in FY 2008 will be substantially reduced in FY 2009, reflecting increased
reliance in FY 2009 on local partners for the particular systems strengthening activity of equipment
acquisition. Otherwise minor narrative updates have been made to highlight progress and achievements.
CDC supports improved data management, dissemination, and data for decision-making in the delivery and
management of health services in national and local institutions in Zambia. Systems beyond the realm of
traditional strategic information activities require support to ensure efficient treatment and care capabilities
in all facilities. Using FY 2005 and FY 2006 funds, CDC procured 662 desktop computers and 34 laptops
for various institutions and affiliated United States Government projects focused on HIV/AIDS. In FY 2007,
CDC provided expanded support to laboratory informatics and remained responsive to equipment needs in
local health offices in targeted provinces. In FY 2008, some of this type of support was no longer optimal or
possible through this mechanism, although, specific ongoing technical support for infrastructure
enhancement was provided for the Chest Diseases Laboratory (CDL) and the Tropical Diseases Research
Center (TDRC) tuberculosis (TB) laboratory. In FY 2009, CDC will continue to provide technical support on
installation, routine maintenance planning, software licensing, and input on establishing relationships
between assisted organizations and technical support providers in Zambia. This will require frequent
supportive supervision visits by CDC staff to active project sites or for CDC to engage other technical
support as required, including a growing emphasis in training for systems strengthening. As an instance, in
FY 2009 increased use of computer based distance learning methods will employed, building on successful
preparation of DVD based training materials in FY 2008. Lastly, as CDC has staff placements at increasing
numbers of locations around the country providing direct support and technical assistance (TA) at provincial
health offices, there are increasing communication costs supporting dedicated lines to the central offices, in
addition to the infrastructure support at these sites (see also CDC-TA under HVSI).
Continuing Activity: 15596
15596 3721.08 HHS/Centers for US Centers for 7192 3013.08 CDC Technical $500,000
9024 3721.07 HHS/Centers for US Centers for 5016 3013.07 CDC Technical $500,000
3721 3721.06 HHS/Centers for US Centers for 3013 3013.06 Technical $300,000
Table 3.3.18:
