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 narrative is a draft and will be revised upon the award of the new follow on to RAPIDS-
SUCCESS activity in FY 2009. Targets will be adjusted based on the actual starting date of the new
project. It is envisioned that there will be an overlap between the current and new project so that services
continue to be provided to new and existing clients.
A new partner will be selected in FY 2009 to implement effective behavior change communication (BCC)
activities focusing on abstaining or delaying the age of first sex and being faithful to a single partner, with a
particular focus on modifying social acceptance and tolerance of the practice of having multiple concurrent
partners, as well as seeking similar attitudinal changes to transgenerational sex and transactional sex.
This activity links with other sexual prevention, biomedical prevention (male circumcision), counseling and
testing, and pediatric and adult treatment activities. Abstinence/be faithful (AB) activities also support both
Zambian and the PEPFAR goals through a comprehensive approach that promotes better health seeking
behavior. The new follow on partner will work in all nine provinces in close partnership with United States
Government (USG) partners.
All BCC activities related to HVAB will be evidence-based, will draw on peer-reviewed research, and will
support of the National Prevention Strategy (NPS). In 2008, the Ministry of Health (MOH) in collaboration
with the National HIV/AIDS/STI/TB Council (NAC) and other local partners developed the NPS to reverse
the tide of HIV/AIDS by intensifying prevention activities nationwide. The follow-on activity will focus on
mobilizing faith based groups.
The new BCC partner will carry out community based as well as mass media campaigns targeting young
people to inform them about abstinence and being faithful as means to prevent HIV/AIDS transmission.
The follow-on will coordinate its messages with the new SO 7 BCC activity which will be pre-tested for
effectiveness and translated into multiple local languages. At the same time, the new partner will engage
traditional, religious, and community leaders including teachers, musicians, artists, and other role models
who will assist in reaching out to youth and spread appropriate AB messages.
At the community level, activities will stimulate viable economic opportunities for youth, and support
recreation, dramas, music, and peer education programs for in- and out-of-school youth. Special efforts will
be made to reach out-of-school youth, who are generally more likely to engage in risky behavior. All of
these interventions consider existing gender roles with the goals of reducing violence, empowering young
women to negotiate healthier choices, promoting positive male gender norms and male responsibility, and
improve partner communication and mutual decision making,.
The follow on will join other USAID partners in providing technical assistance and other support to the NAC
in the dissemination and implementation of the NPS, which focuses on scaling-up behavioral change efforts
including abstinence and being faithful. The new partner will ensure that its activities are also integrated
into district and provincial plans ensuring ownership and sustainability.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14445
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14445 14445.08 U.S. Agency for To Be Determined 6843 6843.08 RAPIDS-
International SUCCESS
Development follow on
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Reducing violence and coercion
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
ACTIVITY IS MODIFIED IN THE FOLLOWING WAYS
This HBHC activity is a component of a new follow-on mechanism to both replace and improve on two
USAID-HBC projects, RAPIDS and SUCCESS. These two mechanisms will reach their funding ceiling by
December 31, 2009. The new award will scale up aggressively by December 31, 2009, so that there is a
smooth transition, and to minimize any gaps in services or coverage areas. USAID will have competed a
Request for Application (RFA) in FY 2008 and awarded a follow-on.
The activity will link to RAPIDS-SUCCESS follow on activities in ART adherence, Orphans and Vulnerable
Children (OVC) and CT, as well as to other CT, ART, OVC, Care and Support, and PMTCT activities
supported by the USG, GRZ, and other donors, whether ongoing or new. The activity will also align with
new strategic directions of the USG and GRZ, including any compact signed.
Activity Narrative
This new follow on the project that began late in FY 2008 will be one integrated program capable of
reaching or exceeding the combined HBHC targets and coverage areas of the RAPIDS and SUCCESS
projects, building wherever possible on the work of these existing partners. The new follow on will, add new
clients, caregivers, partners and areas to increase coverage in geographic and population terms.
New sub-partners may include faith-based and non-faith based structures which demonstrate their
capability to provide quality services and to produce results, either under USG Zambia existing projects, or
in related projects elsewhere in the region or continent. There will be an orderly hand-over of project activity
to the follow on with particular attention to ensuring that as many PLWHA as possible continue to receive
quality care and support, and to prevent any gaps in service or coverage. Through this planned transition, it
is expected that the follow-on will reach the combined totals of RAPIDS and SUCCESS in terms of clients,
caregivers, sites and areas early in 2010. If possible, the follow on will exceed these previous projects
through economies of scale.
The New Awardee may incorporate the best practices and lessons learned from the two previous projects,
such as the household model, but will not be limited to existing service patterns. The follow on may also
incorporate best practices and lessons learned as well as technical innovations proven effective elsewhere.
In addition, the new follow on project may provide additional services and coverage not included in the
current projects, dependent on funding, the scope of the award, as well as policy and priorities of the
President's Emergency Plan For AIDS Relief (PEPFAR II), the Zambian National Strategy, and USG
Zambia goals and objectives.
Examples of new emphases that may feature prominently in the follow on include: earlier initiation of care
and support (following earlier diagnosis of HIV infection) with referral to effective support structures such as
positive living groups; greater recognition of the impact of wide-scale ART through a shift in patterns and
locations of care and support service delivery, away from an exclusive home visit focus, towards multiple
locations in all communities; a stronger and more technically robust package of "prevention for positives;"
improved pain relief, including qualified mental health services for PLWHA;
Lastly, the New Awardee will propose innovative methods to extend care and support to middle and upper
class Zambians, for example, by linking to their private health care providers, as a means to break "stigma
at the top," where it remains entrenched. There will be a conscious effort to remedy the unintended "over-
focus" on the poor in previous projects, which resulted in a lack of care and support for more educated and
prosperous Zambians, despite the fact that HIV status correlates positively with education and level of
income.
While not diverting an undue amount of scarce resources from services to the neediest, the New Awardee
will seek to include private providers and sites in service delivery schemes. Private providers and clients
will be expected to contribute to the cost of care to the extent possible, but the intent is still to ensure
equitable access up to the highest levels of society. This effort will link to new HIV/AIDS leadership
initiatives. The theory is that if the national leadership class from political, business and faith circles gain
access to needed services and support, and come to terms with HIV in private, they will be able to speak
out in public.
The New Awardee will provide a comprehensive set of cost-effective, quality care and support services
following Zambian as well as OGAC adult and pediatric preventive care guidelines, and USG Zambia
Palliative Care Forum strategies. These will include but not be limited to: basic nursing care, home-and
community based care and support, early referrals to clinical care, treatment of OI, legal services, links to
livelihood and income generation activities, education on prevention for positives, psycho-social support,
preventive treatment, and support to hospices, including establishment of facilities in geographic areas
which lack any hospices. The New Awardee will continue the support to the movement hospice in Zambia
begun by the SUCCESS project.
The New Awardee will continue to train and support caregivers and other HBHC health providers. The New
Awardee will build capacity of community committees currently working on home and community based
care and support activities, and scale-up support- male and youth-groups. The New Awardee will ramp up
routine Cotrimoxazole prophylaxis for all HIV-infected clients.
Other emphases of the follow on will include: continued strengthening of Pediatric Care training for
caregivers, and closer linkages to Pediatric ART sites with emphasis on referral of HIV-exposed infants for
early diagnosis and referral using PCR technology where available, to decrease HIV-related infant mortality.
The Awardee will collaborate with OGAC and USG Zambia on an effort to shift to a Food by Prescription
approach, which is client focused rather than family focused.
The Awardee will support the development and implementation of a USG Zambia food and nutrition
strategy, and consider adopting a common technical approach to food and nutrition support (or at least to
adopt the major elements of a common approach). The New Awardee will continue Food and Nutrition
Activity Narrative: Support to PLWHA, on its own or in conjunction with others, via therapeutic feeding for malnourished
PLWHA, and nutrition activities for HIV exposed infants and young children to improve nutrition status in
treatment/care clients. Food and nutritional support will follow both national and OGAC Guidance. The
New Awardee will also build on extensive malaria control activities begun during FY 2007 to reduce malaria-
related illness and death in PLWHA.
Options for the follow-on structure include a consortium model, like RAPIDS, a single organization, like
SUCCESS, or a variety of other appropriate management models. The successful New Awardee will
propose the most promising technical and management approach and cost models to extend quality care
and support to the largest number of adults and children living with HIV/AIDS, as well as the widest
geographic coverage.
Geographically, coverage by the New Awardee may be a mix of the former service areas of RAPIDS and
SUCCESS, and new areas, including previously underserved or unserved areas. Examples include the
populous but remote triangle from the Tanzanian border between Mbala and Nakonde, down to Mpika, as
well sparsely populated and remote areas of Western and Southern provinces. The New Awardee will offer
new models to extend coverage and services into these areas sustainably and at reasonable cost
The New Awardee should scale up aggressively and reach full operational capacity by December 31, 2009,
when RAPIDS and SUCCESS reach their funding ceilings and End of Project dates. The New Awardee
may continue to work with the local partners of the former RAPIDS and SUCCESS projects, and other
palliative care programs for synergy and complementarities. The New Awardee may also add new
structures and programs.
The New Awardee will continue to link PLWHA to livelihood initiatives. These linkages will contribute to the
overall goals of the program. However, the New Awardee will need to demonstrate that it has the capacity
to support technically sophisticated and proven effective models, or rely on linkages to other projects which
do.
The New Awardee will also support HBHC activities via sub-grants and small grants to strengthen HBHC
community based groups/organizations and to extend coverage into underserved or unserved geographic
areas. The New Awardee will however have to demonstrate the ability to supervise, monitor and evaluate
the work of all sub-grantees, and must possess a robust and effective sub-grant mechanism.
To support the palliative care preventive package, the New Awardee will address malaria, diarrhea and
prophylaxis of opportunistic infections in PLWHA and their families. This will include working with the
National Malaria Control Center, PATH, and other stakeholders to promote use of Insecticide Treated Bed
Nets (ITNs). The New Awardee may obtain ITNs through purchase or donation. Likewise, the New
Awardee will promote safe water and Cotrimoxazole prophylaxis widely.
The New Awardee will provide effective pain management, for mild to severe pain, including access to
qualified mental health services to address mental anguish.
The New Awardee will increase the emphasis on sustainability and capacity building in the last year of
PEPFAR. To promote sustainability, the New Awardee will both support GRZ efforts, and work through
communities. To further the sustainability of current grassroots efforts, the New Awardee will train CBOs
and FBOs to not only provide care and support to PLWHA, including children and adolescents but also in
areas like advocacy and paralegal support. The New Awardee will facilitate sustainable linkages between
communities, GRZ and other service providers. The New Awardee will support training of local community
based organizations to improve management skills and the ability to access existing HIV/AIDS resource
streams. The New Awardee will "Train Trainers" to equip FBO/CBO HIV/AIDS service providers with skills
to support sustainable methods of training supervisors, peer educators, and staff within respective
institutions and organizations.
Also the follow on will seek to emulate the extraordinary public-private partnership (PPP) success of
previous awards such as RAPIDS, which demonstrated that it is possible to match USG support one-to-one,
and to mobilize enormous quantities of in-kind gift support. Such PPP support will expand the quantity and
quality of care and support, and will leverage the USG investment to mobilize private sector donation and
investment.
All FY 2009 targets will be reached by September 30, 2010
Continuing Activity: 14448
14448 14448.08 U.S. Agency for To Be Determined 6843 6843.08 RAPIDS-
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Malaria (PMI)
Estimated amount of funding that is planned for Human Capacity Development
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools
and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Commodities
Estimated amount of funding that is planned for Water
Table 3.3.08:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
This HTXS activity is an ongoing component of a new follow-on mechanism that was launched in late FY
2008 to both replace and improve on two USAID-HBC projects, RAPIDS and SUCCESS. The activity will
link to RAPIDS-SUCCESS follow on activities in CT, OVC and Care and Support, as well as to other CT,
ART Adherence, OVC, Care and Support, and PMTCT activities supported by the USG, GRZ, and other
donors, whether ongoing or new. The activity will also align with new strategic directions of the USG and
GRZ, including any compact signed.
Activity Narrative:
These two mechanisms will reach their funding ceiling by December 31, 2009. The new award will scale
up aggressively by December 31, 2009, so that there is a smooth transition, and to minimize any gaps in
services or coverage areas. USAID will have competed a Request for Application (RFA) in FY 2008 and
awarded a follow-on between March-July 2009.
