Activities for Track 1 and Track 2 funding at site level overlap therefore the narratives for the two tracks of funding are the same. EGPAF/CIDRZ supports the Zambian Ministry of Health (MOH) in providing comprehensive, integrated, and quality clinical services to prevent mother-to-child HIV transmission (PMTCT) and care and treatment of HIV-positive adults and children. Programs work closely with MOH staff at all levels, and provide technical support to improve clinical and management capacity. EGPAF will continue to support the MOH with management of SmartCare continuum of care patient tracking system and will continue supporting Africa Directions who provide counseling and testing services and pediatric psychosocial support services to HIV positive children in Mtendere Compound-Lusaka.

We will improve the health and well-being of HIV-positive mothers and exposed infants by providing comprehensive care and links to HIV care and treatment. Specific objectives are to:

1. Support comprehensive PMTCT services in all antenatal and delivery wards in 301 sites.

2. Provide more efficacious regimens (dual and triple therapy prophylaxis) to 70% of all women who receive PMTCT.

3. Support integrated antiretroviral therapy (ART) in 14 maternal-child health wards (MCH) and expand to four sites.

4. Integrate PMTCT in clinic and community-based comprehensive primary health care in Chongwe, Kafue, and Luangwa districts.

5. Increase district ownership by promoting district oversight, data monitoring and use and performance based funding.

The adult HIV care and support program will improve the health of HIV-positive people by providing pre- ART clinical care, comprehensive prevention services, and a continuum of care in primary health clinics. Objectives are to:

1. Provide a minimum package of prevention for positives.

2. Support pre-ART clinical care at 72 sites, including the provision of select drugs to treat opportunistic infections.

3. Support peer educators and treatment supporters to provide clinic services and in-home patient education.

4. Identify and pilot innovative methods to follow up pre-ART patients for repeat ART eligibility screening.

5. Support integrated HIV screening and care in nine outpatient (OPD) wards, and expand to five new sites.

6. Provide comprehensive women's health clinical services, including cervical cancer screening and treatment, HIV testing, and screening and treatment for sexually transmitted infections in 19 sites.

The adult HIV treatment program goal is to improve the quality of life of HIV-positive patients, and reduce mortality from HIV, by supporting MOH staff to provide clinical services and monitor their quality and impact. Objectives are to:

1. Support treatment at 72 sites and 10 satellite sites through advanced clinical training, mentoring and quality improvement systems.

2. Improve capacity in MOH staff to provide clinical oversight and conduct ART management training.

3. Improve adherence to treatment and reduce the proportion of patients lost to follow up.

4. Provide lab support through training, testing, specimen processing, and equipment.

5. Provide technical support to MOH in developing and piloting new HIV treatment guidelines.

6. Integrate ART in clinic and community-based comprehensive primary health care in Chongwe, Kafue, and Luangwa districts.

The pediatric care and support program aims to improve the health of HIV-positive children through integrated services that link early identification and diagnosis with psychosocial services and antiretroviral treatment. Objectives are to:

1. Increase the number of HIV-positive infants and children enrolled into HIV care through active case finding in under-five, in-, and outpatient wards.

2. Expand early infant diagnosis (EID) services through training, specimen transport, and lab diagnosis.

3. Improve links between PMTCT, EID and ART services.

4. Support pediatric peer educators to provide clinic-based outreach and education to increase the number of infants and children screened.

5. Increase awareness of and demand for pediatric HIV services through community outreach, educational materials, puppetry, and other means.

The pediatric treatment program goal is to increase the survival of HIV-positive children by supporting comprehensive, high-quality clinical pediatric ART services. Objectives are to:

1. Support clinical pediatric ART care in 72 sites and 10 satellite sites through training, on-site clinical mentoring, and quality improvement.

2. Provide specialized adherence counseling and psychosocial support by pediatric peer educators.

3. Provide technical support to the MOH in the development and revision of pediatric treatment guidelines, algorithms, and forms.

We support MOH PMTCT sites in Eastern, Lusaka, and Western Provinces. The target population is all pregnant women, and their partners and children. We support MOH and private HIV care and treatment sites in Eastern, Lusaka, Southern, and Western Provinces. The target population is all HIV-positive children and adults.

In FY 2010, we will integrate HIV prevention messages for both HIV-positive and HIV-negative clients, and will focus on improving male involvement and couple / family testing.

Cost-efficiency strategies include task-shifting through peer educators; increasing adherence and reducing loss to follow-up and need for second-line regimens; and actively identifying HIV-positive children to promote early testing, early treatment and decreased morbidity and mortality.

We will provide a minimum package of prevention for positives by:

1. Training peer educators to assess sexual activity and provide prevention counseling.

2. Training nurses to assess family planning needs and provide counseling.

3. Including prevention modules in existing trainings.

We will support pre-antiretroviral treatment (ART) clinical care by:

1. Providing routine prevention counseling and ensuring condom availability.

2. Procuring select opportunistic infection drugs if needed.

3. Strengthening technical capacity at the district, provincial, and national levels.

4. Participating in technical working groups and providing technical support for guidelines and training packages.

5. Supporting 50 community sensitization drama performances.

We will support peer educators and treatment supporters by:

1. Recruiting and training 40 new peer educators and supporting 160 peer educators.

2. Providing ongoing mentoring and support to all peer educators and treatment supporters.

3. Conducting 12 trainings with treatment supporters and Neighborhood Health Committees on prevention for positives.

4. Disseminating prevention information, education, and communication materials.

5. Providing technical support for task-shifting guidelines and training packages.

We will pilot follow up of pre-ART patients for repeat ART eligibility screening by:

1. Analyzing program data to understand missed opportunities.

2. Assessing the feasibility of using methods such as text messages, phone or home visit reminders.

3. Reviewing the impact and operational demands of increased pre-ART patient follow-up.

We will support integrated HIV screening and care in 14 outpatient (OPD) wards by:

1. Providing ongoing monthly clinical mentoring at integrated sites.

2. Training 15 clinic staff in five new sites.

3. Recruiting and training 10 lay counselors.

We will provide comprehensive women's health clinical services by:

1. Providing 19 sites with trained personnel, equipment, and supplies.

2. Creating effective linkages through trained clinic-based peer counselors.

3. Conducting ongoing mentoring and quality improvement systems.

4. Supporting ongoing health promotion and advocacy.

5. Training staff and students at the University of Zambia School of Medicine.

We will support quality clinical care at existing antiretroviral treatment (ART) sites by:

1. Training 80 health care workers in advanced clinical management. (All trainings in-service)

2. Developing capacity in Zambian Ministry of Health (MOH) clinicians to conduct ongoing quality improvement (QI). Outcomes monitored are via SmartCare electronic medical records system

3. Supporting 20 Nurse Practitioner trainees.

We will improve the capacity of MOH staff to provide oversight and training by:

1. Training 40 MOH staff in clinical mentoring.

2. Conducting QI activities jointly with MOH staff.

3. Integrating with provincial strategic plans.

4. Supporting MOH provincial trainers to conduct four basic ART trainings.

5. Developing MOH capacity to assess training and mentoring needs and capacity.

6. Developing MOH capacity to assess and improve logistics management.

We will improve adherence to treatment and reduce loss to follow up by:

1. Training peer educators to address treatment failure and address causes of loss to follow up

2. Providing counseling for assisted disclosure to partners and family.

3. Continuing adherence counseling for all pharmacy visits and follow up of late patients.

We will provide ongoing laboratory support by:

1. Providing diagnostics for clinical monitoring of HIV.

2. Ensuring quality assurance (QA) of dried blood spot testing.

3. Providing good clinical laboratory practice training.

4. Procuring limited essential new equipment within national guidelines.

5. Supporting national lab QA plans.

6. Developing MOH capacity to assess equipment needs and provide logistics management training.

7. Increase links between districts and vendors and hand over maintenance contracts.

We will provide technical support to MOH by:

1. Participating in MOH HIV treatment technical groups.

2. Participating in efforts to improve the national inventory stock management system.

We will integrate ART in clinic and community-based comprehensive primary health care in three districts by:

1. Providing technical assistance to promote integrated services.

2. Supporting training in ART management.

3. Supporting district-based clinical QI staff.

Target population is all HIV-positive adults and children.

We will support clinical pediatric antiretroviral treatment (ART) care by:

1. Supporting provincial teams conducting trainings in pediatric HIV care and treatment (one training per province; 30 participants per training). Trainings support current WHO/Zambian guidelines to treat all HIV-infected infants.

2. Training clinical mentors at the provincial and district level to mentor clinic staff in pediatric ART, and providing ongoing support to trained mentors.

3. Training clinic, district, and provincial pediatric mentors in the use of pediatric clinic performance reports and the development, implementation, and assessment of quality improvement activities.

4. Providing quarterly supportive supervisory visits by the CIDRZ clinical team.

5. Piloting the use of viral load monitoring in children on ART.

6. Using pediatric patients as entry points for testing parents/guardians in order to improve parent/guardian health and consequently child survival.

7. Training clinicians to identify sexually transmitted infections in adolescents and manage or refer appropriately.

We will provide pediatric adherence counseling and psychosocial support by:

1. Implementing adolescent support groups at eight sites.

2. Training 16 peers to identify high risk sexual practices and provide age appropriate counseling including safer sexual practices.

3. Training 40 peer educators to provide adherence counseling of children on ART.

4. Training 80 peer educators in disclosure counseling for children as a way of improving adherence.

5. Strengthening referrals and access to community awareness programs on child sexual abuse and the availability of HIV prevention strategies for abused children.

We will provide technical support to the MOH by:

1. Participating in MOH pediatric treatment technical working groups and actively supporting the review of guidelines and development of training materials, clinical algorithms, and forms.