The Centers for Disease Control and Prevention (CDC) provides technical assistance (TA) to implementing partners across Zambia. Through trainings, procurement, travel, and contractors, CDC is able to monitor and evaluate activities and programs for quality assurance. CDC is a resource to implementing partners to help troubleshoot technical and logistic problems. With its extensive scientific background, CDC is strategically placed to provide timely assistance across all technical areas.

Though CDC provides TA to implementing partners in all nine provinces of Zambia, the majority of its efforts are concentrated in Lusaka, Eastern, Western, and Southern provinces. CDC targets its TA to implementing partners that work in urban and rural regions of Zambia. Recipients of CDC TA include the Ministry of Health (MOH), Provincial Health Offices, District Health Offices and Management Teams, community health care workers, lay counselors, traditional birth attendants, local non-governmental organizations, and international aid organizations.

In FY 2010, CDC will use TA to:

Strengthen monitoring and data systems

Strengthen linkages within referral and follow-up systems

Procure supplies to avoid stock-outs and disruptions of services

Produce information and education materials

Provide programmatic guidance to partners to align with the Zambian National HIV Preventions Strategy (ZNHPS)

Monitor implementation

Build capacity for effective prevention approaches

Develop evaluations and assessments of impact and program effectiveness

Scale-up prevention with positive programs (PWP)

Integrate prevention aspects into all programs

Update manuals and guidelines

Ensure quality of service

Provide applicable capacity building training courses

Collaborate with other donors

Through provision of TA, CDC is able to build capacity of local organizations and local workers. Ensuring the quality of health facilities, labs, and services, CDC strengthens the Zambian health systems.

Utilizing local CDC staff in the provision of TA enables implementing partners to save monetarily from subcontracting to other organizations with high overhead and consultancy costs.

CDC Branch Chiefs and the CDC management and operations staff monitor the expenditure of TA funds.

This activity builds on achievements of PEPFAR 1. Technical assistance (TA) funding will support; 1) TA to National HIV drug resistance (HIVDR) surveillance and monitoring, 2) supervisory visits to ART treatment, care and support sites, 3) developing capacity of ART sites to use SmartCare (a standardized electronic health record system) 4) development and integration of prevention for positives (PWP) in ART treatment and care programs, and 5) working with the Ministry of Health (MOH) and National AIDS Council (NAC) to update treatment and care training manuals and guidelines.

During FY 2005, in response to a specific request from the MOH, the USG provided TA to the national ART program in developing a national plan for surveillance for HIVDR. In fiscal years 2006, 2007 and 2008, the USG provided support for the procurement of equipment and supplies, and training for laboratory staff in testing for HIVDR. The USG also provided TA to prepare key sites for monitoring of HIVDR, in close collaboration with the World Health Organization (WHO), MOH, and NAC. MOH commenced HIV DR monitoring in 2 sites in FY 2009. The lessons learned from these pilot sites will be used to scale up HIVDR to additional sites and strengthen laboratory capacity for HIVDR monitoring.

In FY 2009 USG provided TA through supervisory visits to ART delivery sites and will continue to do so in FY 2010 to ensure that quality of service is maintained.

In FY 2008 and FY 2009 funds supported TA for CDC care, treatment and strategic information (SI) teams to the national program focusing on a quality improvement and expansion of SmartCare to more than 450 ART and prevention of mother to child HIV transmission sites. In FY 2010 CDC will support MOH to strengthen capacity at these sites to use SmartCare to identify gaps in service for improving service delivery.

PWP is a new activity that the USG will work in collaboration with MOH and NAC to develop and introduce in service delivery sites and will update treatment and care guidelines and training manuals to include PWP as part of the standard of care. Funds within this activity will also be used for staffing costs needed to monitor the ARV services and infrastructure rehabilitation.

HVCT technical assistance (TA) will develop and implement community based agreements or "compacts" to decrease HIV incidence in Zambia. The term "community compacts" represents a different approach to HIV prevention, aimed at engaging directly with target communities and entering into a process whereby leaders and individuals alike are all involved in decreasing the number of new HIV infections.

Counseling and Testing (CT) is an essential intervention in all HIV/AIDS programs as a link between prevention, care and treatment efforts. Those who test HIV negative can change their behavior in order to prevent acquisition of the virus in the future. Those who test positive can change their behavior to prevent transmission to their partner(s) and to make informed decisions about seeking appropriate care and treatment.

In FY 2010, CDC will provide TA within communities and various points of care to integrate prevention. CDC will provide TA to partners to implement the new prevention strategy within their objectives. This will include support to partners engaged in house to house counseling and testing and those that provide adherence counseling to people on treatment.

CDC will provide TA in the implementation of goals and objectives in relation to care, treatment, and prevention in close collaboration with Zambian partners, District Health Management Teams, local chiefs, and community leaders. This activity will support meetings that focus on HIV prevention, importance of CT, the value of couples CT and the importance of maintaining less risky behaviors in communities.

This TA will support national CT and prevention meetings, travel to the field to monitor implementation of CT and prevention programs, and one international or regional travel to attend relevant trainings, workshops, or symposiums.

The TA will introduce community based electronic health record (EHR) data collection and use. This will begin with use of paper forms at point of service, with electronic entry of forms and linkage to full EHRs effected subsequently, at nearest health care facility. During 2010, one or more portable electronic platforms will be tested for candidacy as an immediate data capture device at the point of care.

In FY 2010, CDC Zambia will continue to provide Strategic Information (SI) technical expertise and support to the Ministry of Health (MOH), and other partners in three areas:

1) ICT expertise for: (a) procurement, maintenance, and replacement of IT equipment for the new Pediatric and Family Center of Excellence at UTH; (b) maintenance contracts for printers & computers, continued network operability for remote sites, VSAT and terrestrial communication links, and network hardware; (c) training for CDC and partner IT staff in networking and server administration; and (d) ZNBTS support on linking SmartCare to the national donor retention database, and continued salary support for CDC staff.

2) M&E support to: (a) the national M&E capacity and workforce building initiative in cooperation with NAC, MOH, and other partners to deliver performance-based ongoing training, mentoring, and scholarships to Provincial and District partners; (b) finalize and disseminate a system dynamics evaluation of antiretroviral therapy treatment success and the role of ancillary services; (c) develop appropriate tools, manuals and quality assurance processes for SmartCare implementation; (d) Provincial Health Offices for M&E, SmartCare deployment and data quality assessments; and (e) to Zambian M&E professionals to publish and present operations and evaluation research.

3. HIV/AIDS surveillance support to: (a) Government of the Republic of Zambia (GRZ) in HIV and syphilis surveillance and reporting, and HIV incidence and prevalence in antenatal clinics using BED-CEIA assay; (b) strengthen the Zambian National Cancer Registry in surveillance and reporting of AIDS-related malignancies; (c) CSO to expand Sample Vital Registration with Verbal Autopsy (SAVVY) System; (d) MOH in monitoring transmitted HIV drug resistance prevalence among young antenatal clinic attendees; (e) provide expertise and training to increase Zambian human resource capacity in data management, statistical analysis, scientific writing, and preparation of manuscripts for publication; (f) improve Zambia's geographic data layers for mapping to support HIV/AIDS monitoring, evaluation, and response through MOH; and (g) GRZ to develop and implement an AIDS Indicator Survey.

In partnership with Support for HIV/AIDS Response in Zambia (SHARe), the University of Zambia Center of Excellence (UNZA COE), and the Joint United Nations Program on AIDS (UNAIDS), the National Association of State and Territorial AIDS Directors (NASTAD) assisted the Zambia National HIV/STI/TB Council (NAC) in promoting information flow and improving system-wide planning from districts and provinces to the national level. NAC strengthens multi-sectoral planning and data use efforts with NASTAD and SHARe by supporting Provincial AIDS Coordinating Advisors (PACAs), District AIDS Coordinating Advisors (DACAs), Provincial AIDS Task Forces (PATFs), District AIDS Task Forces (DATFs) and Community AIDS Task Forces (CATFs). On-going technical assistance (TA) to NAC, PATFs and DATFs in Southern, Lusaka and Western provinces will continue to focus on strengthening the national system for collecting, disseminating and using data to inform the national response to HIV/AIDS, the institutional capacity of the UNZA COE, and data utilization and dissemination in support of evidence-based policy and prevention program planning for community-level responses to HIV/AIDS. These activities will allow Zambia to understand its HIV/AIDS epidemic better and use local data to inform policy and HIV/AIDS programs.

The USG has been instrumental in facilitating joint capacity building with NAC and the national Monitoring and Evaluation (M&E) Technical Working Group to ensure harmonization of capacity building efforts and procedures in Zambia. An Evaluation Capacity-Building Sub-Committee includes staff from NAC, SHARe, UNAIDS, United Nations Development Program, Global Fund, Ministry of Health, United States Agency for International Development, and CDC. The sub-committee follows a plan which ensures an integrated and coordinated implementation plan for provision of technical assistance. Continued goals for FY 2010 are to: 1) strengthen HIV/AIDS program management, leadership, policy development and evaluation; 2) use data to inform policy and program development, and improve communication at the national, provincial, and district levels; and 3) strengthen the monitoring, evaluation, and planning training capacity of the UNZA COE.

In FY 2010, the Abstinence and Being Faithful (AB) technical assistance (TA) will support interventions that promote abstinence and be faithful. The TA will focus on supporting institutional and community-based AB programs implemented by USG partners. The AB activities will aim to reducing the transmission of HIV among youth and adults. The activities will mobilize religious and community leaders in facilitating the dissemination of AB messages during ceremonies and other events. TA will be provided to partners to align their activities with the new National HIV Prevention Strategy which recognizes the challenges of HIV prevention.

It is essential to promote programs that support AB as most young people engage in early sexual activity. According to ZDHS (2007), 16 percent of women aged 20 49 and 13 percent of men in the same age group reported that they had sexual intercourse by age 15. It is therefore important to target this age group with abstinence interventions. This activity will link to other program areas to build effective synergies and a consolidated approach to HIV prevention. Appropriate AB prevention models will be promoted and scaled-up to various groups with a goal of changing social norms and attitudes, focusing on reduction of multiple concurrent partnerships, age disparate partnering, gender-based violence and reduction in alcohol abuse. The activity will have a strong link to mobilization for increased uptake of MC services. The AB will be closely linked with TC so that individuals know their status. Those who test negative will be encouraged to remain negative while those who test positive will be reached with prevention for positive messages.

Regular field visits will be conducted for consultations with partners, monitoring implementation as well as building capacity of local staff to implement comprehensive AB interventions. The TA will encourage and support training in relevant behavioral science to build local capacity for effective prevention approaches; development of evaluation and assessments for impact and programmatic effectiveness. In addition these funds will allow for one international travel to attend relevant training, workshop, or symposium.

In FY 2010, this activity will focus on implementing Other Prevention activities and promote behavioral change to contribute towards the reduction of sexual transmission of HIV. The activity is linked to all prevention narratives, Abstinence and Being Faithful, Male Circumcision (MC) and counseling and testing (CT); it is also linked to antiretroviral treatment (ART) section addressing prevention with positives. Activities will also focus on providing technical assistance (TA) to implementing partners and communities to scale-up and integrate prevention messages targeted towards community members, families and individuals. In line with the GRZ approach to prevention, implementing partners will be encouraged to buy-in and follow the new National HIV Prevention Strategy.

The activity will target and address high risk behaviors among MARPS beyond AB and will focus on partner reduction and increased access to and availability of condoms. Information on condom use will emphasize consistent and correct condom use. Partner reduction and condom use will require that men are also mobilized to take part in prevention activities and sexual and reproductive health, in general, for the benefit of their families and the wider community. This activity will be carried in close collaboration with the GRZ, other partners and USG agency technical specialists. Provincial meetings will he held with partners on the national strategy to build capacity of local partner staff to take leadership in promoting comprehensive and effective HIV prevention.

CDC TA will provide oversight, to ensure that PEPFAR funded activities are consistent with the Zambian National Prevention Strategy and local partners will be trained in relevant behavioral science disciplines in order to build local capacity. Capacity of local partners will also be developed in evaluation of program effectiveness and impact of interventions. Under this activity, funds will support attendance at NAC/MOH meetings as well as travel to the field to monitor implementation of prevention activities. Support for travel to attend international meetings and workshops related to prevention, MC, CT and STIs will be provided.

Centers for Disease Control and Prevention (CDC)-Zambia will continue providing technical assistance to the Ministry of Health (MOH), the National HIV/AIDS/STI/TB Council (NAC), and implementing partners in the continued expansion of prevention of mother to child transmission of HIV (PMTCT) services nationally.

Since FY 2007, CDC-Zambia has continuously assisted the MOH to strengthen the monitoring and data system from facility to national-level reporting using the CDC developed PMTCT monitoring system and SmartCare. This activity will continue to be rolled out in the country in collaboration with MoH and partners.

In FY 2007/8, PCR testing on infant dried blood spots was rolled-out and implemented nationwide based on the courier systems linked to the three PCR reference laboratories (two additional planned for FY 2010). CDC will strengthen the linkages with the Pediatric Care and Support program to ensure that there is continuity of care of the exposed infant through the integration of dried blood spots (DBS) in routine maternal, neonatal and child health services.

In FY 2010, as in previous years, the USG will continue strengthening the national PMTCT program through the procurement of back-up (buffer) supplies in-line with the U.S. Five-Year Global HIV/AIDS Strategy. As part of this activity, the USG will procure supplies that are vital in the provision of the national minimum package of PMTCT to avoid national stock-outs that would disrupt provision of services. CDC will support the national PMTCT program with technical assistance and support for study tours and other relevant programmatic reviews. Lack of male involvement in PMTCT has been one of the compounding factors that impact on the program significantly. CDC will work with partners to improve on male participation in PMTCT and address the need to train PMTCT providers in couple counseling and testing.

CDC will also support the production of materials that will enhance PMTCT uptake including revision of guidelines. Finally CDC will work with PMTCT programs to leverage funds in support of the mother-2-mothers program that provides peer-to-peer education/psychosocial support services for PMTCT clients.

In FY 2010, the Laboratory Infrastructure and Support Branch of CDC Zambia (CDC) will continue to provide technical expertise and pre- and in-service training to the MOH, partners, and other US agencies. These efforts will improve the quality of laboratory services, strengthen the national quality assurance program, and build sustainable laboratory systems in Zambia. Efforts will be focused in the following areas:

1) Coordination and provision of technical support for:

a. National laboratory QA programs focused on rapid HIV testing, TB smear microscopy, CD4 enumeration, chemistry, and hematology;

b. National laboratory-related training courses for Zambian laboratory personnel focused on management, TB smear microscopy, QA/QC phlebotomy, and basic computer skills;

c. National roll out training for HIV rapid testing and TB smear microscopy;

d. Collaboration with ZPCT and other partners to standardize the quality of HIV rapid testing and TB smear microscopy;

e. Microbiology and opportunistic infection diagnoses at UTH laboratory

f. Development of a 5-year national laboratory strategic plan, and a national operational plan;

g. Laboratory Information System evaluation;

h. Laboratory accreditation activities; and

i. Laboratory response to outbreaks of diseases

2) Support of:

a. Three locally employed laboratory staff and two international senior laboratory experts

b. CDC staff in-country travel to perform on-site training and supervisory visits;

c. Laboratory personnel to attend international workshops and training for career development; and

d. Laboratory professional promotion events.

3) Provision of :

a. Material support for QA/QC;

b. Technical support and training in support of expansion of infant diagnosis utilizing PCR techniques at 3 provincial General Hospitals; and

c. Technical assistance to DOD in support of expansion of the military clinical and laboratory services in Zambia.

4) Assistance to the MOH to collect and analyze data at the MOH central collection point, followed by dissemination of national EQAS data through workshops, scientific meetings and/or conferences.

5) Follow-up on site visits.

6) Collaboration with other donors (e.g., Global Fund, WHO, PMI, USAID, and JICA) to ensure harmonized efforts.

In FY 2010, CDC will provide support to the Ministry of Health (MOH) National TB Program (NTP) in the following areas: Printing of 2000 copies of the National TB manual, print 2000 copies of the Facilitators manual for training TB treatment supporters for use by health care providers in the program. CDC will print 1000 TB registers for documenting the TB and TB/HIV data at diagnostic and TB treatment centers. Support will also be given to the National TB prevalence survey whose objectives are to: 1) Assess the prevalence of smear positive and bacterilogically positive pulmonary TB, 2) Assess the prevalence of symptoms suggestive of TB and predictive values, 3) Evaluate the magnitude of TB care out side NTP, and 4) Measure HIV prevalence.

CDC will support the NTP to continue providing support in printing the quarterly TB/HIV news letter to facilitate the sharing of knowledge and experiences in the implementation of activities at all levels.

In addition support will also be given to program evaluation and the use of cotrimoxazole for HIV positive TB patients in TB clinics. This activity is currently being implemented in the HIV clinics and some co-infected TB patients are not accessessing the cotrimoxazole.

In FY 2010, CDC will continue to provide support to the Ministry of Health (MoH) National TB Program (NTP) through technical supportive supervision at National, Provincial, District and health center levels in Lusaka, Southern, Eastern and Western provinces. On the job training to health facility staff will be held during these visits.

CDC will support the NTP to strengthen the TB/HIV coordinating bodies through technical support at meetings held quarterly in the Provinces and also provide similar support at National, Provincial and district TB/HIV data review meetings.

Financial and technical support in the national TB review where an evaluation will be conducted in all the provinces will also be provided by CDC. Attendance at international TB/HIV trainings and conferences and salary support will be offered to CDC staff.

In addition, CDC and the MOH National TB Program will be focus its efforts in the following areas : conducting of consensus building meetings/workshops aimed at documenting existing TB-TB/HIV data elements for purposes of building a SmartCare TB module, developing operational procedures of using the SmartCare TB module, signing off the SmartCare user interface (screens) and reports, and training 100% of the eligible TB facilities on how to use the SmartCare TB module.