The Zambia Prevention, Care and Treatment Partnership II (ZPCT II), started in June 2009, supports the Ministry of Health (MOH) to scale up, strengthen and sustain clinical HIV/AIDS services in Central, Copperbelt, Luapula, Northern and North-Western Provinces.

In September of 2009, the Office of the U.S. Global AIDS Coordinator announced its intention to make available up to $15 million to the President's Emergency Plan for AIDS Relief, Zambia Team (PEPFAR/Zambia) in FY 2010. PEPFAR/Zambia was chosen as one of the countries which could significantly improve the coverage of ARV prophylaxis, and change its regime from single dose nevirapine to more efficacious PMTCT regimens for mother and infant pairs. PEPFAR/Zambia has continued to make tremendous progress in counseling and testing coverage but lags behind in the provision of ARV prophylaxis for HIV positive women and their exposed infants. This plan therefore, demonstrates how these FY 2010 funds can assist ZPCT II's advancement in reaching 80% of HIV positive pregnant women and their HIV exposed infants with more efficacious PMTCT regimens.

With an understanding of the need to strengthen efforts to reduce infections and the resource burden of the HIV/AIDS program in Zambia, in its Country Operational Plan (COP) 2010 presentation PEPFAR/Zambia through its implementing partners indicated its intention to enhance the PMTCT program to further strengthen its prevention emphasis. This plan outlines how ZPCT II will utilize these one-time funds, in order to achieve a highly effective PMTCT program. ZPCT II will there use these fund to:

Upgrade/remodel physical and laboratory infrastructure necessary for efficient and quality PMTCT services, including antenatal, maternity and post-natal;

Disseminate updated policies and guidelines based on recent international recommendations;

Update/develop curricula and materials and conduct training necessary to implement these guidelines rapidly;

Roll out PMTCT interventions that optimize care for HIV+ women

Strengthen community approaches that will increase coverage of efficacious PMTCT;

Update the data collection tools and registers based on the new generational indicators; and

Conduct strategic planning for PMTCT in conjunction with the development of the National AIDS Strategic Framework and the National Health Strategic Plan.

As next generation indicators are being rolled out, the USG in Zambia has been preparing its partners to be able to analyze and present this information using standardized indicator terminology. ZPCT II will use part of this plus-up allocation to strengthen M&E systems. ZPCT II will work with the MOH to upgrade the sub-structure of the PMTCT related aspects of the HMIS and linkage to SmartCare for standardized records and continuity of patient care. Because roll out of national HMIS related systems requires a national focus and strategy, actual dissemination of the updated documents will be carried out using established MOH structures. Part of this exercise will include the development of standard operating procedures on data recording, aggregation and data flow structures showing clear channels through which data are submitted. This activity will be carried out primarily at the national level with support from lower levels.

A major issue with quality of data is the lack of consistency in the versions of PMTCT tools that are currently found in various facilities. Plus-up funding will also be used to clean up facilities in a one-time 'mop up' activity to be carried out through the Provincial Medical Offices. Through this exercise, provincial health information officers will work with their district counterparts to clean up PMTCT records at clinic levels. Training and retraining of health level staff on usage of new/updated forms will be carried out to ensure consistent usage of PMTCT HMIS tools across the country.

One-time funding will be considered for:

5.4 Analysis and dissemination of information using Next Generation PMTCT indicators to assess program effectiveness including the impact of COP funding increases for operational costs and these one-time plus-up funds.

Many antenatal and maternity facilities are improvised and not appropriate for delivery services and lack private space for HIV testing and PMTCT counseling. Further some facilities have provision only for antenatal care, without any delivery rooms. In many rural facilities, staff housing for PMTCT staff is limited or substandard to attract qualified staff. Facility deliveries are low due to long distances and lack of transport. Many sites lack electricity and proper water supply affecting quality of delivery services. These would require solar power and boreholes to improve service delivery. Laboratory systems have been developed with couriers for CD4 and other tests. As these funds will be provided on a one-time basis, all recurring costs from these enhancements will be transferred and factored into the routine program interventions.

One-time funding will be utilized to implement the following:

1.1 Construct, upgrade, remodel or refurbish antenatal clinics, maternity units, MCH and laboratory facilities to improve efficiency in PMTCT services. The MOH will assist in site selection based on a criteria that places emphasis on prioritizing facilities with poor infrastructure and potential impact;

1.2 Conduct district level laboratory assessments with MOH and other partners and procure equipment as appropriate for maximum cost-effectiveness and coverage:

1.2.1 CD4 machines for district or facility laboratories

1.2.2 Hematology to measure anemia

1.2.3 Blood chemistry

1.3 Assess and strengthen, as necessary and in consultation/collaboration with MOH, courier systems for facilities without full laboratory services;

1.4 Procure bicycle ambulances for facilities where appropriate.

Under service delivery, activities will include training for nurse midwives and counselors in complementary feeding and nutrition education as apporpriate.

Activities to achieve this strategy will involve one time start up costs for commodities and supplies for a further 2 years.

4.2 Procurement of PMTCT commodities;

4.2.1. ARVs;

4.2.2. Laboratory reagents and supplies