Zambias population is13, 046,508 with 1,707,731 people in Eastern Province. The HIV prevalence in the 15 to 49 year age group is 14.3% while Eastern Province is at 10.3% (ZDHS 2007).Knowledge about HIV/AIDS stands at 99% amongst the adult. Only 15 % know their HIV status.Eastern Province has 8 districts with staffing in facilities standing at 57%; the project will aim at strengthening Health Systems and service delivery.Eastern Provincial Health Office (EPHO) will continue to work towards accelerating of the national PMTCT program towards the goal of MTCT elimination by 2015.Out of 227 health facilities only 196 are PMTCT sites. Using the PMTCT Base funds, EPHO will expand PMTCT services to the remaining 31 facilities. Annually 13,090 babies are exposed to HIV and MTCT is at12 %.( 2007, ZDHS).Tuberculosis is a major cause of morbidity and mortality in people living with HIV/AIDS. TB patients will be tested for HIV and vice versa.TB notification stands at 2623 and 89% of patients were counselled and tested for HIV in 2010 (EPHO, TB report 2010).Sexually Transmitted Infections (STIs) constitute 10% of outpatient attendances. Emphasis will be on sensitizations, early detection, effective treatment of STIs and screening for HIV. Partner tracking and data management will be strengthened.Other prevention activities are in 42 facilities of Chipata; EPHO will scale up to 15 health facilities in each of these districts: Chama, Chadiza, Mambwe and Nyimba.Despite improvement in C&T there is need to conduct more trainings for untrained health workers.COP12PMTCT PLUS UP $165,000 will be used to implement one-off activities intended to strengthen the base of the PMTCT program in the province for a more effective MTCT elimination drive.

The major objective of the program is to strengthen Adult HIV Care and support in PLWHA in the province in line with the national vision of taking HIV services as close to the families as possible. There has been ongoing strengthening of health system and service delivery in the area of counseling and testing, TB/HIV, STI, ART, condoms and other prevention activities and male circumcision, however some gaps exist. This funding will strengthen Prevention with the Positives (PwP) and ensure all patients in HIV care are linked to appropriate support groups. Monthly Community therapeutic support meetings will be held to ensure that patients on ART and TB treatment have a forum where they can share their experiences. Due to shortage of staff in ART sites, EPHO will recruit 8 health workers. EPHO will train 100 community members as ART adherence supporters who will be provided with stationary, and transport. This will facilitate the provision of the health services in the community and improve the linkages between the community and the health facilities. Refresher trainings will be conducted for 80 ART adherence supporters. This will facilitate the giving of new updates to the community members. Couple counseling and testing (discordant Couples) will be promoted to ensure that all HIV positive clients and their partners are tested for HIV and are supported. This will help in the disclosing of the results, treatment and support to the HIV positive clients and the families. Radio programs will be conducted to sensitize the community on positive living. HIV positive clients will participant in the Radio programs to promote positive living and behavioral change. Recording and Reporting will be strengthened at all levels by quarterly monitoring being part of the activities. Monthly/quarterly integrated technical support supervision, follow ups and mentorship will be conducted. Meetings will also be held at all levels to ensure that data collected is discussed. Post training follow up will be conducted to the community lay counselors and the adherence supporters. EPHO will procure material for Nutrition Assessment, Counselling and Support. The program will train 60 health workers in NACS.

The goal of the TB/HIV programme is to reduce the burden of TB disease among the population of Eastern province including HIV infected individuals.

EPHO will conduct intensified Active TB case finding at community level. Screening of HIV infected patients for TB within the ART/MNCH clinics will be strengthened. EPHO will Strengthen provision of CPT and ART for HIV positive TB patients by making Co-trimoxazole and ART available in TB clinics. EPHO will implement interlinked patient monitoring systems for TB/HIV cases.

MDR-TB Management will be monitored through testing for resistance to first-line anti-TB drugs to 20% of the new and all the retreatment TB patients. A courier system will be put in place for transportation of the samples. EPHO will train 100 Health workers in MDR TB management and Strengthen TB infection control measures in hospitals, outpatient clinics and health centers managing suspected/MDR-TB patients.

EPHO will train 50 health workers and 80 community members in TB infection control and management. Treatment supporters will play an active role in sensitizations on DOTS and TB/HIV preventive health messages. Quarterly TB/HIV Coordinating bodies meeting will be held at all levels through improved implementation of joint TB/HIV control activities at Provincial, district, facility, and community levels.

EPHO will improve the diagnosis of TB among AFB smear-negative TB cases through screening of people living with HIV, and increase access to quality-assured AFB microscopy with effective external and internal quality assurance (EQA & IQA) and procurement of laboratory reagents

Improved community participation through sensitization will be done through drama and use of the local print and electronic media.

To improve on data quality and program performance, EPHO will conduct technical review meetings at Provincial, district, health centre, and community levels. Districts will be monitored quarterly to assess on their performance through Joint Technical Supportive supervision and mentorship with partners which will include impact measurement.

EPHO will commemorate the world TB day, and support the transportation of sputum specimens to the diagnostic centres. EPHO will conduct refresher courses for 40 microscopists.

EPHO will strengthen and scale up Pediatric Care and support services and ensure equity of care for mother-baby pair through scaling up of static site, improving staffing for ART sites, training staff in the provision of ART services. Early infant diagnosis, child counseling, Provider initiated counseling and testing, and linkages of positive babies from PMTCT to other programmes will be reinforced. Quarterly technical support and mentorship will be conducted to MNCH staff to strengthen follow-up of exposed babies and the provision of Co-trimoxazole prophylaxis within acceptable period domains. The programme will support linkages through referral to the next level of management of pain and treatment of opportunistic infection. Baby friendly services will be promoted through renovations (paintings and decorations) of childrens wards in the districts and buying of toys for children. The Program will orient 50 health workers in baby friendly and adolescent services from hospitals. Retesting of all HIV exposed and negative babies after breastfeeding cessation will be promoted with support from the PMTCT program. Clinical symposia, technical review meetings, and technical support supervision will be carried out. With the PCR Laboratory in place at Chipata General Hospital, early receipt of results will be reinforced by EPHO through creation of courier systems in partnering with Riders for health. This will ensure timely commencement of clients on treatment once found eligible. Linkages will be created between counseling and testing, PMTCT, TB, infant and young child feeding and nutrition. This will be done through intra facility meetings, technical review meetings and by providing ART in the MNCH and provision of Cotrimoxazole at the TB clinic as well as well as MNCH. EPHO will procure therapeutic food by prescription programs to support pre-ART and ART children with malnutrition. EPHO will integrate the Pediatric care and support services with other services through intrafacility meetings and technical review meetings and mentorship. EPHO will also procure reagents for the PCR machine.

EPHO laboratory objective is to strengthen laboratory services to support quality TB/HIV/AIDs/STI Care, Treatment, and Prevention services. EPHO in collaboration with level II hospitals will conduct quarterly supervision and quality control/improvement activities in all the diagnostic laboratories in order to strengthen the quality assurance system. EPHO will empower districts with funds to carry out supervision and onsite mentorship to health centre laboratories as a scale up of quality control/assurance activities. The Program will procure EQA schemes as only four (4) laboratories are participating in the National piloted EQA schemes. In order to execute this activity with proper competence and knowledge of the process, EPHO will train 10 laboratory staff in Good Clinical Laboratory Practices (GCLP). Equipment maintenance and calibration by service engineers still remains a key priority in the implementation of Good Clinical Laboratory Practice. EPHO will engage reputable firms to provide the equipment maintenance service. The program will employ 10 laboratory qualified staff in an effort to alleviate the challenge of understaffing and ensure quality health service delivery. EPHO will train 4 Laboratory staff in PCR and support EID through the provision of laboratory reagents. The newly rehabilitated health centre laboratories still face the challenge of power to run the equipment to provide basic laboratory service. EPHO will support health centre laboratories through provision of solar panels and laboratory equipment. In order to secure the laboratories and its staff, EPHO will procure safety equipment such as fire extinguishers, fire blankets and first Aid boxes for 30 zonal centres. In order to supplement on Medical Stores Zambia laboratory logistics, EPHO will procure buffer essential laboratory commodities to alleviate the shortages. EPHO will print in house laboratory Standard Operating procedures and rehabilitate 2 level II laboratories. The program will procure 6 computers to support laboratory database scale up implementation. EPHO will support sample referral and feedback from the rural health centres to the diagnostic centres. EPHO will carry out minor rehabilitations to the staff houses which will be occupied by the laboratory technicians(painting, filling of wall and floor cracks, replacement of glass panes and door shutters).

The main objective of SI is to improve and strengthen information management system in HIV care for effective planning, monitoring, reviewing and program management. It provides efficient and effective monitoring and data management services in all program areas of the project. Methods applied in SI enable Program Officers to assess their progress, to make adjustments and achieve goals.To strengthen SI for decision making, EPHO will conduct re-orientation of 50 Program Managers and District medical Officers in project reporting tools, Target and indicator setting, Data Analysis and How to monitor and evaluate HIV projects.Further, to ensure that the project resources achieve the intended objectives, 50 Program Managers and Health workers will be trained in Resource Tracking MethodsQuarterly Technical Review of HIV programs will be conductedMonthly progress review will be conducted in order to improve performance on all supported areas.Quarterly Cooperating Partner meetings will be held in order to share information, exchange ideas and strengthen partnerships.Under Smart Care electronic health records system, the following will be done;? There will be scaling up on sites from the current 48/227 to 90/227 sites.? Training of 200 SmartCare Users will be conducted? Re-orientation of 300 current SmartCare users will be conducted? Monthly supervision SmartCare facilities by District Health Offices? Quarterly supervision and mentorship of all District Health Office by EPHO? Onsite mentorship and follow-up of trained staff will be conducted? Quarterly maintenance of the Smart Care computers and all other computers, internet connectivity (V-SAT) and Local Area Network (LAN) will also be done routinely to all districts by the ICT Officer.? Procurement of solar panels for health facilities without power for computers? Provision of SmartCare computers in partnership with CDC

EPHO will continue holding quarterly data quality audits (data cleaning, quality self assessment) and management in all the districts.Asset verification and branding will be done bi- annually at both provincial and the district level.Compilation and Submission of the Semi Annual and Annual Progress Reports (APR)Will be done routinely.

The EPHO will support training of provincial and district staff in data analysis, M& E and report writing through advanced epidemiology for data user trainings each year. The provincial staff would be trained as trainers who would then conduct two trainings for district staff. These trainings enable staff to create epidemiology profiles, conduct data quality assessments and conduct various analyses of HMIS, NACMIS and SmartCare systems to inform decision making.

In FY 2012, EPHO will continue implementing MC as an integrated measure for HIV Prevention. EPHO will continue to supplement government efforts in MC in order to meet the target of 100,000 negative males circumcised by the year 2012 in Zambia by providing MC to 4,000 HIV negative males. EPHO will strengthen the national MC program by recruiting an MC coordinator dedicated to overseeing MC program activities at provincial level and provide ongoing support to all sites to ensure provision of high quality MC services.The Province will train 100 health workers in MC in the eight districts. In order to reduce resistance to change, the culture of no male circumcision to a male circumcision culture, EPHO will orient 20 chiefs in MC, 160 head men and 160 Community based volunteers to improve community participation. In the already established MC sites in the districts, EPHO will scale up MC services to 16 zonal centers to improve MC access; minor renovations to five Zonal centers one in each district will be done. EPHO will conduct quarterly supportive supervision, mentorship and Quality assurance meetings will be conducted. EPHO will conduct 12 radio programs to create awareness. EPHO will conduct outreach and mobile MC activities as part of the mobile health service. Linkages will be strengthened between MC, CT, PMTCT and family planning services. Improved referral networks between CT, PMTCT and ART will be strengthened through monthly intra facility meetings. EPHO will purchase bicycles for the oriented village headmen and CBVs to strengthen community involvement and participation. EPHO will procure a vehicle to facilitate and strengthen mobile MC services to ease transport challenges. To ensure continued mass education EPHO will facilitated IEC production and distribution in the province on the benefits of MC. Massive MC campaign especially during holidays targeting school going youths will be conducted in the 5 districts. EPHO will ensure equipment; linen and supplies are available in all MC sites.

The major objective of the program is to provide counseling, testing and care in all health facilities of the province. This serves as the entry point and linkage to care, antiretroviral service provision and prevention activities. The counseling services will be strengthened through family centered approach including couple counseling by means of door to door counselling and testing through the lay counsellors trained in counselling and testing, and finger pricking. EPHO will procure 100 bags for the trained lay counsellors for carrying testing kits. Sensitizations on strong messages of abstinence, faithfulness to one partner in relationships and use of condoms will be conducted through the print and electronic media. Provider Initiated testing and counseling as opposed to voluntary counseling and testing will be strengthened in all health facilities. EPHO will train 60 health workers in child counseling. To enhance counseling services and also address the issue of discordance, couple counseling will be strengthened by training of 60 health workers. The districts will conduct one day sensitization meetings for 50 community leaders in couple counseling. EPHO will train 80 lay counselors in finger pricking for HIV testing. The Province and districts will conduct quarterly and monthly integrated mentorship and technical support supervision to monitor the provision of counseling and testing services respectively. Quarterly counselors meetings will be held to share experiences and review progress in implementing planned activities. The Province will facilitate commemoration of World VCT. EPHO will initiate printing and updating of a catalogue for trained staff. Follow up visits to the trained counselors, lay counselors and headmen will be conducted continuous soliciting for support and instilling sense of ownership of the programme. Technical support and mentorship will also be conducted to lay counsellors to strengthen referrals for CT and also for Pre ART assessment. EPHO will conduct quarterly quality assurance and control of HIV testing. EPHO will integrate with the Provincial Senior Medical Laboratory Technologist to ensure availability of testing kits. EPHO will purchase bicycles for the 100 oriented headmen. EPHO will pay salaries and Gratuity 6 employees

EPHO has scaled up other prevention activities to Chipata, Chama, Nyimba, Mambwe and Chadiza. EPHO will train 100 peer educators in from all 5 districts. An integrated approach with other program areas will be used in creating awareness, creation of preventive messages during biannual youth festivals, and school competitions for youths to reach other youths and adults. Creation of awareness through sensitization through airing of 12 radio programmes on local radio stations will be done, and this will include messages on prevention with positives and negatives, causes, prevention, and stopping youths from engaging in substance abuse. An integrated approach will be adopted .EPHO through DHOs will Sensitize youths in the dangers of early marriages and unwanted pregnancies, family planning and safer sex. Integrated monthly and quarterly technical review meetings will be conducted at provincial, district, facility and community levels. Monthly and quarterly mentorship, supervision, follow up and monitoring will be conducted health workers, youth coordinators, and youths by the district and province respectively. EPHO will strengthen youth friendly corners through procurement of furniture. An inventory, establishment, and support of anti AIDS clubs in schools will be done. Quarterly meetings and consultations with civic leaders, local authorities, business communities, and other key stakeholders will be conducted as a way of monitoring behavioral changes towards beer drinking and substance abuse. EPHO will integrate MC awareness during meetings and through the radio programmes, sporting events, national/provincial events and traditional ceremonies. EPHO will purchase bicycles and spare parts for youths in the 5 districts. The programme will Strengthen NHC participation and will conduct monthly community sensitization meetings to reach out to 20,000 youths. EPHO will train 100 health workers from 5 districts in youth friendly services. EPHO will link with NZP+ and conduct follow up on PLWHA and adherence supporters oriented in PwP. EPHO will support games for life. Salaries and gratuity will be paid to three officers.EPHO will work in partnership with stakeholder to reach the most at risk populations (MARP). Through the district EPHO will facilitate creation of mass awareness on HIV/AIDS prevention through radio programmes in 8 districts. Integration with other programme areas like TC, TB/HIV and ART will be strengthened. The community will be fully engaged in the provision of IEC.A total of 500 uniformed personnel will reach in 2012 with a total of 1,000 will be reached in 2013. By 2013, 600 commercial sex workers and 600 other vulnerable populations will be reached.Linkages to other programmes, MC, CT and ART will be created

EPHO will scale up and strengthen PMTCT services. EPHO will support integration with other partners in monitoring and review of programs. The use of combination therapy will be strengthened during technical support supervion and mentorship and technical review meetings. EPHO will train 160 health workers in provider initiated testing and counseling. Districts will hold biannual follow up meetings with 100 traditional leaders. EPHO will conduct mentorship activities quarterly to the districts and district monthly to the health facilities and communities. The District and Health facilities will support SMAGs and other support groups through technical support. The SMAGS and TBAs will support the referral of clients from the community to the health facility. Institutional deliveries will be promoted. DBS courier system will be strengthened by partnering with Riders for Health. EPHO will orient 300 health workers on DBS collection, storage and transportation. The districts will strengthen male involvement by holding 16 meetings to sensitize community leaders in couple counseling. Creation of awareness on HIV /Prevention will be enforced through sensitization on the electronic and print media. A total of 156 radio programmes will be aired. Unwanted pregnancies in HIV positive women will be reduced through provision of family planning and counseling services. This will include promotion and provision of both male and female condoms of which consistent use will be advocated for.Intra facility meetings will be used as a means of monitoring. Initiation of ARVs in the MNCH department will be supported to ensure all HIV infected pregnant women and infants are timely commenced on treatment. Adherence treatment supporters will play a major role in strengthening the referral system and supporting clients to adhere to treatment and other care and support activities. Extended NVP prophylaxis for breast fed babies of HIV positive mothers will be enforced. PMTCT will strengthen TC services at all levels and thus HIV concordant couples will be identified for treatment of positive partners preferably within MNCH for women, whilst negative male partners will be linked to the MC programme. . Clients will be tested for syphilis at least once during her pregnancy and those who test positive will be counseled and tested and treated. Advocating for male involvement will lead to strengthening of couple counseling and women who test negative at initial test will be supported by the family to have a repeat test. By creating linkages with TB/HIV, ART, baby pair tracking will be strengthened by providing baby mother follow-up registers, providing motivational packs (incentives) to community based volunteers. Three hundred (300) health workers will be trained in Infant and young child feeding. An additional $40,000 of COP12 PFIP funds will go towards operationalization of the new PCR testing site, build on work initiated using previous years PEPFAR resources Infrastructural improvements and accessory equipment purchases required to operationalize the new PCR facility will be done

EPHO will strengthen and expand the ART services in the province in line with national objective to halt and begin reducing the spread of HIV/AIDS by increasing access to quality HIV/AIDS services.EPHO will train 100 health workers in the new Adult ART management guidelines. Monthly mentorship, On Job Training, follow ups, and technical support supervision by clinical care teams in districts and Quarterly by Provincial Clinical care team to the districts. EPHO will facilitate holding of quarterly clinical symposia in all the districts and bi-annual provincial clinical symposia at the two level two hospitals. EPHO will integrate prevention with positives (PwP) as part of standard care in all ART sites through the care and support. Quarterly community drug and therapeutic committee meetings will be held to strengthen adherence and retention of patients on treatment. The community drug and therapeutic committee will be strengthened through technical and supportive supervision by the province and district teams. The Province will spearhead monitoring and reviews through holding of quarterly HIV/TB review meetings, and technical support by districts. The provincial quarterly technical review meetings with the districts will be integrated with other programs e.g. TB. EPHO and the districts will participate in the commemoration of World AIDS day. EPHO will strengthen provision of mobile ART services and scaling up to 10 more centers. TB and PMTCT clinic will be strengthened to provide ART to patients attending the respective clinics. 10 mobile ART sites will be upgraded to static ART sites. EPHO will purchase laboratory equipment and supplies which will facilitate in quick provision of quality ART services. EPHO will 50 train health workers in logistical management to strengthen the logistics management in ART services. Buffer drugs and supplies will also be procured. Intra-facility meetings will be held to strengthen referral system between ART and other programs. EPHO will strengthen reporting systems and clinical meetings in order to monitor the number of clients with reactions to ARV drugs and monitor the number of clients changed from first line drugs

EPHO will ensure that at least 10% of patients on ART are children by strengthening and scaling up Pediatric ART services. Routine screening of HIV positive children for OIs and nutrition will be strengthened during clinical reviews, during childrens clinic. EPHO will train 50 health workers in new pediatric ART management guidelines, and 50 health workers in pediatric mentorship.Monthly mentorship and technical support supervision by district clinical care teams in all districts will be conducted. The province will provide mentorship on quarterly basis. During mentorship the teams will look at ART management, DBS, PITC, and child counseling, follow up of exposed children, and Co-trimoxazole prophylaxis. Clinical symposia will be integrated with the Adult treatment symposia. Quarterly HIV/TB review meetings for eight districts and the technical review meetings by PHO will be integrated with other programs and will act as a monitoring and review tool. EPHO will also support scale up of mobile ART service to all districts. The trained community lay counselors in drug adherence under Pediatric care and support program will play a major role in ensuring that clients adhere to treatment and follow up visits to the facilities for reviews. In order to keep the lay counselors abreast with new information, quarterly meetings will be held at district level. EPHO will join the rest of the world in commemorating WOLRD AIDS DAY. Mass community sensitization through the media and other forum will take place. Production of IEC materials on HIV/AIDS/TB/PMTCT to reinforce prevention interventions will be printed. EPHO will procure laboratory reagents to support diagnosis and management. EPHO will also procure reagents for the PCR machine