ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

•There will be an increased focus on training of couple counselors and capacity building within GRZ

facilities.

•ZEHRP will explore models of delivery of couples' voluntary counseling and testing (CVCT) to reach larger

numbers of couples

•ZEHRP will continue to train influential leaders who encourage and promote CVCT and faithfulness with

knowledge of status in their communities.

•Services will be expanded to include pre-marital and non-cohabiting couples and children who accompany

their parents to CVCT.

The majority of new HIV infections in Africa are acquired from a spouse, and couples represent the largest

HIV risk group in Africa. Abstinence is not an appropriate message for married couples and faithfulness is

not effective in the 10-20% of couples who have one HIV positive and one HIV negative partner (‘discordant

couples') unless these couples know their discordant status and protect the uninfected partner. Couples'

voluntary counseling and testing decreases transmission of HIV by more than 60% within discordant

couples, and reduces sexually transmitted infections and unplanned pregnancies in all couples. CVCT

directly increases gender equity in HIV/AIDS programs by promoting the testing of men and women

together, which innately increases male involvement in HIV/AIDS activities. Additionally, CVCT

programming supports the behavior change priority program area by providing counseling support to

discordant couples as part of the testing process. Multi-sectoral promotions mechanisms are employed to

address large-scale change at the community level with regards to social norms, values, and sexual

behavior.

Accomplishments to Date:

Since FY 2005, the Zambia-Emory HIV Research Project has been supported with PEPFAR funds through

CDC. In FY 2005, ZEHRP was a sub-partner of the Association of Schools of Public Health. In October

2007, ZEHRP became a Prime Partner as a local non-governmental organization. At present (FY 2007),

ZEHRP operates at three fixed sites and five district clinic integration programs in Lusaka, one fixed site in

Kafue, one integration site at the Mazabuka District Hospital, and one additional weekend District Clinic

based in Mazabuka, Southern Province. Currently a site in Monze is being established; along with three

additional integration programs in Southern Province.

Since FY 2005, ZEHRP has provided CVCT to over 11,200 couples and trained 130 nurse/counselors in

Zambia in CVCT procedures.

Scope of Work:

CVCT Service Provision:

1) Offer CVCT in two existing fixed sites in Lusaka District (Twatotela/Emmasdale, Chawama), one fixed

site in Kafue District, and 14 integration sites throughout Lusaka and Southern Province. During FY 2008,

ZEHRP worked to phase out one current fixed site in Lusaka (Kanyama) and open two integration sites in

Monze, Southern Province. The resources from closing the Kanyama site will be re-allocated to 4 new

district clinic integration programs in Lusaka.

2) Provide didactic and practical training in CVCT promotion and couples' counseling procedures through

these centers

3) Refer all HIV-positive individuals for care and treatment

4) Scale-up expansion of CVCT services outside Lusaka by continuing services in Southern Province

5) Expand the scope of testing couples to include "all" couples regardless of marital and co-habitation

status.

6) Train 100 counselors in Zambia in CVCT delivery. Of the 100 trained, 20 with at least two from each

province will be trained as trainer-of-trainers to further scale up capacity building for CVCT in the districts.

Counselors will be selected from each of the nine provinces in Zambia. This activity includes support and

supervision for follow-up observation of trained counselors to ensure that they effectively initiate and expand

CVCT activities within their own institutions.

7) Capacity building for staff to be able to begin testing children in 2009.

FY 2009 Planning

CVCT Service Provision:

In FY 2009, ZEHRP plans to continue activities conducted in FY 2008, with an increased emphasis on the

monitoring and evaluation of CVCT service provision. ZEHRP will work closely with District Health

Management Teams (DHMTs) to ensure that integration activities are performed smoothly and continue to

transfer coordination and oversight responsibilities to DHMTs. The gradual reassignment of the managerial

aspects of CVCT programming to district clinic employees will ensure continuity of CVCT services after this

program concludes. To further the sustainability of CVCT in Zambia, ZEHRP will focus on establishing

more district clinic integration sites throughout Lusaka and Southern Province. Government-employed

nurse counselors will be trained on CVCT procedures. Although ZEHRP-organized weekend CVCT

programs will continue, the increase in CVCT-trained staff at the district level will augment the capacity to

deliver CVCT as a routine component of HIV counseling and testing. Continued capacity building will occur

throughout Zambia by training additional 100 counselors from all nine provinces in CVCT delivery. Of the

100 trained 20, two from each province, will be trained as train-of-trainers to further scale up capacity

building for CVCT in the districts and other health facilities in the provinces.

Another focus in 2009 will be to offer HIV testing to all children who accompany their parents to the CVCT

program.

To ensure that increased demand will accompany the enhanced supply of CVCT throughout Lusaka and

Southern Province, ZEHRP will continue to utilize clinic-based community health worker systems for

sensitization and promotion of CVCT at integrated sites. Further work will be done to encourage the

incorporation of the CVCT message into existing programs and structures (e.g. PMTCT, ANC, TB). ZERHP

will maintain strict monitoring and evaluation of all promotional strategies used to provide support for

Activity Narrative: evidenced-based decisions on future implementation of CVCT promotional models.

Center of Excellence for CVCT Training:

Through Headquarters Operational Plan (HOP) funding in FY 2008, ZEHRP will establish a center of

excellence to build local and regional capacity in delivering CVCT by training 100 counselors from eight

PEPFAR focus countries (including Zambia) in CVCT.

Pending the continuation of funding in FY 2009, ZEHRP will continue to provide training in CVCT

counseling to countries throughout Africa. These trainings will consist of CVCT delivery and/or training of

trainers in CVCT. ZEHRP will explore the possibility of providing technical assistance and/or monitoring

and evaluation support to countries where initial training occurred. These trips will be country-specific and

focus directly on advising the integration, implementation and scale-up of CVCT activities.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15505

Continued Associated Activity Information

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

System ID System ID

15505 15505.08 HHS/Centers for Zambia Emory 7163 7163.08 Zambia Emory $810,000

Disease Control & HIV Research HIV/AIDS

Prevention Project Research

Project (ZEHRP)

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $150,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.14: