This narrative is a draft and will be revised upon award of the USAID SHARe follow-on Partnership project. Targets will be adjusted on the actual start date of the project.

USAID/Zambia's new Partnership project will support the Government of Zambia's multi-sectoral efforts to reduce the impact of HIV/AIDS. The Partnership project is a follow- on to the John Snow Institute Support to the HIV/AIDS Response to Zambia (SHARe) project. The Partnership project will build on lessons learned and successes from the previous project, however it also represents a more cohesive and consolidated approach to integrating HIV/AIDS services in the workplace, and strengthening the implementation of HIV/AIDS related policies and laws into workplaces. Most of the partnerships established under the SHARe project are expected to continue under this project. A more concerted effort in generating additional partnerships will be made and the project will be responsible for coordinating, managing, monitoring and reporting on all alliances and public-private partnerships. This project will also address technical and financial sustainability considerations including graduation.

In collaboration with the GRZ, USG and other PEPFAR implementing partners, the project will focus on three key areas by doing the following: 1) Implementing comprehensive HIV/AIDS workplace programs in the public and private sector as well as informal workplaces and expand critical services to surrounding outreach communities; 2) Locating and collaborating with new private sector partners that are willing to contribute resources to the expansion of their own workplace and outreach community HIV/AIDS programs; and 3) Strengthening the implementation of HIV/AIDS related policies held by public or private sector organizations.

The Partnership project will implement comprehensive workplace programs that target a range of public and private sector organizations, including: large corporations in tourism, trade, banking, telecommunications and agribusiness, as well as owners and employees of small and medium size businesses, especially through the District Business Associations and the Zambia HIV/AIDS Business Coalition. The project is expected to strengthen public sector programs in the ministries of Agriculture, Trade and Commerce, Mining, Communication, Tourism, Home Affairs, Education, Health and the Judiciary. In addition, key informal workplaces will be targeted and work in coordination with the new Corridors of Hope project. Not only will this project serve working men and women but also families in communities surrounding the workplaces where services are provided.

The project will support workplace and community programs that include behavior change messaging, particularly using abstinence and be faithful (AB) prevention models, and appropriate behavior change messages to higher risk populations. The successful use of mobile prevention messaging, counseling, and testing services in informal market places that was initiated by SHARe will be expanded under the new project. Mass sensitization sessions and one-on-one interpersonal counseling with vendors will be provided. Communities will be involved in developing innovative prevention approaches to ensure that the programs are responsive to local needs. The prime partner in the project will provide outreach activities using private sector funds, linking partners to government resources for IEC materials. Efforts will be made toward improving supportive supervision to ensure quality of messaging and to encourage trained peer educators to intensify efforts to reach out to more individuals and improve reporting.

Under the Partnership project, prevention programs will be coupled with counseling and testing services so that individuals will know their status. Current data suggest that only 9.4% of women and 13.8% of men in Zambia have ever been tested for HIV. The project will work with partners to provide counseling and follow-up or referral to appropriate groups for employees or community members that are HIV negative to help them maintain their status. Direct referrals to services will be offered for those who are positive to prevent them from transmitting HIV to their partners or children and to link people with care, treatment and support services, with a focus on prevention with positives. It is anticipated that strong linkages will form with other PEPFAR implementing partners such as, the Health Communications Project for the development of appropriate messaging, as well as public and private sector services to ensure patients are linked to PMTCT, ART, palliative care, TB, orphans and vulnerable children and male circumcision services.

Strengthening and implementation of policies and laws related to the workplace through partnerships will also be a component of this project. This includes working with employers on planning, in light of the impact of HIV/AIDS, and working with employees on how they can access legal services to deal with the challenges brought on by HIV/AIDS. Strengthening the regulatory environment to protect people living with HIV/AIDS by working with national, provincial and district level coordinating bodies is also a priority. Partners will be integral to ensuring that HIV/AIDS policies, work plans, and budgets are developed to sustain their HIV/AIDS workplace activities through government, other donor funding , and the private sector.

This activity will focus on extending CT in the workplace and outreach communities in the public, private and informal work places. In addition, it will link to other program areas including HVAB, OHPS, and HVOP while strengthening and expanding the capabilities of the workplace to provide TC, including quality assurance, quality improvement and supportive supervision to trained TC providers provision of on site and mobile TC and linkages with other TC service providers.

Provider initiated TC will be offered within public and private sector health care facilities as part of routine medical care. This activity will also expand community-based HIV to include outreach mobile TC facilities, innovative campaigns will be adopted such as the door-to- door campaigns which embrace a family-centered approach to TC as well as couples counseling to reduce HIV transmission in sero-discordant couples.

Creative ways to engage and connect communities to TC will be sought, through community sensitization and mobile TC at traditional ceremonies and other social mobilization events such as World AIDS Day and Voluntary Counseling and Testing Day. Emphasis will be placed on working with Members of Parliament, traditional Leaders, industry heads, and young influential Zambians (musicians, artists, youth leaders) to promote and advocate for increased TC uptake within communities. Additional focus will be placed on increasing male's involvement in TC.

Enhancing access to rapid test kits through the District Health Management Teams and Medical Stores Ltd in order to expand nationwide TC services will be a major focus of this project. TC providers will link HIV positive clients to ART and palliative care services in their respective communities to ensure continuity of care.

The project will assist partners to provide on-site, facility-based and mobile TC services, create links for referrals to off-site services where on-site facilities are not available, link to the District Health Management Teams logistic management system and other sources for a consistent supply of TC test kits and reagents, and network with prevention, care and treatment sites. The Project will work with partners and the Ministry of Health to promote adoption of the TC opt-out/provider-initiated approach to offer TC within all antenatal services, at TB clinics, and during annual medical exams.

This activity will focus on supporting the institutional capacity of partners in public, formal and informal sector workplaces. Support will include annual assessments of internal mainstreaming and institutional strengthening of all line ministries. The project will support the implementation of HIV/AIDS related policy and regulatory framework developed under the SHARe project. Support will be given to standardizing workplace policies in both the private, public, and informal sectors.

One aspect of the project will emphasize implementation of policies and laws developed by the National AIDS Council (NAC that have become part of the national legal and policy systems. Technical and management capacities of the partner organizations will be strengthened and support mobilized to secure financial resources to ensure the sustainability of their activities. Activities will include participatory analysis of current levels, sharing of successful sustainability strategies, and development of sustainability plans.

As a result of this activity, comprehensive AB programs will be implemented in the workplace and outreach to communities in public, private and informal workplaces. The activities will link to other program areas including HVCT, OHPS, and HVOP and expand the capacity of partners to implement AB programs that support the recently launched National Prevention Strategy. Comprehensive AB programs in workplaces and communities will target adolescents, men, women, the business community, PLWHA and mobile populations including truckers, miners and agricultural workers. Appropriate AB prevention models will be promoted to various groups of adults with a goal of changing societal norms and attitudes, focusing on reduction of multiple concurrent partnerships (MCP), age disparate partnering, and the harmful role of alcohol abuse and gender based violence in HIV transmission. Men will be actively engaged to participate in, act as role models and promote positive behavioral change.

Both male and female condoms will be made available through health facilities and through retail outlets. AB prevention will be closely coordinated with TC mobilization, so that individuals know their status. Focus will be placed on maintaining the negative health status of the majority that will test negative, but also on prevention with positives to be addressed through both behavioral and biomedical interventions. The use of mobile AB and TC services in informal market places will be expanded under this new project with the use of mass sensitization sessions and the provision of one-on-one interpersonal AB counseling with vendors.

The partner communities will be involved in developing innovative community AB prevention approaches such as drama, peer group discussions, and social mobilization events ensuring that the programs are responsive to local needs. Support to AB strategic planning and policy development will be provided to the partners.

The project will work with all of its partners through continued strengthening of technical and management capacities and mobilization of financial resources. In addition, it will support sustainability plans for HIV/AIDS workplace and community outreach activities using private sector funds and linking these to government resources for IEC material.

This activity will focus on implementing Other Prevention activities and promote behavioral change to reduce sexual transmission. The needs of high risk workers in the public and private sector and the informal workplace will be identified and addressed. Other prevention strategies will focus on innovative community prevention programs in areas with high migrant populations, miners and market fish vendors and other most at- risk populations. Furthermore, this project will provide education to tackle HIV high risk behaviors among Most at-Risk Populations (MARPs) that go beyond AB and focus on partner reduction, increased access to and availability of condom uses correctly and consistently, knowing one's status, screening and treatment of sexually transmitted infections, and referrals to male circumcision. The harmful role of alcohol abuse and gender-based violence in HIV transmission through multi level interventions will also be addressed.

Emphasis will be placed on increasing male involvement in other prevention efforts. Information and counseling on behavioral change will promote respectful relationships between men and women. Peer educators trained under the SHARe project will implement Other Prevention education, promote condom use, refer for STI management, and work to prevent and respond to alcohol abuse and gender-based violence.

Sites with high risk groups will be linked to the Corridors of Hope III project and to socially marketed and free condoms in collaboration with the District Health Management Team and Society for Family Health. Private sector companies with clinical facilities will expand the provision of STI diagnosis and treatment services and will be encouraged to provide post exposure prophylaxis for health workers and victims of sexual violence. Counseling and testing will be integrated as an essential component and emphasis will be placed on ensuring that those who test negative remain negative, with messages focusing on multiple concurrent partnerships and age-disparate partnering and the harmful role of alcohol in reduced perception of risk.