Founded in 1961, Project Concern International (PCI) is an international non-profit health and development organization committed to preventing disease, improving community health, and promoting sustainable development. With a FY 2009 organizational budget of $37 million dollars, PCI serves over 4.5 million people annually through programs based in 15 countries spanning the Americas, Asia and Africa. PCI's programs worldwide focus on integrated, community based solutions built on interventions combining food and nutrition security; disease prevention; maternal and child health; water and sanitation; and capacity building/institutional strengthening.

PCI has more than 25 years of experience successfully managing major USG awards and cooperative agreements, including managing sub-grant programs. PCI has established systems at both field and headquarters levels to ensure high quality financial and program management and reporting. PCI is a USAID-registered PVO and has expertise in USG reporting procedures, maintains a Federal Letter of Credit, conducts an annual A-133 Audit, and is familiar with all relevant OMB circulars.

PCI's global work in HIV/AIDS spans the range of prevention, care and support interventions. PCI's HIV/AIDS work emphasizes building lasting local capacity to design and deliver high quality HIV/AIDS programs. The overall approach to development is one in which civil society and government work together in a coordinated manner in order to maximize the potential for ownership, impact, and sustainability in any endeavor, and PCI's partnership with the Zambia Defence Force (ZDF) is no exception.

PCI will sub-grant some activities under HVOP to the Baptist Fellowship of Zambia (BFZ) and UNAIDS. PCI will continue to participate in the quarterly joint consultative meeting with DFMS, the DoD office at the US Embassy in Lusaka, JHPIEGO, and other stakeholders. In order to ensure that the program effectively addresses the priority needs of the ZDF, plans have been developed jointly with the ZDF, through the Director General of Medical Services and the HIV/AIDS Coordination Unit, and in close consultation with the US Embassy/Zambia, and JHPIEGO.

With an estimated adult HIV prevalence of 14.3%, HIV/AIDS affects all sectors of the population. According to the 2007 Demographic and Health Survey, approximately 70% of all males have had sex before the age of 20. Thus, the majority of young men, upon joining the military, are sexually active. Furthermore, when young men join the military, it is often the first time they are away from home and have access to income. The cultural norm of multiple sexual partners combined with extended periods of time away from home; highly predispose military personnel to HIV infection. PCI will use a combination of strategies to reduce the rate of HIV transmission and provide care and support among uniformed personnel.

The Zambia Defense Force Medical Services (DFMS), together PCI, have been implementing an HIV/AIDS prevention and care program in Zambia since 2003, with funding from the U.S. Department of Defense HIV/AIDS Prevention Program (DHAPP). Over the past five years, PCI has worked with the ZDF to develop the physical and human resources infrastructure and skills necessary to support a comprehensive HIV prevention, care and support program. PCI has trained ZDF personnel in HIV counseling and serology testing, ART adherence, sexually transmitted disease management, peer education, palliative care and others. In addition, PCI has assisted the ZDF by renovating and equipping VCT centers. To reduce HIV-related stigma, PCI has supported the involvement of HIV+ ZDF personnel in prevention and care activities.

PCI and UNAIDS will continue to support gender mainstreaming throughout all programs, taking into account the special environment in ZDF, and thus addressing gender-biased perceptions, attitudes and risk behaviors among male and female staff.

PCI will continue to promote the sustainability of the program through capacity building of ZDF personnel. The salaries of these personnel are paid by the ZDF; therefore, their service is not limited to the duration of a particular grant. PCI will work with the ZDF leadership to ensure that they take on more of the financial responsibility of the program by incorporating HIV/AIDS activities into their annual budgets. To this end, PCI has supported ZDF to develop an HIV/AIDS Strategic Plan, followed by the development of camp-specific work plans and budgets. Additionally, PCI is continuing to work with the ZDF to build their resource mobilization skills and increase their capacity to plan and manage HIV/AIDS activities independently.

Building on the achievements and lessons learned from the past five years, the overall goal of the proposed program is to continue to strengthen the capacity of the ZDF to implement effective HIV prevention, care and support activities. Proposed activities focus on improving quality of services, strengthening strategic information systems, using data for decision-making, and implementing sustainability strategies. Specific objectives are:

1. To promote positive sexual behavior change among ZDF personnel, their families and civilians in the surrounding communities beyond abstinence and being faithful;

2. To provide accessible, confidential, quality counseling and testing services at static ZDF sites and through mobile outreach;

3. To ensure that chronically ill HIV positive patients are receiving comprehensive palliative care, with links to anti-retroviral therapy (ART) and other HIV-related services;

4. To build the capacity of the DFMS in the collection, analysis, dissemination, and use of HIV/AIDS-related data; and

All proposed activities are organized in accordance with four select PEPFAR program areas: other sexual prevention (HVOP), counseling and testing (HVCT), adult care and support (HBHC), and strategic information (HVSI). PCI will continue to engage ZDF leadership for their support of HIV/AIDS activities throughout the ZDF. In FY 2010, PCI will conduct two leadership workshops targeting 60 senior officers to ensure their ongoing commitment to ZDF HIV/AIDS initiatives and discuss opportunities to build on ongoing efforts

Activities will be implemented in all 54 ZDF camps in all nine provinces of Zambia: Lusaka, Southern, Northern, North-Western, Eastern, Western, Central, Copperbelt and Luapula.

Since 2004, PCI has trained HBC volunteers at all 54 ZDF camps to identify and register chronically ill PLHA . The HBC volunteers provide care services in support of families, conduct ART adherence monitoring, and refer patients to health facilities for additional care and treatment services.

In FY 2010, PCI will not train additional caregivers due to continued reduction in the number of clients requiring HBC support as a result of improved access to ART. The budget allocation for the procurement of HBC kits will be reduced to reflect this trend.

PCI will continue to provide food supplement to PLWHA in care and treatment programs including PMTCT programs. Therapeutic Food will be given to malnourished under 5s. Care providers have been trained in anthropometry and provided with the equipment. All clients receiving food and nutrition intervention will undergo nutrition counseling and will be linked to community based food security and livelihood assistance where possible. In addition they will receive Clorin to promote safe drink drinking water.

In FY 2010 PCI will reinforce prevention messages with PLHA, in order to prevent potential HIV transmission to all current and future sexual partners of that infected person. To respond to this, PCI will support on-site training of medical personnel, community volunteers (peer educators, adherence supporters, TB treatment supporters, and lay counselors) to offer PwP messages.

In FY 2008 and FY 2009, PCI provided financial support to sixteen support groups to pilot income generating and livelihood projects. In FY 2010, PCI will support an additional 6 support groups

In FY09, PCI trained 10 DFMS nurses in cervical cancer screening in an effort to reduce the number of women dying due to late diagnosis of this cancer. In FY 2010, PCI will continue to support these nurses to accompany the mobile CT units to conduct cervical cancer screening. Women with abnormal results will be referred for couples HIV counseling and testing because of the close association between cervical cancer and HIV.

Volunteer retention remains one of the program's main challenges. In FY 2009, PCI provided financial support for income generating activities to 10 pilot service delivery sites, which provided HIV/AIDS program volunteers with sustainable income as a retention strategy. In FY 2010 PCI will scale-up this initiative to 8 additional sites?

Linkages have been made with the Palliative Care Association of Zambia to ensure that ZDF has access to technical input, guidelines, and training packages. PCI staff conducts supportive supervisory visits to ensure that services meet established quality standards.

According to the 2007 Zambia DHS, only 22% of all men have ever been tested for HIV. Provision of CT services to the ZDF is more costly and challenging than to the general public because military bases are scattered all over the country and many personnel are highly mobile, or are stationed in very secluded and remote locales.

CT services are very important in PCI's programming given their effectiveness as a prevention strategy and an entry point into other HIV-related services. In FY 2010, PCI will continue to support the DFMS in ensuring that high quality services are provided at the all the 54 fixed CT centres through on-site supportive supervision and mentoring of CT providers.

PCI will continue to support the mobile CT tour of ZDF camps and other military operation areas. Funds will be used for the operation and maintenance of two vehicles, logistical support for CT providers, and medical supplies. All mobile CT providers are trained in rapid HIV testing, and a qualified on-site laboratory technician carries out quality assurance on 10% of the samples.

PCI will conduct annual refresher trainings for CT providers, with a focus on building CT provider capacity to provide PwP messages. Pre-ART clients will be referred to support groups of PLHA for regular HIV prevention messages in between clinic appointments. In order to cut down on cost, PCI will stop giving T-shirts to CT clients. Instead, inexpensive branded caps and arm bands will be given as a demand creation strategy. Condoms will be offered to all Ct clients.

PCI will continue with the initiative started in FY 2009 aimed at strengthening referral services for CT clients. Clients who test HIV-positive will have their blood drawn and sent to the nearest health facility with CD4 capability. The ZDF health facility staff will collect the CD4 results and clients will be given a date for collecting their results. ART adherence supporters will follow up clients that fail to collect their results. Clients with the recommended CD4 count will be commenced on ART, or referred to appropriate health facilities.

In FY 2009, PCI supported the training of 40 HBC volunteers to provide CT services to family members of HBC clients including PwP messages. PCI will scale-up delivery of these services by training an additional 40 service providers. Home based CT services help to overcome barriers to CT, including transport to CT centers and stigma. It also offers a unique opportunity for couples counseling and testing.

In order to improve the quality of services being provided, PCI has adopted UNAIDS CT assessment tools for the ongoing monitoring of CT activities.

PCI will continue to support the ZDF in strengthening its capacity in strategic information management and promoting evidence-based planning and strategic decision-making at all levels. PCI will continue to provide annual refresher training to the HIV/AIDS Unit Coordinators and Ward Masters from each ZDF camp and central-level HIV/AIDS Unit staff to effectively monitor, supervise and report on all HIV/AIDS-related activities in their respective camps. To ensure the sustainability of strong camp-level strategic information management and use for decision-making, the HIV/AIDS Unit Coordinators will be assisted to develop and update camp-specific M&E plans during these trainings.

In April 2009, PCI began the process of developing and pilot-testing additional process, output, outcome and quality of services indicators that measure key metrics needed to inform decision-making. These indicators are captured on the Camp Assessment Tool. This tool is designed to be used quarterly by camp-level DFMS and PCI staff to routinely assess the quality of services, outcomes of key activities and includes instructions for providing continuous quality improvement based on this information.

PCI will work closely with JHPIEGO to ensure efficient and effective referrals and linkages between community-based and clinic-based HIV/AIDS prevention, care and support services. Referral forms will be used when referring clients from the community to the clinic and vice versa. In addition, a referral feedback form will be issued to the client as proof that they received the required services.

In FY2009, PCI provided technical assistance and support to the DFMS to establish a central database for all HIV/AIDS service level statistics and activities. This activity was conducted in close collaboration with JHPIEGO and other partners to ensure that the system generated all of the information necessary to respond to individual programmatic and collective information needs. In FY 2010, PCI in collaboration with JHPIEGO will support DFMS to electronically link all the service delivery sites to the central data base. This will be achieved through procurement and installation of data cards linked to a mobile service provider.

With the leadership of the DFMS HIV/AIDS office, PCI will also continue conducting supervision tours of ZDF camps to monitor the quality of services being provided by trained cadres of health workers and provide on-site technical assistance. PCI will continue to provide continuous monitoring, mentoring and follow up of service providers to ensure the quality of the HIV/AIDS activities at the camp level.

In FY 2010 PCI will continue to support the tour of ZDF camps by Lusaka based ZDF drama group. In addition, PCI will offer technical assistance to local drama groups established in the 54 ZDF camps in FY 2009. These groups have been trained in theatre for development (TFD), a BCC strategy that uses performance arts to communicate HIV/AIDS messages. Performance will focus on male circumcision, Couples HIV Counselling and Testing, alcohol abuse, PMTCT, and multiple sexual relationships.

In FY 2009, PCI initiated the integration HIV/AIDS awareness activities into sporting events such as inter-service sports days. Local organizations (Grassroots Soccer and EduSport) trained 10 ZDF officers from 10 camps to facilitate HIV awareness at such events. In FY 2010, PCI will scale-up this activity by training facilitators from 20 additional ZDF camps.

In FY 2009, PCI conducted a ToT workshop for 90 anti-AIDS club youth leaders from 45 ZDF schools and provided them with skills in youth-centered and driven interactive communication strategies for HIV prevention, including abstinence, secondary virginity, peer pressure, and condom use. In FY 2010, PCI will continue to support these activities through provision of stationery and other HIV/AIDS educational materials. PCI will help establish youth friendly corners at ZDF clinics where youths will be referred for various services.

Through a sub-grant to the Baptist Fellowship of Zambia (BFZ) PCI will provide logistic support to military chaplains to scale-up marriage seminars in all ZDF camps. These seminars provide couples with an opportunity to communicate on various issues that affect their relationship such as sexuality, gender violence and alcohol abuse.

Through another sub-grant to UNAIDS, PCI will strengthen ZDF capacity to address HIV/AIDS in its UN peacekeeping and local border security operations including new recruit training sessions. Activities will include facilitation of pre-deployment HIV/AIDS sensitization and counseling and testing and equipping troops with condoms and educational materials. Military chaplains will be supported to conduct group counseling sessions for troops returning from peace keeping operations and their spouses in order to psychologically prepare them for re-union.

PCI will reproduce military-specific BCC materials which were developed and updated in FY 2009. Topics covered include HIV risk assessment, STIs, CT, ART, male circumcision, Cervical cancer, PMTCT, alcohol abuse, multiple sexual partnerships, and couples counseling and testing.

Military branded condoms will be distributed at all 54 service delivery sites.