ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAY:

•Build capacity of the Southern, Eastern, Western, and Lusaka Provincial Health Offices, AIDSRelief, and

IntraHealth to implement prevention with positives (PWP) program.

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

circumcision activity, AIDSRelief, IntraHealth, and all Eastern, Western, Lusaka, and Southern Provincial

Health Offices.

The SOM, through NIH funding, has been piloting The Partner Project in a clinical setting. 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, STIs and alcohol use.

In FY 2008, SOM expanded the program to six clinics within Lusaka Province to determine how it would

work in a community setting. Due to the positive outcome at a clinical setting and a pilot at a community

setting, CDC through IntraHealth will collaborate with SOM to adapt this concept and scale-up an adapted

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

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

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

Two IntraHealth staff will be trained as a training-of- trainers (TOT) to take over and work with provinces as

they scale the program into the districts and provide supportive supervision.

In FY 2009, SOM will work mainly with IntraHealth to continue to building their capacity as they expand the

program into districts and provide supportive supervision. In FY 2009, SOM main role will be to develop

program evaluation tools and train the coordinators on how to track program outcome and how to use the

outcome to inform program implementation. SOM will also work with IntraHeallth to analyze the program

evaluation data and use of the evaluation outcome to improve on service delivery. The community will be

trained and engaged in program evaluation as well as implementation of the recommendations. Funds will

also be used to continue training support, program evaluation, data analysis and dissemination.

The goal is to have at least one person at each program implementation site trained on how to evaluate

programs and feed outcome to improve program process.

SOM staff who will provide training consist of staff who are currently implementing the program. These

include the clinical and community staff implementing the program as well as the project manager and

director who will equally be engaged in program administration, adaptation of materials and training

curriculum adaptation for training.

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

New/Continuing Activity: Continuing Activity

Continuing Activity: 17574

Continued Associated Activity Information

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

System ID System ID

17574 17574.08 HHS/Centers for University of 7921 7921.08 UNZA/SOM $40,000

Disease Control & Zambia School of

Prevention Medicine

Emphasis Areas

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:

This activity also relates to activities in Counseling & Testing (#0631), TB/HIV (#0724) and PMTCT (#0158).

The School of Medicine at the University of Zambia in collaboration with the University Teaching Hospital

(UTH) and JHPIEGO (The John's Hopkins Program on Obstetrics and Gynecology), has run a male

circumcision (MC) service at the UTH since August 2004. With the support of the World Health

Organization (WHO) the site has conducted 4 Male Circumcision trainings to providers from eight countries

in the region. In March 2007, following the publication of three randomized control trials, the WHO and

UNAIDS issued a joint statement, recommending Male Circumcision as an additional tool in HIV prevention.

The WHO has also placed emphasis on a minimal package for MC, which should include counseling, safe

sex counseling, voluntary counseling and testing (VCT) and MC services.

There is need to establish a training center dedicated to providing training to providers for the scale-up of

MC and the necessary supportive supervision. This funding is being requested to support two main

components on MC: 1) integrate counseling and testing as part of MC within the same building. For the last

four years counseling and testing (CT) has been provided by an off-site VCT team from the nearby VCT

centre run by Society for Family Health. This mode of provision of CT, made the service less accessible to

the MC clients, 2) establish a training center at University of Zambia (UNZA) School of Medicine based at

the UTH to build capacity for the scale-up of MC within Zambia. Funds will thus be used to hire counseling

and testing staff; renovate to create space for CT, develop a core of trainers to build capacity and provide

the support necessary for support supervision. Funds will also be used to develop standardized training

package which will be given to those trained as guide for implementation. The counseling to be provided

will be based on the WHO minimum package which includes safe sex messages on abstinence, being

faithful, and condom use. The site uses the Society for Family Health materials which are based on the

JHPIEGO/WHO training manual for MC.

It is anticipated that in FY 2009, the center will provide training to 100 providers and provide actual MC

services to 600 clients The site intends to train 50 MC counselors from among the staff of the University

Teaching Hospital .To establish a sustainable program, and thereby to have a large pool of trained staff

within the Hospital. The site intends to train a further 50 MC counselors from Lusaka DHMT to help with

follow up of MC clients within Lusaka district, who will receive services at the UTH. SOM will work with

existing clinical facilities and NGOs and strengthen their capacity to provide high quality MC services. The

SOMs' goal is to establish a high-quality MC training and service provision system to effectively scale up

into provinces.

The University Teaching Hospital School of Medicine (UTH SOM) has a new service site for MC which

these funds will help to support. JHPIEGO and UTH SOM have an on-going collaboration which allows

JHPIEGO to provide the technical expertise while UTH SOM provides the site for MC training. This proposal

is in harmony with JHPIEGOs MC activities, because it strengthens the UTH SOM MC site, for future

national scale-up. This funding is anticipated to strengthen counseling and testing services at the UTH SOM

service site.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Construction/Renovation

Gender

* Addressing male norms and behaviors

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $80,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.07:

In order to meet the challenges of the HIV epidemic, relevant and appropriate training preferably university

level is required. In FY 2009, funding is requested to support 3 activities: 1) $270 000 is for the laboratory

upgrading activity, and 2) $80 000 for the nursing certificate program, and 3) $45,000 to support visiting

lecturers to the University of Zambia (UNZA) School of Medicine (SOM).

This activity links SOM MMed (9787.08) and MPH activities (#12536.08) as well as, Diploma in HIV

Medicine residency program (#3698.08)

This narrative relates to activities in strengthening the quality and scope of the laboratory services at the

School of Medicine as well as to strengthen nurses training for effective care and support interventions for

HIV/AIDS in the Republic of Zambia. It has three components associated with it. One component is to

strengthen the scope and quality of laboratories for medical, biomedical sciences and pharmacy training

within the School of Medicine whereas the other component is concerned with the development,

implementation, and evaluation of a Certificate Program to prepare nurses in Zambia to provide

comprehensive care, treatment and support, including initiation of antiretroviral therapy (ART) for patients

with HIV/AIDS. The third component is to support visiting professors from within and outside the region to

give lectures and provide clinical skills teaching in disciplines with limited available expertise as determined

by the Dean's Advisory Committee of the School of Medicine.

The School of Medicine has often emphasized the need for requisite tools necessary for the training of

health professionals. One such critical area is the provision of quality laboratory equipment. In this regard

this FY 2009 activity is focused on strengthening the quality and scope of the laboratory equipment and

service for both undergraduate and graduate courses in the School of Medicine.

The School of Medicine at the University of Zambia is the only medical school in Zambia. Its first

admissions were in 1966 when Zambia's population was about four million. The school now serves a

population of about 12 million. In its 40 years of existence it has produced over 1,600 graduates. The

school has been operating below levels that would be required to produce adequate health manpower for

Zambia. This is basically owing to four factors namely: 1) Lack of adequate trained staff; 2) Lack of

teaching facilities, lecture rooms, and laboratories; 3) Poor conditions of service; and 4) Lack of student and

staff houses.

The Government of the Republic of Zambia's vision of training 100 doctors per year dating as far back as

1970 has not been realized. In the last 40 years, there has been no corresponding growth and

development in particular support areas such as laboratories and physical structures in spite of the

introduction of post graduate programs in 1983 and more recently, the undergraduate programs in

pharmacy, physiotherapy, Biomedical Sciences, Environmental Health and HIV residency diploma course,

that trebled the number of students. The programs aforementioned have not had additional teaching

facilities developed commensurate with a seven fold increase in training programs at the school in the last

40 years. There has also been an increased output of graduates from 14 medical students to well over a

100 health professionals in various disciplines per year without corresponding expansion of infrastructure

and equipment over the past 40 years. In 2006, as the School introduced a new Environment Health

program, the first new building in three decades was put up with assistance from the World Bank.

The school laboratories cater for not only medical students but other programs in the school as well. The

laboratories meant to cater for 40 students are usually overcrowded to unacceptable levels. In the ideal

situation new laboratories need to be built along with the rehabilitation of the old ones.

Through reprogramming from CDC technical assistance funds in FY 2008, initial funding was made

available to support renovation of two laboratories in the SOM and to conduct training for the first group of

nurses in the antiretroviral therapy (ART) nursing certificate program. Funding for these activities have

recently been made available and implementation of these activities will commence soon.

FY 2009 funds are requested to strengthen the quality and scope of the laboratory equipment and services

for both undergraduate and graduate courses in the School of Medicine for improved long-term antiretroviral

treatment outcomes. This will improve training and development of skills necessary for effective provision

of care, support and treatment in HIV/AIDS/TB/STI programs once students graduate. Health professionals

trained under such a conducive environment are likely to progress to be strong public health professionals

who will be equipped to respond to the care, treatment and prevention challenges caused by the

HIV/AIDS/TB/STI epidemics.

Another activity to be supported in FY 2009 is the implementation and evaluation of a Certificate Program to

prepare nurses in Zambia to provide comprehensive care, treatment and support, including initiation of ART

for patients with HIV/AIDS. This activity is built on the realization that an emerging strategy for addressing

the health workforce shortage and rapidly increasing access to HIV and other health services involves task-

shifting or the redistribution of tasks among health workforce teams. In this regard there is need to develop

mechanisms for clinical training, mentoring and supervision of workers who assume expanded roles, and for

developing financial and/or non-financial incentives in order to retain and enhance the performance of

health workers with new or increased responsibilities. One of the guidelines in the of World Health

Organization (WHO) report (2008) specifically addresses the recommendation that nurses and midwives

can safely and effectively undertake a range of HIV clinical services. The main focus of this activity is to

train nurses and expand their roles so that they are able to meet the challenges of HIV/AIDS care and

support programs, including ART provision.

.

The third activity area to be supported by FY 2009 funding is short-term stays by visiting professors from

within and outside the Southern African region to give lectures and provide clinical skills teaching to UNZA

SOM students and other health professional students in the SOM programs. Due to the shortage of human

resources there are some training programs within the SOM that are grossly understaffed. This support will

pay for the visiting professor's travel and upkeep to provide the block of lectures and clinical skills training.

We will as much as possible identify and bring in experts from within the region as it would be cheaper to do

so and therefore maximize on the utilization of the available funds. Where regional expertise is not

Activity Narrative: available, experts will be identified from outside the region

Cutting across all the three activities is the fact that these programs will improve capacity for women in line

with the Southern African Development Community initiative that encourages member countries to maintain

at least a 30% enrolment for women. At the UNZA SOM, 40% of the places for all the enrollment have

been reserved for women. Given this scenario, the FY 2009 activities will participate in empowering women

in these activities. This empowerment is more evident in the certificate course for nurses in that more than

85% of the nurses are women.

New/Continuing Activity: Continuing Activity

Continuing Activity: 20729

Continued Associated Activity Information

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

System ID System ID

20729 20729.08 HHS/Centers for University of 7921 7921.08 UNZA/SOM $370,000

Disease Control & Zambia School of

Prevention Medicine

Emphasis Areas

Construction/Renovation

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $395,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.09:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

•Have added a more detailed background section to the University of Zambia School of Medicine and the

Masters of Public Health Program

•Have added a section on infrastructure development

This activity links with the Master of Medicine (MMed) strengthening program(#), The laboratory

infrastructure and antiretroviral nursing certificate program(#), the Diploma in HIV Medicine program(#), the

infrastructure development program(#), the male circumcision training center program(#)

This cooperative agreement was undertaken in order to strengthen and upgrade the Master of Public Health

(MPH) degree program at the University of Zambia UNZA so as to increase the number of trained public

health professionals in Zambia that are capable of effectively tackling the challenges of HIV/AIDS/TB/STI.

The overall goal of this agreement is to create a pool of highly trained public health professionals that

should be a key national resource in delivering of care, policy formulation and able to carryout public health

evaluations (PHE) in HIV/AIDS/TB/STI.

In this regard, this program area focuses on strengthening the quality and scope of the only Master of Public

Health degree program offered by University of Zambia (UNZA) School of Medicine (SOM). An average of

30 students graduate from this program annually and they become leaders in public health delivery

including policy making in Zambia. The MPH program in the SOM is a major contributor to the human

resource development in public health in Zambia. The funding in the program will strengthen the capacity of

the local institution in developing its curriculum and necessary human resources that will be involved in

HIV/AIDS work.

To ensure sustainability of the capacity building for public health care delivery in TB/HIV/AIDS/STI in

Zambia, FY 2009 funding will help UNZA MPH program to develop concentrations in Epidemiology and

Biostatistics by supporting student scholarships and faculty in curriculum development, teaching and

resources to develop these programs. Developing these concentrations will enable the MPH program to

support and train additional HIV/AIDS health professionals with expertise in public health care delivery,

policy formulation and public health evaluation methodology, including study designs, data management,

statistical analysis & interpretation, scientific writing, communication of health information, and research

results to health professionals' policy makers and the general public.

The FY 2009 application is tackling an area which has been identified by the Government Republic of

Zambia and SOM as priority. In achieving these objectives, local experts will be utilized to upgrade the

curriculum and the teaching in epidemiology and biostatistics, with the contribution of regionally based and

international experts so as to strengthen the quality and competencies of MPH graduates who will in turn

effectively contribute to the fight against HIV/AIDS/TB/STI. This has a huge bearing on sustainability in that

a pool of able local and international experts will be working together to develop a program locally that is

relevant to combat HIV/AIDS/TB/STI. The student scholarships that will be provided will not only be useful

to facilitate learning, but will be critical in training leaders in health care delivery, management and policy

especially in the area of HIV/AIDS/TB/STI care and treatment. Some of the work will be carried out in

organizations that are strong and active in providing HIV/AIDS/TB/STI interventions and this will also

improve and strengthen partnerships and synergies for not only providing internship opportunities but also

for future collaboration. Another area this activity will focus on in FY 2009 is in strengthening the learning-

resource unit at the Department of Community Medicine by procuring additional computers for the computer

laboratory and strengthening the internet connectivity for the students to access information and peer-

reviewed, international medical journals. This brings another dimension of collaboration as it will cement

public private initiatives that the University of Zambia is involved in such as the one with a computer

company called NECOR. The University has an understanding with the local private computer company to

address acquisition of critical resources such as computers. In this arrangement, for every computer bought

by the School of Medicine, this company supplies one extra computer at no cost. This kind of partnership

has potential to contribute effectively to the success of the FY 2009 collaborative initiatives. With this

arrangement, the long term impact of this funding will have a huge bearing in generating knowledge on

effective HIV interventions as well as in understanding the dynamics and determinants of HIV transmission.

This kind of knowledge will save lives when translated into practice and policy.

The curriculum under these activities will also emphasize management, care and prevention of pediatric

AIDS. In addition, prevention and early access to pediatric care will also be strengthened through training of

students in the prevention of mother-to-child-transmission program.

Progress made in FY 2008

In FY 2008, activities were delayed mainly due to the administrative set-up of the award but have since

been addressed. Working very closely with CDC-Zambia, the project is currently on schedule in

implementing all 2008 activities. The activities that have been implemented are as follows;

•Produced a School of Medicine approved curriculum draft document for the concentrations in epidemiology

and biostatistics, with emphasis on HIV/AIDS/TB/STI within the MPH program. The final product will be

ready for circulation by end of this calendar year, which is three months before commencement of the

course.

•Identification of locally based organizations that are strong and active in providing HIV/AIDS/TB/STI

interventions and can provide internships for MPH students. This process is still on-going and it is hoped

that a sampling frame of eligible organizations will be completed by December, 2008.

By December 2008, an approved curriculum for the concentrations in epidemiology and biostatistics will be

ready. In FY 2009, course outlines of at least three courses offered as part of the Epidemiology and

Biostatistics concentrations offered to MPH students will be documented. In addition, upgrades to the

learning-resource centre as well as broad band internet connectivity will be achieved. Other deliverables

Activity Narrative: include documenting up to 10 students enrolled in epidemiology and biostatistical tracks. Furthermore, we

aim at placing at least three MPH students in locally based organizations working in the area of

HIV/AIDS/TB/STI in internship positions.

The UNZA SOM is the only medical school in Zambia. Its first admissions were in 1966 when Zambia's

population was about 4 million. The school now serves a population of about 12 million and has had very

little building improvements since its inception. For many years the school has been confined to operating

below levels due to the out-of-date facilities. Additional funds in FY 2009 are being requested to renovate

existing facilities to enhance and upgrade the school to produce adequate health manpower to satisfy the

health workforce needs for Zambia for optimal health care delivery in combating HIV/AIDS/TB/STIs/Malaria

and other health needs. The proposed project will involve renovating the laboratory and existing student

lecture theatre to accommodate seating for 180 persons.

The SOM will procure computers for an electronic medical library to enhance availability, accessibility, and

utilization of learning resources via internet for medical students. Currently the available medical library

does not have adequate seating capacity, textbooks, and journals for the increased number of health

professionals in training. With subsequent fiscal year funding, we intend to improve the learning resources

in this library as well. These activities will contribute to the PEPFAR goal of increasing training and

development of a well trained workforce to reduce the health workforce deficit in PEPFAR funds recipient

countries.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15575

Continued Associated Activity Information

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

System ID System ID

15575 12536.08 HHS/Centers for University of 7921 7921.08 UNZA/SOM $100,000

Disease Control & Zambia School of

Prevention Medicine

12536 12536.07 HHS/Centers for University of 6189 6189.07 $100,000

Disease Control & Zambia School of

Prevention Medicine

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $700,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.18: