PMTCT one time plus-up funds are being added to support: Community approaches to improve uptake of highly efficacious PMTCT regimens including the monitoring thereof. Developing and building programs that improve and expand confidential testing and counseling and PMTCT is critical for achieving overall primary prevention of HIV in Zambia. Overall, 11.2% of cohabiting couples are discordant for HIV, including 6.6% of couples where the man is positive and woman negative, and 4.6% of couples where the woman is infected. With low national uptake of counseling and testing, the vast majority of Zambians do not know their HIV status and that of their partners/spouses. While over 80% of pregnant women were tested in 2008, only about 10% of their male partners were tested. Increasing the promotion of and access to testing and counseling, beginning at the community level is one of the focus strategies to reaching the enhanced uptake as low levels of male partner involvement in PMTCT services in Zambia have been of great concern.

Male/partner testing and counseling needs to be promoted through mobilization of communities and their leaders need to take active involvement in PMTCT matters. To increase PMTCT uptake among both men and women, focus should be placed upon male involvement through direct participation and sensitization using various innovative strategies and approaches. If traditional leaders' influence and involvement in PMTCT services is aggressively solicited to promote community involvement, the uptake of male partner counseling and testing is more likely to increase resulting in reduced infection among women and their infants and also among negative male partners in discordant relationships. Traditional and other community leaders can also play a critical role in assisting to ameliorate negative social norms associated with gender imbalances. Active involvement of all the key stakeholders at community level resulting into increased partner counseling and testing will also reduce stigma. While health facilities are the nucleus of PMTCT services in any given locality, outreach activities that promote and encourage increased community participation in breaking down barriers to partner counseling and testing are necessary and crucial.

Community leadership coupled with health worker commitment is critical to improve uptake of new regimes, of partner testing, and to improve coverage of four antenatal visits, testing uptake, facility delivery, repeat maternal testing, early infant diagnosis, and prompt treatment of infected children. Lessons learned from successful communities will be disseminated.

PMTCT one time plus-up funds are being added to support: The monitoring and evaluation of community based activities. Resources will be utlized to monitor uptake of couples counseling using community approaches as well as adherance to regimens for women entering the PMTCT program.

Given the unique nature of these funds, monitoring of accomplishments will be critical to show program success and to advocate for continued funding. Using both existing and potentially new PEPFAR indicators to track implementation progress will be essential in order to identify where interventions have an impact and where adjustments are required. Reporting out at national and international levels will also be an important responsibility covered with the use of these resources.

PMTCT one time plus-up funds are being added to support: Community based interventions woven into the newly procured community based prevention, care, and treatment program.

Activities under this area will strengthen the new activity which will promote testing and counseling. With the addition of these one time funds, activities will focus on the promotion of couples counseling for the antenatal setting. Community based personnel will work at a household and catchment level to foster an environment where men take greater responsibility for pregnancy outcomes, including knowledge of partner status during pregnancy.

Community based health providers will focus activities within their catchment areas to identify pregnant woman and encourage them, along with their partner, to access testing and counseling and enter into the PMTCT program should the results so require.

Community activities will also focus on adhearance to medications for woman who require the more efficacious regimens and will also include promotion of infant feeding and nutrition demonstrations. Given that this will be a relatively new phenomenon for these women, implementing the new protocol will require both vigilance and follow up. Activities at the community level will provide this follow up and serve as a touch point to ensure women follow appropriate prescription practices as well as continue to access services on a routine basis.