This activity is closely linked to the University of Zambia (UNZA) School of Medicine (SOM) Prevention with

Positives (PWP) activity, AIDSRelief, and all Eastern, Western, Lusaka and Southern Provincial Health

offices' Other Prevention activities.

The UNZA SOM through NIH funding, has been piloting The Partner Project. The Partner Project is a

behavioral intervention designed to reduce high-risk behavior among HIV positive men and women through

engaging them in safer sex discussions, reproductive choice, and partner participation. Topics addressed

include but are not limited to, HIV prevention, sexually transmitted infections (STIs) and alcohol use.

In FY 2008, the SOM expanded the program to five clinics within Lusaka Province. Due to the positive

outcome of the pilot, CDC through IntraHealth will collaborate with SOM to adapt this concept and scale up

the program to Eastern, Western and Southern provinces as well. In FY 2008, the SOM trained Prevention

with Positives coordinators at each of the four PHOs, Chreso and IntraHealth on the program delivery

methodology. Working with these partners, SOM will adapt current materials to meet each province's need.

Two IntraHealth staff will be trained as trainers to take over and work with provinces and other partners to

scale the program into the districts and provide supportive supervision.

In FY 2009, IntraHealth will work with Provincial Health Officers (PHOs) and District Health Management

Teams (DHMTs) to further build provincial health facilities' capacities to deliver effective prevention with

positives program. IntraHealth will also work with PHOs to integrate prevention into CT and other aspects

of healthcare including counseling and testing (CT), prevention of mother-to-child transmission of HIV/AIDS

(PMTCT), tuberculosis (TB) and antiretroviral therapy (ART) and ensure these areas refer those who are

positive and negative to the prevention workshops. Those who come for CT will be asked if their partners

know their status and engaged in discussion to motivate them to bring their partners for CT. Once the

partner is engaged they will both receive couples counseling with emphasis on prevention

IntraHealth will also make sure that those who are engaged in workshops are further referred to community

discussion groups. Funds will be used to hire a point person at IntraHealth's office to work with PHOs and

provide supportive supervision to the capacity building process of the prevention with positives program.

Funds will also be used to conduct meetings with field coordinators hired through the PHOs to share

lessons learned and challenges and trouble shoot on the way forward and how to make the program more

efficient and effective. Funds will also be used to institute reliable transportation to the field to conduct

monthly field visits to the provinces for monitoring and supervision.

A monitoring component will be implemented for program evaluation to track program outcome. One

objective is to have at least four people trained at each district hospital to deliver prevention with positives at

points of counseling and testing service delivery leading to about 50 adults trained in Southern (16), Eastern

(14), and Western Provinces(12).

In order to ensure sustainability of the program and to promote lasting behavior change, prevention

activities will be integrated as part of regular health services provided by the district health offices.

Community leaders will be engaged and trained to conduct community mobilization and to hold community

prevention discussion. The number trained will depend on needs of each province. Community health

workers currently covering counseling and testing, prevention of mother to child, TB and Malaria in each

district selected will be further trained to include prevention of sexual transmission messages in their packet

for community health education.

Interventions will be designed to involve the community leaders to be prevention emissaries in communities

where they live. The expected outcome of prevention will be made clear by making sure each community

member understands his/her role in prevention and the need to reduce new infections and adopt less risky

sexual interactions.

Targets set for this activity cover a period ending September 30, 2009.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Construction/Renovation

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

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

Economic Strengthening

Education

Water

Table 3.3.03:

ACTIVITY NARRATIVE MODIFIED IN THE FOLLOWING WAYS:

•Update on current activities

•Planned activities for 2009

•Targets adjusted

Activity Narrative:

This activity is related to the following counselling and testing activities: SPHO #3667.08; CIRDZ 19501.08;

and ZEHRP # 15505.08.

Voluntary counseling and testing (VCT) services are being scaled-up in much of the country, thanks to the

efforts of many partners, however, the most rural and remote populations have not been adequately

reached. The Zambia Voluntary Counseling and Testing (ZVCT) services coordinate most of the

counseling and testing (CT) services in the country, including both non-governmental organizations and

government run centers. Most of the 1028 sites (including a few mobile services are along the railroad lines

and cover urban and peri-urban populations . Very few are conveniently situated to cover the most remote

and rural populations, due to poor roads and a higher cost per person due to transport logistics.

The funding to IntraHealth International (IntraHealth) was intended to expand CT to rural areas starting with

two districts: Namwala in Southern Province and Luangwa in Lusaka Province, both of which are rural and

underserved. FY 2007 was the first year of activity and the project was also IntraHealth's first presence in

Zambia. Year one activities involved setting up the program from scratch, obtaining a letter to work in

Zambia from the Ministry of Health, registering the NGO, establishing an office, hiring of key staff, recruiting

district coordinators and lay counselors and providing them with training in CT and an orientation to the

program. Due to a delay in funding, IntraHealth was only able to begin work in mid-year.

Once started, however, IntraHealth engaged the Zambia Counseling Council (ZCC) to train six trainers in

counseling and testing, including IntraHealth's two site supervisors as well as two clinical staff from each

district. This training of trainers was followed by the training of 46 lay counselors (24 from Namwala and 16

from Luangwa).

Other partnerships in the first year included one with the Health Communication Partnership (HCP), an

NGO operating in Luangwa district. This organization is supplying psychosocial counselors with Information

Educational and Communication (IEC) materials in Luangwa. IntraHealth also partnered with Zambia

Network of People living with HIV/AIDS (NZP+) and National HIV/AIDS/STI/TB Council (NAC).

In FY 2008, IntraHealth continued to roll out rural VCT through the trained lay counselors in Namwala and

Luangwa districts. The momentum during most of this year increased as the counselors gained confidence

and experience and more people accepted counseling and testing. The lay counselors were provided with t-

shirts, bicycles and shoulder bags to carry their test kits and records. The IntraHealth site supervisors

supervised and supported the lay counselors in carrying out their assigned tasks, and held monthly

meetings to review their progress and problems. Couples counseling was fostered among the lay

counselors in order to facilitate partner notification, reduce post-test violence, and promote prevention for

positives in the future. IntraHealth collected the lay counselors' data and reported it back to the district and

provincial health offices as well as to the IntraHealth office in Lusaka.

Using lessons learned from implementing mobile VCT the previous year, IntraHealth expanded into two

additional districts in the Southern Province in FY 2008: Siavonga and Gwembe. These are two more

remote and wet districts, including areas bordering the Zambezi River frequented by fishermen and women

and that currently remain underserved. Partnerships were developed with the district health officer and

other organizations working in these two districts to leverage resources and identify potential lay counselors

who could contribute to counseling and testing clients. IntraHealth investigated the availability of boats to

navigate along the river and provide services to the population accessible by river.

IntraHealth collaborated with the Zambia Emory HIV Research Program for training of trainers in couples

counseling in FY 2008. These trainers in turn trained psychosocial counselors in couple counseling and

partner notification in the districts. IntraHealth also coordinated closely with CIDRZ, which is conducting a

similar intervention in Shangombo district.

In FY 2009, the project will continue to support lay counselors in all four districts, Namwala, Luangwa,

Siavonga, and Gwembe where IntraHealth worked in the two previous years. In addition, IntraHealth will

expand to Sinazongwe and Kalomo districts, also in the Southern Province. Although IntraHealth will have

site supervisors for these districts, it will try to maximize partnerships with other organizations in order to

extend the leverage of the funding available. This will include sharing transportation, office resources, and

doing joint programming. IntraHealth will continue improving on its referral mechanisms to ensure that as

many people as possible make it to the referral sites. The mobile VCT's will continue to ensure that CT is

offered to people either nearer to their homes or at outposts within their reach. The mobile units will move

from village to village providing services. Bringing services nearer to the people provides an opportunity to

those who are unable to move to distant VCT centers due to lack of transport, long distance, and lack of

time due to competing priorities.

To make this a sustainable program, IntraHealth will work with the DHMTs to strengthen their capacity to

supervise and support lay counselors based in clinics and rural area. They will be encouraged to budget for

resources for on-going support and supervision for the lay counselors.

Ultimately, IntraHealth will coordinate with the District Health Management Team (DHMT) to send ART,

PMTCT (including family planning), and tuberculosis (TB) teams with the mobile CT lay counselors so that

treatment will be available to people in the remote areas over time. Lay counselor will refer pregnant

mothers to PMTCT and family planning and will address TB with all clients. In the meantime, the emphasis

will be on prevention of transmission in those who test positive (positive prevention) and prevention of

Activity Narrative: acquisition of HIV in those who test negative. This will include the couples counseling that was begun in

2008.

In 2009, the DHMT, local chiefs, and community leaders will be enlisted into supporting prevention activities

and encouraged to become prevention advocates. IntraHealth will hold meetings with chiefs and headmen

in the six districts to discuss HIV prevention, importance of CT, the value of couples CT and the importance

of maintaining less risky behaviors among their youths and adults. IntraHealth will undertake gender

sensitization activities aimed at self-assessment of gender norms in the community and identification of

norms that promote unhealthy behavior and put males and females at risk of HIV infection. It is hoped that

transferring such knowledge to the community and engaging them in discussion to identify local solutions to

stigma and prevention might foster more sustainable behavior change. IntraHealth will build upon and

strengthen its messages for prevention, and will facilitate support groups for People Living with HIV/AIDS

(PLWHAs) in the districts. IntraHealth will work with these groups in skill building and will try to link them

with microfinance organizations for income generation. Tested men will be requested to be actively

involved in sensitization of the community in HIV testing and prevention and this should be inclusive of

traditional leaders. IntraHealth will also work with the New Partner Initiative in its Men Taking Action

program and "Mothers 2 Mothers" project to promote CVCT. IntraHealth will make programs on gender,

gender violence, alcohol, nutrition and healthy living a part of the support groups for PLWHA. IntraHealth

will work with CDC Zambia to engage the community into focus groups for a year to observe the impact of

their interventions.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15503

Continued Associated Activity Information

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

System ID System ID

15503 15503.08 HHS/Centers for IntraHealth 7161 7161.08 Mobile VCT $500,000

Disease Control & International, Inc Services

Prevention

Emphasis Areas

Gender

* Addressing male norms and behaviors

Health-related Wraparound Programs

* Family Planning

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $40,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.14: