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
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
RAPIDS cooperative agreement will end in December of 2009. The project will continue activities with all
partners during October 2009 and then begin the phase over process to the new mechanism. This phase
over process will begin soon after the new mechanism is awarded and the new cooperative agreement
comes into effect. Plans for phase over will include programmatic topics, staffing, finance, disposal of
assets, and continuity of care for all RAPIDS clients. There will be a concerted effort for a fluid transition to
ensure that both clients and caregivers are adequately supported. A lapse in programmatic coverage will
be avoided through a coordinated plan for phase over and thus a successful transition.
During FY 2008 modules on reproductive health and sexually transmitted infections (STIs) will be
incorporated into the HVAB curriculum. These modules will be utilized in FY 2008 and continuing into FY
2009.
Activity Narrative:
RAPIDS, which undertakes care and support activities in 52 of the 72 districts in Zambia, is a consortium of
six organizations: World Vision, Africare, CARE, CRS, The Salvation Army, and the Expanded Church
Response (ECR), as well as other community-based organization (CBO) and faith-based organization
(FBO) local partners. RAPIDS uses a household approach which creates a basis for extending care and
support to youth, orphans and vulnerable children (OVC), and people living with HIV/AIDS (PLWHA) within
the context of needs and priorities identified at a household level. RAPIDS will support the Zambia National
HIV/AIDS Prevention Strategy and may participate in campaigns, and will work with PEPFAR funds to
reduce HIV transmission accordingly, within its project mandate, and to the extent its resources permit.
In FY 2009, RAPIDS expects to reach 3,786 youth with Abstinence and Being Faithful for Youth (ABY)
messaging. This number represents those youth graduating from a nine-month ABY life skills course.
RAPIDS will continue targeted prevention strategies to focus on boys/young men. This is in view of the
central role they play in courtship and HIV transmission, as well as in the empowerment of women and
reduction of gender based violence. RAPIDS will specifically encourage young men to form or participate
in existing support groups as allies in the reduction of violence against women and children and to get
involved in home-based care (HBC) work in order for them to assume a community caring role. RAPIDS
will contribute to the reduction in HIV transmission by promoting abstinence among unmarried young people
aged 10-24 years and faithfulness among young married couples. Through the Youth Forum, RAPIDS will
interface with Government of the Republic of Zambia (GRZ) to contribute to the National Youth Policy field
implementation and monitoring.
In FY 2008 and to the extent possible in Oct. 2009, RAPIDS will adapt and distribute a variety of AB
information, education, communication (IEC) materials in coordination with national abstinence and being
faithful (AB)-related campaigns and with the PEPFAR-funded health communication partnership (HCP)
Project. In addition, RAPIDS will apply other strategies for dissemination of information such as drama
campaigns, sport, radio, and music festivals. In monitoring its youth support activities, RAPIDS will continue
to refine and adapt its monitoring and evaluation (M&E) tools to align with overall PEPFAR guidelines and
indicators, which are currently under review. As a matter of practice, RAPIDS M&E will also correspond
with the "Three Ones." RAPIDS will support consortium members in utilizing the ABY M&E systems
developed in FY 2008, capable of documenting interventions and demonstrating impact. RAPIDS will
encourage documentation of case studies/success stories at all levels.
2,365 boys /young men will be trained in life skills with a focus on gender roles in order to counter
stereotypes that encourage risky sexual behaviors. In order to assist youth with community care roles,
training will be provided in basic counseling and psychosocial support (PSS) so that they can provide
counseling to their peers who might be going through trauma of illness or loss of their parents.
In FY 2008 and to the extent possible in Oct. 2009, RAPIDS will sensitize ‘Gate Keepers' such as traditional
leaders and traditional initiators to ensure that they fully understand and appreciate their role in promoting
AB among young people.
In FY 2008 and to the extent possible in Oct. 2009, RAPIDS will enhance the nutritional status of youth and
at-risk OVC by providing life skills and skills in food processing and utilization. The life skills training will
equip the target groups to identify, analyze, and deal with inequalities and power imbalances between
women/girls and men/boys in communities. The program will also work with traditional initiators/leaders to
eliminate harmful traditional and cultural practices which put youth at high risk such as early initiation of sex,
dry sex, sexual cleansing, and wife inheritance.
In addition, RAPIDS will work to reduce transactional sex, a strategy commonly used by young women for
coping with poverty, by providing livelihood training and access to business start-ups. The effort will not
focus only on one side of the problem, younger women as "victims." This will also include efforts to
discourage older male behavior ("perpetrators") from using their financial advantages to exploit younger
women as well. As part of HIV prevention, youth will be educated on the link between alcohol and
HIV/AIDS and advocacy efforts made to reduce intake of alcohol among youth. In partnership with Society
for Family Health (SFH) and according to GRZ and USG guidelines, RAPIDS will help to promote male
circumcision as a prevention method.
In the closing months of RAPIDS, staff and volunteers will strengthen referral networks at district level, and
will continue to work with Government of Zambia (GRZ) structures such as District AIDS Task Forces
(DATFs). The referral process will involve identification of key service providers, formalization of
collaborative relationships, and follow-ups. RAPIDS's partners and sub grantees will continue and conclude
efforts to identify and refer at-risk youth to relevant services such as voluntary counseling and testing for
HIV (VCT), sexually transmitted infections (STI) testing, and treatment. The community-based counseling
and testing (CT) program will conduct counseling and testing for youth. RAPIDS will continue to support
apprenticeships and internships through private-sector partnerships that provide youth with valuable work
Activity Narrative: experience and job opportunities.
RAPIDS's main approach to promotion of sustainability is through mobilization of communities nationwide to
take a lead role in the response to HIV/AIDS in Zambia. To further the sustainability of current grassroots
efforts, RAPIDS will link CBOs and FBOs to existing HIV/AIDS resource streams. RAPIDS technical and
material support for the development of prevention activities include equipping HIV educators within
FBO/CBO institutions with a "Training of Trainers" program designed to help them provide further training to
supervisors, peer educators, and staff within their respective institutions and organizations. These
opportunities for cascading training will have equipped the FBOs/CBOs with management and fundraising
skills.
In addition, RAPIDS provides a practical component where special workshops are arranged to train youth in
agricultural skills, crafts such as pottery and basket weaving, home economics, cooking and gardening, and
other such vocational skills as appropriate to each setting and local markets.
Over the last five years, the RAPIDS sub-grant program equipped CBOs/FBOs working in AB to respond to
HIV/AIDS in their communities more effectively through mentorship and training. All sub-grantees will be
identified to the new USAID mechanism, ideally with GPS coordinates, a brief description, and performance
review. The funding for GPS has not been identified but will be sought during FY 2008.
Because AB clients will not carry over from COP FY 2008, RAPIDS will only begin to provide AB services
for one month early in COP FY 2009, resulting in a massive decrease of over 90% from COP FY 2008.
RAPIDS will still count and report the youth it reaches as direct clients.
All FY 2009 targets will be reached by October 31st, 2009.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14439
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14439 3556.08 U.S. Agency for World Vision 6841 412.08 RAPIDS $2,408,152
International International
Development
8945 3556.07 U.S. Agency for World Vision 4995 412.07 RAPIDS $2,066,700
3556 3556.06 U.S. Agency for World Vision 2922 412.06 RAPIDS $1,590,000
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Increasing women's access to income and productive resources
* Increasing women's legal rights
* Reducing violence and coercion
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $35,846
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
partners during October 2009 and then begin the phase over process to a new follow on mechanism. This
phase over process will begin soon after the new mechanism is awarded and the new cooperative
agreement comes into effect. Plans for phase over will include programmatic topics, staffing, finance,
disposal of assets, and continuity of care for all RAPIDS clients. There will be a concerted effort for a fluid
transition to ensure that both clients and caregivers are adequately supported. A lapse in programmatic
coverage will be avoided through a coordinated plan for phase over and thus a successful transition.
This activity is connected with other RAPIDS activities including HVAB, HTXS, HVCT, PMTCT and HKID,
especially NPI HBHC partners in need of mentoring, such as Kara/FBR and Nazarene Compassionate
Ministries. Other emphases include: continued strengthening of pediatric care and closer linkages to
pediatric ART sites with emphasis on referral of HIV-exposed infants for early diagnosis using Dry Blood
Spot (DBS) samples and Polymerase Chain Reaction (PCR) technology to decrease HIV-related infant
mortality. RAPIDS will also work closely with therapeutic feeding for malnourished PLWHA and with infant
and young child nutrition activities while collaborating with USG Zambia on client-focused strategies for food
and nutrition support.
RAPIDS will also build on extensive malaria control activities which began during FY 2007 to reduce malaria
-related illness in PLWHA. In FY 2009, RAPIDS will refer clients to hospice and will support routine
cotrimoxazole prophylaxis for all HIV-infected clients possible. In FY 2008 and continuing in FY 2009,
RAPIDS will help implement the palliative care pain relief strategy document. Palliative care and
management of simple and moderate pain will be included as part of the minimum standard of care for
PLWHA. Lastly, RAPIDS will emphasize sustainability in these last few months of operation of the grant by
linking caregivers with the new mechanism.
six organizations: World Vision, Africare, CARE, CRS, The Salvation Army, and Expanded Church
Response (ECR), as well as community-based organization (CBO) and faith-based organization (FBO) local
partners. RAPIDS uses a household approach to extend care and support to youth, OVC, and PLWHA
within the context of household needs and priorities identified.