This new project will be one integrated program capable of reaching or exceeding the combined HTXS
targets and coverage areas of the RAPIDS and SUCCESS projects, building wherever possible on the work
of these existing partners. The new follow on may also add new clients, caregivers, partners and areas to
increase coverage in both geographic and population terms.
in related projects elsewhere in the region or continent. There will be an orderly hand-over of project
activity to the follow on with particular attention to ensuring that as many PLWHA as possible continue to
receive quality care and support, and to prevent any gaps in service or coverage. Through this planned
transition, it is expected that the follow-on will reach the combined totals of RAPIDS and SUCCESS in terms
of clients, sites and areas by early 2010. If possible, the follow on will exceed these previous projects
through combined economies of scale.
The Follow On will face a greater challenge in that it will inherit the task of addressing three types of
Adherence concerns: 1) longer term adherence to ART by old clients with emerging chronic health
problems related to ART; 2) supporting initial Adherence by new ART clients; and 3) assisting to help
investigate signs of emerging ART resistance and seeking to contain it. The New Awardee may
incorporate the Adherence Support best practices and lessons learned from the two previous projects, but
will not be limited to existing service patterns. The follow on may also incorporate best practices and
lessons learned elsewhere, as well as technical innovations that have proven effective.
previous projects, dependent on funding, the scope of the award, as well as policy and priorities of PEPFAR
II, the Zambian National Strategy, and USG Zambia goals and objectives.
The awardee will provide a combination of clinical adherence support and home-based/community
adherence support for ART clients. This follow-on project will help the GRZ and USG Zambia to support an
ever-increasing number of adults, infants and children receiving and adhering ART, through formal linkages
with clinical facilities; improve ARV compliance; while supporting ART quality improvement, such as better
management of ART-related symptoms, such as neuropathic pain. The Awardee will also establish links to
ART Centers of Excellence as a client referral destination and utilize the Centers of Excellence as a source
of learning for adults and pediatric ART.
The Awardee will provide Adherence Support both in urban areas, and in remote, rural areas of Zambia,
through both paid staff and volunteer networks nation-wide. The applicant will propose a variety of models
of adherence support adapted to be both cost-effective and appropriate for urban and rural areas. These
models will direct clients to ART sites and in cases where transport is a major barrier, will assist with client
transport. In addition, the Awardee will facilitate, where and when possible, bringing ART closer to clients,
for example, through support of ART in hospices or other community settings.
The intent is to develop one integrated program that is capable of reaching the combined HTXS targets and
target populations of RAPIDS and SUCCESS as well as new clients and service areas. USAID will make
the award between March-July 2009 to allow for an orderly overlap and transition from RAPIDS and
SUCCESS to the new awardee, without a gap in services, or a decrease in target levels. It is imperative for
the well-being of the existing caseload of HTXS beneficiaries to avoid any interruption in Adherence
support.
This activity will be integrally connected with other related activity areas including HVAB, HVCT, HKID,
PTCT, and HTXS. Emphases will include: continued strengthening of pediatric ART knowledge for OVC
caregivers, and closer linkages to pediatric sites with referral of HIV-exposed infants for early diagnosis
using Dried Blood Spots/Polymerase Chain Reaction (PCR) technology where available, to decrease HIV-
related infant mortality.
In terms of Food and Nutrition Support, the Awardee will collaborate with OGAC and USG Zambia on an
effort to shift to a Food by Prescription approach, which is client focused rather than family focused. The
Awardee will support the development and implementation of a USG Zambia food and nutrition strategy,
and consider adopting a common technical approach to food and nutrition support (or at least to adopt the
major elements of a common approach). The Awardee will follow both GRZ and OGAC Food and Nutrition
guidance to work closely with therapeutic feeding for malnourished PLWHA as well as with infant and young
child nutrition activities.
The Awardee and its partners will have a successful track record as well as expertise in adherence support
for ART clients including adults, families with HIV+ children, and orphaned children on ART. The Awardee
will continue and strengthen Pediatric adherence support through the four Family Support Units (FSUs) in
Activity Narrative: Lusaka, Livingstone, Ndola, and Kitwe.
The Awardee will continue to collaborate with government and other GRZ and USG funded ART efforts to
increase access to ART, including Pediatric ART through strengthening referral systems, and will ensure
that PLWHA from HBC and hospices are linked to ART services. The Awardee will also strengthen the
skills and knowledge of HBC providers through training in ART adherence and support for pediatric ART
clients.
To provide effective links with ART providers, the Awardee will continue to train home-based care (HBC)
caregivers and other medical personnel in ART adherence, prevention of resistance to ART, monitoring of
side effects, and management of pain and basic clinical management of Opportunistic Infections (OIs) such
as use of Cotrimoxazole. Other activities will include: education on prevention of re-infection especially for
PLWHA on ART treatment; training and follow-up on ART adherence to improve client health status; and
social support such as Positive Living, PMTCT, and nutrition support. A new significant component will be
to increase access to ART by providing limited support for laboratory investigations. Although the priority
will be to bring ART closer to clients, the Awardee may also provide funds or vehicles to help patients who
are unable to access ART due to lack of transportation.
The Awardee will intensify community-based adherence support and care for those on ART through regular
follow-ups and community/home visits by caregivers and Positive Living adherence supporters. The follow
on will provide psychosocial and spiritual support, nutrition counseling, education, monitoring, and support
for families with children or adults on ART.
The Awardee will continue to strengthen linkage between HBC and Hospice and referral to nearby health
facilities. The Awardee will significantly increase the number of care coordinators and caregivers trained in
ART literacy and adherence, management of OIs and in referral networking. The program will include
identification of client transport options, linkages with HIV Counseling and Testing (CT) programs.
The Awardee will address gender concerns so women and men have equal access to ART, as clients and
as caregivers. Reporting disaggregated by sex will reflect an increase in the percent of men on ART, who
have lagged significantly behind women, in part due to the role of PMTCT in initiating ART for women. The
Awardee will train caregivers and health providers in stigma reduction strategies for adults and children.
The Awardee will ensure that the program is integrated into existing district structures, both government and
NGOs, and build their capacity to ensure sustainability. The Awardee will solidify and reinforce critical
networks and alliances, share lessons learned and best practices, leverage resources, form partnerships,
ensure that duplication is not occurring and advocate for the promotion of improved policy.
All targets will be reached by September 30, 2010
Continuing Activity: 17100
17100 17100.08 U.S. Agency for To Be Determined 6843 6843.08 RAPIDS-
Table 3.3.09:
This HKID activity is an ongoing component of a new follow-on mechanism launched in late FY 2008 to both
replace and improve on a flagship USAID-OVC project, RAPIDS, and possibly to replace Track 1 OVC
projects which are closing out as well . The activity will link to RAPIDS-SUCCESS follow on activities in
ART adherence, CT, and Care and Support, as well as to other CT, ART, OVC, Care and Support, and
PMTCT activities supported by the USG, GRZ, and other donors, whether ongoing or new. The activity will
also align with new strategic directions of the USG and GRZ, including any compact signed.
RAPIDS will reach its funding ceiling by December 31, 2009. The new award will begin in late in FY 2008
and will scale up aggressively by December 31, 2009, so that there is a smooth transition, and to minimize
any gaps in services or coverage areas. USAID will have completed a Request for Application (RFA) in FY
2008 and awarded follow-on by March - July 2009.
This new project will be one integrated program capable of reaching or exceeding the combined HKID
targets and coverage areas of RAPIDS and any other OVC projects which may end and thereafter, be
folded into the follow-on, building wherever possible on the work of these existing partners. The new follow
on will add new OVC clients, sites, caregivers, partners and areas to increase coverage in geographic and
population terms. USAID expects to have made the new follow-on award by March-July 2009 to allow for
an orderly overlap and transition to the new awardeeawardees, without a decrease in target levels or
disruption in performance. The follow-on is expected to reach the numbers of clients, training and sites of
RAPIDS in year one of the follow on project's operations.
Where possible, the follow-on will also absorb and retrain caregivers from SUCCESS project to enable them
to extend services to OVC found in the homes of client PLWHA.
Also, ensuring a smooth transition of the most of the massive RAPIDS OVC caseload to the follow on is
critical to the ability of the USG Zambia to reach mandated OVC targets. Experience from the start of
PEPFAR Phase has shown that a lack of overlap for follow-on can result in gaps in services and massive
drops in clients and other results.
Together with relevant USG agencies and other OVC partners, the AwardeeAwardees will continue to
operationalize the GRZ Strategic Framework for OVC, and adhere to OGAC guidelines, as well as the USG
Zambia joint OVC strategic plan as well as participating in the USG Zambia OVC Forum. The aims are to
align OVC activities, improve quality, increase impact, and reach targets in a coordinated and cost-effective
fashion.
Emphases will include: continued strengthening of Under-5 health care and Early Childhood Development;
Pediatric Care training for OVC caregivers, and closer linkages to Pediatric ART sites with emphasis on
collection of Dried Blood Spot (DBS) samples and/or referral of HIV-exposed infants for early diagnosis
using PCR technology. The follow-on will link closely to PMTCT and CT sites and services for the earliest
possible referrals and initiation of OVC Care and Support.
adopt the major elements of a common approach). The Awardee will seek to include therapeutic feeding for
malnourished OVC, and will expand OVC under 5, infant and young child nutrition activities to reduce
stunting and prevent lasting harm to children early in life. These activities will link closely to USG Zambia
and GRZ supported Nutrition activities, and allow the follow on to access quality food products at the best
possible price, as well as to adhere to current technical methods.
The Awardee also will expand on preventive package activities, such as building on massive bednet
distribution activities to reduce malaria-related illness and death, especially pregnant women and infants.
The Awardee will also ramp up other routine Cotrimoxazole prophylaxis for HIV-infected OVC, as well as
continuing to promote safe water and hygiene for OVC.
The follow on program will scale up by September 30, 2009, seeking to encompass as much as possible of
the RAPIDS portfolio of 199,185 OVC and 15,000 caregivers. The RAPIDS project was national in scope.
The follow on will, wherever it overlaps with RAPIDS' prior efforts, work to utilize RAPIDS assets in terms of
trained caregivers, local sub-partners, etc. This will add to cost effectiveness by reducing new training
costs, and reduce the time needed to train new caregivers as well as to identify and register OVC.
The Awardee will continue to support GRZ and NGO district level facilitation of the provision of OVC care
and support, work with community groups and stakeholders, training and mobilizing them. The Awardee
will continue to enhance the capacity of FBOs/CBOs by strategically providing sub-grants and small grants
to expand OVC outreach into new areas and to reach new or previously neglected OVC clients.
other USG funded OVC projects, as well as new areas, including previously underserved or unserved
areas. Examples of new service areas might include the populous but remote triangle from the Tanzanian
border between Mbala and Nakonde, down to Mpika, as well sparsely populated and remote areas of
Western and Southern provinces. The New Awardee will offer new models to extend coverage and
services into these areas sustainably and at reasonable cost
Partnerships with FBOs/CBOs will help train caregivers, peer educators, and clergy in OVC care and
The Awardee will seek to participate in the National AIDS Council Impact Mitigation Thematic Group and
Activity Narrative: the National OVC Steering Committee. If requested, the follow on will continue to support a policy advisor
at the Ministry of Youth, Sport and Child Development, to help disseminate and operationally the National
Child Policy (approved by Cabinet and launched in June 2006) and the GRZ OVC Plan and contribute to
the roll-out of the National Plan of Action for Children. If requested, the Awardee will continue to support a
technical advisor at the Ministry of Community Development and Social Services. The Awardee staff, along
with members of district structures and the media, will, in coordination with other USG supported media
efforts, provide training in OVC advocacy and policy formulation. The follow on may also wish to continue
media awards for the best media coverage on OVC issues.
At Family Support Units (FSUs) which target CLWHA at hospitals and health centers in Ndola, Lusaka,
Livingstone Kitwe, and elsewhere, the Awardee will support improved quality "play therapy" and other non-
medical care and support for OVC. Awardee support for "non-medical" services of the FSUs will include
improved psychosocial and educational support, and qualified mental health services, plus linking children
to ART.
The New Awardee will also propose innovative methods to extend care and support to OVC from middle
and upper class Zambian families, for example, by linking to workplace and private health care and support
providers and facilities, as a means to break "stigma at the top". The Awardee will help to remedy the
unintended "over-focus" on the poor in previous USG projects, which resulted in a lack of OVC care and
support for more educated and prosperous Zambian families, despite the fact that HIV status correlates
positively with education and income. While not diverting scarce resources unduly from services to the
neediest, the New Awardee will seek to include private providers and sites in OVC service delivery
schemes. Private providers and their clients will contribute to the cost of "upscale" OVC care and support,
but the intent is still to ensure equitable access up to the highest levels of society.
The Awardee will continue to identify the needs of individual needs of OVC and provide a wide range of
care and support, including educational support, clothes, medical care, shelter, legal support, nutrition
support, and psycho-social support. The Awardee will support OVC livelihoods and food security.
However, while seeking to offer broad and comprehensive support, the Awardee will not exceed its
technical capacity or scope of award. The Awardee will have to demonstrate the competence, capacity,
quality, and cost effectiveness of each of its planned interventions.
The Awardee will go well beyond previous awards to ensure full gender mainstreaming, and will continue
efforts to protect the girl child. The awardee will ensure gender equity in access to and utilization of OVC
services, and in recruitment of OVC caregivers.
The Awardee will sustain mobilization of communities as the key to long-term sustainability in the response
to HIV/AIDS. Training of caregivers will ensure community capacity to serve households. Livelihood
options for the households and the caregivers will contribute towards a better life for all. The Awardee must
offer proof in advance of financial viability and feasibility of livelihood and microfinance activities.
The Awardee will continue links with Pediatric Anti-Retroviral Treatment (P-ART) through hospitals and
government structures at district level. As part of an exit strategy, the Awardee will work to ensure continued
community support beyond the life of the program as well as contribute to the UNAIDS-endorsed Three
Ones (One coordinating mechanism, One framework and One M&E system).
To further the sustainability of local efforts, the Awardee will train and take over sub/small grants to CBOs
and FBOs supporting OVC programming. The training will improve programmatic and management skills
and provision of quality services. The Awardee will provide technical and material support for the
development of prevention activities, including equipping HIV/AIDS educators within FBO/CBO institutions
with life skills "training of trainers" program designed to help them provide further training to supervisors,
peer educators, and staff within their respective institutions and organizations.
All FY 2009 targets will be reached by September 30, 2010.
Continuing Activity: 14449
14449 14449.08 U.S. Agency for To Be Determined 6843 6843.08 RAPIDS- $969,647
* Increasing women's legal rights
Table 3.3.13:
This HVCT activity is a component of a new follow-on mechanism that was launched in late FY 2008 to both
replace and improve on two USAID- projects with HVCT activities, RAPIDS and SUCCESS. The activity
will scale up rapidly starting in FY 2009. The activity will link to RAPIDS-SUCCESS follow on activities in
ART adherence, OVC and Care and Support, as well as to other CT, ART, OVC, Care and Support, and
Two mechanisms, RAPIDS and SUCCESS, will reach their funding ceiling by December 31, 2009. The
new award will scale up aggressively by December 31, 2009, so that there is a smooth transition, and to
minimize any interruption in services or loss of coverage areas. USAID will have completed a Request for
Application (RFA) in FY 2008 and will have awarded a follow-on activity between March-July 2009.
This new project will be one integrated program capable of reaching or exceeding the combined HVCT
of these existing partners. The new follow on may also add new clients, counselors, partners and areas to
increase coverage in geographic and population terms. A key difference is that the follow on will work much
more closely with HBC, OVC, ART and PMTCT services to ensure that HIV positive clients receive the
earliest possible referrals leading to early initiation of care, support, and treatment. This will help PLWHA
remain healthier longer, and help break stigma.
Another key difference is that the follow on will link with other USG and GRZ efforts to expand CT in various
ways, including promotion of routine and diagnostic CT, mobile CT, promote CT to Zambians with multiple
concurrent partners who drive the epidemic, and importantly, better marketing for CT to men and for
Zambians from all walks of society. The New Awardee will propose innovative methods to help expand
uptake of CT by male clients significantly. It will also propose models to reach more middle and upper class
Zambian families, for example, by linking to workplace and private health CT providers and facilities, i.e.,
training private doctors in CT as a means to break "stigma at the top."
The Awardee will thus help to remedy the unintended "over-focus" on the poor in previous USG projects,
which may have contributed to the failure of more educated and prosperous Zambians to learn and accept
their HIV status, and to become vocal leaders and advocates. While not diverting scarce resources unduly
from services to the neediest, the New Awardee will seek to include private providers and sites in CT
training and service delivery. Private providers can contribute to expand "upscale" CT, but the intent is still
to ensure equitable access and break stigma at the highest levels of society.
to the follow on with particular attention to ensuring that as many people as possible receive CT to prevent
any gaps in service or coverage. Through this planned transition, it is expected that the follow-on will reach
the combined totals of RAPIDS and SUCCESS in terms of clients, counselors, sites and areas early in
2010. If possible, the follow on will exceed these previous projects through economies of scale. The new
follow on project may provide additional services and coverage not included in the current projects,
dependent on funding, the scope of the award, as well as policy and priorities of PEPFAR II, the Zambian
National Strategy, and USG Zambia goals and objectives.
The Awardee will continue to integrate CT services into all its activities targeting eligible youth, PLWHA,
CLWHA (using DBS), couples, and OVC. Emphases will also include: more direct CT than in the past;
completion of the shift to the approved finger-stick protocol; and support for Pediatric HIV diagnosis via
collection of Dried Blood Spots (DBS) for analysis where possible. The Awardee will continue CT activities
as many of the RAPIDS and SUCCESS areas as possible, and may add new areas. The Awardee will
propose the most appropriate, cost-effective models to expand CT services to the most clients. The
immediate goal will be to scale up operations by December 31, 2009, and reach as many or more clients in
year one as were reached by RAPIDS and SUCCESS.
Where possible, the Awardee will obtain VCT kits from the district level supply chain, or from the Medical
Stores, Ltd. Strong linkages will be made with GRZ health centers at district level to ensure clients are
provided with services through follow up and feedback using the government recommended referral system.
The Awardee will make effective referrals from CT to other services, and will develop effective systems to
quickly link post-test clients to prevention, care and ART services. The awardee will link HIV positive clients
immediately to existing PLWHA support groups or help create new groups. The aim will be to boost
"Prevention for Positives," maintain the health of PLWHA for as long as possible, and reduce the need for
ART. The Awardee will access and distribute CT promotional materials and messages developed by other
USG programs.
To promote operational linkages and enhance the network model approach, the Awardee will forge
partnerships with other USG supported partners and sub-partners that provide CT. The sub-awardee will
encourage FBO/CBO sub-grantees to include provision of direct CT.
To ensure that men and women adults, and male and female youth have equal access to CT, the Awardee
will plan with a deliberate focus on gender-sensitive issues. The Awardee will concentrate on reducing
male and female barriers to CT, recognizing, for example, that due to the role of PMTCT programs in
alerting women to their HIV status, far fewer men than women receive CT and know their HIV status.
The awardee will address concerns of single and married persons, with attention to the risk of violence for
women who seek CT without advance knowledge or consent of their partner or spouse. The Awardee will
aggressively tackle CT for multiple concurrent partners. The Awardee will target youth at-risk and children
Activity Narrative: in HIV/AIDS affected families with strategies that respond to the needs of each age group within their family
and social context. The Awardee will work with FBOs and faith leaders to encourage congregants to
undergo CT and to reduce stigma and discrimination sensitization on the importance of CT and through
supporting mobile testing vans to conduct CT at churches i.e., during or in conjunction with religious
celebrations and other church activities.
For sustainability, the Awardee will ensure that the program integrates into existing structures, and
contributes to building their capacity and generate CT demand. The Awardee will also contribute to the
sustainability of the HIV/AIDS response by solidifying and reinforcing critical networks and alliances; sharing
lessons learned and best practices; leveraging resources; forming partnerships; ensuring that duplication is
not occurring and advocating for the promotion of improved CT support.
All FY 2008 targets will be negotiated during the procurement process.
Continuing Activity: 14450
14450 14450.08 U.S. Agency for To Be Determined 6843 6843.08 RAPIDS-
Table 3.3.14:
