This activity narrative is a draft that will be revised upon award of the contract. Targets will be adjusted on the actual start date of the project.

The aim of this project is to support more effective prevention, care, and treatment of HIV infections over the next five years through more efficient and effective programming in the respective areas. The eventual awardee will submit a more detailed narrative, describing its approach, after competition has been completed. The more detailed partner narrative will be entered in place of this overview.

Main project areas will be Orphans and Vulnerable Children (HKID), Adult Care and Support (HBHC), Other Prevention (HVOP), and Testing and Counseling (HVCT). The project will focus on discrete task areas which can be carried out in a defined time period for activities such as enhanced economic support programs. Actual activities will not be implemented through this mechanism but will be identified and defined as conceptually viable. Implementation will be through other programs and projects across the U.S. government portfolio.

The projects goal is to support the development of state-of- the-art, rigorous prevention, care, and treatment interventions within existing U.S. government programs and projects. Specific objectives will be defined as the project is further developed, however in general the objectives and concomitant activities will focus on discrete technically focused interventions which have a proven track record and are able to be incorporated into other projects and/or programs. The IQC will serve to carry out the "proof of concept" for new interventions. Other activities may include support for the further development of public-private partnerships, identifying promising examples of local institutional capacity building and provide focused support for U.S. government actions, including data quality assessments or other time limited interventions.

The geographical scope of the project will vary depending on the task order driving the activity. Interventions may be at the national level or at the provincial, district or community levels. The primary target populations include the 85% of Zambians who are HIV-negative, at-risk OVC and youth, other vulnerable groups (PLWHA and the discordant/uninfected spouses/partners of PLWHA), women affected by Gender-Based Violence (GBV), their families and communities, and Zambians whose risk of infection is increased by abuse of alcohol and other substances.

This project may be utilized to provide long term technical assistance to appropriate Ministries such as: the Ministries of Health, Youth Sport and Child Development, and Community Development and Social Services.; other targets may include the National AIDS Council. Additionally, a targeted study to design more successful and self-sustainable economic growth (employment and empowerment) opportunities could be focused on youth and young adults. A key element of economic growth activities will be careful analysis of market demand prior to design and implementation. The study's design will respond to effective demand, and not be supply-driven.

Cross-cutting program elements include: closer alignment of USG prevention efforts with those of the GRZ; greater continuity and integration of prevention efforts with Care and Treatment interventions; prevention centered around evidence-based approaches, including reduction of multiple and concurrent partners; gender integration of prevention efforts; and addressing alcohol as a risk factor.

The target of this project is to define cost effective and efficient approaches to prevention, care, and treatment. Discrete activities which would be identified and requested through a task order process are designed to identify the most state of the art and cost effective approaches. All task orders will include a focus on cost efficiency and sustainability.

Monitoring and evaluation will include a focus on how to ensure that programs are able to report in a timely and efficient manner through local and national systems.

Task orders under this area will focus on integrating HIV prevention messages into adult care and support activities. Illustrative tasks include identifying opportunities to link care and support with HIV prevention through prevention with positives types of activities, or for targeting discordant partners. Tasks in this area will focus on ways to return individuals to a state of productivity in line with their vocation prior to HIV diagnosis. Other tasks include assessing the types of economic empowerment activities which are appropriate for HIV positive individuals across different sections of Zambian society from farmers to those who may have previously had formal employment. These foci may differ as well by geographic location whether in urban/peri-urban settings or largely rural.

The focus of all interventions under this area will be to move people back into a level of productivity that they previously held prior to onset of AIDS. This will be accomplished by mixing care and support activities, including palliation as necessary, with economic growth opportunities. The expectation is not to turn the poor into the rich, but rather return individuals to a level of productivity that allows them to support their households.

Task orders under this area will focus on linking activities to support orphans and vulnerable children with other HIV prevention services targeting at risk youth. This will include activities highlighted under HVOP, HVCT, and HBHC in order to define approaches for all key target groups. Illustrative activities will include linking economic growth activities to OVC services where sustainable jobs are created and fill an identified void. These approaches will only be tested and validated under this activity with scale up to follow through other implementation mechanisms.

Activities will also focus on the linkage between formal education and individual risk perception as it relates to the acquisition of HIV. Task orders could be used to identify the approaches to reach vulnerable children both in and out of school and identify mechanisms to keep kids in school and ideally return those who were once in school back to the formal setting. Linkages to economic opportunities will also be critical as the youth "bulge" continues to move up through the demographic pyramid and will soon become the largest productive age group.

In this area, public-private partnerships will be explored with an eye toward directly linking up sectors with employment needs to the types of skills that can easily be developed by those with minimal or limited education. Opportunities for those with greater education (partial secondary or even full secondary, but who have not had the opportunity for tertiary education) will also be linked with the assumption that they could be geared more towards skilled labor.

Task orders under this area will focus on defining testing and counseling approaches to reach high risk groups including adolescents and young men. Activities will highlight ways to reach adolescents about their status, the practice of preventive behaviors and joint learning with new partners. Approaches, once identified and validated, will be scaled up through other programs. Illustrative tasks include strategies to reach out of school youth and those on the street, as well as ways to promote testing for young, higher risk individuals that does not reward risk taking behavior. Some other activities might include methods to promote young men to come in with their partners or spouses for testing and counseling. These activities will be task driven and respond to an identified programmatic need or gap.

Task orders under this area will focus on effective HIV prevention services primarily targeting at-risk adolescents and others, the majority of whom are still HIV negative. Activities will focus on the development of interventions likely to garner impact for this risk group which can be integrated into existing and or new HIV prevention activities at either community or higher levels. In general, activities/interventions will be tested under this mechanism with larger scale implementation through partnership arrangements with other programs.

Illustrative activities include defining approaches to reach out of school, but not adult age, adolescents a high risk target group with excessive amounts of unstructured time and activity, and limited constructive life focus or goals. Interventions could include methods of promoting peer-to-peer messages; or ways to identify and reach adolescent mentors who can help their peers make and maintain safe choices which could include the use of condoms. In all cases, the focus will be on the HIV negative individual with links to other services if individuals are identified as positive.