In FY 2009, RAPIDS plans to provide home- and community-based palliative care and support to 51,855
PLWHA. This is possible as caregivers will continue to visit clients in their homes and other community
settings, even during the last month of programming. As more HBHC clients go on ART, and return to
active life, RAPIDS will provide care outside the home. This will include the formation and support of
Positive Living groups. Caregivers will also conduct outreach in designated sites for those who are
ambulatory.
Care and support "outreach" sessions offered to ambulatory clients in various convenient-locations. They
will save time and allows for more clients to receive services from each single caregiver. However, there
are some drawbacks, such as potential loss of privacy and confidentiality, and overload of the caregiver. As
earlier stated, the phase over to the new mechanism will be in process and will address such issues, taking
into consideration that each client should be aware of new projects providing modified support services.
Quality Assurance (QA), while evident in project design and monitoring, gains focus in FY 2008, and in FY
2009 will continue to be a priority. QA mechanisms include caregiver checklists, patient chart review, and
monthly care improvement meetings between caregivers and nurse supervisors.
Palliative care services include: education to improve knowledge, attitudes, and practices on HIV/AIDS;
drugs for opportunistic infection (OI) treatment; psychosocial and spiritual support; infection prevention
through provision of medical equipment; symptom/pain assessment and management; and patient/family
education and counseling. Case coordination will include community-based "Care Coordinators" to refer
clients to various service providers. RAPIDS will continue to counsel PLWHA on behavior change
(reduction in alcohol intake to decrease risky sexual behavior), nutrition, and provide appropriate, factual
information on Other Prevention strategies. RAPIDS will also provide PMTCT sites with coordinates of its
home based care programs, to which PMTCT providers will refer PMTCT clients for follow up in the
community from birth through at least six months to support breast-feeding and timely weaning using
appropriate weaning and complementary foods. RAPIDS will also refer female PLWHA who are (or may
be) pregnant to PMTCT.
In FY 2008, RAPIDS will place a HBPC Policy Technical Advisor at the Ministry of Health, who will continue
into COP 09. This experienced key staff will promote innovations in palliative care in both policy and
practice. RAPIDS will also support efforts by AIHA-PCAZ and SHARe to advocate for, promote, and
disseminate policies and guidelines favorable to comprehensive palliative care. RAPIDS will continue to
work with SUCCESS and other HBHC programs and link them to livelihood initiatives.
RAPIDS HBHC activities are integrated into existing government and NGO district structures and comply
with the "Three Ones." RAPIDS also contributes to the sustainability of the HIV/AIDS response by
solidifying and reinforcing critical networks and alliances; sharing lessons learned and best practices;
leveraging resources; forming partnerships; ensuring that duplication is not occurring, and advocating for
the promotion of improved policy in home-based and palliative care support.
To the extent possible in the month of October, RAPIDS will, through private and corporate donations,
provide and resupply nurse and volunteer caregiver kits. In FY 2008 and FY 2009, WV will continue to
solicit in-kind donations of kits, while exploring more sustainable means to produce and resupply kits in
Zambia using local products, providers and facilities. Clients will receive kits as prescribed by the HIV/AIDS
National Guidelines on "minimum standards of care." RAPIDS will provide volunteers with non-cash
incentives (‘tools for work') through public/private partnerships with USA corporations Gifts-In-Kind (GIK)
Activity Narrative: programs. Such items include raincoats, bags, shoes and bicycles. RAPIDS will continue "care for
caregivers" interventions to ensure that caregivers meet their basic needs while continuing to support
PLWHA.
At midterm, RAPIDS began to notice an increase in the percentage of male caregivers. Project staff will
continue to sensitize men to join caregiving activities both as clients and caregivers, striving to increase the
percent of men as clients in COP 08 and continuing this effort until close-out in COP 09. To reach men,
project staff will conduct sensitization meetings in the evenings, after normal working hours. Sensitization
meetings will also include information on income generating projects for caregivers and the value of certain
tools for work has on the ability of the household to generate income, e.g. bicycle.
RAPIDS will provide targeted nutritional supplements for PLWHA according to national and PEPFAR
Guidance. RAPIDS will support recommendations by FANTA and IYCN in determining nutritional needs,
and promoting better nutritional assessment and counseling, in close coordination with GRZ agencies such
as the National Food and Nutrition Commission (NFNC), NAC and the MOH Nutrition focal persons.
RAPIDS will collaborate with USG Zambia to develop and implement a food and nutrition strategy, including
a shift to a "Food by Prescription" approach.
In FY 2008 and continuing in FY 2009, RAPIDS will continue to reach out to Positive Living Groups with
clients referred directly from CT. Part of RAPIDS's strategy is to create a continuum of care wherein, once
a PLWHA enters a support group, he/she can access a range of basic services, both HIV directly related
(health/medical) and other socioeconomic, psychosocial and human rights/legal services. This strategy of
service provision, as well as support should motivate more men to join support groups.
Caregivers and HBHC providers will continue to combat stigma and discrimination by increasing
understanding of the disease and the challenges faced by PLWHA; encouraging participation of PLWHA in
the design and implementation of projects; and promoting the involvement of youth, particularly males, as
caregivers. RAPIDS will also mainstream gender equality in its care and support activities. RAPIDS will
support gender equity efforts in palliative care led by SHARe and ASAZA for example, to reduce violence
against women related to HIV diagnosis or discordant HIV results. Each project mentioned includes
counseling for men, for example, to reduce violence towards women, to teach new methods to resolve
conflict, and to improve communication and rapport.
RAPIDS designed and implemented a Training of Trainers (ToT) program to equip FBO/CBO HIV/AIDS
service providers with skills to ensure long-term scale-up of training of supervisors, peer educators, and
staff within their respective institutions and organizations. ToTs will be encouraged to participate in the new
USAID mechanism.
All subgrantees will be identified to the new USAID mechanism, ideally with GPS coordinates, a brief
description, and performance review. The funding for GPS has not been identified but will be sought during
FY 2008. RAPIDS will recommend to the new USAID mechanism how to budget for workshops to inform
current subgrantees about options to apply for funding to continue their programming under the new
mechanism.
Because most care and support clients will carry over from COP 08, and will receive services early in COP
09, RAPIDS will count them and report them.
All FY 2009 targets will be reached by Oct 31, 2009.
Continuing Activity: 14440
14440 3558.08 U.S. Agency for World Vision 6841 412.08 RAPIDS $5,392,962
8946 3558.07 U.S. Agency for World Vision 4995 412.07 RAPIDS $4,034,064
3558 3558.06 U.S. Agency for World Vision 2922 412.06 RAPIDS $2,871,000
Estimated amount of funding that is planned for Human Capacity Development $63,292
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $25,000
and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Commodities $35,000
Table 3.3.08:
This ART adherence support activity is connected with other RAPIDS activity areas including HVAB, HVCT,
HKID, and HBHC. RAPIDS does not provide ART directly, rather, it supports adherence by clients of other
direct ART providers. ART adherence activities and emphases include: continued strengthening of pediatric
care training for OVC and HBC caregivers, and closer linkages to pediatric ART sites with emphasis on
referral of HIV-exposed infants for early diagnosis where available. RAPIDS will work closely with
therapeutic feeding for malnourished PLWHA and with infant and young child nutrition activities while
collaborating with USG Zambia on client-focused strategies for food and nutrition support. RAPIDS will
collaborate with USG Zambia to develop and implement a food and nutrition strategy, including shifting to a
"Food by Prescription" approach.
In Oct. 2009, RAPIDS will continue the community-based adherence support and care for those on ART
through conducting regular follow-ups and home visits by caregivers and Positive Living adherence
supporters, providing psychosocial and spiritual support, nutrition counseling, education, monitoring, and
provision of support for families with children and adults on ART through existing HBHC programs in 52
districts.
RAPIDS will continue to strengthen the linkage between HBHC and referral to nearby health facilities. In
order to do this, RAPIDS will work with HBHC coordinators and caregivers trained in ART literacy and
adherence, management of OIs and in referral networking. The program identifies client transport options,
linkages with HIV Counseling and Testing (CT) programs, and uses a wraparound approach to access food
supplementation.
Through adherence support efforts, RAPIDS will help the GRZ and USG Zambia to: support ART patients
and sites and support ART quality improvement and M&E. RAPIDS will employ established links to ART
Centers of Excellence as a client referral destination and utilize the ART Centers of Excellence as a source
of learning for adults and pediatric ART. RAPIDS will continue to provide particular adherence support in
remote, rural areas of Zambia through its vast community based volunteer network nation-wide. These
volunteers will direct clients to ART sites. In cases where transport is a barrier, RAPIDS will assist with
client transport. RAPIDS will facilitate where and when possible in bringing ART closer to clients, for
example, through support of ART in hospice or other community settings.
RAPIDS will continue malaria control activities which began during FY 2007 to reduce malaria-related
illness in ART patients. RAPIDS will support routine cotrimoxazole prophylaxis for all PLWHA.
six international and local organizations: World Vision, Africare, CARE, CRS, The Salvation Army, and
Expanded Church Response (ECR), as well as other CBO and FBO local partners. RAPIDS will continue
to be a leading provider of community-based ART referrals and ART adherence in FY 2009. RAPIDS will
reach 12,590 beneficiaries (out of the total 51,855 being directly reached with general home-based palliative
care (HBHC)) with ART access and adherence support services in the month of October 2009.
