The goal of the Integrated Tuberculosis and AIDS Program (ITAP) is to reduce HIV/AIDS/STI transmission among the lowest socio-economic class in Eastern Province. ITAP comprises three strategic interventions, namely TB/HIV, Counseling and Testing (CT) and the Prevention of Mother To Child Transmission of HIV (PMTCT). Under this mechanism, TBD will continue support in the six (6) districts of Zambia's Eastern Province: Chipata, Chadiza, Chama, Katete, Petauke and Lundazi.

Since FY 2008 CARE has been supporting one hundred and seventeen (117) health facilities in the six (6) districts to expand access to TB/HIV/CT and PMTCT services especially to populations with limited access to health services and those in hard- to- reach areas. In FY 2010, TBD will support one hundred and fifty four (154) facilities in expanding services to all sites in the six (6) districts and addressing the service delivery needs and concerns raised in those districts.

TBD `s aims to assist the government through increasing the expertise of field-based staff and by building stronger referral networks. ITAP will emphasize the documentation of best practices, success stories, and lessons learned at every stage of programming.

TBD will continue to implement capacity building activities aimed at improving health systems and conduct quality assurance visits to health facilities, on-site technical mentoring of trained health workers in TB/HIV/PMTCT/CT, family planning, and community focus group discussions to inform service utilization. Other activities include renovation of staff houses (20) in the rural health facilities to motivate staff, support the maintenance and retention of clinical officers and midwives (26) deployed in FY 2009, and monitor the quality of care at facility and community levels.

ITAP will incorporate gender issues in all activities by addressing male norms and behaviors and increasing gender equity in accessing HIV/AIDS activities and services. PLWHA will be actively involved in information dissemination and recruitment of pregnant mothers diagnosed as HIV+. In close liaison with clinic staff, PLWHA will carry out client follow-up and mobilize communities for collective action to support other PLWHA. ITAP will emphasize male involvement in PMTCT, safe motherhood, and family planning. ITAP will utilize the "mother-2-mother" approach to provide opportunities for PLWHA to take responsibility for managing HIV/AIDS service delivery at family and community levels and increase their capacity for decision-making on issues surrounding their wellbeing.

TB detection and training of TB treatment supporters will be done in conjunction with THANZI, a USAID funded project. ITAP will strengthen TB/HIV coordinating committees at regional, district, and community levels in coordination with other TBD-facilitated projects such as the EU-funded Strengthening Tuberculosis, AIDS, and Malaria Prevention Program (STAMPP).

ITAP seeks to roll out stigma and discrimination training among community volunteers and health workers using STAMPP trained trainers. ITAP will develop strategies for community-based volunteers and health workers to incorporate stigma and discrimination messages in their routine health education.

ITAP will coordinate the transportation of sputum for quality assurance testing with CIDRZ and joint supervision and quality monitoring with CIDRZ, PMO/MOH, District Health Management Team (DHMT) and any other major partners. ITAP will collaborate with JSI in the procurement and distribution of family planning in case of gaps in the government supply chain. IEC materials will also be procured and distributed in partnership with Health Communications Partnership (HCP) and Society for Family Health (SFH). ITAP will continue to undertake Mobile Counseling and Testing campaigns in conjunction with the Comprehensive HIV/AIDS Management Program (CHAMP).

ITAP will continue to support World Vision's mobile ART services in Chipata District and provide transport to Chipata DHMT for mobile ART in conjunction with the general hospital and other partners.

TBD will support provincial TB/HIV coordinating committee meetings jointly with other partners, thus reducing the costs and dependence on any one project. TBD shares travel and supply costs for joint quality monitoring visits. When the objectives and intended participants overlap, TBD shares some training activities with other projects to reduce costs and avoid duplication of activities across projects within and outside TBD. Increased emphasis on joint planning will provide opportunities to identify partner activities that could be undertaken jointly on a cost-sharing basis.

Monitoring will focus on strengthening data collection and documentation at community and health facility levels using the revised PEPFAR Next Generation Indicators. TBD will scale up on-site technical support and verification of data in all 154 health facilities via joint quarterly field visits and meetings. Documentation of data at community level will assess the contribution of community based volunteers such as treatment supporters and lay counselors on:

- TB suspects identified

- TB suspects referred or sputum examination

- Clients referred for counseling and testing (including ART services).

TBD will establish a database in all six (6) field offices for continuous update and verification.

By the end of FY 2010 ITAP will provide increased access to counseling and testing for 15,000 prospective HIV/AIDS clients in one hundred and fifty four (154) health centers in six (6) districts of Eastern Province: Chadiza, Chama, Chipata, Lundazi, Katete and Petauke through the following activities;

ITAP will facilitate the scale-up of CT services from 47 to 154 health facilities in all six districts. Counseling and testing for HIV is a key entry point for HIV prevention, care and support and TBD's role will be to strengthen the capacity through provision of technical support as well as working with other organizations such as CHAMP and, SFH to scale up mobile CT from twenty (20) to twenty three (23) sessions during the year. In addition, household counseling and testing will be adopted after training lay counselors in this approach. These will in turn counsel and test household members for HIV and refer those who test positive for TB screening and provide HIV prevention messages and interventions. So far 80% of the health facilities have trained health workers as well as lay counselors in CT who are already providing counseling services. TBD will train fifty (50) health workers and fifty (50) lay counselors in hard- to- reach areas to provide on- site counseling to individuals, while couples counseling will be enforced through PMTCT services where disclosure of HIV results between couples will strengthen prevention efforts especially in discordant couples.

ITAP will facilitate twelve (12) radio prevention programs in community radio stations in Lundazi, Chipata, Petauke and Katete. The stations will be used to disseminate information and sensitize communities on the importance of counseling and testing for HIV as a key entry point for HIV prevention, care and support.

ITAP will facilitate and support commemoration of CT Day in all six (6) districts. The project will support satellite activities in communities to sensitize them of the importance of knowing their HIV status on June 30th which has been designated as National VCT Day. These activities will form part of the commemoration of the actual day where more CT activities are conducted.

ITAP will use similar strategies s those employed in the PMTCT program to ensure accurate HIV test results will be delivered to clients.

By the end of FY 2010, ITAP will ensure the provision of a minimum PMTCT package for 20,000 women in 63 health centers in three rural districts of Eastern Province; Chadiza, Chama and Lundazi.

Antenatal services will be the main entry point for all PMTCT services and other reproductive health activities such as safe motherhood, family planning, sexually transmitted infections screening and micronutrients support. At every contact at health facility or community level, men and women in the reproductive age will receive information about available services.

ITAP will train health workers (50) in couples counseling and encourage discordant couples to adopt safer sexual behaviors which will help reduce new infections. Existing Behavior Change and Communication (BCC) materials from MOH and other stakeholders such as SFH and HCP, will also be used for dissemination and creation of demand for PMTCT services.

ITAP will strengthen the existing support groups (24) and support the establishment several new ones, linking the groups to the Network of Zambian People Living With HIV/AIDS (NZP+) and other organizations such as Zambia National AIDS Network (ZNAN) for financial support.

Through quarterly on-site technical supportive supervision and quality assurance monitoring visits, ITAP will ensure quality service delivery of PMTCT services in line with revised modules and protocols. ITAP will facilitate the printing and distribution of new guidelines and protocols to all project sites on PMTCT.

Through CIDRZ, the project will improve collection of dried blood samples from HIV exposed babies from all health facilities (63) and their quick transportation, examination and timely commencement of treatment, thereby contributing to MTCT reduction. ITAP will procure heamacue, RPR kits and infection control supplies to all PMTCT sites to enhance service delivery.

ITAP will ensure the quality of rapid HIV testing performed by non-laboratory staff (e.g. by providing refresher course training of rapid HIV testing to PMTCT staff, hiring of lab QA staff, providing tools, job aids and supplies, performing regular sites visits, and enrolling all ITAP supported sites with the national QA program).

In FY 2010 ITAP will provide access to improved TB and HIV services for four thousand (4,000) prospective TB and/or HIV AIDS clients in one hundred and seventeen (117) health facilities in four (4) districts of Eastern Province; Chipata, Lundazi, Katete and Petauke

TBD will continue to build on lessons learnt since 2005 to improve the quality of service delivery for TB/HIV collaboration activities. The focus in FY 2010 will be to expand and institutionalize multi-level linkages between the response to TB and HIV, quality service delivery, and sustainability strategies. TBD will continue to focus on activities to increase TB case detection. TBD will scale up activities for TB suspects and HIV positive clients through community involvement, expansion of the system of sputum collection points, and training and placement of microscopists. These activities will enhance the referral of TB suspects and HIV positive clients, improve access to and provision of TB microscopy services, increase the diagnosis of smear positive among pulmonary TB cases and ensure increased screening of TB in HIV positive clients to 100%. TBD will scale up interventions aimed at increasing TB treatment success rates from 81% to 83% and strengthen infection control measures at facility level by providing supplies such as aprons, bin liners and other waste disposal methods and training TB treatment supporters and health workers in infection prevention. Other activities that will strengthen the referral network between TB and HIV are:

- Improve transportation of sputum specimens of HIV positive clients to TB microscopic centers for diagnosis

- Strengthen TB/HIV coordinating committees

- Conduct focus group discussions to inform service utilization and improve knowledge on TB/HIV co-infection

- Facilitate quarterly on-site technical mentoring of four hundred and sixty six (466) health workers and community volunteers in TB/HIV including family planning and data verification

- Update health workers and community volunteers on TB/HIV and data management

- Facilitate linkages of HIV positive clients to NZP+ for continuum of support and linking them to micro-finance institutions.

- Promote condom use and partner notification

- Support to TB/HIV review meetings at provincial, district, health centre and community levels.