The National Alliance of State and Territorial AIDS Directors (NASTAD) represents the United States' (U.S.) chief state health agency staff who have programmatic responsibility for administering HIV/AIDS healthcare, prevention, education, and supportive service programs. The NASTAD Global Program (GP) works internationally to enhance indigenous leadership to plan, manage, and evaluate evidence-based HIV prevention, care, and treatment programs, strengthen organizational capacity to support the delivery of HIV programs, and create sustainability for effective programs. Through this, NASTAD embodies greater involvement of people living with or affected by HIV/AIDS.

The GP focuses on building human resource capacity of national, regional, and local health departments through transfer of existing experience and skills. Responding to technical assistance (TA) requests from the field, the GP forms carefully selected teams of U.S. state AIDS directors and their staff to engage their counterparts in twinning relationships, and in bi-directional exchanges of AIDS program management skills, experiences and information. With more than eight years of global TA provision, NASTAD also draws on indigenous public health experts as south-to-south TA providers. The GP is unique in that it does not provide direct HIV services, but rather, supports local government in developing its own infrastructure and systems for the delivery of those same services.

NASTAD has worked in partnership with Zambia's National HIV/AIDS/STI/TB Council (NAC) to implement the Zambia National HIV and AIDS Strategic Framework (2006-2010), whereby individuals, families, communities, districts, and provinces all take strong roles in identifying needs and opportunities for effective services since 2005. The focus of NASTAD's TA has built capacity for monitoring and evaluation (M&E), data use, quality improvement, and evidence-based community planning at the central, provincial, district, and community levels. Following needs assessments, NASTAD developed training tools and process documents, and implemented training curriculum. Most TA occurred with the Provincial, District, and Community AIDS Task Forces (PATFs, DATFs, and CATFs), the bodies responsible for planning, monitoring, and coordinating AIDS activities in Zambia. NASTAD worked with Provincial AIDS Committee Advisors in all of Zambia's nine provinces, and with PATFs, DATFs, and CATFs in five provinces (Lusaka, Central, Copperbelt, Southern, Western).

Through FY 2010, NASTAD will work with the NAC to support and improve its M&E of HIV prevention and care programs. NASTAD has been closely involved in the creation and implementation of Zambia's decentralized M&E system, and has assessed and provided trainings and TA to all levels of the program. Indicators gathered from implementers at the community level (21) and from the districts (22), through the NAC Activity Reporting Form, feed into many of the PMTCT, blood safety, other prevention, VCT, OVC, treatment and care, and SI PEPFAR indicators. Though a M&E system is in place, and staff were trained nearly three to four years ago, recent assessments show that there is a great need for quality improvement of the system to ensure complete and representative data.

From 2007, NASTAD has worked closely with the University of Zambia (UNZA) to scale-up their M&E Centre of Excellence including the creation of a strategic plan and a community advisory committee. To date there have been six offerings of the three-week short course, reaching over 400 people. Together, there is focus on the expansion of the curriculum, mentorships for the faculty, partnerships with international universities, and strategies to reach a broader public including pre-service certification.

NASTAD uses costed work plans to continually assess cost-effective implementation strategies. Looking into PEPFAR II, and embodying efficiency and efficacy, NASTAD will use a mixed-bag of TA provision, including south-to-south TA, webinars and on-line training, greater partnerships with local organizations, and select use of skilled and experienced U.S.-based TA providers. Furthermore, NASTAD's model of building capacity is a means to an end sustainable, indigenous-led initiatives that need little or no NASTAD support.

NASTAD's approach to evaluation mirrors the goals of our capacity-building work which fosters sustainability. To do this, our evaluation efforts are participatory in order to build capacity, and support the Three Ones. NASTAD's evaluation will focus on program improvement, accountability, and dissemination of best practices, and depends on ongoing needs assessment and evaluation. We constantly modify our work to improve its relevance to the local context and its effectiveness.

NASTAD is a fiscally experienced organization with a 15 year history of managing grants, cooperative agreements, and contracts, spanning multiple years and ranging in size from $5,000 to over $5M. To date, NASTAD has managed over $40M in federal, state, and private grants and contracts, domestically and internationally, in over a dozen countries and regions around the world. The professional NASTAD finance and accounting team is led by a seasoned manager with 20 years of experience in contract management and supported by two full-time, well-trained accountants.

With District Assessment data from 2009, NASTAD and NAC will complete a situational analysis of the M&E system, and create a plan for future system development. M&E support for the decentralized levels (provinces and districts) will be implemented through the creation and offering of a cascade training to PACAs and PATFs. NASTAD will support the cascading to DACAs and DATFs in two-to-three provinces. Districts will be empowered to train the CATFs. Curricula will include modules on community mobilization, data collection and quality assessment, and data use for decision making. Using the 2005 M&E Cascade Training model, NASTAD will work with other partners for input and funding to implement the training country-wide. NASTAD will also continue to support the M&E Officer position at NAC.

NASTAD will work with UNZA's CoE and the advisory committee ( NAC, UNAIDS, Global Fund, CDC, USAID, et.al.) to identify opportunities for pre-service training in M&E for health care workers, community lay workers, and line ministry staff, and to offer the training in partnership with other organizations. Focus will be placed on using UNZA's expertise to build capacity country-wide around M&E, and using data for effective planning. NASTAD has contacts within two Fogarty International programs that work at UNZA's medical school and the National laboratory to train biomedical researchers and health care providers. NASTAD will propose an integration of the M&E short course into their training, and use of their indigenous expertise to support the short course. These opportunities will work towards providing mentorship and collaboration between and among entities working in the area of HIV/AIDS.

NASTAD will monitor a minimum of seven programmatic outputs including evidence of:

Systems in place to assess and supervise PACAs and PATFs

Strong decentralized M&E supervision and leadership

Intra-province M&E-related support and collaboration

Intra-partner collaboration for M&E-related capacity building

HIV M&E data being used for decision making and program change

Continued development of UNZA's CoE

Scale-up of M&E continuing education and professional development through UNZA's COE.