ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

This activity also relates to PCI activities in Health System Strengthening, Sexual Prevention/Johns Hopkins

Program for International Education in Gynecology and Obstetrics (JHPIEGO), Prevention of Mother-to-

Child Transmission (PMTCT) /JHPIEGO, tuberculosis (TB)/HIV/JHPIEGO, Adult Care and Support/Project

Concern International (PCI), Counseling and Testing/PCI, and Adult treatment/JHPIEGO.

The aim of this program is to prevent new HIV infections through promotion of positive behavior change.

Research indicates that the key to slowing the HIV/AIDS pandemic lies in controlling the spread of the

disease among young people. Adolescents who are properly informed may be more likely to avoid risky

sexual behavior. This is particularly true among those who have not yet begun having sex. Those who are

sexually active need to know that they can reduce the risk of infection by being faithful to their partners. As

in many countries, adolescents in Zambia may feel that they are not vulnerable. This is a dangerous

attitude given the high prevalence of HIV/AIDS among the younger population in Zambia, as demonstrated

by the results of the 2006-2007 Zambia Demographic and Health Survey (ZDHS).

This program has a number of components. The first component involves supporting 45 Anti-AIDS youth

groups, established in FY 2006, FY 2007, and FY 2008 in the Zambian Defense Force (ZDF) primary and

secondary schools. The 45 schools which are on military bases have been targeted for organizing

children's clubs that include HIV/AIDS education and programs on abstinence and anti-discrimination

against people living with HIV/AIDS (PLWHA). The purpose of the program is to inform, inspire, and

challenge young people to choose to refrain from sex before marriage or otherwise delay debut of sexual

activity. The formation of these groups is in response to numerous requests received by the ZDF from the

students' parents to support such youth activities.

The first activity under this component is selection and reproduction of HIV/AIDS educational materials from

among those developed for use in Zambia through the Ministry of Health (MOH), National HIV/AIDS/STI/TB

Council (NAC), United States Government (USG)/PEPFAR-funded partners, Baptist Fellowship of Zambia

(BFZ) or other sources. These are additional materials to what was distributed in FY 2006, FY 2007, and

FY 2008. The materials selected will be those promoting abstinence until marriage for youths who are not

sexually active and a return to abstinence for those who are sexually active. The second activity will be

refresher training of 100 teachers and patrons of Anti-AIDS youth groups in mobilizing youth groups and

integrating HIV/AIDS prevention and stigma reduction into their education curricular. The training will equip

teachers with skills for communicating age-specific messages that encourage young people to avoid

contracting HIV by abstaining from sex until marriage. Teenage sexuality, virginity, gender-based violence,

and life skills will be among the topics that will be covered. The youth group patrons will be given an

orientation to the "True Love Waits" (TLW) abstinence-based toolkit that aims to communicate to students,

teachers, and families a working alternative to the "safe sex" massage. The third activity under this

component is to provide other logistic support for youth group activities. All these activities will be

implemented in close consultation and collaboration with the ZDF education directorate. The goal of this

program is to reach 18,000 youths with HIV/AIDS prevention messages and promotion of abstinence,

including reduction of stigma and discrimination against PLWHA.

The next component of this program involves reaching out to military personnel and their families with

messages promoting abstinence until marriage and faithfulness to one's partner using chaplains from ZDF.

In FY 2005, The Baptist Fellowship of Zambia (BFZ) trained 63 chaplains and their assistants in HIV/AIDS

prevention, care, counseling, peer support, and palliative care. In FY 2006 and FY 2007, 80 chaplains and

their assistants participated in training to build on the work done in FY 2005 and help the chaplains relate it

to ministry to the family and their communities, including the "True Love Waits" (TLW) abstinence-based

toolkit for use with military personnel and their families. In FY 2008, training courses were provided to 80

chaplains to continue building on the aforementioned objectives, skills, and services to additional bases. To

carry out the TLW program, local TLW Clubs were established in communities, and churches around

selected military bases. The chaplain initiative will continue the family support component aimed at

stemming the spread and impact of HIV/AIDS. In FY 2008, 80 chaplains and their spouses were trained to

better identify and intervene in issues of violence, especially sexual and spousal abuse. In FY 2009 an

additional 60 chaplains will be trained. As part of this training, BFZ will give the chaplains and their wives

additional tools to encourage and support marital faithfulness. These tools include training in a program

called "True Love Stays". BFZ will also provide training to chaplains to start "Keep the Promise" support

groups and conduct marriage seminars targeting married couples. Information, education and

communication (IEC) materials promoting abstinence, faithfulness, other prevention methods, stigma

reduction, and counseling and testing (CT), sexually transmitted infection (STI) management, and

antiretroviral therapy (ART) will be reproduced and distributed. The goal of this program is to reach out to

8,000 military personnel and their families with messages promoting abstinence and being faithful.

The long-term sustainability of this program lies in the capacity which will be built through the training of

teachers, other Anti-AIDS youth group patrons, and chaplains to replicate, scale-up and manage youth-led

programs in the future. As with other interventions with the ZDF, sustainability is promoted through an

emphasis on planning, implementing, and monitoring all activities with leadership from ZDF personnel

themselves, supported by PCI and other technical resources, as well as through capacity building through

training and through establishing and supporting ZDF-owned structures such as the drama groups and

support groups. In this area, training and mobilization of support from ZDF leadership has also proved very

effective at ensuring necessary support and involvement in HIV/AIDS-related programming and

intervention.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14628

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14628 9170.08 Department of Project Concern 6890 3041.08 DoD-PCI $275,000

Defense International

9170 9170.07 Department of Project Concern 4939 3041.07 DoD-PCI $180,000

Defense International

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Reducing violence and coercion

Military Populations

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $47,278

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.02:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

This activity also relates to activities in Health System Strengthening (JHPIEGO), Sexual Prevention

(JHPIEGO), Sexual Prevention (PCI), PMTCT (JHPIEGO), Adult Treatment (JHPIEGO), Adult Care and

Support (PCI), Adult Care and Support (PCI), Health System Strengthening (PCI), and Counseling and

Testing (PCI).

The first component is support to ZDF drama groups in the 54 military camps. Since FY 2003, two ZDF

drama groups, consisting of 39 members, have traveled to all 54 ZDF facilities throughout the country

spreading messages on abstinence, faithfulness, the correct and consistent use of condoms, HIV

counseling and testing, stigma reduction, the influence of alcohol on risk behavior, and other key messages

identified through regularly updated qualitative research with the target group to ensure continued maximum

relevance and acceptance. Feedback from ZDF leadership, officers, and enlisted personnel indicates that

the tours are extremely well accepted and are effective at increasing HIV/AIDS-related knowledge and

promoting positive behavior change in ZDF personnel, their family members, and local communities

surrounding the bases. Given the isolated nature of many of the ZDF sites, these drama performances were

often the only exposure many of these communities, both military and civilian, had to HIV/AIDS prevention

messages.

In FY 2008, PCI assisted ZDF to expand and decentralize drama activities to all 54 ZDF military camps.

Establishing drama groups at each ZDF site has ensured that that the plays reflect the reality on the ground

in each camp. In addition, it is a cheaper strategy compared to the cost of supporting two drama groups to

tour 54 ZDF camps across the country. 108 individuals (two from each of the 54 camps) were trained in

Theatre for Development (TFD). This is a locally adapted behavior change communication (BCC) strategy

developed in collaboration with the Open University of Zambia. This method uses qualitative research

methods together with performance arts such as song, drama, poetry, and dance for a targeted audience.

The training included skills in developing HIV/AIDS-related scripts and performances. The groups were

trained to measure the impact of the drama performances (using pre and post-exposure questionnaires as

part of the intervention itself) to ensure quality and effectiveness of the drama performances.

In FY08 the drama performances were aimed at promoting change in gender social norms that predispose

women to HIV such as sexual violence and abuse. In FY 2009, CT, PMTCT and ART will be focus areas in

order to strengthen links with these USG supported activities of the ZDF. PCI will support TFD experts to

tour the 54 ZDF camps to provide logistical support and on-site technical assistance to the drama groups

that have been formed by the 108 individuals trained in TFD.

Information, education, and communication (IEC) materials promoting abstinence, faithfulness, and other

prevention methods, as well as stigma reduction, CT, STI prevention and management, and ART will be

reproduced and distributed during the HIV/AIDS sensitization tours conducted by ZDF HIV-positive

personnel. In addition, IEC materials will be distributed through mobile CT visits, monitoring visits, new

recruit training sessions and other forums. PCI will also develop and print some brochures promoting male

circumcision which is yet to be rolled in ZDF health facilities. As a member of the "Prevention of Sexual

Transmission of HIV" Group, which has recently been recognized by the National HIV/AIDS/STI/TB Council

as one of their technical groups, PCI works with this national-level organizing body to ensure that all IEC

materials used in the project are based on national standards for providing consistent, evidence-based

messages on prevention of sexual transmission of HIV.

The second component of this activity is to continue assisting in the mobilization of people living with

PLWHA to encourage their involvement in HIV/AIDS prevention activities. Whereas in 2003-2004 there

were no openly positive ZDF personnel participating in the HIV/AIDS prevention, care, and support

program, to date there are over 300 individuals associated with the ZDF actively participating in the program

through HIV/AIDS sensitization with their colleagues and peer education, as well as support group formation

at five ZDF units. In order to promote sustainability of this activity, the ZDF has established a new position

at its national HIV/AIDS unit, filled by an openly-positive Major, to spearhead the formation, guidance, and

supportive supervision of support groups at individual ZDF sites. PCI will build on this success through

continued support for these activities and continued support for the formation of HIV-positive support groups

or post-test clubs at ZDF installations. PCI will continue to provide technical and logistical support to HIV-

positive ZDF personnel in organizing and programming visits to 54 military units to promote CT, ART, and

stigma reduction. This group will be selected from the ZDF support groups that have been established in the

military camps across the country.

The third component of this activity is to orient ZDF medical staff to the new treatment guidelines for

sexually transmitted infections. In FY 2005, PCI trained 100 ZDF medical personnel in Syndromic

management of STIs. The Ministry of health recently revised the treatment guidelines for STIs. In FY 2009,

PCI will conduct three workshops to orient ZDF medical personnel to these new guidelines.

From FY 2005 to FY 2008, leadership workshops have been conducted targeting different categories of

ZDF leadership. In FY 2009, two leadership workshops will be conducted targeting 60 adjutants. These

workshops have proven to be extremely successful at engaging ZDF leadership and support at different

levels for HIV/AIDS prevention activities in ZDF units. In all prevention activities, the role of alcohol in the

transmission of HIV will continue to receive emphasis. Current training materials developed by PCI and the

DFMS, including the peer leader training guides, educational videos ("Watch Out Soldier" and "HIV positive:

No Longer a Death Sentence"), facilitation guides, and written educational materials, already incorporate

messages in this regard and will be updated as needed. Awareness-raising by peer educators, PLWHA, the

drama teams, mobile and facility-based clinical staff, and the HIV/AIDS unit through ongoing tours, training

of new recruits, and training of pre-deployment personnel will also emphasize the impact of alcohol.

Possible policy-level interventions will be discussed and planned for especially at the leadership workshops

and at the HIV/AIDS Unit and DFMS levels. Lessons learned from local and international HIV/AIDS

conferences, at which ZDF is represented, will be incorporated as feasible into PCI's interventions. As with

other interventions involving the ZDF, sustainability will be promoted through an emphasis on joint planning,

Activity Narrative: implementing, and monitoring all activities with leadership from ZDF personnel themselves. In this area,

training and mobilization of support from ZDF leadership has also proved very effective at ensuring

necessary support and involvement in HIV/AIDS-related programming and intervention. Most ZDF sites are

accessing free condoms through their respective Department of Health Management Teams (DHMTs).

DFMS has solicited for bicycles for peer educators from Zambia National Response to HIV/AIDS

(ZANARA).

The goal of this program is to reach out to 22,500 troops including family members with community

outreach that promotes HIV/AIDS prevention through other behavior change beyond abstinence and/or

being faithful.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14629

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14629 3733.08 Department of Project Concern 6890 3041.08 DoD-PCI $350,000

Defense International

8786 3733.07 Department of Project Concern 4939 3041.07 DoD-PCI $232,500

Defense International

3733 3733.06 Department of Project Concern 3041 3041.06 DoD-PCI $360,000

Defense International

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Reducing violence and coercion

Military Populations

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $51,278

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.03:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

This activity also relates to PCI activities in Other Sexual Prevention activities (PCI), Health System

Strengthening (PCI), Sexual Prevention/Abstinence/Be Faithful (PCI), PMTCT (JHPIEGO), Adult Care and

Support (JHPIEGO), Counseling and Testing (PCI), HIV/AIDS Treatment/ARV Services (JHPIEGO), and

the Navy Medical Centre, San Diego (NMCSD) program.

The aim of this program is to ensure that chronically ill HIV positive patients in the military health facilities

receive comprehensive care and support services that include medical care, treatment of opportunistic

infections, pain management, psycho-social support, material support, nutritional supplement, referral and

adherence to ART, and other HIV-related services. Through this activity, PCI will support Defense Forces

Medical Services (DFMS) to provide quality health care and support services to HIV-positive patients

including Zambia Defence Force (ZDF) members, their family members, and people living in the

surrounding community. The ZDF serves as the only source of health care and support services for

communities in surrounding locations, given the remoteness of many of the ZDF units.

PCI will support DFMS to undertake this comprehensive program in all 54 ZDF units in the nine provinces of

Zambia, with a focus on 16 existing sites (Maina Soko Military Hospital in Lusaka, ZAF Livingstone, Tag-

urgan Barracks in Ndola, ZNS Kitwe, Gondar Barracks in Chipata, Chindwin Barracks in Kabwe, ZNS Mbala

and ZNS Kamitonte in Solwezi, Mikango Barracks in Chongwe, ZNS Luamfumu in Mansa, Luena Barracks

in Kaoma, ZAF Mumbwa, ZNS Chiwoko in Chipata, ZAF Mt Eugenia in Lusaka, Taungup Barracks in

Mufulira and ZNS Choma), and four additional sites (to be established in FY 2009). This activity will be

integrated with other DOD-PCI and JHPIEGO activities, to ensure effective referrals between CT, TB/HIV,

STI, HBC, ART and other services. Clients presenting with TB or STIs at the health facility are encouraged

to test for HIV and those that test positive are referred for pre-ART medical assessment including CD4

count and liver function at the nearest health facility with this capability. Clients that are commenced on ART

were closely monitored by community-based ART adherence supporters trained by JHPIEGO in FY 2006.

Most of these clients are registered on HBC and benefit from Adult Care and Support services provided by

trained HBC care givers. Capacity building will include formal and informal training for HIV/AIDS unit staff

including the HBC coordinators, HIV/AIDS unit coordinators, and ZDF caregivers. Logistical support to

enhance the quality of ongoing supervision and monitoring of Adult Care and Support activities by the

DFMS is provided, and linkages with indigenous sources of technical support such as the Palliative Care

Association of Zambia (PCAZ) have been made in order to ensure that the ZDF has access to technical

input, national palliative care guidelines, and training packages adapted to their situation and needs.

From FY2004 through FY2008, 495 HBC volunteers were trained in Adult Care and Support. PCI's training

of caregivers in comprehensive Care and Support was coordinated with PCAZ to ensure the consistency of

the training and care services with those of other USG-funded programs. These caregivers are actively

involved at all 54 ZDF units in nine provinces, responsible for identifying and registering chronically ill

patients both among military personnel and their families, as well as from nonmilitary populations in

surrounding communities, providing community level care services in support of families, and referring

patients to DFMS or other health facilities for additional care and treatment services. Adherence support for

clients on ART has been added to the training modules in support of the expansion of ART services at ZDF

health facilities. Caregivers are also trained to carryout out a nutritional assessment of their clients with

emphasis on measurement of mid arm circumference for children and Body Mass Index (BMI) for adults.

This is important to ensure that ARV patients have adequate and appropriate nutrition to ensure the

effectiveness of their treatment. Those in need are referred to receive food supplements.

In FY2009, PCI will support the training of 80 additional caregivers in Adult Care and Support. The

additional caregivers will be drawn from 32 service delivery sites (ZDF camps) which currently have less

than five trained caregivers. The caregivers include spouses of military personnel and civilians within the

catchment area of the military health facility. Majority of the HBC volunteers to be trained will be men in

order to promote male involvement in the provision of HBC. The training will address gender norms and

behavior as they relate to the provision of care in the family and community. Traditionally, most of the HBC

volunteers trained are women. PCI will continue to make use of ZDF trainers who were trained by PCAZ in

October 2006 in order to promote sustainability of this activity. The quality of Adult Care and Support

services will be closely monitored by two nurses employed by PCI in FY2007. A check list on minimum

standards for HBC developed by the National HIV/AIDS/TB Council will be used for monitoring purposes.

PCI will continue to support the development and provision of HBC kits for clients and their caregivers.

These HBC kits have been evaluated in collaboration with the DFMS, Ministry of Health, and PCAZ and

include patient education materials relating to medicines, doses, nutrition, and referral information. Care

givers kits contain pain killers, anti-diarrhea medicine, antifungal creams, multivitamins, bleach, disinfectant,

gloves, wool and bandages. The kits are refilled on a monthly basis according to the number of patients

reflected in the HBC registers and monthly field reports completed by the caregivers. In addition to clients'

HBC kits, PCI will continue procuring food supplements for clients who qualify following an assessment of

their nutritional status by a care provider. These include OVC, HIV-positive lactating or pregnant women,

and clients on ART presenting evidence of severe malnutrition. Material support to the new caregivers, such

as bicycles, umbrellas, bags, scales and shoes, are provided as a means of facilitating their work and

motivating their continued participation. This logistical support, in particular the bicycles, makes it easier for

caregivers to visit their clients more often than would otherwise be the case. Regular home visits are

particularly important for ART adherence monitoring and support, and improved logistics enable serious

cases to be identified and referred early on for further treatment at the health facility.

From FY 2006 to FY 2008, PCI supported the training of 600 support group members in 30 ZDF units using

56 ZDF "stay healthy" master trainers who were trained in FY 2006, FY 2007 and FY 2008 with support

from the NMCSD twinning program. In FY2009, PCI will support the training of additional 20 "stay healthy"

master trainers to be drawn from 10 new ZDF support groups. The 20 master trainers will be supported to

train an additional 200 support group members in their camps. The effectiveness of training will continue to

be assessed and monitored through pre-and post-training tests, as well as with support from the NMCSD

twinning program. The workshops will focus on promotion of health and wellness, with support in dealing

Activity Narrative: with HIV symptomology, depression, stigma, adherence to ART, self-efficacy, and substance use. Positive

living materials developed by the Health Communication Partnership (HCP), the Academy for Educational

Development (AED)/USAID, and other local groups were reviewed by the NMCSD team for adaptation and

will be used under this activity.

Finally, through a partnership with the Baptist Fellowship of Zambia (BFZ), PCI will continue to support the

capacity building and involvement of military chaplains in HIV/AIDS and spiritual counseling, with emphasis

on ministry skills relating to the individual and the family. This includes marital relationships, parenting,

gender-based violence and development of peer support systems. Training sessions also deal with child

abuse, addictive behaviors, and management of family crisis, illness, death, and trauma. BFZ will establish

family crisis services at a targeted number of bases and their surrounding civilian communities. In FY 2006,

the BFZ trained 80 military and police chaplains including their spouses in Adult Care and Support including

spiritual counseling. They also provided on site technical assistance to clergymen at 16 military bases. In

addition, they reproduced an HIV/AIDS manual used in faith-based communities for use by the chaplains.

In FY2007 and FY 2008, 80 chaplains and their assistants participated in training to build on the work done

previously and help the chaplains relate it to ministry for the family and their communities. In FY2009,

chaplains will be supported to continue providing the above services to ZDF bases. PCI has developed a

tool to evaluate the quality of the Adult Care and Support services being provided to HBC clients. The tool

also assesses client satisfaction with the services being provided by the caregivers. In order to ensure the

sustainability of the activity, PCI works in close collaboration with the DFMS HIV/AIDS unit, which has

established a Palliative Care office, through which all activities are planned, implemented and monitored.

Sustainability is also promoted through ongoing supportive supervision visits by DFMS, PCI staff, and HBC

coordinators in order to reinforce the training and to identify and address any performance and/or training

gaps. The use of HBC volunteers is another important sustainability strategy. The target of this activity is to

have 6000 people benefiting from Adult Care and Support services at the 54 ZDF service delivery sites.

These are clients that will have been provided with Adult Care and Support services through HBC, military

chaplains or support groups of PLWHAs.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14630

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14630 3737.08 Department of Project Concern 6890 3041.08 DoD-PCI $610,000

Defense International

8787 3737.07 Department of Project Concern 4939 3041.07 DoD-PCI $480,000

Defense International

3737 3737.06 Department of Project Concern 3041 3041.06 DoD-PCI $580,000

Defense International

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

* Reducing violence and coercion

Military Populations

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $115,018

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $60,000

Economic Strengthening

Education

Water

Table 3.3.08:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

This activity also relates to PCI activities in Other Sexual Prevention Activities, Sexual

Prevention/Abstinence and Be Faithful (PCI), Health System Strengthening (PCI), PMTCT (JHPIEGO),

TB/HIV (JHPIEGO, Adult Care and Support (PCI) and Adult Treatment (JHPIEGO).

Observation of previous Counseling and Testing (CT) activities and results from research supported by

(PCI) and PEPFAR (2005) reveal that military personnel may be more resistant to CT than the general

public. According to the joint study conducted by PCI and DFMS, although nearly seven in ten ZDF

personnel know of the availability of CT services in their camp/unit, only 10% have ever participated in CT.

This is worrisome in light of the relatively high risk behavior among military personnel and despite the fact

that over 30% believe they might already be HIV infected. Military personnel are also hard-to-reach with

static services because military bases are scattered all over the country and many personnel are highly

mobile or are stationed in very secluded locations. The remoteness of ZDF units, relatively poor

infrastructure, poor linkages with national supply systems (e.g. of CT kits), and the organizational isolation

of the military, also make providing CT services to the ZDF more costly than to the general public.