The current proportion of men to women in RAPIDS HBC programs is 60% women and 40% men, a
significant "gender gap," About half (50%) of the men and women are on ART. Every effort will also be
made to encourage men to be tested by availing CT in the home and at weekends. RAPIDS will continue
its efforts to increase the percent of men as ART adherence clients beginning in COP 08 and will continue
this effort until close-out in COP 09. Providing CT at more targeted venues and hours should assist in
reaching a higher proportion of men with testing, subsequent linkage to treatment and in turn adherence
support. These efforts will commence in FY 2008 and continue into FY 2009.
RAPIDS will continue and strengthen non-clinical support to four Family Support Units (FSUs) in Lusaka,
Livingstone, Ndola, and Kitwe. RAPIDS partners will build on proven integrated methods to encourage
parents and guardians to seek CT for children; provide community-based support for ART adherence;
provide psychosocial support for children living with HIV/AIDS and their family members; address stigma
and discrimination in the community; and deal with the specific needs of family caregivers, families where
both parents and children are on ART, and children in need of counseling.
During October of 2009, RAPIDS will continue to collaborate with government and other USG funded ART
projects such as ZPCT, AIDS-Relief and CIDRZ. The goal will be to increase access to ART. Strengthened
pediatric ART referral systems will ensure that HIV- positive pediatric patients from the HBHC program are
linked to ART services. RAPIDS will collaborate with AIDS-Relief and CIDRZ to identify and refer HIV-
positive children, where pediatric-ART services (PDTX) are available. These interventions will include
increase awareness, promote early CT, support parents managing ART for their children, promote issues
related to adherence, and enhance psychosocial support for pediatric ART clients.
These services will link to clinic-based services in specific areas where PDTX is available. The RAPIDS
consortium will also strengthen the skills and knowledge of HBHC providers through training in the provision
of care and support for pediatric treatment. Moreover, RAPIDS is working to ensure that PLWHA under its
coverage benefit fully from the GRZ scale-up of ART and expanded palliative care services. These
benefits will mainly be ensured through the strengthening of the established system of referrals and
linkages with health facilities and regular follow-up support.
Activity Narrative: RAPIDS will address gender concerns so that women and men are included in the ART program more
equitably, such as increasing the percent of men as clients. This will also be reflected in the reporting
which will be disaggregated by sex. Like all RAPIDS activities, ART adherence activities are designed to
reduce stigma and discrimination through training of caregivers and health providers in stigma reduction
strategies.
Given the magnitude of the HIV/AIDS problem, it is evident that formal health care and support services
cannot cope with the numbers of individuals requiring assistance. Thus, the front-line response to
HIV/AIDS must come from communities themselves, as they increasingly take on the responsibility for
caring for their members and providing support to those on ART. Currently, RAPIDS mobilizes community
committees as the primary mechanism for providing care and support to OVC, PLWHA, youth, and
vulnerable households. These community committees draw their membership from a broad spectrum of
community stakeholders in an effort to ensure multi-sectoral representation and a holistic and coordinated
response. RAPIDS is achieving significant momentum in mobilizing communities and ensuring that
communities take the lead in mitigating the impact of HIV/AIDS and sees this as the key to long-term
sustainability in the response to HIV/AIDS in Zambia. During FY 2008, as soon as the follow-on USG
mechanism is determined, RAPIDS staff will create an enabling environment for HTXS activities to continue.
From inception in FY 2004, RAPIDS designed and implemented a "Training of Trainers" program to equip
FBO/CBO HIV/AIDS service providers with skills to ensure long-term scale-up of training of supervisors,
peer educators, and staff within their respective institutions and organizations.
Before and during the phase over period, RAPIDS will encourage local community-based organizations to
improve management skills and to access existing HIV/AIDS resource streams. To this end, WV has
developed a specialized Organizational Capacity Building (OCB) guide in order to ensure that the internal
capacities of community-led structures are sufficiently developed to sustain their important efforts in the long
term. The OCB guide is aimed at sub-grant recipients. RAPIDS will also invite the participation of GRZ
entities in OCB sessions. The OCB Guide focuses on strengthening the general organizational capacities
(as opposed to HIV/AIDS-specific technical skills) of CBOs. The OCB process is a three-stage, iterative
one, beginning with organizational self-assessment, followed by selected trainings based on the results of
the assessment, and supplemented with additional follow-up support.
RAPIDS is ensuring that the program is integrated into existing district structures, both government and
NGOs, and is contributing to building the capacity of these structures to ensure sustainability beyond the life
of the program. RAPIDS will also contribute to the sustainability of the HIV/AIDS response in its work to
solidify and reinforce critical networks and alliances, share lessons learned and best practices, leverage
resources, form partnerships, ensure that duplication is not occurring and advocate for the promotion of
improved policy in the core RAPIDS program areas.
Because most adherence clients will carry over from COP 08, and will receive services early in COP 09,
RAPIDS will still count them, but will report them as direct clients. RAPIDS support is limited to adherence,
and does not include direct provision of ART.
All FY 2009 targets will be reached by October 31, 2009.
Continuing Activity: 14443
14443 3566.08 U.S. Agency for World Vision 6841 412.08 RAPIDS $1,567,700
8948 3566.07 U.S. Agency for World Vision 4995 412.07 RAPIDS $1,283,157
3566 3566.06 U.S. Agency for World Vision 2922 412.06 RAPIDS $1,061,000
Estimated amount of funding that is planned for Human Capacity Development $11,346
Table 3.3.09:
partners during October 2009 and then begin the phase out process to the new mechanism. This phase out
process will begin soon after the new mechanism is awarded and the new cooperative agreement comes
into effect. Plans for phase out will include programmatic topics, staffing, finance, disposal of assets, and
continuity of care for all RAPIDS clients. There will be a concerted effort for a fluid transition to ensure that
both clients and caregivers are adequately supported. A lapse in programmatic coverage will be avoided
through a coordinated plan for phase out and thus a successful transition.
In FY 2008 and continuing in FY 2009, RAPIDS will deepen psychosocial support provision which includes
training caregivers to identify traumatized children that need therapy and refer them for professional
therapy. Thus, psychosocial support interventions will be measured with more detailed indicators. This
intervention will be piloted in the geographic areas where the A Safer Zambia (ASAZA) program is
implemented to allow for cross-referrals for victims of gender-based violence. While activities to provide
food security and sustainable livelihood options for households such as livestock restocking, community
gardens and provision of low level irrigation systems will be continued, other food strategies will be
developed in concert with USG. RAPIDS will collaborate with USG Zambia in the development and
implementation of a food and nutrition strategy as well as adopting elements of a common approach. A
shift to a client-focused shift to "Food by Prescription" is anticipated.
RAPIDS will conduct OVC activities throughout the month of October 2009, reaching 199,185 OVC with
supplemental direct support, rather than primary direct support. This is due to the fact that RAPIDS will not
be able to fund school fees a full term in advance.
This activity is connected with other RAPIDS activity areas including HVAB, HTXS, HVCT, and HBHC, as
well as with other orphan and vulnerable children (OVC) activities, ART, PMTCT, and CT. Emphases
include: continued strengthening of pediatric care training for OVC caregivers, and closer linkages to
pediatric ART sites with emphasis on collection of Dried Blood Spot (DBS) samples and/or referral of HIV-
exposed infants for early diagnosis where available. RAPIDS will work more closely with therapeutic feeding
for malnourished PLWHA, and with infant and young child nutrition activities. RAPIDS will also build on
extensive malaria control activities which began during FY 2007 to reduce malaria-related illness and death
in OVC. RAPIDS will ramp up routine cotrimoxazole prophylaxis for HIV-infected OVC. Lastly, RAPIDS will
emphasize sustainability during FY 2008 and FY 2009.
RAPIDS, a consortium of six organizations (including: World Vision, AFRICARE, CARE, CRS, The
Salvation Army, and the Expanded Church Response) as well as other faith (FBO) or community-based
organization (CBO) local partners, undertakes care and support activities in 52 of the 72 districts in Zambia.
A RAPID uses a household approach, creating a basis for supporting youth, OVC, and PLWHA within the
context of the household.
In the last month of client services, October 2009, RAPIDS plans to reach 199,185 OVC with supplemental
direct support. RAPIDS will continue to apply a network approach at national, provincial, and district levels
to link and coordinate efforts with other USG and GRZ prevention, care, and treatment efforts. Caregivers
will practice quality care and psychosocial support, legal and social protection of OVC, based on needs
identified during home visits. Caregivers will facilitate referrals of potential HIV-positive infants and children
for HIV testing and clinical care at pediatric ART sites. Children born to mothers in PMTCT programs will
receive follow up through home visits and be referred to health services. Parents will be referred for
counseling and adherence support. RAPIDS will provide PMTCT sites with coordinates of its OVC care and
support programs, to which PMTCT providers will refer their clients for follow up in the community from birth
through at least six months to support breast-feeding and timely weaning using appropriate weaning and
complementary foods. RAPIDS will also refer any female OVC of child bearing age who are (or who may
Counseling and testing of children with a community-based approach will continue through mobile units and
family-based household counseling and testing, according to national guidelines, by trained counselors.
RAPIDS will help test infants by collecting DBS specimens and sending them to PCR centers.
District RAPIDS staff will facilitate the provision of care and support through mobilized community groups.
RAPIDS will remain a key member of the National AIDS Council Impact Mitigation Thematic Group and the
National OVC Steering Committee. RAPIDS will support a policy advisor at the Ministry of Sport, Youth and
Child Development, to help disseminate and implement the National Plan of Action for Children. The OVC
Policy Advisor will complete the training of staff and volunteers on new quality improvement techniques
acquired at an international conference on quality improvement in OVC programming led by USAID in
November 2008. This activity will begin in FY 2008 and conclude in FY 2009.
RAPIDS will continue to provide non-clinical support to Family Support Units (FSUs) which target children
living with HIV and AIDS (CLWHA) next to hospitals and health centers in Ndola, Lusaka, Livingstone, and
Kitwe. RAPIDS will support quality psychosocial pediatric support to CLWHA and their parents/guardians,
specializing in play therapy. Involving HIV-positive children in play activities will reduce stigma and
discrimination. RAPIDS will support non-medical services of the FSUs, linking children to ART services and
supporting ART adherence. CDC partners or ZPCT will support technical/clinical aspects of VCT clinical
training, equipment, and supplies.
RAPIDS will continue to ensure gender mainstreaming and gender equity. For example, linkages will be
formed with the Victims Support Units (VSU) of the Zambia Police and hospitals/health centre paralegal
support centers in order to deal with gender-based violence (GBV) cases and community sensitization and
awareness deliberately involving local leadership, to protect children especially the vulnerable girl child.
RAPIDS will also continue to promote positive male role models to influence behavior patterns in youth.
Activity Narrative: RAPIDS also include counseling for men to reduce violence and abuse towards girls, to teach new methods
to resolve conflict, and to improve gender relations.
RAPIDS will continue to work with USG and 27 OVC partners to operationalize the USG/OVC joint strategic
plan to align activities and reach targets with greater synergy and coordination through the OVC Forum
Technical Advisor and provide support to the Ministry of Community Development and Social Services.
RAPIDS will link OVC with clinics for food and nutrition support according to PEPFAR and national
guidelines. Infant young child feeding will also be encouraged and private food processors engaged.
RAPIDS will participate in and support efforts by FANTA and IYCN projects to determine OVC nutritional
needs, and promote better nutritional assessment, counseling, and support in all OVC care and support
activities in Zambia. This will be in close coordination with GRZ agencies such as the National Food and
Nutrition Commission (NFNC), NAC and the MOH Nutrition focal persons.
RAPIDS will mobilize communities as the key to long-term sustainability in the response to HIV and AIDS in
Zambia. The caregivers, as well as the members of the committees, work as volunteers and do not depend
on external support. Livelihood options for the households and the caregivers will contribute towards better
life for OVC.
Links with government support such as Pediatric ART (P-ART) through the hospitals and government
structures at district level, District AIDS task forces (DATFs) are included in RAPIDS. This collaboration is
part of the exit strategy to ensure continued community support beyond the life of the program as well as
contribute to the UNAIDS-endorsed "Three Ones."
To further the sustainability of local organizations efforts, RAPIDS provided training and sub-grants to CBOs
and FBOs supporting OVC in FY 2008. The training targeted programmatic and management skills along
with stressing the importance of providing quality services to OVC. During the same trainings, RAPIDS
undertook skills building in fundraising so that sub grantees could access other existing HIV and AIDS
resource streams.
All sub grantees will be identified to the new USAID mechanism, ideally with GPS coordinates, a brief
FY 2008. RAPIDS will recommend to the new USAID mechanism to organize workshops to inform current
sub grantees about options to apply for funding to continue their programming under the new mechanism.
Because most OVC clients will carry over from COP 08, and will receive services early in COP 2009,
RAPIDS will count them and report them but as supplementary, not primary.
Continuing Activity: 14441
14441 3559.08 U.S. Agency for World Vision 6841 412.08 RAPIDS $7,198,487
8947 3559.07 U.S. Agency for World Vision 4995 412.07 RAPIDS $5,917,923
3559 3559.06 U.S. Agency for World Vision 2922 412.06 RAPIDS $4,565,000
Estimated amount of funding that is planned for Human Capacity Development $84,582
Table 3.3.13:
This activity is integrally connected with other RAPIDS activity areas including HVAB, HTXS, HKID, and
HBHC. Activities and emphases include: testing at the household-level by finger-prick protocol approved
by the Government of Zambia (GRZ) Ministry of Health and support for pediatric HIV diagnosis via
collection of Dried Blood Spots (DBS) for analysis where possible. RAPIDS will create an enabling
environment for sustainability in the last month of programming, during FY 2008 and early FY 2009. The
most lasting gains in sustainability will be in terms of: organizational sustainability (organizations will
continue operations after PEPFAR); and sustainability of services (organizations will continue services as
resources permit). The most difficult to achieve will be financial sustainability (maintaining the same level of
funding) however, it is anticipated that there will be another USG mechanism to support CT beyond October
2009. RAPIDS will actively participate in the phase over to this mechanism.
six international and local organizations: World Vision, AFRICARE, CARE International, CRS, The
Salvation Army, and the Expanded Church Response (ECR), as well as other CBO and FBO local partners.
RAPIDS uses a household approach which creates a basis for extending care and support to youth, OVC,
and PLWHA within the context of needs and priorities identified at the household level.
RAPIDS will continue to integrate CT services into all its care and support activities targeting youth,
PLWHA, HIV-positive children, and OVC. RAPIDS will target providing VCT to 1,554 clients in FY 2009,
which is 1/12th of FY 2008 levels due to the time limitation.
RAPIDS will source rapid test kits through the GRZ test kit distribution mechanism. Test kits will be
distributed to caregivers to be supplied in caregiver kits to allow for testing in households. Static test
providers will be linked to the local district level supply chain of rapid test kits. The health care providers will
conduct CT for clients referred by lay counselors as well as through mobile outreach services in the
communities. Trained counselors under the Family Support Units will continue using rapid test kits so that
FSUs are able to continue their outreach services into the communities. Strong linkages will be made with
GRZ health centers at district level to ensure clients are provided with services through follow-up and
feedback using the government recommended referral system.
In addition, RAPIDS will seek creative and practical ways to connect communities to CT by sensitizing them
to the importance of CT. RAPIDS focuses on home/family-based testing. Through the household or family-
centered approach, interventions will be conducted reaching a target population which includes OVC, youth,
men, women, and home-and community based care (HBCC) clients and their family members. In addition
to direct counseling and testing, RAPIDS will continue with its CT, ART and PMTCT referrals.
Counselors will make immediate referrals for post-test clients to prevention, care, and ART services. Those
who are HIV-positive will be linked to ART services and PLWHA support groups or encouraged to create
new groups. Counselor caregivers will distribute CT promotional materials developed by other USG
programs such as HCP. All six RAPIDS partners will implement CT activities to ensure that RAPIDS
reaches its CT targets.
To promote operational linkages and enhance the network model approach, RAPIDS will continue
partnerships with other USG supported initiatives that provide CT such as Zambia Prevention Care &
Treatment (ZPCT), AIDS Relief, and Centre for Infectious Disease Research in Zambia (CIDRZ), Corridors
of Hope II, and PSI New Start. Each of the RAPIDS consortium partners, and some of its FBO/CBO sub-
grantees, will include direct provision and/or support of CT in OVC, youth, and HBC programming. RAPIDS
will follow GRZ guidelines on lower age limits for providing CT for youth with or without parental advice and
consent.
To ensure that men and women adults, and male and female youth have equal access to CT, RAPIDS will
program in FY 2008 and October of 2009 with a deliberate focus on gender-sensitive issues. RAPIDS will
concentrate on reducing barriers to CT that men and women face, as well as concerns of single and
married persons. RAPIDS will give attention to the risk of violence for married women who seek CT without
advance knowledge or consent of their spouse. Other perceived barriers of women accessing CT are fear
of being thrown out of the house, the distance to CT sites is prohibitively far, and the high cost of transport
to CT sites.
For men, uptake of CT is often an issue. In FY 2008 and FY 2009, RAPIDS will address the low uptake of
men to CT by the following strategies: encouraging couples counseling, encouraging household testing,
focusing on the head of household as the decision-maker during counseling, and extending hours to
weekends to allow for CT outside normal working hours. To address accessibility, caregivers trained as
counselors will provide testing in the home and/or refer to mobile testing events. RAPIDS will continue its
efforts to increase the percent of men as CT clients, beginning in COP 08 and will continue this effort until
close-out in COP 09.
RAPIDS will target youth-at-risk and children in HIV/AIDS-affected families with strategies that respond to
the needs of each age group within their family and social context. RAPIDS will work with FBOs and faith
leaders to encourage congregants to undergo CT, reduce stigma and discrimination through sensitization
activities on the importance of CT, and support mobile testing vans to conduct CT at churches especially
Activity Narrative: during religious celebrations and other church activities.
RAPIDS is ensuring that the program is integrated into existing district structures including the health
facilities, and is contributing to build the capacity of these structures to ensure sustainability of CT services
and demand beyond the life of the program. RAPIDS will also contribute to the sustainability of the
HIV/AIDS response by solidifying and reinforcing critical networks and alliances; sharing lessons learned
and best practices; leveraging resources; forming partnerships; ensuring that duplication is not occurring;
and advocating for the promotion of improved CT support.
Continuing Activity: 14442
14442 3555.08 U.S. Agency for World Vision 6841 412.08 RAPIDS $858,028
8944 3555.07 U.S. Agency for World Vision 4995 412.07 RAPIDS $573,485
3555 3555.06 U.S. Agency for World Vision 2922 412.06 RAPIDS $350,000
Estimated amount of funding that is planned for Human Capacity Development $4,935
Table 3.3.14:
