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
THIS ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
Updates on progress
Addition of new sites for training
Increase in target for training
Activity Narrative:
This activity is closely linked with the University Teaching Hospital (UTH) Pediatric Centre of Excellence
9765) and the UTH pediatrics Child Sexual Abuse program (#3693).
The Zambia Children New Life Center (ZANELIC) is a shelter for sexually abused children in Lusaka's Linda
compound, which was started in February of 2002 as a result of increasing cases of reported child sexual
abuse in Lusaka. The Center also received financial support and recognition through the Rebook Human
Rights award for young human rights activists. The main objective of the centre is to work towards
prevention and protection of children against sexual abuse and promoting children's' rights by working
closely with family, community and government. A number of trainings on awareness about sexual abuse in
children have been conducted in Linda where the centre is located. The centre provides emergency
accommodation for children at risk of harm in their current environment, psychosocial counseling, and
preparation for court sessions, medical attention. Links have been established with the UTH Pediatric
Centre of Excellence for antiretroviral therapy (ART) services for positive children and the One-Stop Centre
for post exposure prophylaxis (PEP) soon after sexual abuse is reported.
Among the achievements of the centre are: the recognition and acceptance of the centre by the community
(many of the children are referred by the police, social welfare department, or NGO's and individuals);
increased public awareness which has led to increase in reporting of sexual abuse cases in Lusaka's' Linda
compound and Mazabuka district. Support from organizations like World Food Program to help feed the
children; and some successful income generating activities within the community. The centre has also
managed to win limited financial assistance from Kindernotehilfe in Germany and Cordaid Netherlands to
cover educational programs, income generating activities, food, and rentals. On average 40 children are
seen every month.
Funding from PEPFAR in FYs 2007 and 2008 supported training in the community to raise awareness in
HIV/AIDS transmission through child sexual abuse. Recognition and prevention of sexual abuse in children
require a number of key elements be taken into account. For example, staff are provided with trainings that
equip them to identify some key elements, or "tell tale signs" of sexual, physical, and emotional abuse. To
date most of the trainings have been confined to Linda compound in Lusaka and Mazabuka districts.
Among the trained personnel are teachers, church leaders, police, parents, and caregivers, and other key
community leaders as well as children themselves. The funding is being used to establish a formal referral
system between the police, law enforcement agencies, schools, hospitals, and churches.
In FY 2009, funds will be used to continue running the current centres in Linda and Mazabuka. ZANELIC
will also train more community leaders and key figures in four additional compounds of Lusaka (Chaisa,
Mandevu, Chazanga, and Chipata) as well include a new district, Kafue, where training will be carried out.
These sites have been strategically chosen because of their location and also because a number of new
activities under the UTH Pediatric Centre of Excellence, Family Support Unit and Child sexual abuse
program that provide PEP will be extended in tandem to these areas in 2009. Ninety people will be trained
in each of the five new sites, with a total of 450 trained. These training will also include specific trainings for
children in schools and communities in issues around their rights and how to recognize and report abuse.
Efforts will also be made to document the number of referrals between the various partners and monitor and
evaluate the impact of out training.
Targets set for this activity cover a period ending March 31, 2010.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15576
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15576 12522.08 HHS/Centers for University 7191 576.08 University $125,000
Disease Control & Teaching Hospital Teaching
Prevention Hospital
12522 12522.07 HHS/Centers for University 5024 576.07 University $75,000
Emphasis Areas
Health-related Wraparound Programs
* Child Survival Activities
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $30,000
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 $3,000
Economic Strengthening
Education
Water
Table 3.3.03:
April 2009 Reprogramming: Activity deleted due to protocol not approved. Funds have been reprogrammed
to UTH to support DCT program.
This PHE activity, "Evaluation for renal insufficiency in patients commencing Highly Active Antiretroviral
therapy at the University Teaching Hospital in Lusaka, Zambia ", was approved for inclusion in the COP.
The PHE tracking ID associated with this activity is ZM.07.0176.
Continuing Activity: 15584
15584 9756.08 HHS/Centers for University 7191 576.08 University $40,000
9756 9756.07 HHS/Centers for University 5024 576.07 University $40,000
Estimated amount of funding that is planned for Public Health Evaluation $40,000
Table 3.3.09:
This activity relates to Columbia ICAP pediatric treatment (#3691.08) and care and support (NEW), as well
as all UTH supported activities under treatment CSA (#9043), PCOE (9765.08 counselling and testing FSU
(#9044)and Opt-Out (# 9717.08), and pediatric care and support PCOE #(NEW) community HIV/Nutrition
#NEW, palliative care (# 12230.08), mobile initiative # NEW. Also relates to the SPHO counselling and
testing (#3667.08), pediatric treatment programs and Nebraska (# 3701.08)
The University Teaching Hospital has received funding from CDC through two co-operative agreements
established directly with the Department of Paediatrics and the Dermato-venereology clinic (Clinic 3).
Though both agreements are managed by the central administrative office, the accounts are separate and
the location of the two departments is physically separate. To communicate the importance of the breadth
of activities and for purposes of coordination, the activities linked to the two departments have been
submitted as separate narratives.
This is a new activity narrative, although support for early infant diagnosis since FY 2006 has been through
the Paediatric treatment funds under Paediatric Centre of Excellence (PCOE) activity. Request for direct
funding in FY 2009 will allow the early infant diagnosis (EID) laboratory to carry out its mandate to serve as
national level reference laboratory covering a major part of the country.
In 2006, UTH-PCOE was chosen by CDC to collaborate closely with Clinton foundation, CDC, and service
cooperating partners (MOH, EGPAF, ZPCT, Boston University (BU), CRS-AIDSRelief and other partners, to
scale up early infant diagnosis (EID) services at national level.
The PCOE with direct support from CDC embarked on a program to offer EID of HIV in April 2006. The
support included providing technical assistance, training and laboratory equipment in performing HIV DNA
PCR using the Roche Amplicor HIV-1 DNA test version 1.5 on Dried Blood Spot (DBS) samples. This
program served as the primer for the successful introduction of EID of HIV in the country. Since its inception
the program has provided assistance leading to the successful introduction of EID at two other laboratories
in late 2006 and 2007 and eventually to the on-going implementation of a nation wide EID program.
The set up of two other EID laboratories has led to the establishment of a national DBS program with the
three laboratories providing services to specific regions of the country. The UTH Pediatrics Research
laboratory receives EID specimens from 1) The UTH Department of Pediatrics 2) The private health
institutions in Lusaka, 3) The faith based health institutions under the Churches Health Association of
Zambia (CHAZ) located in Lusaka, Eastern and Western provinces 4) All health facilities in the 11 districts
of Southern Province
Goals & Objectives of EID laboratory (2006)
1.To set up a dedicated Early Infant Diagnosis laboratory at UTH PCOE
2.To strengthen the Early Infant Diagnosis Laboratory activities at UTH
a.Continue to implement early infant diagnosis program with PCR testing for all children <18 month
identified (through linkage with PMTCT program or rapid test screening) at Family Support Unit, UTH
outpatient clinics, and UTH wards.
b.Continue to pilot an interim early infant diagnosis program, using dried blood spots (DBS) to support
Livingstone PCOE, the rest of Southern Province and CHAZ supported sites.
c.Continue to train PCOE and UTH staff on early infant diagnosis
d.Implement and enhance the logistics and transport system for DBS to support areas outside Lusaka with
a focus on supporting Livingstone PCOE
e.Enhance PCR results reporting systems to decrease post-test counselling turn around time
f.Ensure that families receive results promptly, accurately and as part of a counselling session
g.Provide supportive supervision and quality assurance on all aspects of early infant diagnosis service
delivery.
Most of the above objectives have been achieved except for objective 1, and we continue to train and
provide supportive supervision on all aspects of EID. In the year 2006, the laboratory tested 1,040 DBS
samples, almost all from patients seen at UTH. In 2007 the number of tests performed increased by almost
100% to 2067. In the year 2008 the laboratory anticipates to perform over 3,000 DNA PCR tests and about
double this amount (6,000) will be performed in the FY 2009 funding.
The current space available in the UTH Pediatrics Research laboratory is inadequate to meet the increasing
sample load. All the EID activities currently being carried out in the UTH Pediatric laboratory will be moved
into the proposed new laboratory that will allow for increased working space. Equipment dedicated to EID
activities will also be relocated to the new laboratory. Equipment necessary to support the anticipated
increase in sample load will be purchased.
The new dedicated EID laboratory will lead to de-linkage of EID activities from Research activities being
carried out in the UTH Pediatrics laboratory and reduction in activities currently undertaken in the
laboratory. Several challenges to effective and efficient delivery of services have been identified. These
include 1) Laboratory space 2) Human resource 3) Data management 4) Poor quality of DBS specimen 5)
DNA PCR stock management.
In a meeting held with CDC in April this year, it was agreed that in order to improve numbers of DNA PCR
done, there was a need for a dedicated stand alone EID laboratory. The procurement of the molecular
laboratory container is in process through ICAP FY 2007 no-cost extension, but the laboratory will require
full time laboratory personnel to be employed once this activity moves out of the research laboratory In the
past EID related activities have greatly relied on bench space, personnel and sometimes reagents provided
by the research laboratory.
In FY 2009
The PCOE will continue collaborating closely with MOH and partners to scale up the availability of infant
diagnosis nationwide. PCOE will provide continued collaboration and supervision of the other two EID labs,
Activity Narrative: improve its provision of early infant diagnosis services at national level and continue training personnel at
national level on early infant diagnosis. It will also:
a)Implement and enhance the logistics and transport system for DBS to support areas outside Lusaka
b)Enhance PCR results reporting systems to decrease post-test counseling turn around time
c)Provide supportive supervision and quality assurance on all aspects of early infant diagnosis service
The quality of some DBS specimens still remains a challenge despite training of health workers in DBS
collection, handling and packaging. To address this issue a lab specific Quality Assurance/Quality
improvement (QA/QC) officer will be recruited and this person(s) will be the linkage between the laboratory
and the various districts hubs and facilities collecting DBS specimens by conducting periodic and as
necessary site visits to assure quality.
UTH will collaborate closely with all health service cooperating partners to scale up the availability of infant
diagnosis nationwide. UTH will provide direct collaboration and supervision of other two labs doing DNA
PCR in Zambia. UTH will provide direct infant diagnosis services to rural mission hospitals through its
collaboration with CRS -AIDSRelief and the Church Health Association of Zambia (CHAZ). While it is
difficult to estimate the HIV exposure rates for infants in our coverage areas it is anticipated that the scale-
up in DBS collection and transportation will significantly increase the sample load justifying the need to
scale-up current laboratory activities.
Sustainability:
The UTH and Livingstone PCOEs are part of the government run tertiary referral and teaching hospitals and
all activities in this proposal are within the confines of the priorities of the two hospitals that strive to
establish a sustainable program, through training of health care workers, development of standard
treatment protocols, strengthening of the physical and equipment infrastructures, implementation of a facility
level quality assurance/quality improvement program, improved laboratory equipment and systems and
development, and strengthening of the health information systems. The two referral hospitals will be able to
cost share with the President's Emergency Plan for AIDS Relief funds by provision of some aspects of the
program, these include: staff time, drugs, reagents and supplies such as needles and syringes, specimen
bottles and test kits, and supportive laboratory services. The benefit of this shared cost is that in the long-
run, sustainability requires minimal funding once staff is trained and systems are in place.
New/Continuing Activity: New Activity
Continuing Activity:
* Malaria (PMI)
* TB
Estimated amount of funding that is planned for Human Capacity Development $10,000
Table 3.3.10:
THIS ACTIVITY NARRATIVE HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
•Shift from program area HBHC in FY 2008 to PDCS
•Update on FY 2008 and plans for FY2009
This activity relates to Columbia ICAP pediatric treatment (#3691.08), care and support (NEW) and TB/HIV
(#17633.08), as well as all UTH supported activities under treatment CSA (#9043.08 and, PCOE (9765.08)
counselling and testing FSU (#9044)and Opt-Out (# 9717.08), and pediatric care and support EID #(NEW)
community HIV/Nutrition #NEW, palliative care (# 12230.08), and Nebraska (# 3701.08)
established directly with the Department of Pediatrics and the Dermato-venereology clinic (Clinic 3).
In order to bring equitable and quality child health care services, as close to the family as possible, the
PCOE introduced a mobile clinic unit that reached out to disadvantaged children in Lusaka's Misisi
Township, in FY 2008.
The mobile pediatric unit is closely linked to a treatment centre in Lusaka's Misisi Township that is offering
early nutrition screening and support, including access to ART to disadvantaged children. The services
offered at each outreach session include regular growth monitoring and promotion, child immunizations,
health education, clinics for the sick children, psychosocial and HIV counseling and testing services and
linkages with local community initiatives (USG partners like RAPIDS and SUCCESS) all of which will impact
on better health and palliative care for the children's' well being. In line with the Zambian Ministry of Health
strategy, all activities related to the exposed infant will be linked to the PMTCT programs. Reporting on
activities around the exposed child will be done under the PMTCT program component.
Funds under this activity in FY 2008 were used largely to purchase the mobile clinic and employ a
complement of full-time dedicated staff that provided a range of comprehensive primary health care
services to children. The mobile team comprised of two full time counselors, two nurses, and a clinician.
The funds were also used to purchase consumable supplies. By the end of the first year of this mobile
initiative, 500 children will have received HIV related care and support, including palliation and other child
health interventions.
In FY 2009, with the same amount of funds, the mobile team and all care and support activities will be
running at full-capacity. Children initiating ART will be reported under the pediatric HIV community nutrition
program and all care and support targets will be reported under this activity. It is anticipated that a further
500 will be supported through this initiative in FY 2009, with extension to Kanyama Township in synchrony
with the community nutrition program. At least eight health care workers will be re-oriented in provision of
comprehensive care to children, including OI management, immunizations, and child health monitoring
The government has introduced mobile clinics in some peri-urban areas in trying to bridge the gap of
service delivery as close to the family as possible. With this vision in mind, the PCOE has been assisting
Lusaka district health management team to give quality child health care close to the family. The PCOE has
been working closely with the district in identification of the intervention area as well as the implementation
of this service. The district will provide some of the consumables (especially EPI services) to the mobile
clinic.
THIS ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS
•Updates for each section
•Revised targets in FY 2009
•Addition of a new scope to accommodate a community based intervention
Activity Narrative
(#17633.08), as well as all UTH supported activities under treatment CSA (#9043), PCOE (9765.08
community HIV/Nutrition #NEW, mobile initiative # NEW and Nebraska (# 3701.08).
The University Teaching Hospital (UTH) has received funding from CDC through two co-operative
agreements established directly with the Department of Pediatrics and the Dermato-venereology clinic
(Clinic 3). Though both agreements are managed by the central administrative office, the accounts are
separate and the location of the two departments is physically separate . To communicate the importance
of the breadth of activities and for purposes of coordination, the activities linked to the two departments
have been submitted as separate narratives.
The physiotherapy component of this program first received direct funding through the PCOE in FY 2007.
This allowed for program implementation and building of local capacity and work in close collaboration with
the department of physiotherapy.
Section 1: Physiotherapy: US $100,000
The achievements for FY 2008 activities were the training of 15 Physiotherapists at the University Teaching
Hospital and 20 Community Based Caregivers in basic palliative care skills and basic physiotherapy skills
respectively. The program also managed to orientate the team members in basic monitoring and evaluation
skills. The services under this activity have been extended to the physiotherapy sections of two additional
sites within Lusaka namely Chawama Clinic and UTH. By the end of FY 2008, a total of 2,250 clients will
have benefited from these services.
The main objective for FY 2009 is to expand Physiotherapy in Palliative Care (PC) services to saturate all
communities in Lusaka, using the same activities as outlined in 2008 supplemental activities:
1.To train two Physiotherapists in palliative care at Matero Health centre, bringing the total number of sites
to four.
2.Train 20 Caregivers at new facilities within the Home Based Care program in basic physiotherapy skills in
Palliative Care.
3.Through the collaboration with Ministry of Health (MOH), train 20 more Physiotherapists as trainer of
trainers in Palliative Care.
4.Pilot the basic physiotherapy manual for community caregivers.
5.To provide physiotherapy in Palliative Care services through Physiotherapists and community based care
givers.
To achieve the above, we will continue to liaise with local ART clinics to improve the referral system to
Palliative Care program, admit HIV/AIDS and other chronically ill patients to the program, provide the
physiotherapy management needed to the patients using a holistic approach, conduct stakeholders
meetings to disseminate information on lessons learned.
In FY 2009 we will continue carrying out monitoring and evaluation activities for the activity i.e. weekly site
monitoring on the implementation, collect quantitative and qualitative data during the monitoring visits,
conduct project team meetings to review progress and constraints of the activity implementation, compile
monthly reports to the Project Managers for onward transmission to CDC and offer technical support to
caregivers on monitoring and evaluation. Training of Physiotherapists in Palliative Care at UTH will be an
ongoing process. By the end of FY 2009 at least 3,000 new clients will have benefited with physiotherapy
and related palliation.
SECTION 2: PALLIATIVE CARE US $150,000
Although a request for funding this activity was made in FY 2007, the funds were withheld; however these
funds were made available through a notice of award for a no cost extension for funding from FY2007 to
use for year three budget period beginning April 1, 2008 and ending March 31st 2009. Funds for FY 2009
will build on lessons learned in FY 2008.
BACK UP SUPPLIES
Zambia is a malaria endemic country and malaria is a leading cause of admission to hospitals in children
aged less than five years, and parallel to the very high HIV prevalence is the TB epidemic. Pneumonia is a
leading cause of mortality among HIV infected infants and persistent diarrhea can lead to severe
malnutrition with its associated micronutrient deficiencies. Although effective preventative interventions
exist, they are usually not readily available in our health facilities. In order to provide a comprehensive care
to all HIV positive children we would like to continue with the procurement of back - up supplies that will
prevent and treat serious infections like atypical pneumonia (in particular PCP), TB, malaria and persistent
diarrhea.
Malnutrition and micronutrient deficiency is also common among HIV positive children. In our nutrition unit,
the prevalence of HIV is about 40%. Vitamin A is given routinely as part of EPI, but is also used for
treatment in children with severe malnutrition and other related conditions.
The achievements for FY 2008 were: The procurement of back up supplies that helped prevent and treat
Activity Narrative: serious infections like atypical pneumonia, TB, malaria and persistent diarrhea when usual stocks run out.
Nutritional support was provided through micronutrient and vitamin supplementation for HIV-positive
children eligible and not eligible for antiretrovirals (ARVs). The appropriate syrup formulation of
Cotrimoxazole suspension was offered to all HIV positive children for prophylaxis of opportunistic infections.
In FY 2009, the same amount of funds will continue supporting the management of OIs preventive
therapies, micronutrient supplementation, provision of insecticide treated bed nets (through the Presidents
Malaria Initiative) to vulnerable HIV positive children. To be purchased are: intravenous cotrimoxazole and
suspension, Isoniazid, multivitamin, Vitamin A, zinc, ferrous sulfate, folic acid, (or a mineral mix).
The UTH palliative program will collaborate with USG Zambia partners on an effort to shift to a Food by
Prescription approach, which is client focused rather than family focused, and seeks to ensure good
nutritional status as an adjunct to Pediatric ART and support the development and implementation of a USG
Zambia food and nutrition strategy, as well as to consider adopting a common technical approach to food
and nutrition support.
Trainings
As part of continued skills acquisition three trainings will be conducted on the management of severe
malnutrition and three more trainings on integrated management of infant and young child feeding. 25-30
health workers will be trained per workshop and this will enable health workers to give uniform messages on
these topics. It is anticipated that at least 3,000 children will be reached with these interventions.
SECTION 3: COMMUNITY BASED INTERVENTION US $100,000
We will continue partnering with the Community Based Intervention Association (CBIA) - a small NGO that
provides an opportunity to disabled children in Zambia to live a fulfilling and self-reliant life as much as
possible and in close relation with other people. CBIA strives to provide intervention through the provision of
physiotherapy and home based education to children with disabilities. Since HIV induced failure to thrive
and encephalopathy are early clinical manifestations of HIV in children, a partnership with CBIA (a local
NGO) has improved the quality of care given to HIV infected children with disabilities. We have also formed
a partnership with the palliative care association of Zambia and have strengthened our ability manage
chronic pain in children.
Proposed activities for FY 2009 funding:
The Home School Based Education & Physiotherapy Program: CBIA will continue this early childhood
program for preschool and school age children with developmental challenges. They will coordinate
communities, volunteer teachers, make home visits and train communities to provide educational and
developmentally stimulating activities to children using the Ministry of Education's Home Based Education
Program. They will also offer basic physiotherapy and counseling skills. They will train 20 volunteer
teachers, to reach 200 HIV positive children in 5 communities in FY 2009.
Communities supported by CBIA will provide children and families with access to other health, education,
social and child development services. This will include trainings and workshops in HIV/AIDS care and
management, feeding techniques, and occupational and speech and language therapy principles. They will
also continue sensitizing families on the needs of disabled children and to create environments that will
support and encourage their development and participation in community activities. They will also continue
to advocate for the needs and services of disabled children at national-level.
Monitoring and evaluation
Monthly, quarterly and annual activity reports and audit reports will be used by CBIA to evaluate and
monitor progress over the year. External evaluators will also be engaged towards the end of the year.
The UTH is a government run tertiary referral and teaching hospital and all activities in this proposal are
within the confines of the priorities of the hospital that strive to establish a sustainable program, through
training of health care workers, development of standard treatment protocols, strengthening of the physical
and equipment infrastructures, implementation of a facility level quality assurance/quality improvement
program, improved laboratory equipment and systems and development, and strengthening of the health
information systems. The UTH will be able to cost share with the President's Emergency Plan for AIDS
Relief funds by provision of some aspects of the program, these include: staff time, drugs, reagents and
supplies such as needles and syringes, specimen bottles and test kits, and supportive laboratory services.
The benefit of this shared cost is that in the long-run, sustainability requires minimal funding once staff is
trained and systems are in place. The UTH will also support the CBIA continue its efforts to establish itself
as an independent non-profit organization through capacity building, negotiations and consultations with key
stakeholders
Estimated amount of funding that is planned for Human Capacity Development $50,000
THIS ACTIVITY HAS BEEN MODIFIED IN THE FOLOWING WAYS:
•Former HTXS 9765.08 and has been moved to the new PDCS program area
•Highlights progress and achievement to date
•Expansion plans for FY 2009
community HIV/Nutrition #NEW, palliative care (# 12230.08), mobile initiative # NEW , Nebraska (#
3701.08) and SPHO counselling and testing (#3667.08) and pediatric treatment programs (# NEW)
This program was first funded in the FY 2005 through the International Centre for AIDS Care and Treatment
Program (ICAP) a unit of the Columbia University Mailman School of Public Health to support the
development and operation of a Pediatric and Family Centre of Excellence for HIV/AIDS care at the
Department of Pediatrics and Child Health in Lusaka (PCOE).
Since FY 2006 the PCOE has received funding to allow for program implementation and building of local
capacity and has continued to work in close collaboration with ICAP, which provides technical support. The
primary goals of the PCOE are: 1) increase the number of children engaged in care and receiving
antiretroviral therapy (ART); 2) Training of multidisciplinary teams (MDT) in pediatric HIV/AIDS care and
treatment; 3) Serve as the prime referral site for children with advanced and complicated HIV/AIDS disease.
Two PCOEs have been set up, one at the UTH and the other at Livingstone General Hospital and
achievements include:
•Recruitment of management and implementation staff to support the COEs
•Establishing data systems, logistics and referral flow between various service points
•Supporting ongoing and dynamic training, technical assistance and supportive supervision. In 2007/2008,
643 health personnel were trained in pediatric technical areas such as pediatric HIV/AIDS management,
child sexual abuse, palliative care, child development, adherence; provider initiated testing and counseling
(PITC) and hopes to train 500 more by the end of FY 2009.
In FY 2009:
Comprehensive Pediatric Care and Treatment Clinical Service:
The PCOE will continue to support current activities and expand on them by building on the core
programmatic elements established over the past three years. Will continue partnering with ICAP and offer
technical support to the Ministry of Health (MOH) in the development of pediatric HIV related guidelines and
training manuals, conduct national training and mentoring of health workers in the care and treatment of
children with HIV/AIDS. Together with ICAP will support the expansion of pediatric ART in Monze and
Mazabuka as well as down referral to district sites that filter into the local hospitals.
The PCOE will continue to a) routinely schedule clients for follow-up, adherence and routine visits to ensure
timely provision of additional or new clinical services. b) targeted psychosocial and supportive activities for
the adolescent population, c) Integrate adherence education, information and counseling activities into all
aspects of clinical services, d) Strengthen TB prevention interventions including 1) developing a protocol of
TB prevention 2) assessing and screening clients and family for exposure 3) administering prophylaxis to
eligible children, 4) educating caregivers on prevention, warning signs and action steps.
Continued support of the Adolescent Adherence Support Group will provide therapeutic benefits and will
serve to encourage independence, self empowerment and resilience as they support each other's
adherence to care and treatment as well as other adolescent based issues around growing up HIV positive.
The PCOE will collaborate with USG Zambia partners on an effort to shift to a Food by Prescription
approach, which is client focused rather than family focused, and seeks to ensure good nutritional status as
an adjunct to Pediatric ART; and support the development and implementation of a USG Zambia food and
nutrition strategy, as well as to consider adopting a common technical approach to food and nutrition
support.
Neurodevelopment Capacity Building Program:
The PCOE will continue offering intervention services for children identified with developmental problems.
Caregivers will be educated on child development principles and developmentally stimulating activities for
children, and will serve as a resource for child development, neurodevelopment, and mental health
programming. The PCOE will continue to:
•Maintain linkages with complementary child development services throughout the UTH (departments of
physiotherapy, speech and hearing, UTH special school) and the University of Zambia (UNZA) Assessment
Centre.
•Conduct updates of neurodevelopmental screening and assessment monitoring and management tools.
•Expand this service to Livingstone General Hospital.
•Partner with the Community Based Rehabilitation Association (CBIA) to enable PCOE patients with
developmental challenges to access intervention services in their community and assist CBIA in promotion
of HIV/AIDS awareness and education among their community workers.
Activity Narrative: Community Outreach and Patient Follow-up Program:
The PCOE will continue implementing a comprehensive multifaceted follow-up and tracking program to
prioritize the follow up and tracking of children who are lost to follow up. The outreach team will:
a.Continue building formal relationships with PCOE catchments areas, including clinics, community based
organizations (CBOs) and faith based organizations (FBOs) to support the follow up of children who have
defaulted
b.Continue the implementation of routine lost-to-follow monitoring program within the PCOE system so that
a child that immediately misses an appointment has an active file in the follow-up program.
c.Trace and track difficult, priority or high risk cases; liaise with the nutrition program
d.A performance based contracting approach will be utilized to rapidly respond to the findings of the lost-to-
follow up assessment. Community gatekeepers and stakeholders will be solicited to nominate a small
group of community trackers.
Capacity Building and Training Program:
Building National Pediatric HIV/AIDS Capacity:
1)Continue hosting National Pediatric HIV/AIDS trainings and follow-up with on-site precepting. About 12
trainings will be conducted in 2009 resulting in a minimum of 250 health workers trained in Paediatric ART
and how many to be reached with care
2)Develop and implement a training program whereby staff at sites targeted to initiate pediatric HIV/AIDS
services undergo on-the-job training at the PCOE
3)Help formulate the National Strategic Frame Work for Pediatric HIV care and treatment
4)Formulate a PCOE specific strategic framework and define its position in the above.
5)Together with ICAP, support the development of pediatric HIV/ AIDS expertise among the UTH pediatric
post-graduate students through their placement and integration within the PCOEs (UTH, Livingstone) or
other facilities in the country for a four month rotation. The trained postgraduates will also mentor health
workers at these sites
6)Design and coordinate a small program to support post-graduates to carry out HIV/AIDS related program
reviews within the PCOE.
The PCOE will also revise its training plan to include and incorporate non-clinical content such as program
management, financial management, and monitoring and evaluation. In FY 2009 the PCOE team members
and stakeholders, and partners hope to conduct an evaluation to assess progress to date, discuss lessons
learned, define and describe center future direction.
Livingstone PCOE and other sites
In collaboration with ICAP, continue to provide support to the implementation of the Livingstone PCOE, and
support pediatric services to Mazabuka and Siavonga as well as "down" referral to the district sites. PCOE
staff will continue to build capacity of the sites to independently provide comprehensive pediatric care and
treatment services by staff augmentation, training, task-shifting, clinic reorganization, and minor
renovations. UTH -PCOE will conduct site visits to assess progress and provide technical assistance to
support successful work plan implementation and provision of preceptorship.
Patient Tracking and Monitoring and Evaluation Systems:
The PCOE will continue to implement a centralized database system so that data management and
analysis will be more efficient.
This includes ensuring that a comprehensive system is implemented that:
a.Monitors the critical aspects of comprehensive clinical patient care;
b.Facilitates quality improvement activities;
c.Integrates patient reminders and risk of loss to follow-up prompts (non-adherence);
d.Document referral activities.
The aim of strengthening this system is to ensure patient and program data needs are met, that workforce
burden is reduced by ensuring that monitoring patients becomes less time-consuming and more effective.
The UTH and Livingstone PCOEs, Mazabuka, and Siavonga district hospitals are part of the government
run secondary and tertiary referral and teaching hospitals and all activities in this proposal are within the
confines of the priorities of the hospitals that strive to establish a sustainable program, through training of
health care workers, development of standard treatment protocols, strengthening of the physical and
equipment infrastructures, implementation of a facility level quality assurance/quality improvement program,
improved laboratory equipment and systems and development, and strengthening of the health information
systems. They will be able to cost share with the President's Emergency Plan for AIDS Relief funds by
provision of some aspects of the program, these include: staff time, drugs, reagents and supplies such as
needles and syringes, specimen bottles and test kits, and supportive laboratory services. The benefit of this
shared cost is that in the long-run, sustainability requires minimal funding once staff is trained and systems
are in place.
* Family Planning
Estimated amount of funding that is planned for Human Capacity Development $100,000
Program Budget Code: 11 - PDTX Treatment: Pediatric Treatment
Total Planned Funding for Program Budget Code: $8,515,048
Total Planned Funding for Program Budget Code: $0
Table 3.3.11:
THIS ACTIVITY IS A CONTINUING ACTIVITY FR0M FY 2008 THAT WAS UNDER THE HTXS PROGRAM
AREA, BUT INCLUDED NOW AS A SEPARATE NARRATIVE. MODIFICATION IN FY 2009 INCLUDE:
•a new site within an adjacent township
•increased targets
This activity also relates to activities in pediatric treatment (PCOE #9765.08), care and support (# NEW
UTHPCOE) mobile pediatric initiative (# new)
separate and the location of the two departments is physically separate. To communicate the importance of
the breadth of activities and for purposes of coordination, the activities linked to the two departments have
been submitted as separate narratives
This program was first funded in the FY 2008 through direct funding to the UTH Pediatric Center of
Excellence (PCOE). It allows for program implementation and building of local capacity. The program
promotes the early identification and care of undernourished HIV infected children in the community and
has established a system of early identification of children with HIV related malnutrition; community based
management of moderately malnourished children under five years of age with and without HIV infection; a
pathway for antiretroviral treatment with nutrition support for these children and promotes community based
monitoring of adherence to antiretroviral treatment in these children.
The burden of complicated severe malnutrition in children attending the UTH is very high, and among these
children mortality is also very high (40%) as a result of late health seeking behavior. In FY 2008, the PCOE
started working in two of Lusaka's neighboring compounds, Misisi and Chawama, to identify children less
than five years with malnutrition. An innovative comprehensive community screening program was
established that included early identification of HIV positive children. Community involvement ensured local
ownership and a rehabilitation centre was set-up in Kamwala South next to an adult nutrition program.
This community based program in one of Lusaka's most disadvantaged high-density residential areas
promotes earlier detection of evolving problems in HIV-infected children with malnutrition before they
present to health facilities, thereafter intensive nutrition management is done at the community nutrition
center. Improved nutritional status is used as a marker of success of the comprehensive HIV/nutrition
management program.
FY 2009 Activities:
In FY 2009 we hope to build upon our experiences and excellent relationship of trust with the community in
Misisi Compound and to expand into Kanyama compound, another high-density and poorly served area of
Lusaka. We propose to conduct a door-to-survey of the entire compound, screening all children under five
years of age, using mid-upper arm circumference (MUAC), "bipedal edema check" and the presence of
growth faltering (by checking Children's Card if available) to identify children in need of nutritional support,
and screening children with recurrent illness or growth faltering for HIV.
All identified children in Kanyama will be included in a comprehensive management program designed to
offer a high standard of care, which will include: identification of malnourished with or without HIV; for those
with HIV infection clinical staging of HIV disease will be done; treatment of specific illnesses, such as,
notable diarrhea, respiratory illnesses, otitis media, skin infections etc; Co-trimoxazole (CTX) preventive
therapy for all HIV positive children, anti-retroviral therapy (ART) for eligible children, nutritional intervention
- food by prescription and multiple micronutrient (MM) supplementation.
The emphasis is not on new wonder-drugs, but on systematic early HIV and malnutrition detection and
comprehensive application of existing best practice at community level with community participation that will
enhance sustainability; early identification of HIV positive children needing care and thereby ensure better
outcome; follow-up will be delivered from a community nutrition centre. While the primary target of the
program are malnourished children under five years of age, early identification of other HIV positive older
children who require care will be achieved. Since this is a comprehensive community program other
members of the household will be offered counseling and testing for HIV and the team will facilitate early
entry into care programs for the other family members.
Outcome measures will be a notable reduction in the number of severely malnourished HIV-infected
children older than 18 months in Misisi, Chawama, and Kanyama, improved adherence to medication and
decreased mortality in children. A program evaluation will be conducted and disseminated at the end of FY
2009 prior to subsequent roll-out into other compounds.
In FY 2009 follow-up and care will continue to be delivered from a community nutrition centre which we
have rehabilitated and is located within reach of the residents of the four townships. We will continue
involving the community health workers in identifying and follow-up of children under care and the frequent
structured interaction between the staff and the patients will enhance early identification of HIV positive
children needing care, early commencement of ART and better adherence to ART thereby ensuring better
outcome. This community program is a step further to bringing ART services as close to the community as
possible and to get more eligible children on ART.
The program will collaborate with USG Zambia partners on an effort to shift to a Food by Prescription
an adjunct to ART; and support the development and implementation of a USG Zambia food and nutrition
strategy, as well as to consider adopting a common technical approach to food and nutrition support.
Monitoring and Evaluation (M&E): As noted previously, this program is a component of the larger PCOE
work plan. Consequently, the M&E plans summarised in the PCOE work plan narrative will include the
Activity Narrative: comprehensive monitoring of treatment and lab related activities. The PCOE M&E Unit will aim to
coordinate and integrate the various data collection tools and database that the nutrition program will be
using and there by create one unified reporting system that tracks children from various points of entry,
captures the various services rendered, summarises clinical and psychosocial history and status.
We estimate that the total population of the four townships is 200,000, though precise data are not available
as Census data for shanty compounds are unreliable. Our targets remain similar to the first year of the
program, but the extension into Kanyama Township will allow us to identify many more vulnerable children
in this new population. We propose to screen 5,000 children 5% will be HIV positive. The total number of
malnourished and/or HIV-infected children will therefore be around 250 but we need to allow for numbers
which could be considerably higher than this
This activity is closely linked to the UTH mobile initiative, to provide comprehensive pediatric care and
treatment to children, as well as the early infant diagnosis initiative for early identification of children needing
treatment. During the FY 2008 there were 5,000 children screened for malnutrition and HIV and 300
accessed care, treatment and nutrition rehabilitation. In FY 2009, it is anticipated that a further 5,000
children will be screened for HIV and malnutrition and another 300 will access care, treatment and
nutritional rehabilitation. The success of this model could be replicated in other communities and help in
decongesting the Urban Health Centers in Lusaka, detect children requiring ART early and offer nutritional
rehabilitation to HIV positive children on ART.
The UTH is a government-run tertiary referral hospital and all activities in this proposal are within the
confines of the priorities of the hospital that strive to establish a sustainable program, through training of
systems. The hospital will be able to cost share with the President's Emergency Plan for AIDS Relief funds
by provision of some aspects of the program, these include: staff time, drugs, reagents, and supplies such
as needles and syringes, specimen bottles and test kits, and supportive laboratory services. The benefit of
this shared cost and the enhancement of community participation is that in the long-run, sustainability
requires minimal funding once staff is trained and systems are in place.
Estimated amount of funding that is planned for Human Capacity Development $40,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $10,000
and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Commodities $20,000
THIS ACTIVITY IS A CONTINUING ACTIVITY FROM FISCAL YEAR (FY) 2008 THAT WAS UNDER THE
HTXS PROGRAM AREA AND HAS BEEN MODIFIED TO INCLUDE:
•Update on current activities
•Plans for 2009
This activity relates to University Teaching Hospital (UTH) Pediatric Centre of Excellence (PCOE) ( PDTX
#9765.08 and PDCS), Boston University (PDCS # NEW) ZANELIC (HVOP #12522.08) and HVCT(FSU
#3758.08)
Since FY 2005, the United States Government (USG) has provided support to the Department of Pediatrics
at the UTH to strengthen activities developed for the management and monitoring of cases of child sexual
abuse (CSA). These activities included training of health care workers in the recognition and care of CSA,
the provision of post-exposure prophylaxis (PEP) with antiretroviral therapy (ART), development of a
monitoring system, and a follow-up program for reported cases. Other activities include strengthening links
between the Department of Pediatrics and the Zambia Society for Child Abuse and Neglect, development of
activities to increase community awareness of child sexual abuse, and the provision of psychosocial support
to sexually abused children and their families.
CSA has received increasing media attention since September 2003 in Zambia, when a young eleven- year
-old girl died in the UTH in Lusaka as a result of complications of multiple sexually transmitted infections
(STIs) contracted after she was raped by her step-brother. Cases of CSA are on the rise, though many
cases remain unrecognized or underreported. The perpetrators are often relatives of the victim, neighbors,
or close friends, and often only those that develop complications like physical trauma or STI's reach the
health service. One case of CSA is reported every day in Zambia and it is estimated that for every reported
case there are at least ten others not reported (press release Sept 2003). One in five sexual abuse cases
involve young children. Increasingly girls less than 15 years of age are testing positive for HIV which
contributes to the higher prevalence of HIV among women.
Factors that contribute to the practice of CSA in the population include: misconceptions that sex with virgins
will cure AIDS, or that young girls are HIV negative; traditional sexual cleansing practice with young girls;
poor law enforcement strategies; lack of awareness and knowledge in the communities about victims' rights
and appropriate action to take.
Funding for FY 2006 supported a continuation of activities as well as expansion of similar services to
Livingstone Hospital in Southern Province.
In FY 2007, funds were used to continue current activities, strengthen and integrate networks with the law-
enforcement agents, and other non-governmental organizations working in the area of CSA. Initial
assessments have been carried out to extend services to a third site at Ndola Central Hospital in the
Copperbelt Province and to intensify community sensitizations to ensure early referral of cases to the
hospital as well as to strengthen post exposure prophylaxis and follow-up of abused children.
FY 2008 funds were used to improve accessibility of PEP by establishing community based centers linked
to the public health centers in Lusaka, Livingstone, and Ndola. The decision to extend these services closer
to the community in 2008 was a result of the expected increase in demand for the service due to the
increased level of sensitization activities conducted in previous years. In addition experience has also
shown that many children report late due to lack of transport, missing the chance for appropriate and early
PEP. Emphasis was also placed on adherence to PEP course for those that start treatment. Sixty percent
(60%) of children would be started on PEP and 80% would be able to complete a 28 day course if they
qualify. To date, the referral of children already HIV positive and in need of treatment is well established.
This program is closely linked with the community ZANELIC initiative under activity #12522. The main
focus of this community activity is advocacy, community training, and sensitization on CSA and links and
appropriate referral services.
In FY 2009, in addition to consolidating the activities at the One Stop Centre, funding is requested to roll-out
CSA services. Two sites, one in Mazabuka and one in Kafue District have been identified because of the
high number of cases of CSA. This is in keeping with government policy of provision of service as close to
the community as possible to improve accessibility. It is anticipated that because of the critical shortage of
health care workers in Zambia and the long distances to health care facilities, we propose to train
healthcare workers stationed at health posts in the provision of PEP to reach as many children as possible
who may need the service.
By the end of 2010 the CSA manual will have been operational for two years. Feedback from the users will
be requested on usefulness, clarity etc, with a view of incorporating suggestions in the 2nd edition to make
the manual reflect the needs of the professionals.
All the CSA sites are being established within the government health care system. This will ensure long-
term sustainability through staff training, systems development for quality assurance, monitoring, and
referrals.
Continuing Activity: 15586
15586 3693.08 HHS/Centers for University 7191 576.08 University $250,000
9043 3693.07 HHS/Centers for University 5024 576.07 University $250,000
3693 3693.06 HHS/Centers for University 2950 576.06 University $250,000
Estimated amount of funding that is planned for Human Capacity Development $20,000
IN FISCAL YEAR (FY) 2008 THIS ACTIVITY WAS IN THE HTXS PROGRAM AREA AND HAS BEEN
MODIFIED TO INCLUDE:
•Updates on current activities
This activity relates to Columbia ICAP pediatric treatment (#3691), and Columbia ICAP TB/HIV
(#17633.08), all University Teaching Hospital (UTH) supported activities under treatment CSA (#9043),
counseling and testing FSU (#9044)and Opt-Out (# 9717.08), and pediatric care and support EID #(NEW)
community HIV/Nutrition #NEW, palliative care (# 12230.08), mobile initiative # NEW and Nebraska (#
3701.08)
The UTH has received funding from CDC through two co-operative agreements established directly with the
Department of Paediatrics and the Dermato-venereology clinic (Clinic 3). Though both agreements are
managed by the central administrative office, the accounts are separate and the location of the two
departments is physically separate. To communicate the importance of the breadth of activities and for
purposes of coordination, the activities linked to the two departments have been submitted as separate
narratives
This program was first funded in FY 2005 through the International Centre for AIDS Care and Treatment
Two PCOEs have been set-up at the UTH and Livingstone General Hospital and their achievements
include: Over 3,000 children are on treatment
•Establishing data systems, logistics, and referral flow between various service points
•Emphasis in FY 2007 & 2008 with supporting ongoing and dynamic training, technical assistance, and
supportive supervision to increase human capacity in all areas of pediatric ART. In 2007/2008, 643 health
personnel were trained in pediatric technical areas such as pediatric HIV/AIDS management, child sexual
abuse, palliative care, child development, adherence, provider initiated testing and counseling (PITC)
In FY 2009, the PCOE will continue providing comprehensive pediatric care and treatment clinical service.
Activities include:
1.Continued support and expansion of current activities by building on the core programmatic elements
established over the past three years. It will continue to provide exemplary pediatric HIV care and
demonstrate best practices of care and treatment for HIV infected and exposed children;
2.Partner and collaborate with ICAP to offer technical support to the Ministry of Health (MOH) in the
development of pediatric HIV related guidelines and training manuals, conduct national training and
mentoring of health workers in the care and treatment of children with HIV and AIDS.
3.Together with ICAP will support the expansion of pediatric ART in Monze and Mazabuka as well as down
referral to district sites that filter into the local hospitals.
4.Will pilot the initiation of ART in HIV positive young infants (as soon as a definitive diagnosis is made)
regardless of their CD4 percent as per 2008 WHO guidelines at both the UTH and Livingstone PCOEs
5.Start running mobile multidisciplinary pediatric ART clinics that will offer HIV care and treatment services
to all HIV positive children being saved by the community based nutrition centers.
6.Support the development and implementation of a USG Zambia food and nutrition strategy, as well as to
consider adopting a common technical approach to food and nutrition support
UTH PCOE Linkage, Referral and Coordination with Care and Treatment Programs:
1.Strengthen formal linkages with the UTH adult ART facilities and the Lusaka District Health Management
Team's network of primary health facilities and design a system of follow-up to ensure the referral has been
activated.
1)Continue hosting National Pediatric HIV/AIDS trainings and follow-up with on-site preceptoring.
services undergo on-the-job training at the PCOE;
3)Help formulate the National Strategic Framework for Pediatric HIV care and treatment
5)Together with ICAP, support the development of pediatric HIV/AIDS expertise among the UTH pediatric
post-graduate students through their placement and integration within the PCOE's (UTH, Livingstone) or
other facilities in the country for a four-month rotation. The trained postgraduates will also mentor health
6)Design and coordinate a small program to support post-graduates to carry out HIV and AIDS related
program reviews within the PCOE.
management, financial management, and monitoring and evaluation. In FY 2009 the PCOE team members,
stakeholders, and partners hope to conduct an evaluation to assess progress to date, discuss lessons
learned, define and describe centre future direction.
Activity Narrative: Livingstone PCOE and other sites
support pediatric services to Monze & Mazabuka as well as "down" referral to the district sites. PCOE staff
will continue to build capacity of the sites to independently provide comprehensive pediatric care and
renovations. UTH-PCOE will conduct site visits to assess progress and provide technical assistance to
The UTH and Livingstone PCOEs are part of the government-run tertiary referral and teaching hospitals and
program, these include: staff time, drugs, reagents, and supplies such as needles and syringes, specimen
Continuing Activity: 15585
15585 9765.08 HHS/Centers for University 7191 576.08 University $1,600,000
9765 9765.07 HHS/Centers for University 5024 576.07 University $750,000
•Plans for FY 2009
Related activities: This program is linked to the pediatric treatment activities (PDTX # PCOE 9765.08, PDTX
Columbia 3691.08), Pediatric care and support activities (PDCS # NEW PCOE, PDCS # NEW Columbia
PDCS # EID NEW), and counseling and testing activity HVCT FSU #3758.08.
been submitted as separate narratives.
Opt -out counseling and testing (provider initiated testing and counselling - PITC) was first funded in FY
2005 through the International Centre for AIDS Care and Treatment Program (ICAP) a unit of the Columbia
University Mailman School of Public Health to support the development and operation of a Pediatric and
Family Centre of Excellence for HIV/AIDS care at the Department of Pediatrics and Child Health in Lusaka
(PCOE).
Since FY 2006 the PCOE has received direct funding to allow for program implementation and building of
local capacity and has continued to work in close collaboration with ICAP, which provides technical support.
The primary goals of the PITC are; 1) to test all children admitted to our department for HIV so as to
increase the number of children engaged in care and receiving antiretroviral therapy (ART); 2) Training of
multidisciplinary teams (MDT) in pediatric HIV/AIDS care and treatment.
The PITC continues to work seamlessly as a unit of the PCOE to successfully achieve the work plan
outlined in the FY 2008 PCOE narrative. The unit offers provider initiated HIV testing and counseling to all
children admitted to the department of pediatrics and Child Health and offers voluntary counseling and
testing (VCT) services to the rest of hospital community as well as walk ins from the community. The family
support unit (FSU) also helped sensitize the transition of the pediatric inpatient testing approach to provider
initiated opt-out testing and counseling.
Achievements to date: Since the Provider initiated counseling and testing program was initiated in
September 2005, we have had 37,092 admissions, out of which about 4,000 were readmissions or new
admissions with known status, 25,883 were counseled and 25,407 were tested. We have accumulated
7,642 in care and 6,527 are still active at the PCOE, we have started 2,848 children on ART and currently
2,607 are active on treatment. We have earned national recognition as a model of care for children and
PITC so referred to as the UTH model.
The Ministry of Health (MOH) has requested the PCOE to prepare training modules and guidelines on PITC
that can be used at national level; we have so far trained 41 providers for PITC on behalf of our partners.
We held four trainings for ZPCT and 32 providers were trained, whilst we had one training for CIDRZ and
nine providers were trained. We expect to train another 30 by the end of FY 2008
In FY 2009, the opt out funds will continue improving the uptake of testing and counseling of admitted
children and their families, disseminate the PITC National Guidelines and curriculum, continue training
health providers in PITC at national level and together with ICAP strengthen the in-patient testing and
counseling program in Mazabuka and Siavonga.
We will continue providing provider initiated testing and counseling mentorship to partner organizations and
liaise with cooperating partners on follow-up of site specific program implementation.
a.Provide trainings/seminars for various cadres (healthcare, lay, caregivers) on pediatric HIV/AIDS related
topics. We hope to train about 50 health providers in PITC in 2009.
b.95% of children admitted in in-patients wards will be counseled and tested in FY 2009
c.Coordinate and support the participation of another Zambian MDT to the South-to-South Pediatric
HIV/AIDS Training Initiative (this delegation will target Ndola and Livingstone General Hospitals).
d.Facilitate the annual National PCOE Symposium to share lessons learned and best practices to date with
the larger Zambian Pediatric HIV/AIDS community.
program, these include: staff time, HIV/AIDS rapid tests kits, and supplies such as needles and syringes
specimen bottles, and other supportive laboratory services. The benefit of this shared cost is that in the
long-run, sustainability requires minimal funding once staff are trained and systems are in place.
Continuing Activity: 15581
15581 9717.08 HHS/Centers for University 7191 576.08 University $200,000
9717 9717.07 HHS/Centers for University 5024 576.07 University $150,000
Table 3.3.14:
ACTIVITY UNCHANGED FROM FY 2008
Related activities: UTH HVCT (#9716), UTH HLAB microbiology (# 9015) and Social Marketing PSI HVCT
USAID ###
The Clinic 3 is a dermato-venereology clinic which falls under the Department of Internal Medicine within the
University Teaching Hospital (UTH) in Lusaka. Clinic 3 offers tertiary level services for the Lusaka District as
well as primary care services to walk-in patients with sexually transmitted infections (STIs) and skin
complaints. STI clients referred to the clinic from other health centers often have complicated infections that
do not respond to first-line drugs or have a history of repeated STIs. STIs are a major public health problem
in Zambia; the incidence has been reported at 16 per 1000 person-years. The presence of an STI can
increase the likelihood of acquiring HIV by two to five times and increase the probability of HIV transmission
through an increased level of viral particles in the genital secretions. Therefore, providing testing and
treatment of STIs can help prevent the spread of HIV.
The presence of an STI can indicate that either the client or his/her partner have engaged in risky sexual
behavior and hence are at increased risk of acquiring HIV. The incorporation of HIV counseling and testing
(CT) into the routine clinical management of clients with a STI is an opportunity to reinforce behavior
change messages and refer the HIV-infected individuals to the antiretroviral treatment (ART) program.
From FY 2004, the United States Government (USG) has provided support to the UTH STI clinic for a
number of activities including: laboratory and infrastructure support, Neisseria Gonorrhea surveillance, CT
training, and the implementation of routine counseling and testing for all STIs. These activities have
included clients referred from any other clinical setting within the hospital and other walk-in clients. All HIV
positive clients are linked to the treatment and care program within the clinic facility. In addition to referral of
all STI clients for routine CT, all HIV positive clients in the CT center or in the ART program within Clinic 3
are also screened for STIs.
FY 2008 funds activities focused on continuing to link STI clients to HIV diagnosis, treatment and care, and
screening of HIV positive clients for STIs. All STI clients (100%) are referred for counseling and testing
(unless clients already have proof of being tested within the last three months). All HIV positive STI clients
who up to now had difficulty with accessing CD4 testing will be linked to the National Institutes of Health
CD4 testing services (Activity # 9015) within the hospital so that clients are identified in good time for
treatment. Partner tracing and treatment is part of the standard approach to management of STI clients. All
STI and HIV-related services will be extended to partners of our initial STI clients including PMTCT and care
services.
An additional activity that the Clinic 3 will undertake in FY 2009 is to link-up with the departments' in-patient
wards and provide CT services to all partners of patients admitted in the hospital. The department has
applied for USG funds (Diagnostic Counseling and Testing (DCT) (#9716) to support the recent Zambian
national policy of routine provider initiated counseling and testing in the hospital setting and all in-patient
adults admitted to hospital. Upon obtaining permission from the patient tested under this program, partners
and relatives will be encourage to attend Clinic 3 for CT. HIV test kits are provided through the national
medical stores system.
Due to rapid staff attrition, human capacity in the clinic will need to be improved. Activities to address this
need in FY 2009 include the addition of two laboratory and counseling staff positions as well as the
development of continuing education opportunities and in-service training for existing staff. One of the main
barriers to improving care and treatment for HIV in Zambia has been the lack of human capacity and trained
health care providers. This activity will address these needs. While the cost per person of CT services is
greater than most programs, it is due to the additional support to the STI reference laboratory in terms of
laboratory equipment for STI diagnostics (including molecular technology) and support to the staff salaries
particularly laboratory, counseling and clinical staff.
In FY 2009, Clinic 3 will use the funds to continue to provide all the current activities supported in FY 2007
and FY 2008. These include routine counseling and testing services to high risk STI clients (as well as any
other clients referred or interested in the service), laboratory support to set-up the molecular laboratory
testing for STI's, GC surveillance and CD4 testing, STI screening among PLWHA, treatment of dually
infected STI/HIV infected clients, health education activities and appropriate referral to other services will
continue to be strengthened in this fiscal year.
The activities of the Clinic 3 are part of the government-run tertiary referral and teaching hospital. All
activities in this proposal are within the confines of the priorities of the UTH which strives to establish a
sustainable program, by training of health care workers, developing standard treatment protocols,
strengthening physical and equipment infrastructures, implementing a facility-level quality assurance/quality
improvement program, improving laboratory equipment and systems and development, and strengthening
health information systems. The UTH management has contributed and shared some of the costs for this
program with the President's Emergency Plan for AIDS Relief funds by providing: part time staff, some of
the supplies (needles, syringes, and test kits) and supportive lab services. The benefit of this shared cost
approach is that in the long-term UTH will only require minimal funding once staff is trained and systems are
in place.
Continuing Activity: 15578
15578 3658.08 HHS/Centers for University 7191 576.08 University $150,000
9042 3658.07 HHS/Centers for University 5024 576.07 University $150,000
3658 3658.06 HHS/Centers for University 2950 576.06 University $50,000
Estimated amount of funding that is planned for Education $5,000
This program is linked to the pediatric treatment activities (PDTX # PCOE 9765.08, PDTX Columbia
3691.08, CSA #), Pediatric care and support activities (PDCS # NEW PCOE, PDCS # NEW Columbia
PDCS # EID NEW), and Counseling and testing activities # 9717.08 OPT Out and # 9716.08 DCT dept
Med)
This program was first funded in the FY 2006 through direct funding and with partial support from RAPIDS
to support the development and operation of a Pediatric and Family Centre of Excellence for HIV/AIDS care
at the Department of Pediatrics and Child Health in Lusaka (PCOE).
The Family Support Unit (FSU) provides a number of activities including counselling and testing CT services
to children in inpatient and outpatient care that are seen in other departments of the UTH and community.
The FSU continues to work seamlessly as a unit of the Pediatric Centre of Excellence (PCOE) to
successfully achieve the work plan outlined in the 2008 PCOE narrative under pediatric treatment activities
(# 9765.08). The unit offers psychosocial support to HIV infected children and their caretakers and offers
voluntary counseling and testing (VCT) services to the rest of hospital community as well as walk ins from
the community. The FSU also helped sensitize the transition of the pediatric inpatient testing approach to
provider initiated opt-out testing and counseling.
A total of 3,000 children and 2,000 adults were counseled and tested in the unit over the last three years.
By the end of 2008, an anticipated total number of six sites will be running and an additional 2,000 will have
been counseled and tested and received their results. Through the training activities provided by the
centre, we will train 100 health workers in HIV counseling and testing.
In FY2009, all activities will continue as outlined below:
1. Psychosocial Support and Supportive Counseling:
FSU will continue to offer and expand a menu of psychosocial support and supportive counseling services.
1.Integrate and link with the efforts of the child development/neurodevelopment team to ensure that
complementary services are provided to all children such as play therapy (including writing, drawing, and
games) to:
a.Address disclosure, stigma, discrimination and abuse issues
b.Screen/assess for developmental delays and other neuro-developmental issues.
2.Develop special peer-facilitated activities and counseling programs to address the emerging HIV-infected
adolescent population in the PCOE. This includes targeting positive living, sexual health, and prevention for
positive interventions. Additionally, design and pilot activities to target HIV testing in the local adolescent
population. FSU will partner with a street girls transit home and offer VCT and psychosocial support to these
adolescent girls.
3.Support the integration of adherence information, education and counseling into the activities of the
multidisciplinary team (MDT) to ensure that all children are routinely assessed at every point of service for
adherence issues.
4.Offer intensive adherence counseling and follow up for patients identified as high-risk by the MDT.
5.Continue to offer proper counseling, testing, and support to child sexual abuse cases.
In FY 2009 the FSU hopes to further increase the number of supported service outlets to six including
Mazabuka and Siavonga in providing counseling and testing according to national and international
standards and will continue training (100 - FY 2009) counselors, resulting in an increased number
(additional 5,000) of individuals who received testing and counseling for HIV and received their test results
(excluding TB)
2. Community Outreach and Patient Follow-up Program:
This activity is critical to achieve improved outcomes for PCOE clients. FSU staff has been integrated to
support this activity and also attend to community needs/ requests as they come from our volunteers
located in the FSU. In 2009 FSU will continue expanding into 3 more communities with part of the
community outreach activities receiving support from RAPIDS.
3. Outreach VCT, Educational and Recreational activities:
1.The FSU will continue to offer outdoor/mobile VCT in community events for families and Kid-club activities
for enrolled PCOE clients.
2.Continue to host community sensitization/educational activities in the communities, community schools to
increase awareness of pediatric HIV issues, including availability of treatment, orphans and HIV, PCOE
menu of services. FSU will support this activity with the community outreach, opening of new FSU sites and
patient-follow up program.
3.Will include house hold VCT for clients unable to access health facilities for various reasons. The unit will
target 100 households for the FY 2009.
4.Six FSU sites will be opened by the end of FY 2009, to provide the pediatric HIV care and support. The
areas to be targeted will be where the regular health centers are not able to adequately provide the service.
This will include providing mobile VCT, psycho social support and ART services. There will be mobile
satellite sites identified for these services. This will also involve partnering with the Child sexual abuse unit
Activity Narrative: and community schools who have these gaps.
4. Academic support and recreation activities
1.Will continue offering educational lessons for PCOE clients admitted to UTH and Kanyama health centre.
2.Educational and academic activities will be broadened to outpatient setting as a means to screen children
with possible development issues that impact on learning and other important cognitive functions. This
activity will be done with the child development and neurodevelopment unit
5. Training:
1.FSU will continue to build the national psychosocial counseling and testing capacity by offering a menu of
training interventions, including on-the-job training, cross-cadre mentoring, and more traditional didactic
activities. This will be done as part of the larger PCOE capacity building and training plan.
2.FSU will continue taking an inventory of the number of HBC support groups in the new sites and will target
a total of five groups for orientation in FY 2009.
3.FSU will continue orienting HBC support groups in Pediatric HIV care and support and will target five
community support groups for this training (A total of 100 support group volunteers to be trained).
4.The unit will also provide technical support to partners as requests are made in FY 2009.
The UTH and Livingstone PCOEs and two district hospitals in Siavonga and Mazabuka are part of the
government run tertiary referral and teaching hospitals and all activities in this proposal are within the
confines of the priorities of the two hospitals that strive to establish a sustainable program, through training
of health care workers, development of standard treatment protocols, strengthening of the physical and
systems. The two referral hospitals will be able to cost share with the President's Emergency Plan for AIDS
trained and systems are in place.
Continuing Activity: 15579
15579 3758.08 HHS/Centers for University 7191 576.08 University $150,000
9044 3758.07 HHS/Centers for University 5024 576.07 University $150,000
3758 3758.06 HHS/Centers for University 2950 576.06 University $50,032
Estimated amount of funding that is planned for Human Capacity Development $5,000
THIS ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAY:
•VCT sites opened in 2007/2008 will be consolidated and further capacity built to ensure that sites are fully
operational and provide quality service.
•In remote areas, where HIV psychosocial counselling training needs are identified, funds will be used to
train community counsellors.
•HIV finger-prick testing will also be undertaken for community counsellors.
•Targets will change to accommodate more training
Related activities: EPHO HVCT (#9005), SPHO HVCT, (#9018), and WPHO HVCT (#9047).
established directly with the Department of Pediatrics and the Dermato-venereology clinic (Clinic 3). Though
both agreements are managed by the central administrative office, the accounts are separate and the
location of the two departments is physically separate. To communicate the importance of the breadth of
activities and for purposes of coordination, the activities linked to the two departments have been submitted
as separate narratives.
The Zambia Voluntary Counseling and Testing (ZVCT) program is a Ministry of Health (MOH) initiative
started in 1999 with the support from Norwegian Agency for Development (NORAD). It is also supported
through the National HIV/AIDS/STI/TB Council (NAC). From an initial 22 sites, the program has expanded
to 696 sites throughout the country. This includes government and non-governmental organization (NGO)
run centers. Through support from United States Agency for International Development (USAID), the ZVCT
program has developed a voluntary counseling and testing (VCT) and preventing mother to child
transmission (PMTCT) information system that is currently being used by all VCT service providers
throughout the country. The program has recently attained national status and is integrated with the PMTCT
program. In conjunction with NAC and through the VCT technical working group, Zambia VCT Services has
developed a revised HIV testing algorithm. This is in an effort to make HIV testing standard and accessible
throughout the country with the most practical non-cold chain dependent rapid tests. All test kits for the
counseling and testing (CT) programs are purchased through the existing USG supported central system
with the Central Medical Stores.
In spite of all these achievements, the services have not yet reached many of the rural areas. VCT services
are by and large urban concentrated. It is against this back drop, that the MOH and NAC through the ZVCT
program would like to take the VCT services to the most rural parts of Zambia.
The ZVCT has the experience and technical knowledge of conducting CT trainings and continues to provide
support to trainings conducted in Lusaka and other urban areas (will work closely with UTH Department of
medicine in trainings in CT), (activity # 9716). However the program lacks capacity to increase coverage to
rural areas due to financial constraints including lack of viable and reliable transport. The two operational
vehicles purchased in 2000 have outlived their expected lifespan with extensive use for national level
coverage in all the 72 districts of Zambia.
In FY 2007 funds have been used to set up VCT sites in 11 districts (55 rural sites in all) of Zambia. The
funds for this activity in 2007 has supported the purchase of a vehicle, counseling testing refresher training
and training in rapid testing (Zambia has recently changed options for rapid testing to accommodate use of
finger prick testing and do away with tests that require refrigeration or high technology), establishing
operational VCT sites with follow up technical support visits, quality assurance checking, and monitoring
and evaluating the program.
Funding in 2008 provided for continued scale-up of VCT access for rural disadvantaged communities. 10
districts were chosen (with 3 new sites per district) in conjunction with the MOH to make VCT more
accessible to the rural populations. The actual districts were this will be done have been listed in the table
but are still to be confirmed. The focus was on choosing relevant sites, where adequate space for
counseling is available and where there are adequate health personnel. Training will focus on the new
Zambian testing protocols, data management and quality assurance. A total of at least 60 staff will be
trained by the end of the FY. All new and already established old sites, including PMTCT will be supported
by technical support visits.
Funding in FY 2009 will be used to consolidate sites that have already been established in FY 2007 and FY
2008. All sites will be monitored through local district health management teams. Regular on-site
supervision will be coordinated at least twice a year. Quality assurance will be provided by ensuring that
facilities conduct regular internal meetings. Refresher courses will be conducted for the established sites in
order to provide continuum of care as there is a high attrition rate of staff. The funding for this FY will also
be used to produce and interpret more IEC materials. Activities pertaining to social mobilization will be
enhanced. This will include use of the public and local media. Efforts will be made to encourage local
communities to form Post Test clubs and think of ways of sustenance by way of creating Income Generating
Activities (IGAs). A number of training courses in HIV rapid testing and Finger Prick will be conducted.
Training of psychosocial counselors from the community will need to be enhanced to provide continuity of
services in the facilities.
One hundred counselors will be trained HIV rapid testing and finger prick during this period. During FY 2009
the program will strive to establish a sustainable program, through training of health care workers,
developing standard testing protocols, strengthening physical and equipment infrastructures, implementing
facility level quality assurance/quality improvement program, improving laboratory equipment and systems
and development, and strengthening health information systems.
Continuing Activity: 15582
15582 9718.08 HHS/Centers for University 7191 576.08 University $200,000
9718 9718.07 HHS/Centers for University 5024 576.07 University $200,000
April 2009 Reprogramming: Increase in amount by $40,000 from former UTH Renal PHE not moving
forward.
This activity is related to counseling and testing activities UTH/ZVCT (#9718.08), HVCT UTH/clinic 3(#
3658.08), and UTH Peds FSU (# 3758.08), adult treatment activities EGPAF (# 3687.08) and pediatric
treatment UTHPCOE (#9765.08) and a renal PHE (# 9756.08)
The UTH is the only tertiary teaching hospital and the main national referral center for Zambia. The
Department of Internal Medicine admits on average 1,000 patients every month. An estimated 69% of
clients in the adult admission wards are HIV-infected. The department has six low cost wards (bed capacity
of 240) and one emergency admission ward (bed capacity 42).
A small study conducted in 2003 to determine HIV prevalence among all in-patients admitted to the medical
wards, concluded that 69% of patients were HIV-infected. Approximately 99% (n = 103) of patients agreed
to be tested after counseling, however, 50% of these clients never received results due to delays in
obtaining the HIV test results. Even with the use of rapid tests, samples sent to the main laboratory in a
large hospital lead to unnecessary delays and missed opportunities for diagnosing and identifying clients
that need to be placed on antiretroviral (ARV) medications. The medical emergency and inpatient wards are
also important settings for identifying HIV-infected individuals needing to be enrolled into care and treatment
programs.
Since the beginning of 2006, the Department of Internal Medicine has encouraged the medical residents to
offer routine HIV testing to all patients admitted in the medical wards. In March 2006 the Zambia National
Guidelines for HIV Counseling and Testing recommend routine provider initiated "opt-out" testing in all
clinical care settings where HIV is prevalent and where ARV treatment is available. These guidelines have
helped strengthen the departments' guidelines to routinely test all patients.
Funds in FY 2007 and 2008 were used to embark on an aggressive program to routinely test all patients
admitted in the medical wards and provide same day results. To date, minimal rehabilitation works have
taken place in all the key areas to accommodate counseling and testing (CT) activities, 42 nursing staff
have been trained or re-trained in HIV counselling and testing according to the national standards and close
to 4,000 clients have been counselled and tested and received their results.
Partners (spouses) and other relatives, after obtaining permission from the client, are contacted and
encouraged to seek CT services at the dermato-venereology clinic (#9042), which also falls under the
Department of Medicine if they do not want to undergo CT directly in the wards and Out-patient clinics.
Response from other family members has been good and accounts for close to 40% accepting HIV testing.
CT services include information on risk reduction program and messages on prevention of transmission
among those that test positive (positive prevention). Finally, two-way links have been established with the
Department of Pediatrics Family Support Unit and Pediatric Centre of Excellence to have all at-risk children
tested and supported through care and treatment as well as have parents of children in the pediatric
department referred to us for adult care, treatment and support. In FY 2008, the Department of Internal
Medicine will work closely with CDC, to establish SmartCare in the new adult ART Center and will use this
system for monitoring and evaluation of the quality of the ART service provision in the department. In
addition, the department is working closely with the UTH Department of Obstetric and Gynecology to
strengthen the referral system between PMTCT services and ART services so that mothers requiring ART
are accessing timely care and treatment services.
In FY 2009, the Department of Internal Medicine will continue to work on strengthening the uptake of CT
among patients admitted in the medical wards. The Department will also emphasize on "family approach" to
counseling and testing as well as integration into appropriate care and treatment programs for the sero-
positive clients. An additional activity in FY 2009 will be to extend the CT trainings and provision of routine
counselling and testing to the Department of Surgery. In a study done in 2007, among 420 surgical
patients, 44% were HIV positive. Funds will be used for minor renovations in the surgical wards to
accommodate CT activities and to train an additional 40 staff from the Department of Surgery in CT. By the
end of FY 2009, it is anticipated that at least 11,000 clients will be counselled and tested and receive their
results from the three outlets, medical wards, surgical wards and outpatient filter clinic.
The activities of the Department of Internal Medicine are part of the government-run tertiary referral and
teaching hospital and all activities in this proposal are within the confines of the priorities of UTH. This
system strives to establish a sustainable program through training health care workers, developing standard
treatment protocols, strengthening the physical and equipment infrastructures, implementing facility-level
quality assurance/quality improvement program, improving laboratory equipment and systems and
development, and strengthening its health information systems. The hospital management will be able to
program that include: staff time, supplies such as needles and syringes, specimen bottles and test kits, and
supportive laboratory services. The benefit of this shared cost approach is that in the long-term UTH will
only require minimal funding once staff is trained and systems are in place.
Continuing Activity: 15580
15580 9716.08 HHS/Centers for University 7191 576.08 University $200,000
9716 9716.07 HHS/Centers for University 5024 576.07 University $200,000
Construction/Renovation
ACTIVITY HAS BEEN MODIFIED TO INCLUDE a needs assessment for continual, stabilized power to be
supplied for the pathology laboratories at the University Teaching Hospital (UTH) Lusaka.
This activity is linked to Counseling and Testing (CT) (#0631), Prevention of Mother to Child Transmission
(PMTCT,#0158), National tuberculosis (TB) program, Adult Care and Treatment programs as well as
activities from the laboratory section including The American Society for Microbiology (ASM #9794), Chest
Diseases Laboratory (CDL #15510), Centers for Disease Control and Prevention - Technical Assistance
(CDC-TA #9022), Lusaka Provincial Health Office, (LPHO #9796), Southern Provincial Health Office (SPHO
#9797), Western Provincial Health Office (WPHO #9799), Eastern Provincial Health Office (EPHO #9795),
and EGPAF/CIDRZ (#16956).
This activity has several different components involving the UTH laboratories.
One component is to continue to support the UTH - Virology Laboratory (UTH-VL) in Lusaka, which acts as
the National Reference Laboratory (NRL) for HIV. In fiscal year (FY) 2008 UTH-VL received support from
PEPFAR to develop and manage a national quality assurance (QA) program for rapid HIV testing in
collaboration with the Ministry of Health (MOH), its partners and CDC Zambia ($200,000).
In FY 2009, this activity is aimed at assuring the accuracy of HIV test results generated by all facilities
conducting rapid HIV testing in Zambia including those facilities incorporating CT, PMTCT, and Adult Care
and Treatment programs. Under the direction of the MOH, the NRL will oversee and provide national
quality QA to the provincial laboratories and rapid HIV testing sites in collaboration with other PEPFAR
partners, Zambian Prevention Care and Treatment program (ZPCT), Japanese International Cooperation
Association (JICA) and CDC. The quality of HIV testing will be strengthened at sites at the national level by
hiring two additional laboratory personnel, perform minor renovations to one lab and one office, to assist in
procurement of lab supplies and reagents with supply chain management systems (SCMS), and purchase
of an additional vehicle to include maintenance to meet the demand of the expanding activity. This activity
will assist in a needs assessment for continual, stabilized power to be fed into the whole unit. With support
from other partners such as MOH, CDC, and JICA, UTH - VL will support and co-ordinate a trainers of
trainers course for rapid HIV testing, co-ordinate roll out in Zambia. Trainers at the provincial level will in
turn provide supervisory and on-site training visits to rapid HIV testing sites within their provinces, with the
help of job aids, and supervisory visits to assist with monitoring and evaluation of the program in-line with
MOH national guidelines, and to maintain communications with all sites.
The UTH - VL will build upon the knowledge gained from the establishment of the national external quality
assurance system (EQAS) for HIV and use it to implement a national EQAS for CD4 testing.
The second component of this activity focuses on the UTH -TB laboratory ($150,000). The laboratory is
well-equipped but lacks the resources for quick turn around times for results. The laboratory has two
mycobacterium growth indicator tube (MGIT) 960 instruments which have improved mycobacterium
isolation and the Accuprobe instrument which has reduced the time for the identification of mycobacterium
tuberculosis complex to four weeks. The TB laboratory is linked to the national TB program, the national
reference lab and the PHO's for Lusaka, Eastern, and Western Provinces. In FY 2009, UTH TB will
continue to support and strengthen the EQA program for acid fast bacilli (AFB) smear microscopy, culture
identification of mycobacterium isolates and drug susceptibility testing (DST) on patients suspected to have
Multi Drug Resistant (MDR) tuberculosis and case that are indicative of treatment failure. UTH- TB
laboratory will continue to support servicing and certification of the Class II bio-safety cabinets and the
MGIT. UTH -TB laboratory will begin to run molecular speciation on all mycobacterium isolates and DST
on all confirmed TB isolates to improve the management of TB and MDR cases.
The third component of this activity is the UTH Microbiology laboratory which offers diagnostic services for
Lusaka Province and Zambia in general ($50,000). The microbiology laboratory has received direct
technical assistance in the form of trainings and workshops (through CDC and ASM) and equipment such
as the BACTEC, reagents, and on-site assistance from CDC. Still, inadequacies in material and financial
resources have meant that microbiological testing services have been compromised. In FY 2009, this
activity will continue to provide and focus on; 1) improving diagnostic capability of the microbiology
laboratory at UTH by placing one bio-safety cabinet on one years maintenance and certification and to
recruit at least one technologist and one data entry clerk and; 2) supporting the implementation and
monitoring of a national external quality assurance program with a pilot in two suitable hospital laboratories
where suitable monitoring, evaluation, and support could be given.
All components of this activity focus on the improvement the need to communicate regularly with partners
involved in the laboratory program, co-ordinate, and support regular meetings with CDC and other partners,
to allow dissemination of activity and improve collaboration to avoid duplication of activities and encourage
feedback. The importance of these activities and the need to document and maintain quality in HIV, TB,
microbiology, and CD4 testing at a national level is becoming increasingly obvious as these programs
expand. Activities in this year were aimed at the development and maintenance of coherent and
functioning QA and EQA systems at the national level, to improve the diagnostic capability of both reference
and site laboratories around the country by supporting the improvement of; laboratory infrastructure,
reagents supply and delivery, maintenance of equipment and back up services in the form of a needs
assessment for continual, stabilized power, human resources, and retention through support for travel and
attendance of laboratory staff for continual training, in lab related activities to ensure a sustainable program,
relevant national training program roll-outs; improve support of data entry, data collection and information
dissemination nationally with a comprehensive monitoring and, evaluation system and to work toward
accreditation where relevant to improve standards for a better health service for the Zambian population.
UTH Laboratories will continue to provide technical leadership for a sustainable National QA and EQA
programs for HIV, TB, Bacteriology, and CD4 with existing clinical facilities, MOH, CDC, and partners to
strengthen the capacity in the form of training, supervision, and monitoring and evaluation, and coordination
to provide continual quality lab services and programs in Zambia to compliment the national vision
Continuing Activity: 17439
17439 9798.08 HHS/Centers for University 7191 576.08 University $600,000
9798 9798.07 HHS/Centers for University 5024 576.07 University $320,000
Workplace Programs
Table 3.3.16:
