Comprehensive Goals and Objectives: The AIHA Twinning Center supports the US President's Emergency Plan for AIDS Relief through partnerships, initiatives, and volunteer placements that help build critical institutional and human resource capacity to combat HIV/AIDS.

Through funding from the US Centers for Disease Control and Prevention in Zambia, the Twinning Center supports a twinning partnership between the University Teaching Hospital (UTH) Pediatric Pharmacy Centers of Excellence (COE) in Lusaka and Livingstone with the Center for International Health (CIH) in Milwaukee, WI. The overall goal of the partnership is to contribute to the HIV/AIDS programs of the COE by strengthening the clinical and management roles and building the training capacity of Zambian pharmacists. Specifically, partners will enhance the capacity of Zambian pharmacists and pharmacy technicians who are responsible for the following: (1) assuming the role and functions of practitioner members of HIV/AIDS clinical teams at the Lusaka and Livingstone COE; and (2) demonstrating the knowledge and skills required to organize and manage pharmacy services for the delivery of antiretroviral therapy (ART) interventions in support of HIV/AIDS prophylaxis, treatment, and care for mothers, infants, and children.

AIHA partnerships are volunteer-based peer-to-peer programs, with an emphasis on professional exchanges, voluntary contributions, and leveraging private sector resources in order to create sustainability. AIHA selected the Center for International Health (CIH) to participate in the partnership in part because of their ability to provide donations of in-kind professional time and other material resources from the participating Milwaukee organizations and experts. AIHA is able to achieve cost efficiencies and greater impact of its programs through leveraging of partner resources.

The AIHA staff work closely with twinning partners to organize exchanges and develop a partnership workplan with specific goals and objectives, a partnership communication plan, and monitoring and evaluation plan. The participating institutions identify partnership coordinators who work with Twinning Center staff to monitor the partnerships' progress and to help identify areas where technical assistance might be required. CIH enlisted a monitoring and evaluation expert to focus on the development of appropriate monitoring and evaluation tools and processes to support partnership activities. Through these efforts, the partners will effectively track development and impact of partnership interventions while capacitating the COE staff to better incorporate sound monitoring and evaluation practices in their daily work.

The Twinning Center is responsible for day-to-day project administration including budget monitoring and logistical support and can provide training to individual organizations on financial administration and sub-grant management.

Geographic target and target populations:

The geographic target areas are Lusaka and Livingstone.

The target populations include pharmacists, pharmaceutical technicians, clients, and the general community in Livingstone and Lusaka.

Key Contributions to Health Systems Strengthening:

Through the twinning partnership, participating pharmacists at the COE will play a leading role in fostering a team environment in which physicians, nurses, pharmacists, and other allied health professionals work more closely and with greater coordination to provide enhanced care and services to clients. Physicians will better understand and value the role of pharmacists in the provision of care and services. To enhance the role of pharmacists, the twining partnership will encourage more actively engaged health care teams and include other caregivers, clients, and the general public in health care, leading to greater retention of this important human resource for health.

To ensure the quality of training provided, all in-country workshop modules and training materials will be reviewed, prior to publication, by pharmacists at Children's Hospital of Wisconsin in Milwaukee for accuracy and content. The twinning partners will design an appropriate area-wide approach to pediatric ART by supporting the process of devolving treatment and care to district level health facilities consistent with accepted quality assurance standards. CIH will assist the COE to enhance the clinical role of pharmacists within existing Zambian teaching, training and service systems health structures. Experts from Children's Hospital of Wisconsin in Milwaukee will provide mentoring and supportive supervision of COE staff to ensure that they are correctly implementing the skills being taught in the training workshops.

In FY 2010, APCA and the Twinning Center will continue to support the development of human and institutional capacity of PCAZ. The partnership will finalize the PCAZ strategic plan for 2009-2012, including related business and marketing plans. With PEPFAR funding, APCA will provide training and mentoring to support PCAZ in the implementation of the strategic, business, and marketing plans. Partners will work closely with the newly selected PCAZ board of directors to ensure their engagement and support of PCAZ activities consistent with the new strategic plan. APCA will capacitate PCAZ management and staff members to more effectively manage programs and activities supporting the palliative care agenda in Zambia.

With PEPFAR funding, APCA will support PCAZ in increasing and enhancing the array of resources and services PCAZ provides to members. These resources include the continuation of the quarterly newsletter and PCAZ organizational website. APCA will assist PCAZ in the implementation of its marketing plan, to increase PCAZ membership, thereby increasing private revenue and making PCAZ more sustainable.

APCA will help PCAZ with the development of training activities, educational materials, and advocacy efforts on important issues in palliative care, including pain relief (including morphine availability) and dispensation by palliative care providers. PCAZ will continue to map palliative care services provided by hospices and home-based care providers, and provide technical support in cascading palliative care training for members. As a member of the palliative care technical working group, PCAZ with the support and leadership of APCA- will further review standards of HIV palliative care and educate its membership on the latest changes and available information and resources.

The Twinning Center will establish an LRC at PCAZ, which will serve as a palliative care resource center to be utilized by PCAZ members and staff. With the LRC, PCAZ will be able to access current evidence-based resources on palliative care and other related HIV/AIDS issues. The LRC will serve as a venue for training and education of PCAZ members, and help PCAZ to develop and produce training and educational materials. The LRC will raise the standard and number of services PCAZ is able to offer its members and enhance the capacity of PCAZ to carry out its work in education and advocacy for HIV palliative care.

UTH pharmacists will organize and conduct short-term in-country training workshops for pharmacists, pharmacy technicians, and dispensers to impart the principles of antiretroviral therapy interventions in support of HIV/AIDS prophylaxis, treatment, and care for infants and mothers. Twinning partners will implement these in-country programs to sensitize healthcare providers on the importance of developing effective healthcare teams. Pharmacists at the Lusaka and Livingstone Centers of Excellence, with assistance from colleagues from Milwaukee, will develop a comprehensive training package and tools, including modules and curricula, to serve as resources for trained healthcare professionals. This training package, developed from and inclusive of material taught at previous in-country training workshops, will allow these trained healthcare professionals to refer to the most effective and updated information and will serve as an important learning manual for Zambian pharmacists.

In FY 2010, partners will continue supporting the operations of two Learning Resource Centers (LRCs) housed within the pharmacy departments at UTH and Livingstone General Hospital. These LRCs will allow the pharmacists to increase their access to evidence-based medicine resources and will permit pharmacists to serve as mentors to their colleagues. The LRCs will be utilized by University Teaching Hospital and Livingstone General Hospital pharmacists in the development of staff resources, educational materials for clients, and training tools.

In FY 2010, AIHA Twinning Center will continue to support the established five LRCs as well as establish an additional six LRCs. The six rural LRCs will be within close proximity to the three provincial LRCs and will serve the populations in outlying areas. By establishing rural LRCs and piloting a linkage between a rural LRC and a provincial LRC, a referral network will be created. As additional LRCs are assessed and launched, AIHA will continue to provide training opportunities to the LRC coordinators, including refresher trainings and trainings that encompass effective and pertinent information. Additionally, AIHA will support the logistical coordination of an all LRC-partner meeting so that LRC coordinators can exchange and share ideas, which will create regional expertise and a support network for all LRC coordinators.

In FY 2010, AIHA Twinning Center will establish a partnership between the Defense Force Health Sciences School of Nursing and a qualified US military institution to strengthen the capacity of the of DFHS nursing school to provide quality nursing education in HIV/AIDS care. Additionally, the partnership will focus on building human resource capacity by developing and implementing a new pre-service HIV/AIDS nursing curriculum at the DFHS nursing school, as well as training master trainers and nurse tutors in the curriculum.