The USG has supported the Southern Province Health Office (SPHO) in the last three years to scale-up antiretroviral therapy (ART) services in the province. SPHO rapidly scaled-up ART sites from ten (10) sites in 2005 to forty-one sites in 2009 with the number of ART patients increasing from below 10,000 in 2006 to more than 35,500 in mid-2009.

In 2010, the SPHO will continue to provide leadership in the implementation of comprehensive HIV treatment services to DHOs and other partners in the province. SPHO will continue to support the strengthening of the mentorship program aimed at improving quality of care through support to clinical care teams.

The provision of continuing medical education to staff trained in ART will be provided at existing ART sites. SPHO will ensure that ART is readily available for HIV positive pregnant women and train health workers in ART, andl continue to support DHOs in the provision of mobile ART services in ten selected sites of remote and hard to reach areas. The focus will be quality and cost effective care for ART patients, while increasing access to ART services.

In an effort to strengthen the early detection and management of cervical cancer (CC) in HIV patients, 82 health workers will be trained in CC screening and sensitization of the community in all the ART sites. In addition, the SPHO will procure CC screening supplies to integrate screening of CC in ART sites. SPHO will train fifty (50) peer educators in adherence counseling who will help with patient tracking. Resources will be provided for assessment of ART sites, provision of technical and logistical support to the ART sites in order for them to attain Medical Council of Zambia accreditation standards. SPHO will support infrastructure improvements at the ten new sites in order to increase ART access with integration of prevention with positives in all ART sites.

SPHO will continue with bi-annual clinical symposia to improve HIV/AIDS management and allow exchange of experience and views by clinicians. Support of income generating projects to sustain the activities of the community based volunteers will be maintained.

The Southern Province Health Office (SPHO) will provide leadership for a coordinated scale up of Counseling and Testing (CT) services as an important entry point to HIV prevention, care and treatment. A total of 110 health workers will be trained in couples and child counseling from all eleven districts. In addition, 50 health workers will be trained in Provider-Initiated Testing and Counseling (PITC) from all sixteen hospitals for improved uptake of CT as part of routine health care.

SPHO will work with partnerships and the District Health Offices (DHOs) to strengthen community-based counseling and testing, which will include support to two mobile drama groups in each district, and door-to- door counseling and testing in 11 districts using the new HIV rapid testing algorithm. Twenty community counselors will be trained in each of the nine districts in rapid HIV testing including members of the mobile drama groups. The DHOs will ensure availability of counselors in all counseling and testing sites at all times including task shifting. Funds will be provided to the districts to engage community and religious leaders in community mobilization and advocacy efforts. Collaborations with community radio stations (Chikuni, Sky FM, Macha, Mosi-o-Tunya, Mazabuka and Zambezi) and the Modeling And Reinforcement to Combat HIV/AIDS in Zambia (MARCHZ) to develop and disseminate programs on the importance of CT to the people of Southern Province. It is expected that using the community radio stations, over 80% of the population will extend the reach of CT and prevention messages. Radio programs and IEC materials in local languages will be used to raise awareness on CT, and be integrated with other programs in the area of prevention, care and treatment.

Resources will be provided to the 11 DHOs to carry out assessments and renovations of two counseling rooms per district. Approximately Redacted is set aside to conduct quality training and oversight for SmartCare CT module implementations, at all sites providing this service. Workstations and smart cards will be supplied via EGPAF or MOH.

The Family Support Approach to HIV counseling and testing initiative will be enhanced at seven hospitals with the highest volume of clients who are also potentially HIV positive. Health Workers fro m the seven FSU sites will be trained in couples counseling; it is anticipated that 1,000 couples will be reached through these services.

The Southern Province Health Office (SPHO) will include Health Workers (HWs) from all potential entry points, (e.g., Maternal and Child Health (MCH) and Outpatient Department (OPD), to improve identification of children requiring definitive diagnosis. Thus, 100 healthcare workers will be trained in Comprehensive Pediatric HIV Care (CPHC) and Integrated Management of childhood illnesses (IMCI) to increase the proportion of facilities having at least one healthcare worker trained in CPHC and IMCI from the current 22% to 80% and 50% to 80% respectively. Another sixty healthcare workers and community health workers (CHWs) each, will be trained in Provider -Initiated Testing and Counseling (PITC).