PCI will continue its effort to assist the ZDF provide CT services through strategic and innovative

approaches developed through more than four years experience working with the ZDF in HIV/AIDS

prevention, care and support. The overall objective of this activity is to strengthen the capacity of the DFMS

to provide accessible, confidential, quality counseling and testing services. In FY 2005, four model medical

sites (Maina Soko Military Hospital in Lusaka, ZAF Livingstone, Tag-urgan Barracks in Ndola, ZNS Kitwe)

were developed to provide comprehensive HIV/AIDS services including counseling and testing,

antiretroviral treatment, palliative care, and PMTCT services (in collaboration with JHPIEGO). In FY 2006,

FY 2007 and FY 2008, twelve additional model sites were established. While these twelve sites ( Gondar

Barracks in Chipata, Chindwin Barracks in Kabwe, ZNS Mbala, ZNS Kamitonte in Solwezi, Luena barracks

in Kaoma, ZAF Mumbwa, ZNS Luamfumu in Mansa, Mikango barracks in Lusaka, ZNS Chiwoko in Katete,

ZAF Mt Eugenia in Lusaka, Taungup barracks in Mufulira, and ZNS Choma) maintain the current services,

four additional sites will be established in FY 2009 to provide the same services, targeting other areas

where significant number of military personnel are stationed. This will bring the number of model sites to 20.

Moreover, support for basic levels of CT services will continue to be provided at 34 other ZDF units, who will

have the opportunity to visit and learn from the model sites. Funding will cover renovations of CT rooms,

procurement of necessary medical supplies and equipment and additional training for the DFMS staff in the

new sites. In order to promote sustainability, efforts will continue to be made to effectively integrate the ZDF

in the MOH's national HIV test kits supply system, in collaboration with USAID's JSI/Deliver program. 20

DFMS staff will undergo training in counseling and testing, using national guidelines, to ensure that all four

sites have adequate human resources to provide high quality CT services. In FY 2009, 20 senior ZDF

officers will be trained in CT to encourage senior officers to access CT services. This is in addition to 25

trained in FY 2008. It was observed that senior officers are shunning CT services because the trained

service providers are too junior to them. The rank structure in the military is such that it is difficult for a

soldier to counsel a senior officer. This training will therefore help to bridge this gap.

HIV counseling training is facilitated jointly by PCI and DFMS counselor trainers and local HIV counselor

training organizations, such as Zambia Counseling Council, Kara Counseling, and Ministry of Health. The

HIV testing training will be facilitated by personnel from Maina Soko Military Hospital Virology Laboratory in

Lusaka, using national guidelines. In addition, 20 senior DFMS staff, mostly counselors and/or supervisors

from the new and existing model CT sites, will be targeted for training in supervision to develop their skills in

monitoring, managing, and evaluating HIV counseling and testing services; developing linkage/referral

networks for follow-up treatment and care in ART, TB, PMTCT and Palliative Care; and ensuring quality

standards for services in the comprehensive sites. The trained supervisors will serve to reinforce CT training

through ongoing supportive supervision visits and on-the-job training, and the effectiveness of training will

continue to be assessed and monitored through pre-and post-training tests.

The second component of this activity is to continue supporting the operation of two mobile CT units

established in FY 2006 which are operated by the DFMS with support from PCI. The first mobile unit was

launched on 14th August 2006. Response to the service has been excellent. Community mobilization

dramas and written materials are used to promote couple counseling and testing including issues such as

disclosure and discordance. Prior to the mobile CT units going out, an assessment of the proposed site is

undertaken to check on the catchment's population, existing referral services and to solicit support from the

local leadership. Existing referral services will be printed and shared with clients who come through for

counseling and testing. Clients who test positive will be referred to the local ZDF and other health facilities

for follow-up services. Referral services include, CD4, Anti-retroviral therapy (ART) assessment, TB,

PMTCT, Sexually Transmitted Infections (STIs), Opportunistic Infections (OIs) management, Home Based

Care (HBC), spiritual support, support groups for PLWHAs and psychosocial support.

PCI will work with referral centers to ensure that clients referred to them are tracked. This will help to

determine the effectiveness of the referral system. Clients who test negative are advised to return for a

second test after three months at the nearest CT facility in order to cover the window period, when HIV

antibodies are not yet detectable in a test. The mobile services will gradually increase their coverage to

DFMS sites and surrounding communities throughout the country, taking into account geographical

coverage by static and mobile services, and focused on remote, underserved regions where ZDF units are

typically found. Funding will be used for operation and maintenance of two vehicles, a refresher training for

mobile CT providers and logistical support for medical staff (a core DFMS team and supplemental staff from

the ZDF units in the areas targeted), community mobilization by the ZDF drama teams, peer educators, and

others, and procurement of HIV test kits (to supplement those accessed through Zambia CT Services) and

other medical supplies.

Updated and targeted education materials on CT, ART, STIs and stigma reduction will be reproduced and

available at the counseling and testing sites. All mobile CT providers have been trained in rapid HIV testing.

A qualified laboratory technician/technologist carries out quality assurance on 10% of the samples from

Activity Narrative: each counselor. In addition 10% of all samples are taken to Maina Soko Military Hospital Laboratory for

further quality assurance. PCI will continue to collaborate with other USG-funded partners with experience

in mobile CT, including SFH/New Start and CHAMP to assist DFMS in refining operational procedures and

guidelines to manage and maintain the effectiveness and efficiency of the mobile services and its

operations, particularly staffing, operational budgets, monitoring and evaluation, quality assurance, outreach

programs and educational materials. This will be made possible through refresher workshops and regular

review meetings for key mobile CT providers.

For ongoing monitoring of CT activities, PCI has adopted UNAIDS CT assessment tools. The tools are used

for CT site evaluation of logistics consideration and coverage, training support and work satisfaction,

performance skills of the counselors, and client satisfaction through confidential and anonymous exit

interviews. The tools are administered during the on-going monitoring and supervision tours of ZDF service

delivery sites by PCI staff. Findings from these monitoring visits are being used to improve on the quality of

services being provided. The sustainability of this activity is by strengthening the capacity of the DFMS to

plan, implement and manage CT services with technical support. Capacity strengthening is achieved

through joint planning, assessments, and monitoring of activities, as well as through formal training of ZDF

staff, on-the-job training from experienced CT implementers from PCI and other partners, ensuring access

by the ZDF to national guidelines and policy, basic infrastructural support, and linking ZDF services with

locally accessible sources of resources and technical support (e.g. Zambia CT Services).

PCI has linked DFMS with the government Medical Stores for provision of test kits for the mobile CT

program. This will contribute greatly to the sustainability of CT services. The use of ZDF personnel who are

on government payroll is another important sustainability strategy. The target of this activity is to have 6,000

people receiving CT at 54 ZDF static CT centers. The two mobile units will target an additional 3,000 people

with counseling and testing services.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14631

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14631 3732.08 Department of Project Concern 6890 3041.08 DoD-PCI $600,000

Defense International

8785 3732.07 Department of Project Concern 4939 3041.07 DoD-PCI $675,000

Defense International

3732 3732.06 Department of Project Concern 3041 3041.06 DoD-PCI $775,000

Defense International

Emphasis Areas

Construction/Renovation

Gender

* Addressing male norms and behaviors

Military Populations

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $109,622

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.14:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

This activity also relates to activities in Health System Strengthening by Project Concern International (PCI)

and Jhpiego, PMTCT (JHPIEGO), Adult Care and Support (PCI and JHPIEGO), Counseling and Testing

(PCI), Sexual prevention (PCI) and Adult Treatment (JHPIEGO).

The emphasis in this program area is sustainable capacity building by focusing on training and systems

support within the Zambia Defence Force (ZDF), and in particular building the capacity of those responsible

at central and unit levels for the design, implementation, and Monitoring and Evaluation (M&E) of HIV/AIDS

related activities. As a first activity, PCI will continue to support and strengthen ZDF capacity in M&E.

Funding for this activity will be used to assess and improve communication systems in ZDF units to

increase their capacity in information management, M&E and situation analysis. This activity will build upon

ongoing efforts to strengthen and systematize linkages between DFMS facilities and District Health

Management Teams (DHMT). These linkages are essential as they allow the DFMS to benefit from DHMTs

technical and systems support, medical supplies and community mobilization of the civilian population. This

is critical to the longer-term sustainability of DFMS-managed health care services. To further strengthen

DFMS capacity, computers, printers, uninterruptible power supply devices and other supplies will be

procured to support HIV/AIDS information management at four new model sites for ART, PMTCT, Adult

Care and Support and CT. The four sites will be jointly determined by PCI, DFMS and JHPIEGO.

In FY 2006 ZDF appointed three program officers to assist with HIV/AIDS data collection and management.

In FY 2007 the three HIV/AIDS program officers from Zambia Army, Zambia Air Force and Zambia National

Service were supported to undergo a short course in M&E offered by the University of Zambia. The training

was aimed at building their skills in Health Management Information Systems (HMIS) including M&E data

collection, management and reporting. Following this training, the HIV/AIDS program officers are

responsible for strengthening these areas in ZDF health facilities. Improving the capacity of ZDF staff will

also serve as a means of building sustainable institutional capacity in this area. In FY 2009, 54 ZDF

HIV/AIDS unit coordinators, 54 Ward Masters and six central HIV/AIDS unit staff will participate in an M&E

refresher training to continue building their capacity to monitor, supervise, and report effectively on all

HIV/AIDS-related activities on their units. The workshop will be facilitated by PCI staff and an M&E

specialist from the National AIDS Council (NAC) to maintain national standards. This activity is an

expansion of previous workshops held to address the significant ongoing challenge of obtaining monthly

field activity reports from the units, which impedes the monitoring of progress in ZDF health services. During

the FY 2006 to FY 2008, PCI has supported M&E training for Ward Masters, who assist unit HIV/AIDS

coordinators with data collection and compilation, from each of the 54 ZDF units. The training of ward

masters has led to a significant improvement in HIV/AIDS activity reporting. It is expected that annual

refresher trainings in M&E will help to identify and jointly address data collection and dissemination, further

raise awareness and commitment to the importance of regular data collection, monitoring and reporting, and

increase the number of ZDF units that consistently submit their monthly activity reports.

In coordination with DFMS and JHPIEGO, PCI will conduct baseline facility assessments of the four model

sites during FY 2009. The baseline assessment will look at among other things infrastructure, catchments'

population, human resources, and available equipment and referral opportunities. Based on the assessment

results, PCI will provide support to DFMS to build the capacity of these sites to model site standards. PCI

will also continue to participate in supportive supervision tours of ZDF units, with leadership from the DFMS

HIV/AIDS office (and including the Director General Medical Services, who joins these monitoring tours

periodically with DOD/PEPFAR support). The aim of these tours is to monitor the quality of services being

provided by various trained cadres of health workers and to provide on-site technical assistance were

needed. In addition to these tours PCI staff will monitor HIV/AIDS activities in ZDF units during the mobile

CT tour of the units. The two project nurses hired in FY 2007 will accompany the mobile CT units to

undertake this monitoring exercise.

An additional activity will be to conduct a prevalence study for the ZDF. The last study was conducted in FY

2004 and was instrumental in the programming of HIV/AIDS activities. This will be conducted with the

assistance of CDC and other government partners such as the University of Zambia, Central Statistical

Office and the Ministry of Defence

New/Continuing Activity: Continuing Activity

Continuing Activity: 14632

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14632 3739.08 Department of Project Concern 6890 3041.08 DoD-PCI $200,000

Defense International

8788 3739.07 Department of Project Concern 4939 3041.07 DoD-PCI $180,000

Defense International

3739 3739.06 Department of Project Concern 3041 3041.06 DoD-PCI $200,000

Defense International

Emphasis Areas

Military Populations

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $32,583

Public Health Evaluation

Estimated amount of funding that is planned for Public Health Evaluation $0

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $0

and Service Delivery

Food and Nutrition: Commodities

Estimated amount of funding that is planned for Food and Nutrition: Commodities $0

Economic Strengthening

Estimated amount of funding that is planned for Economic Strengthening $0

Education

Estimated amount of funding that is planned for Education $0

Water

Estimated amount of funding that is planned for Water $0

Program Budget Code: 18 - OHSS Health Systems Strengthening

Total Planned Funding for Program Budget Code: $16,376,028

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

The U.S. U.S. Mission in Zambia continues to support and strengthen the Government of Zambia (GRZ) and its citizens to

respond to the HIV/AIDS epidemic through a broad range of policy and health systems strengthening interventions. Such

interventions form an important component of many U.S. activities. Since 2004, significant progress has been achieved as a

result of this partnership, including accelerated engagement of leadership at all levels, fostering increasingly conducive policy and

regulatory environments, developing human capacity, building local government and non-governmental institutions, and

enhancing coordination and collaborative efforts among the GRZ, bilateral and multi-lateral cooperating partners, faith-based

organizations, the private sector, and civil society. Through collaboration with line ministries, the Zambian Defense Forces, NGO,

FBO, CBO, and other cooperating partners, and the private sector, the impact of many U.S.systems strengthening interventions

will outlast funding.

U.S. partners pursue a myriad of activities that help Zambian institutions plan, manage and implement HIV activities. An

important component of that support is building capacity of provincial and district bodies that form the local implementation and

coordination bodies for funding from the National HIV/AIDS/STI/TB Council (NAC) and other channels. This support is

implemented both through partner technical assistance and a small amount of direct funding through the Joint Financing

Arrangement with NAC. An additional new initiative will strengthen coordination and monitoring and evaluation at the national

level, through the NAC. U.S. partnerships with the corporate sector will continue to facilitate HIV/AIDS service provision and

support the accreditation of private health care facilities. U.S. partners will continue to bolster district and provincial capabilities to

supervise health care providers in their purview. U.S. support will continue for the Zambian Health Worker Retention Scheme,

renamed from the Rural Retention Scheme. A total of 119 health care workers will receive support, including housing

renovations, through FY 2009.

Human and institutional capabilities in both the health and social sectors present a major challenge to effective provision of HIV

and other health services in Zambia. The U.S. Mission in Zambia will work with the GRZ to support task shifting to enable trained

lay workers to do rapid HIV testing, and to increase access to pain management drugs. The U.S. Mission in Zambia will work with

the MOH to disseminate the human resource planning and projection guidelines, and support the provincial health offices to

assess the districts' human resource needs and facilitate the development of the districts' human resource plans. Importantly, the

U.S. Mission in Zambia will support health worker training institutions to ensure inclusion of state of the art HIV care and treatment

information in pre-service and in-service training curricula.

The U.S. approach to sustainability involves empowering individuals, communities and local organizations helping them determine

and pursue their respective roles in health by improving their functionality, developing mutual relationships of support and

accountability, and decreasing dependency on external relationships. To that end, some U.S. programs have decreased their

support in FY 2009, while others work to build systems that are self-perpetuating.

The U.S. Mission in Zambia will continue to support successful programs at the University of Zambia's Department of Social

Development and the School of Community Medicine to build institutional and individual planning, research, monitoring,

evaluation, and information technology capacity for HIV/AIDS. In the Department of Social Development, a short course on

planning, monitoring, and evaluation for new and mid-career working professionals will continue to be supported. The U.S.

Mission in Zambia will strengthen research capacity in public health at the School of Community Medicine and the curriculum in

biomedical research. As a result, more Zambian clinical investigators will have tools to conceive of and manage research

endeavors.

The U.S. Mission in Zambia will continue to strengthen military health services by supporting the procurement and logistics

management system. The U.S. Mission in Zambia will work with UNAIDS to build the capacity of uniformed personnel by focusing

on mentoring and leadership programs for the Zambia Defense Force. Efforts will continue to focus on building resource

mobilizations skills, strengthening policy development and implementation, and increased capacity to effectively plan and manage

HIV/AIDS activities.

In FY 2009, U.S. partners will continue to assist national procurement efforts and make improvements to HIV-specific and broader

essential drugs logistics systems. Employing lessons from the highly successful introduction of the ARV logistics system two

years ago, the U.S. Mission in Zambia is in the process of rolling out an HIV test kit logistics system and will roll out the laboratory

logistics system in FY 2009. In contrast to ARVs, test kits and laboratory commodities, U.S.-procured drugs for opportunistic

infections are a part of the integrated essential drugs system. PEPFAR/Zambia has begun to address this system in a holistic

manner, leveraging other U.S. funding (e.g., malaria and family planning) as well as co-financing from the World Bank.

In collaboration with GRZ, NAC, MOH, and other key stakeholders, such as the Churches Health Association of Zambia and the

Clinton Foundation, the U.S. Mission in Zambia continues to support the national HIV/AIDS Commodity Security Strategic Plan

and associated processes through the national HIV/AIDS Commodity Security Working Group. The plans of this group are used

as inputs for Global Fund procurement plans, both for preparing proposals and for procurements under existing grants. The U.S.

Mission in Zambia will continue to support the expansion of laboratory and other health information technology and cater to the

equipment needs in targeted provincial and district health facilities.

An important component to enhance sustainability is specific interventions designed to build the capacity of indigenous

organizations that move them further along the continuum toward the ability to receive direct cooperating partner funding. In FY

2009, U.S. programs will build the capacity of 60 partner organizations through small grants accompanied by intense

organizational development technical assistance.

Policy work will continue throughout FY 2009. To specifically address gender violence, in FY 2009 U.S. partners will support

programs that address the link between coercion, sexual violence and HIV/AIDS. Through organizational development work with

civil society organizations active in this area, U.S. partners will monitor abuse and provide legal services to victims of coercion and

sexual violence. Further work will engage Zambian leaders, including Members of Parliament and traditional leaders, to highlight

the importance of including violence against women in broader HIV prevention programs. The activity will support development of

a substance abuse policy through the MOH due to the links between alcohol, HIV transmission and gender based violence. U.S.

partners will continue to work in drafting, refinement, approval and dissemination of codified laws and regulations critical to HIV,

such as the draft amendment of the Employment Act and morphine use guidelines.

The U.S. Mission in Zambia, in conjunction with the Swedish International Development Agency (SIDA), forms the bilateral

cooperating partners' representation on the Global Fund's Country Coordinating Mechanism (CCM). With 20 grants and four

principal recipients across the three diseases, the Zambian Global Fund architecture is among the most complex in the world.

Performance of Global Fund grants has been mixed, characterized by long delays punctuated by periods of intense activity once

funds actually flow. The CCM has experienced oversight challenges. The U.S. representative will pursue the possibility of U.S.

Mission in Zambia technical assistance to the CCM to enhance the body's monitoring and evaluation capability.

Table 3.3.18:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

This activity also relates to activities in Strategic Information by PCI, Health System Strengthening

(JHPIEGO), PMTCT (JHPIEGO), Adult Care and Support (JHPIEGO), Adult Care and Support (PCI),

Counseling and Testing (PCI), Sexual Prevention (JHPIEGO), Sexual prevention (PCI), Adult Treatment

(JHPIEGO).

The objective of this activity is to build the Zambia Defense Force (ZDF) capacity in Health systems

strengthening with a particular focus on United Nations (UN) peacekeepers. The ZDF has been actively

involved in peace keeping missions in the African Region. ZDF completed drafting the Defense Force

HIV/AIDS policy in 2006 with technical assistance from UNAIDS and the U.S. Government. During this

workshop, the need to develop a policy on pre- and post-deployment testing and effective prevention

programs for personnel being deployed for peace keeping missions and local border security operations

was identified. Currently the ZDF relies on host government or UN protocols for deployment procedures

including HIV/AIDS pre-testing, post-testing and prevention activities during deployment. There is also no

restriction on the deployment period, which further contributes to the vulnerability of military personnel and

their families to HIV/AIDS infection. PCI will work together with UNAIDS in strengthening the capacity of the

ZDF in planning, developing, implementing, monitoring and evaluating its HIV/AIDS program and toward its

sustainability. In addition to the Ministry of Defense (MOD), UNAIDS will also work with other government

institutions which are involved in the peacekeeping operations such as Ministry of Home Affairs. To further

strengthen ZDF capacity in addressing HIV/AIDS in its peace-keeping operations and local border security

operations, PCI and UNAIDS will work to strengthen peer education as a key component of behavior

change communication and in reducing stigma and discrimination.

In FY 2008, PCI supported refresher training of the 809 ZDF peer educators who were trained in FY 2004.

The peer educators were also provided with logistical support to motivate them to effectively carry out HIV

sensitization activities. The training was aimed at building their capacity in communicating HIV prevention

messages with their peers in the military bases as well as during peacekeeping operations. In addition, PCI

will collaborate with the UNAIDS in targeting Zambian peacekeepers prior to deployment to other countries,

including facilitating HIV/AIDS sensitization workshops as part of the pre-deployment sessions, assuring the

presence of peer educators among the peacekeepers, and equipping them with educational materials. PCI

will continue to support gender mainstreaming throughout all programs, taking into account the special

environment in ZDF, and thus addressing masculinity perceptions, attitudes and risk behaviors amongst

male and female staff. Female peacekeepers will be targeted specifically, addressing their situation as

women and a minority. Further and importantly, the families of the peacekeepers, most often the wives will

be targeted as part of a multi pronged approach. In order to strengthen the capacity of the ZDF to sustain its

HIV/AIDS program, UNAIDS will continue to assist the Defense Force Medical Services (DFMS) with

resource mobilization including identification of other potential indigenous partners for the ZDF HIV/AIDS

programs, coordination of activities and trainings, and coordination of partners such as other bi- lateral

donors, the Ministry of Health (MOH), National HIV/AIDS/TB/STI Council (NAC), other UN organizations.

Building resource mobilization skills, strengthening policy development and implementation, and increasing

capacity to effectively plan and manage HIV/AIDS activities will support the sustainability of the ZDF's

HIV/AIDS activities which currently rely heavily on USG funding. The UNAIDS will also advise the ZDF in

conducting sensitization training, soliciting and dissemination of existing IEC materials. Through all these

activities, UNAIDS will ensure that the ZDF HIV/AIDS program reflects the effective mainstreaming of AIDS

and gender.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14633

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

14633 9171.08 Department of Project Concern 6890 3041.08 DoD-PCI $270,000

Defense International

9171 9171.07 Department of Project Concern 4939 3041.07 DoD-PCI $200,000

Defense International

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Reducing violence and coercion

Military Populations

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $65,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.18: