Jhpiego will continue to implement its Technical assistance, program implementation and capacity building support for multiple emphasis areas in the Republic of Zambia under the President's Emergency Plan for AIDS Relief during this second year of implementation. Jhpiego will build on extensive past experience working with CDC/Zambia, the Ministry of Health (MOH) and the Zambia Defense Forces (ZDF) to achieve the goal of supporting Zambia's response to the HIV/AIDS epidemic by expanding quality interventions in HIV/AIDS prevention, care and treatment and building the capacity of the MOH, the National HIV/AIDS/STI/TB Council (NAC) and other Zambia organizations to deliver quality service in a sustained manner.

This goal will be accomplished through the following program areas: Male circumcision (MC): expand comprehensive MC services with integration of couples counselling; train counselors and clinicians; and implement an MC communication strategy that includes increasing female involvement Palliative care: introduce the "single visit approach" to cervical cancer screening; scale up cervical cancer prevention services. HIV treatment services: finalize and implement the pediatric antiretroviral therapy (ART) continuing education module with the MOH and NAC; support efforts to monitor quality of care in ART services; facilitate use of technology to disseminate and make available clinical guidelines and resources. Tuberculosis (TB): build capacity and expand integration of HIV and TB services; improve infection prevention; strengthen and expand capacity in training skills, supervision, and monitoring; and help improve diagnosis and treatment of TB in HIV-infected and exposed children. HIV counseling and testing: promote task-shifting; provide training for lay counselors; and mobilize and engage communities in the promotion of HCT including couple counselling. Strategic information: support the scale-up and implementation of SmartCare through clinical training, supportive supervision, curriculum review, and site readiness. Human capacity development and training: identify gaps; build capacity in curriculum development and instructional design; conduct technical updates; improve teaching ability; and contribute to MOH's efforts to curb attrition.

Jhpiego has designed a comprehensive program that includes working with all levels of the MOH and frontline healthcare providers as well as schools of medicine and nursing. This strategy will ensure that these institutions will be able to sustain services long after Jhpiego's interventions have ended. Drawing on nearly ten years of experience working with the GRZ, Jhpiego designs programs and interventions with Zambian leadership and involvement at all levels. Jhpiego will continue this model working with district managers, supervisors, and service providers to implement participatory capacity building strategies for annual strategic planning, service delivery, logistics systems, staffing allocation and service supervision management strategies that recognize achievements and identify how to address gaps identified in services. Jhpiego will provide the requisite level of technical assistance to districts, scaling back as milestones are achieved and district capacity is institutionalized in accordance with the national strategy for decentralization.

Target geographical areas are mainly in the Southern, Western and Eastern Provinces of Zambia; MC services will also expand in Lusaka Province. These regions were chosen to continue building capacity and strengthening the integration of results obtained during the last four years that Jhpiego has been working with CDC's support in these regions. However, Jhpiego works at the national level by supporting the MOH in their ongoing activities such as PMTCT and ART Data Use Package work group, MC role out in all nine Provinces, and implementation of the ART CME in all ART sites.

To ensure collection of necessary PEPFAR program-level indicators and other output data for project monitoring, Jhpiego will work through the MOH district, provincial and central level information systems, when feasible, and directly with health facilities when proper information systems are not in place, especially for newer areas such as MC. Jhpiego will use TIMS, the training information monitoring system, to track persons trained and trainers used to facilitate follow-up and record keeping.

Jhpiego will continue to expand cost efficient programs through our blending learning approaches which use distance learning, e-learning, and OJT in addition to classroom settings

Jhpiego will continue to support the Ministry of Health (MOH) and National AIDS Council (NAC) to distribute the clinical care guidelines to providers in useful electronic formats and appropriate technologies (e.g., CD-ROM, web-based, handheld devices). An additional 300 Smartphones will be procured, loaded with the latest ART guidelines and protocols and distributed to the ART providers as a source of updated information as well as a supervisory tool. Jhpiego will continue to support the distribution of the paper -based guidelines as well as a CD-ROM of the guidelines that were procured in FY 2009.

Jhpiego will continue to support the implementation of continuing medical education (CME) for HIV/AIDS clinical staff in public and private facilities. The initial Adult ART module will be disseminated to 450 providers and implemented in 38 preservice institutions. New PMTCT and Pediatric ART modules will be further disseminated to 450 healthcare providers at ART sites as well as 38 preservice education institutions nationwide, to support educational process of medical and nursing students. Jhpiego will also continue to work with the Johns Hopkins University Center for Clinical Global Health Education to implement the online course in ART, PMTCT and Pediatric ART.

Jhpiego will continue its work to develop and implement an ART training simulation in 40 (District Hospitals to begin with since most of them do not have specialists physicians) ART sites using Simentor, a computer-based interactive tool which allows providers to go through a series of HIV care cases and receive feedback on their clinical decision making skills. This is a tool which can be used both for advanced training as well as for monitoring performance.

A-QIP is designed to facilitate quality improvement among the Government of the Republic of Zambia (GRZ) and cooperating partners (CPs) in Zambia. Through the AQIP program Jhpiego will continue to support the PMTCT and ART data use for quality program and will train 400 people (nine provincial data management specialist and nine hospital informatics officers plus training the same as trainers; 72 district health information officers, two ART and two PMTCT providers per provincial hospital and district.

Jhpiego will continue to work with Ministry of Health (MOH) and other partners to 1) train lay workers in HIV counseling and testing (HCT) and 2) ensure that trained lay counselors provide quality services and meet the demand for HCT, both in service delivery sites and in the surrounding community.

Jhpiego will continue training new lay counselors in counseling and testing using finger prick. Jhpiego will seek technical assistance from CDC and UTH virology lab in the training of 15 trainers in the CDC/MOH standardized three days HIV testing course. These trainers will then go on to provide updated training to 120 previously trained lay counselors from Southern, Western and Eastern provinces in HIV testing using the updated curriculum. Jhpiego will also support the training of 120 new lay counselors in HCT. These lay counsellors will provide services in communities and at clinics, allowing qualified medical personnel to attend to clinical care duties. Jhpiego will work to promote couples counseling and prevention counseling for both positives and negative client. Appropriate links for clients to family planning and male circumcision services will be made

Regular post training follow up and supportive supervision will be conducted to ensure quality of HIV testing and counseling of both newly trained and previously trained community counselors. Supervisory teams will include laboratory personnel to ensure correct testing procedures and quality. Lay counselors will participate in the national External Quality Assessment program for rapid HIV testing.

These activities will be complimented by the CT and supervision trainings conducted by the provinces themselves; Jhpiego will work in close collaboration with Community-Based TB/HIV Organization to strengthen their capacity and support the provinces in conducting these trainings.

Jhpiego will continue providing support to the local management and supervisory teams to ensure that they will soon take the lead in both training and supervision activities and will work to enhance their ability to sustain and expand these programs.

Jhpiego will continue to support the implementation of SmartCare through training, deployment, supportive supervision visits, provision of logistical support, and limited site readiness preparation. Jhpiego will work closely with the Ministry of Health (MOH), CDC-Zambia and other partners to prioritize activities focused on pre- and post-deployment to ensure that there is a synergy of efforts as the nationwide deployment continues. Jhpiego will take a leadership role in the development and implementation of post-deployment supervision methodologies and tools that guide managers and supervisors at all levels to measure gaps between actual and ideal usage of the SmartCare System.

Jhpiego will support the training of 250 service providers in the provinces and districts targeted during the scale-up. Jhpiego will work with the provincial and district trainers and with all the partners supporting the scale up of the system to ensure that the quality of training is maintained from the PHOs in the districts.

The sustainability of the SmartCare program is assured through empowering all levels of the Zambian Ministry of Health system with the knowledge and skills to deploy and manage the SmartCare system, from the pre-deployment preparation through post-deployment supervision.

Jhpiego will continue to work with the General Nursing Council and nursing schools to include SmartCare in the pre-service curriculum and in the development of a learning management system framed around EHR. A total of 300 final year nursing students will be trained in the use of SmartCare. It will include the potential development of e-learning materials to enhance the transfer of knowledge, skills and attitudes related to the target competencies while simultaneously preparing future providers to work with the EHR as part of the SmartCare approach.

SmartCare is a cross-cutting data collection and reporting tool for all the three SI areas. Deployment, training and supervisory support will enhance the national SI strategy in the following ways: HMIS data collection and reporting for decision support at all levels; capture and report on PEPFAR & other indicators for M&E purposes; provide data for use in some of the surveillance and survey activities.

Jhpiego will continue to support 20 MC service delivery sites and will expand support to an additional ten sites. Jhpiego will work with the Ministry of Health (MOH) to ensure that all processes are well coordinated: orientation of managers; involvement of Provincial Medical Office (PMO)/District Health Office (DHO), site assessments, renovations and refurbishment, training providers, provision of equipment and clinical supplies, and post training follow-up with supportive supervision.

Jhpiego will hold two-day orientation workshops to provide an overview of MC including site preparedness and supportive supervision. The MC skills course is a 10-day training that uses the UNAIDS/WHO/Jhpiego training package to equip providers with the necessary knowledge, skills and attitudes to provide safe MCs. The MC counseling course is a separate five day activity where trainees are trained to provide MC-specific counseling including HCT. Jhpiego will promote couple counseling in the MC program and facilitate referrals between services linked to MC, e.g. HIV care and PWP programs.

Jhpiego will provide safe mobile MC services in consultation with traditional leadership in areas where traditional MC is practiced, and at selected Zambia Defense Forces youth vocational training sites. MC will also be integrated in the training curriculum of Medical Licentiate and Clinical officers at Chainama College of Health Sciences.

Jhpiego will continue to;

Provide ongoing support to all sites to ensure provision of high quality, comprehensive MC services through 3-day supportive supervision visits using a standard-based management and recognition approach.

Ensure quality in counseling and HIV prevention messages by monitoring changes in sexual risk behavior of clients post MC.

Engage sub-partners to promote Behaviour Change Communication on MC, HIV/AIDS and other male reproductive health issues and promotion of female involvement through community based activities, emphasizing combined prevention strategies that include ABC and HCT as an integral part of MC.

Screen and treat for sexually transmitted infections before MC provision

Work with MOH/NAC and other stakeholders in the dissemination of MC guidelines.

PMTCT one time plus-up funds are being added to support: the Ministry of Health (MOH) with updating the national PMTCT guidelines and their implementation.

Jhpiego will work with the Ministry of Health to update the National Guidelines for PMTCT to comply with the recently released WHO guidelines. Jhpiego will consult with PMTCT experts, the national PMTCT Technical Working Group, the Provincial Health Offices, and other stakeholders to ensure that the guidelines are translated into Zambia-specific materials. Jhpiego will print and disseminate curricula, training materials and jobs aids for nurse prescription of HAART during pregnancy, use of complex regimens including, if recommended, prevention of lactation transmission. Jhpiego will oversee the development and piloting of modules for couple prenatal education that includes couple testing and counseling, male reporductive health, and parenting information. In order to roll-out the implementation of the new guidelines, Jhpiego will host training of trainers sessions for selected participants from each province.

Jhpiego trained 387 health care providers in the first half of FY 2009. In FY 2010, Jhpiego will strengthen and expand the capacity at the provincial level in skills, supervision and monitoring, and will continue to develop district level HIV/TB clinical training skills by ensuring that new trainers co-train with experienced trainers. Jhpiego will train 40 new trainers to account for the attrition. These trainers and those trained previously will support the scale-up of TB/HIV trainings in the districts using resources from MoH and other partners.

Jhpiego will support the MOH in reviewing and updating the PITC Learning Resource Packages and support the printing of 3000 copies of the training package. Jhpiego will promote the integration of couples counseling and prevention counseling in TB services. In addition, JHPIEGO will support raining of 200 providers in TB infection control and will support the local PMO/DHO teams to provide post training follow up, supportive supervision and on the job training (OJT) to ensure implementation of TB infection control. An additional 80 service providers will receive OJT in 10 additional district hospitals.

Community Based TB/HIV Organization (CBTO) and the PMO/DHO will be used to support the training of 120 Community Care and Treatment Supporters (CCTS). The focus will also be on strengthening supportive supervision and exploring an integrated system that includes HIV/TB/PMTCT/Malaria. Strengthening the TB/HIV bodies and TB data review meetings is also a priority. In order to enhance record keeping, 3000 home visit diaries will be provided to the Community volunteers.

Jhpiego will support the pre-service education institutions in strengthening their TB/HIV curricula component through access to continuing education programs with the latest evidence-based information. Jhpiego's blended learning approach will ensure that frontline providers and students are given the knowledge and the skills that they need to provide quality service. The initial and new educational modules will be provided to 38 preservice education institutions nationwide, reaching 700 final year students to support educational process of medical and nursing students