The SPHO will train fifty (50) HWs in DBS collection. To ensure quality scale-up of pediatric ART services, we will continue to strengthen clinical mentoring at district level and provide technical up-date meetings to ensure clinical practice is evidence based at all times.

We shall maintain the number of Pediatric Centers of Excellence (PCOE) but with more support provided for programmatic reviews on a quarterly basis involving all PCOEs. Infrastructural improvements will be supported in Kalomo, Namwala and Monze.

Use of CHWs for community sensitization shall continue and will be linked to the Family Support Unit (FSU) activity under counseling and testing. The production of behavioral change communication materials in local languages will also be supported. CHW roles will include family psychosocial support and community tracking for adherence purposes.

In line with Medical Council of Zambia requirements for ART site accreditation, we will strengthen quality assurance (QA) by developing QA tools, and provision of technical assistance for setting up systems in all sixteen hospitals. The SPHO will also support the production of job aids such as algorithms and dosing charts. SPHO will support ongoing assessment, retention and adherence of pediatrics on the ART program including support for adolescent activities. We will leverage resources to incorporate nutrition support for children in underprivileged families.

In the last two years, efforts to improve strategic information through monitoring and evaluation (M&E), communication services, and the SmartCare electronic health record infrastructure has improved the flow of health information between the Ministry of Health and the District Medical Office (DMO), while providing continuity of care for patients.

The SPHO will strengthen and support 108 SmartCare sites and open 36 new sites, bringing the total to144. Particular emphasis will be devoted to ensuring that existing sites are fully operational (in entry of data, local use of reports, and submitting data to MOH each month), prior to opening any new sites. Supplies for smooth implementation will be provided routinely and a total of 288 health workers will be trained in SmartCare.

Support will ensure monthly flow of data from facilities with electronic health records to the DMOs, to SPHO and finally to the central level of the MOH for planning and policy decision making, using the same schedule as HMIS data submissions. The SPHO will seek guidance for SmartCare upgrades as needed.

The SPHO will support the nineteen (19) major hospitals in the province for an enhanced information management system. This support will strengthen the clinical mentorship program that is improving the quality of care for TB and HIV/AIDS patients in the province. Clinical mentors will be enabled to access the latest information in the clinical management of TB and HIV/AIDS via internet and monthly subscriptions to key medical journals (Lancet, AIDS).

Quarterly planning and performance review meetings with DHO staff will be held to improve quality and use of data. The DMOs will be funded to collect, verify and report data promptly each month to SPHO. They will ensure both old and new health staff are competent to record, analyze, use for clinical care and report health data using the standard MOH reporting tools. The registry clerks will be oriented to document and to assist health staff to report, health information.

To strengthen M&E, the SPHO will support an M&E officer recruited in 2008, and eleven Data Associates; one based at each DMO; two at Livingstone General Hospital; and one each at Choma General Hospital, Monze Hospital, Maamba, Siavonga, Kalomo, Mazabuka and at the SPHO. Supplies will be provided.

PMTCT one time plus-up funds are being added to support: PMTCT missed opportunities evaluation of program and Provincial PMTCT M&E training on the OGAC next generation indicators. Cost information on pediatric HIV/AIDS care and treatment is limited, plus-up funds will be used explore missed opportunities for PMTCT and PMTCT failures across the cascade, including the social, cultural, laboratory and clinical factors that contribute to infant infection. SPHO will focus on PMTCT sites within the Southern Province of Zambia. SPHO will use these funds to strengthen existing monitoring and evaluation systems throughout the provincial network and ensure that timely usable data is collected from the covered PMTCT sites.

The aim of this activity is to enable the Southern Province Health Office (SPHO) to increase access to safe male circumcision (MC) by increasing the number of health facilities offering comprehensive MC by renovating the existing infrastructure and building capacity of the health workers and community health workers and have at least 2500 clients circumcised by end of March 2010.

In FY 2010, USG will support SPHO to expand MC services from the nine (9) district health facilities to all sixteen major hospitals in the province. The funds will be used for capacity building and establishment of MC teams at each of the health facilities. Approximately 58 health personnel will be trained from the seven new sites. In order to create favorable and safe MC environments, renovation of space at the seven new sites will be performed. Additional activities will include the procurement of necessary MC surgical equipment, and translation of MC information into local languages. The SPHO will work with JHPIEGO and the University of Zambia, School of Medicine who have massive experience in MC to conduct site assessment and supervise implementation for quality improvement and assurance.

The SPHO will ensure that there is stronger community participation through community mobilization and sensitization. SPHO will provide direct funding to the districts based on the detailed assessments and plans developed by the districts for scaling-up of MC in the Ministry of Health 2010 plans.

In order to ensure sustainability of the program and promote longer lasting behavioral change, MC services will continue to be integrated as part of routine health services. Community leaders such as chiefs, headmen and local councilors will be engaged and educated to assist in community mobilization for MC services. Community health workers currently providing counseling and testing, prevention of mother to child HIV transmission, tuberculosis (TB), adherence support and malarial messages in the districts will be further trained to include MC messages in their package of community health education.

The SPHO will ensure that MC interventions are continuously integrated with strong HIV prevention messages and HIV counseling

Southern Province Health office (SPHO) will intensify HIV prevention services targeting youth and couples and strengthen partnerships with the community. Prevention activities for youth will be scaled- up based on life-skills training, distribution of male and female condoms, and promotion of Adolescent Sexual Reproductive Health (ASRH) services in all districts. We will provide quarterly financing to the District Health Offices (DHOs) to engage community leaders in driving prevention activities and to run prevention group meetings in zonal centers. Approximately 220 Community Health workers (CHW)/counselors will be trained in behavior change communication (BCC) and 30 health workers will be trained per district to provide leadership to the CHW's. An additional fifteen individuals will be trained in BCC skills for continuity and supervision.

SPHO will finance HIV prevention programs on six community radio stations and lead development and dissemination of BCC materials in local languages.

DHOs will collaborate with the Ministry of Education to develop and implement HIV prevention programs for teachers, including training of health center directors and 5 teachers per district in BCC and skills building. Youth friendly corners in all facilities will be enhanced for out of school youth, which will include educating 30 peer educators per district. Funds for infrastructure improvements will be provided for three youth friendly corners per district.

Four managers per district will be trained to implement the MOH HIV work-place policy incorporating CT. Roll-out of peer education programs at the health facility level to address HIV prevention will be supported.

SPHO will train 100 health workers in Syndromic Management of STIs to improve case management.

Incentives will be provided to men for coming with their families to HIV counseling and testing. In the urban areas, DHOs will develop flexible CT working hours in order to cater to working couples.

This activity will be monitored through regular technical support, quarterly review meetings and monthly reports through HMIS under strategic information.

The intra-district dried blood spot (DBS) courier systems and referral systems for linking HIV exposed babies to ART programs will be strengthened.

Basic infrastructure renovations will be performed at fifteen sites for improved PMTCT services. Sixty PMTCT mentors will be trained to conduct onsite skills development for 125 health workers (HWs); 25 health workers will be trained in integrated PMTCT to cater for attrition. Community role models for PMTCT and monthly mobile PMTCT services to increase access will be initiated. Seventy-five male PMTCT agents will be trained to enhance male involvement, couples counseling, and address gender based violence. Incentives for men in the form of "daddy cool packs" will be procured. To promote facility deliveries, we will procure baby mother packs and support renovations of 5 mother's shelters in each district.

Based on the successful model of infant follow-up system in Sinazongwe, we will continue to strengthen this area in three focus districts. Sixty community health workers per district will be trained in this system.

Community mobilization and leadership meetings with traditional and civil leaders will be supported. The District Health Offices (DHOs) will train 108 community lay counselors in PMTCT and rapid HIV testing. Capital funds will be provided to support income generation activities (IGAs) at the community level for sustainability under the leadership of IGA coordinators in each district.

Contraception in ART, TB, STI and inpatient medical departments will be enhanced by targeting HIV positive women and those women at highest risk of being HIV positive. We will strengthen links with Adolescent Sexual Reproductive Health Services to reduce HIV incidence in young people. Fifteen trainers- of-trainers and skill building of 30 health providers in ASRH will be supported. Promotion of condom use and partner disclosure remains an essential component as is support for PMTCT supply chain management through TSS.

PMTCT one time plus-up funds are being added to support the procurement of bicycle ambulances for facilities in Southern Province where it is difficult for pregnant women to reach appropriate facilities in time for a safe delivery of their baby. Provision of PMTCT at the time of delivery is an important intervention for HIV prevention that can be maximized by the utility of bicycle ambulances to transport expectant mothers to the health facility.

In FY 2010, SPHO will provide financial support to districts for DBS sample transportation to district laboratory hubs for onward transmission to Livingstone Center of Excellence for DNA/PCR and sputum samples to the reference laboratories in Lusaka. A logistic transportation system will be developed for specimens' referral from health care facilities that do not have full laboratory testing capacity to district or provincial laboratories. SPHO will pilot the system, support transportation costs, and procure stabilized blood tunes and specimen transportation systems. In addition, SPHO will continue to support the establishment of an early infant diagnosis laboratory through coordination, equipment procurement and training.

SPHO will procure laboratory equipment service maintenance contracts. External quality assurance in TB sputum smears and HIV testing will continue and expand. SPHO will liaise with the MOH and CDC to begin the process of laboratory accreditation.

In FY 2010, SPHO will support the implementation of Laboratory QA programs for rapid HIV testing, TB smear microscopy, CD4, hematology, and blood chemistry in collaboration with the MOH and CDC. SPHO will continue to support laboratory staff to attend training in laboratory management, good laboratory practice, phlebotomy, accreditation, basic computer skills, and laboratory information systems.

PMTCT one time plus-up funds are being added to support: Improvements in infrastructure for PMTCT clinical and laboratory services

SPMO will conduct district level laboratory assessments and procure equipment as appropriate for maximum cost-effectiveness and coverage for use in facilities in Southern Province. CD4 machines for district or provincial laboratories, hematology to measure anemia, and blood chemistry kits and equipment will be procured for the PMTCT sites most in need. In many facilities throughout Southern Province, the use of clinical and laboratory equipment is often monopolized by ART patients. SPMO will use these funds to increase PMTCT patient access to important clinical and laboratory services as PMTCT-specific demand for these services increases with the new WHO PMTCT guidelines.

The Southern Province Health Office (SPHO) will strengthen the implementation of TB/HIV integrated services including testing suspects for HIV, as TB patients tested and counseled for HIV increased from 39% in 2006 to 78.9% in 2008.

The SPHO will support 134 TB/HIV sites in seven districts in the implementation of TB/HIV activities, and with support from CIDRZ four districts. The SPHO will take overall responsibility for ensuring partner coordination.

TB case finding will be enhanced by opening ten new diagnostic sites, training of ten microscopists, procurement of microscopes and strengthening of external quality assurance (EQA) mechanisms. Approximately 100 community health volunteers will be trained in directly observed therapy and assist to conduct meetings with community leaders and CBOs on TB.

SPHO will conduct quarterly technical support supervision and data review meetings at provincial and district levels to ensure quality service and consistent data, using MOH approved tools. The Provincial TB/HIV coordinating body will continue providing strategic direction on TB/HIV integration activities at all levels.

SPHO will train one hundred (100) health workers in provider initiated testing and counseling and in infection control. Infrastructure improvements to reduce the risk of transmission of TB in ten ART sites and fifteen DOTS corners will be performed. Community sensitization activities using support groups and mobile drama groups in each of the seven districts will be conducted. Income generating activities to sustain community participation in TB control will be enhanced. SPHO will support the strengthening of quality systems for improved linkages and referral mechanisms. We shall continue to strengthen program management at provincial levels through the Provincial TB/HIV Coordinator. HIV prevention strategies will be integrated across all TB/HIV activities.

SPHO will support refresher training of laboratory staff including microscopists for TB smear microscopy and ensure that all TB diagnostic sites enroll into the national QA for TB smear microscopy.