This is a continuing mechanism that was created during the AUgust 2009 Reprograming. Kara Counseling and Training Trust (KCTT) is a Zambian, non-governmental organization that works to prevent new HIV infections and counter the ravaging effects of the HIV epidemic in Zambia. It started as a pioneering project in psycho-counseling and HIV testing services in1989 and became an independent registered trust in Zambia in January, 1991. KCTT operations are in Lusaka, Kabwe and Choma.

The main activities of the trust are:

Provision of voluntary and confidential HIV/AIDS counseling and testing services

Provision of general counseling services to individuals and families

Provision of support and care for persons living with HIV

Training of HIV positive persons in community AIDS awareness, positive living and peer education skills

Provision of skills training for income generation activities for persons living with HIV

Provision of training courses in counseling and home-based care for health practitioners

Provision of care for AIDS orphans and street kids

Provision of hospice based palliative care services

In FY 2009, KCTT received funding to intensify counseling and testing programs to ensure that as many people as possible know their HIV status, through mobile, stand-alone and community- based counseling and testing services. KCTT has contributed significantly to the training of counselors in Zambia and this has contributed significantly to the strengthening of counseling and testing services of health institutions.

In FY 2010 KCTT with support from PEPFAR, will work in three key areas in Lusaka district:

Support training for Prevention Interventions in Southern Africa This training will focus on prevention in the context of individual HIV test results. Specific messaging for HIV positive and HIV negative clients and behavior changes that are required to meet further prevention of transmission of HIV.

Counseling and Testing services Continue to provide counseling and testing services using different strategies, help in the development of national guidelines, including child counseling and provider initiated testing, and strengthen participate I national events like VCT and World AIDS Days.

Adult and Pediatric palliative care Continue to work with the Jon hospice service in Lusaka. This includes treatment for opportunistic infections, pain management, adherence counseling, spiritual and psychosocial support, and food by prescription.

KCTT will collect routine aggregate statistics on our program. Regarding HIV testing rates, the project will ensure provision of palliative care services and regional training data for the prevention training program. Monitoring will be an on-going process and comprising review of meetings, monthly, quarterly and annual reports, site visits and annual audit

Kara Counseling and Training Trust (KCTT) is running a hospice service in Lusaka's Kamwala suburb, a high density poor residential area. This is very closely linked to home-based care (HBC) services that work in the surrounding community. The HBC providers identify clients in need of

a) Spiritual and emotional support

b) Physical wellbeing and need for medical attention. The caregivers are trained lay counsellors who are able to provide psychosocial support, test clients and give out some basic non-prescription medicines

c) Refer anyone in need of medical attention/hospice care to the Jon hospice through an established referral system.

d) Treatment for opportunistic infections, pain management (with new legislation allowing for access to morphine in hospices) and food by prescription are provided to clients at the hospice. Other services include screening for TB, ART adherence counseling, on-going information on HIV/AIDS, prevention counseling and basic nursing care and support.

e) Food and nutrition support for malnourished pre-ART and ART will follow the draft Zambian Food by prescription guidelines.

f) The hospice will continue to follow all current guidelines in injections safety and infection prevention

With FY 2010 funding these activities will be strengthened with emphasis on prevention for positives and family centered approach to counseling, testing and prevention of new infections.

Kara Counseling and Training Trust (KCTT) are pioneers of counseling and testing (CT) services in Zambia. In FY 2010, KCTT will intensify counseling and testing programs to ensure as many people as possible know their HIV status.

KCTT will implement three strategies for CT activities, these are: (1) mobile community (2) family-based, and (3) walk-in counseling and testing. The mobile community strategy will target hard to reach and less serviced areas. Community mobilization and sensitization activities, such as community based drama groups, will be used to support CT in these areas. Family-based CT will involve couples, children and dependents within a household. Walk-in counseling and testing will be the third strategy KCTT will use in support of CT services. Counselors will also use these as opportunities to identify individuals needing further care and support.

Greater emphasis will be placed on appropriate prevention education for all clients based on the results of HIV tests, disclosure, and appropriate links and traceable referrals to follow-up services.

All clients reached will be encouraged to join positive living groups regardless of their HIV status.

Mobile and door-to-door testing that rely on lay counselors will be closely monitored for quality of both counseling and testing. Monitoring will be an on-going process and will comprise the review of meetings, monthly, quarterly and annual reports, site visits and annual audit.

Through these activities, KCTT will increase the number of people accessing counseling and testing as well as prevent primary HIV infections. KCTT will contribute to the global goal of preventing 12,000,000 infections.

Kara Counseling and Training Trust (KCTT) is running a hospice service in Lusaka's Kamwala suburb, a high density poor residential area. A children's day care centre is attached to the hospice.

The Jon Hospice "Ambuya" childrens centre will continue to provide the following services for children infected and affected by HIV:

Basic educational support to ensure continued schooling

Basic health and nursing care, pain management, treatment of opportunistic infections and admission for basic medical service for those in need

Food and nutrition support for clinically malnourished pre-ART and ART patients following the current draft government food by prescription guidelines

Trauma-focused cognitive behavior therapy and ART adherence counseling

Adolescent specific activities and support

Sensitizations on the rights of the child and general HIV/AIDS information

Home visits and support to families of sick children through trained care givers

Psychosocial and spiritual support and support to integrate back into the communities/homes

In FY 2010, Kara Counseling and Training Trust (KCTT) will embark on a new Prevention Training program for the Southern Africa region. This training will focus on prevention in the context of individual HIV test results; it will also include specific messaging for HIV positive and HIV negative clients and behavior changes that are required to meet further prevention of transmission of HIV. The training will benefit various stakeholders involved in HIV interventions at both community and facility levels of health care.

These are evidence-based social and behavioral interventions that have shown effectiveness. The training will impart behavioral science, knowledge, and skills that will enhance the effectiveness of the staff. These prevention interventions will be offered at different levels: primary prevention, to prevent HIV infection in the first place; secondary prevention, with a focus on screening and testing to detect HIV; and thirdly, improving general conditions through support, treatment, appropriate referral, and prevention of further spread of HIV.

The trainings will focus on prevention interventions that work at different levels ranging from individual, couple and family, groups and community. Structural barriers to effective behavioral change will be a focus area during the training. Biomedical prevention interventions like male circumcision, mother to child transmission, post exposure prophylaxis and pre-exposure prophylaxis will all be discussed and appropriate referral made to service providers.