Western Province which is predominantly rural will by 2012 have a population of 906,379 (Central Statistical Office) and 211 health facilities. The challenging terrain, compounded by low population density, low staffing levels, and insufficient infrastructure make health service provision difficult. Provincial HIV prevalence is 15.3% (ZDHS 2007). Key HIV drivers are vertical transmission from mother to child, multiple and concurrent sexual partners, low and inconsistent condom use, low levels of male circumcision, mobility and migration.

Western Provincial Health Office (WPHO)s overall goal is to prevent new HIV infections and improve quality of life for people living with HIV/AIDS/TB. Target populations will include those living in high HIV and TB burden areas, pregnant women, children, PLWHA, and MARP.

Using the base funds, WPHO will increase access to services by scaling up, integrating services, and supporting outreach activities. WPHO will ensure quality of services in all technical areas through capacity building, mentoring, and adherence to quality assurance.

WPHO will support HIV prevention through implementation of PMTCT, Male Circumcision, education on risk reduction focusing on key HIV drivers with linkages to quality CTC, ART, and TB services that will be supported by quality laboratory services and strategic information.

WPHO will strengthen early infant diagnosis (EID), retention of mother baby pairs, Provider Initiated Testing and Counseling using family approach, and prevention among PLWHA and collaborate with other partners for nutrition assessment, counseling and support (NACS).

WPHO will develop a monitoring and evaluation plan for tracking progress and ensure adherence to USG financial regulations.

The objective of providing care and support to PLWHA is to improve quality of life of PLWHA. The linkages and referral systems within and between institutions and community is still weak.

WPHO will continue integrating treatment, care, and support to PLWHA in all districts. Further, we will maximize opportunities created by civil society with comparative advantage in working with communities to provide psychological, spiritual, social, and nutrition support.

Clinical care shall include provision of isoniazid preventive therapy (IPT) to 50% of eligible HIV positive patients, prevention and treatment of opportunistic infections, and other HIV/AIDS-related complications including Malaria and Diarrhea. WPHO will therefore support provision of commodities such as pharmaceuticals, insecticide-treated nets, safe water interventions and related laboratory services targeting PLWHA and their families. WPHO will support development of appropriate data collection tools to facilitate the follow up of faltering clients such as those missing pre ART appointments.

WPHO will strengthen linkages and synergies with other health programs aimed at leveraging resources. WPHO will train health providers and CBVs in home based care, NACS and create a forum for continued engagement of traditional and spiritual healers. WPHO will support the orientation of 20 stakeholders and 20 health providers in legal protection instruments related to care and support of PLWHA.

WPHO will support nutrition assessment and counseling to guide food supplementation and therapeutic feeds for patients with moderate and severe malnutrition. WPHO will also link PLWHA to other livelihood community programs.

WPHO will work in collaboration with other USG partners such as home based care (HBC) and others in implementing NACS while providing leadership in ensuring adherence to national home based care guidelines.

WPHO will monitor and evaluate care and support services through monthly reports, analysis of treatment supporters reports, technical review meetings and supportive supervision. The information generated from the health facilities and community will be shared with other stakeholders through multisectoral meetings.

The TB cure rate increased from 79% in 2009 to 82% in 2010. Ninety one percent of TB patients were counseled and tested for HIV, 75% were put on CPT and, 40% on ART.

WPHO will increase TB cure rate to 85%, counsel and test 95% and, put 90% of co- infected patients on CPT by FY 2012. WPHO will put 50% of eligible HIV positive patients on isoniazid preventive therapy (IPT) by 2015, increase the number of TB/HIV co- infected patients on ART from 40% to 60%, and screen 95% of HIV positive clients for TB by 2012.

WPHO will provide quality TB services by training 50 health providers in WHO TB modules, multi drug resistant tuberculosis (MDR-TB), TB infection control in ART sites and OPD, IPT, sputum fixation, and train 100 CHWs in TB treatment support.

WPHO will improve diagnosis of TB with smear examination for all suspects and improve quality of smear diagnosis through training of health providers and EQA implementation. WPHO will support activities for increasing TB detection through community out-reach TB campaigns and focused active TB case finding such as in prisons and other high TB burden areas. Further, WPHO will strengthen TB screening in pediatrics, PMTCT, CTC, MC, and care, support and treatment settings.

WPHO will screen health workers for TB annually and treat those found with TB. We will procure 20 microscopes with solar panel sets for health centres in order to increase smear positive case detection and procure GeneXpert for MDR-TB diagnosis.

WPHO will support treatment adherence, strengthen defaulter and contact tracing through procurement of 100 bicycles and 200 T-shirts for treatment supporters. We will continue to support 17 TB corner nurses, 2 drivers, TB/HIV Coordinator and Accountant.WPHO will support commemoration of World TB day, and support provincial, district and health centre TB/HIV coordinating body meetings and activities. WPHO will actively engage community leaders in implementing community TB activities.

WPHO will support transportation of slides to diagnostic centres and sputum specimen for MDR-TB from districts to University Teaching Hospital.

WPHO will support quarterly TB/HIV technical support from Province to District and District to health center; conduct technical data review meetings to ensure data consistency and quality.

WPHO will monitor and evaluate TB services through data quality assessment, monthly, performance assessment, and supportive supervision reports. WPHO will also ensure sustainability of TB services by ensuring that TB activities are included in district annual plans.

The goal of Pediatric Care and Support is to optimize the quality of life for the HIV infected children and their family through delivery of a comprehensive package of care. WPHO will support development of a system that will ensure strong and effective linkages to treatment.

WPHO is experiencing a long turn-around time for Polymerase Chain Reaction (PCR) contributing to low pediatric enrolment on care, support and treatment. The long turn-around time is compounded by inadequate DBS collection skills and inefficient courier system. WPHO is experiencing difficulties in capturing data on nutrition, OI management, palliative care, links to water and sanitation, and TB/HIV in children due lack of standardized reporting tools at facility and community levels. WPHO will therefore support development of appropriate data capturing tools.

WPHO will increase access to quality care and support by supporting and training support groups and health providers in NACS and strengthen PITC at both facility and community levels. WPHO will further, strengthen the courier system for DBS and where possible support short message service transmission of PCR results in order to improve EID and early treatment initiation.

WPHO will collaborate with and link HIV infected infants to partners implementing OVC programs in order to promote long-term HIV-free survival. Further, WPHO will strengthen maternal and neo-natal child health services. The preventive care package will include prevention of OIs including co-trimoxazole (CPT) prophylaxis, promotion and education on use of safe water and basic hygiene, immunizations, and provision of ITNs.

WPHO will support NACS, formation of adolescent support groups, and training of 28 adolescent peer group members in order to enhance prevention among adolescents infected with HIV, scale up adolescent ART services including sexual and reproductive health and increase treatment retention.

WPHO will train and provide mentorship to 20 providers in PITC, 20 in pediatric counseling, DBS collection, palliative care and nutritional support. WPHO will procure a PCR machine for the provincial laboratory in order to reduce DBS results turn-around time. WPHO will therefore support training of laboratory technologists in the operation of the PCR machine.

WPHO will train community adherence supporters in tracking mother-baby pairs. The treatment supporters will be assigned mother- baby pairs for support and follow up in order to ensure continuum of care and retention. Further, WPHO will support districts to support treatment supporters in order to minimize turnover and ensure provision of comprehensive care.

The goal is to improve the capacity of laboratory services to provide quality, reliable, and accurate results, in order to enhance diagnosis, patient monitoring and management of HIV/AIDS/TB/STI related conditions.

Human resource is still a challenge, of the 54 positions in the provincial establishment only 22 are filled. WPHO will scale -up laboratory services to ten more facilities and will increase the number of 100% supported laboratory personnel from eight to ten.

WPHO will support the accreditation of two laboratories, train 20 laboratory workers in strengthening laboratory management towards accreditation. The trainings will be under taken in collaboration with MOH and chest disease laboratory.

WPHO will support training of 20 health providers in rapid HIV testing and TB diagnosis to increase access to TB/HIV testing. The quality of rapid HIV testing, preparation and fixing of sputum smears has not reached the desired standard and therefore, WPHO will strengthen supportive supervision and mentoring activities. WPHO will support procurement of solar systems for microscopes in health facilities without power to ensure continuous supply of power for laboratory services.

Laboratory quality assurance (QA) is weak in some of the laboratory investigations such as chemistry, hematology and malaria while TB and CD4 external QA has improved. WPHO will therefore strengthen EQA for other laboratory investigations. WPHO will train 20 laboratory personnel in QA and strengthen QA system at all levels.

WPHO will support procurement of one PCR machine in order to reduce the turn-around time for DBS from three to one month ultimately increasing paediatric ART enrolment. We will renovate three laboratory structures to meet the demand for increased laboratory services and accreditation criteria.

WPHO will contribute to strengthened specimen referral and transportation system by procuring cool boxes and fuel for motorbikes in order to reduce delays in TB/HIV diagnosis, initiation of clients on treatment and disease monitoring.

WPHO will monitor implementation of activities through quarterly technical support, quarterly review meetings, and progress reports.

The goal is to strengthen the PHO, DHO s and health providers capacity in data collection, analysis and its utilization for decision making and service delivery improvement as well as monitoring of program performance.

WPHO in FY 2010 trained 26 health providers in SmartCare, procured and installed solar panels to power SmartCare machines in eight sites in FY 2010 and procured 15 additional solar panels using PMTCT plus funds for sites earmarked for scale-up. These interventions have contributed to improvement in data consistency, data quality and patient continuity of care. However, SmartCare scale-up is still constrained by lack of power in 65% of health facilities.

WPHO will support a systematic and consistent flow of data from Health facilities to DHO, to PHO, and finally to MOH headquarters and partners. WPHO will support Data Associates (DA) and Health Information Officers (HIO) to conduct onsite report collection and data verification. This support will strengthen timely reporting and improve data quality. Further, HIOs and DAs will provide technical support to facility health providers on data collection, management, analysis, and its use in improving implementation of health services. WPHO will continue salary support for the eight Data Associates.

WPHO in FY 2012 will train 50 providers in SmartCare, support orientation for 20 health providers on the new SmartCare modules. WPHO will continue supporting districts to sensitize communities on the benefits of Smartcards through drama performances, community meetings, and radio programs. WPHO will procure 15 solar panels for sites earmarked for SmartCare scale- up.

WPHO will support training of provincial and district staff in data quality assessments, data analysis, M&E and report writing through the advanced Epidemiology for data users training. The provincial staff will be trained as trainers who will then conduct two trainings for district staff. These training will enable staff to create epidemiological profiles, conduct data quality assessment and conduct various analyses of HMIS, NACMIS, and SmartCare systems to inform decision making.

WPHO will also continue paying monthly bandwidth usage for the seven DHO and PHO internet sites.WPHO will monitor strategic information activities through monthly reports, technical review meetings, progress reports, and site supervisory visit reports.

The goal of systems strengthening is to increase access, utilization of, effectiveness and efficiency of TB/HIV services in WP. WPHO will support a leadership capacity building orientation for PHO and DHO program officers in project management in order to enhance the quality of project planning, implementation, monitoring, and evaluation and ensure timely submission of reports to CDC. WPHO will support one annual project planning meeting, quarterly project review meetings, and one team building retreat for PHO and DHO program officers in order to enhance ownership and integration of the project activities at all level. WPHO will develop a comprehensive monitoring and evaluation plan encompassing all technical areas in order to facilitate tracking of progress and achievements. WPHO will continue providing leadership in implementing TB/HIV programs in collaboration with other partners and support partners meeting and sharing of best practices at both national and international fora. WPHO will support 100% salary supported project staff in the existing implementing sites and in new scale-up sites in order to mitigate the shortage of staff. WPHO will develop a strategy for absorption of eligible staff on 100% supported provider into government payroll system.

WPHO will support training of CEs in order to facilitate task shifting to reduce pressure exerted on the existing few trained staff. WPHO will also support capacity building for trained health providers in all technical areas. WPHO will conduct annual staff performance appraisal for the 100% supported project staff and support the DHOs in supportive supervision of the health facility staff. WPHO will also support the creation of a human resource database in order to strengthen the provincial human resource information system and use it as an advocate tool for more provider allocation. WPHO in line with the women and girl centered approach will support linkages to victim support services, Tetanus Toxoid immunization, family planning, and renovate four mother's waiting shelters in selected districts. WPHO will support districts to in cooperate CoAg supported technical areas into the district plans in order to ensure sustainability. WPHO will support the provision and maintenance of the transport fleet, procurement of fuel, lubricants, office stationery, and other logistics. It will also support the financial audit of the project books of accounts to ensure accountability and adherence to USG financial regulations and expenditure guidelines. The WPHO continue will supporting training of Provincial and District staff in data quality assessments, 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 epidemiological profiles, conduct data quality assessments and conduct various analyses of HMIS, NACMIS and SmartCare systems to inform decision-making.

The goal is to contribute to the reduction of the high (15.3%) provincial HIV prevalence and achievement of USG/GRZ target of 100,000 circumcisions for FY 2012.WPHO scaled-up MC services from three in FY 2009 to 11 sites in FY 2010. WPHO trained 17 MC providers, 19 MC counselors, and performed 2,204 MC procedures by June 2011 against the target of 4,000.

In FY 2012, WPHO will promote and support provision of MC by circumcising 4,900 HIV negative males in the age range of 13-39 years.

WPHO 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.WPHO will strengthen community MC activities and create demand through work with traditional leaders; train 30 CBVs as MC counselors; in order to meet the demand, 30 MC providers and 30 counselors will be trained, and MC services scaled-up to seven zonal health facilities.

WPHO will partner partnership with JHPIEGO and other USG partners to provide a comprehensive package of MC services including CT, risk reduction counseling, promotion of correct and consistent use of condoms and linkages other prevention, treatment, care and support services.

WPHO will use of community structures such as neighborhood health committees, Barotse Royal Establishment, churches, and schools to increase awareness; and support 40 radio programs on MC focusing on role of MC in HIV prevention, location of services and clarification of myths and misconceptions. WPHO will also support sensitization and education of at least 60% of prisoners; and will make efforts to reach youths with MC messages targeting at least 40 schools, YFHCs, and at youth gatherings. WPHO will support production of 10,000 brochures in local languages, and support MC campaigns in selected communities.WPHO will renovate ten MC rooms in order to create space for provision of MC services and procure surgical equipment and supplies for MC sites.WPHO will strengthen linkages for clients testing HIV positive to ART, family planning and STI services.

WPHO will support technical supervision and mentoring of MC providers in all sites in order to ensure quality MC services and reduce risk of post operative adverse effects,

MC services will be monitored and evaluated through monthly program review meetings and reports, performance assessments and bi-annual progress reports.

The goal is to increase the number of people knowing their HIV status in order to promote timely enrollment to care, support and treatment for those testing positive to the HIV test and contribute to the reduction of new HIV infections through risk reduction education irrespective of the HIV status.WPHO trained 40 health workers and 35 CEs in CTC, 33 Health Workers and 35 CBVs in couple counseling and as a result of these interventions, 82,391 clients (exceeding the target of 60000) were counseled and tested by June 2011.

In FY 2012, WPHO will create demand for CTC services by engaging community leaders in educating and sensitizing their subjects on the importance of knowing their HIV status. WPHO will also work with other line ministries to come up with strategies for strengthening HIV prevention activities and increase testing and counseling up take in workplace areas. WPHO will support linkages to care, support and treatment services.

WPHO will train and mentor 80 CBV in CTC, support drama performances and door to door CTC strategy in collaboration with the CIDRZ rural VCT, community compact teams and coordinate quarterly stakeholders meetings at all levels.

WPHO will support districts to increase access to CTC services by scaling-up CTC services from 161 to 181 sites, support CTC outreach activities to market places, fishing and lumbering camps. WPHO will build capacity in providing quality CTC services by training 40 health workers and 80 workers from other line ministries in individual, couple and peer counseling. Further, WPHO will strengthen PITC in health facilities, communities focusing on at risk populations, support the provincial TB/HIV campaign and promote CTC family centered approach and linkages to support groups.

WPHO will strengthen linkages between other reproductive health services including MC and adolescent reproductive health services, treatment and TB services. Further, WPHO will support districts to implement activities aimed at reducing pre-ART loss to follow-up through use of CBVs. WPHO will support linkages monitoring activities in order to ensure an effective and efficient referral system. Furthermore, WPHO will ensure that positive partners in discordant relationship are initiated on HAART regardless of their CD4 count. Individuals testing HIV negative will be educated on HIV risk reduction focusing on vertical transmission of HIV from mother to child, multiple and concurrent sexual partners, low and inconsistent condom use, low levels of male circumcision, mobility and migration

WPHO in line with MOH guidelines will ensure provision of quality CTC services with a focus on mentoring and adherence to HIV testing algorithms.

WPHO will monitor and evaluate CT services through data quality assessment, monthly, performance assessment, and supportive supervision reports. WPHO will also ensure sustainability by encouraging districts to integrate CT activities in annual plans.

The goal of the HIV other prevention is to contribute to the reduction of new HIV infections. In FY 2010 WPHO trained 60 youths in peer counseling, 29 health workers in syndromic management of sexually transmitted infections (STI) and provided technical support to all the districts. WPHO reached 48, 578 individuals with messages on HIV prevention by June 2011 and tested 606 youths for HIV.

WPHO will train CBVs in order to mitigate the impact of high drop-out rates and scale-up HIV prevention services targeting general population, PLWHA, and MARPs such as prisoners, youths, and those living in fishing and lumbering camps. WPHO will support 3 districts to carry outreach activities to fishing and lumbering camps and enter into strategic partnerships with community leaders, CIDRZ rural VCT team and community compact partners (CIDRZ, CMMB and Concern International) in supporting community driven HIV prevention interventions.

WPHO will train health providers and PLWHA support groups in HIV prevention, 40 community leaders and 60 CBVs as mentors, and 60 peer counselors in order to enhance community HIV prevention activities. WPHO will further train 80 health workers in syndromic management of STIs.

WPHO will renovate two youth friendly corners, procure TV sets, and DVD players for facilities with electricity or solar power and collaborate with Zambia National Information Services for communities without power to enhance dissemination of HIV prevention messages. Further, WPHO will support youth friendly corners to provide youth friendly services with a focus on prevention of HIV, alcohol and substance abuse, teenage pregnancy and other sexually transmitted infections. WPHO will support Mongu Youth Alive to undertake youth targeted HIV prevention activities such as HEART life skills, Behavior change communication, peer HIV counseling, testing, and education, and facilitate interschool debates on selected TB, HIV, MC and other adolescent sexual and reproductive health topics.

WPHO will support production of local videos using local personalities to model abstinence and faithful behaviors and safe sex practices for sexually active youths. Further, WPHO will support local artists to compose HIV prevention songs that will be played in public transport, and large gatherings such as football pitches, traditional ceremonies and global and national commemoration days. WPHO will also support airing of HIV prevention messages.

WPHO will work with Modeling and reinforcement to combat HIV Zambia in promoting behavior change targeting key drivers of HIV. WPHO will support integrated HIV prevention out-reach activities such CT, PMTCT, condom distribution, sputum slide-fixing for suspected TB cases, STI screening and linkages to ART, TB, STI, MC, and PMTCT services to ensure continuity of care.

WPHO will monitor activity implementation through review meetings, reports from technical support, performance assessment, and supportive supervision visits to districts and districts to health facilities and communities.

The goal of mother to child transmission (MTCT) is to attain elimination of MTCT of HIV by increasing coverage and access to quality services using more efficacious ARV regimens, and fully integrating PMTCT program into maternal neonatal and child health (MNCH) services.Since 2009, 295 providers were trained in PMTCT resulting in 160 health facilities offering PMTCT services; HIV testing uptake increased from 75% in 2009 to 88% in 2010; ARV prophylaxis to PMTCT mothers and exposed babies was at 79% and 95% respectively.In FY 2012, WPHO will support implementation of a comprehensive package of PMTCT services. CIDRZ will provide PMTCT services in four districts while WPHO will support the remaining three districts (Sesheke, Shangombo, and Senanga) resulting in 17 new sites. WPHO will create demand for PMTCT services by working with community leaders, men and SMAGs in sensitizing and mobilizing communities to support and utilize PMTCT services.

WPHO will intensify use of efficacious ARV regimens, increase couple counseling and testing, CD4 testing, retention and adherence of mother- infant pairs and linkages and referral to care and treatment. Further, WPHO will promote integration of FP in all services such as CTC, Male Circumcision (MC) and infant and young child feeding (IYFC).

WPHO will train 60 health workers and 30 Classified Employees (CE) in PMTCT and Family Planning (FP), TB screening and couple counseling, train 20 PMTCT trainers, and 40 health workers in IYCF, and 100 SMAGs; and conduct mentorship in these areas.

WPHO will integrate ART in selected PMTCT sites in order to improve mothers and infants access to ART services. WPHO will train 300 PMTCT mothers and discordant couples in PMTCT counseling and peer education and strengthen support groups in order to enhance follow-up of motherbaby pairs and link postnatal mothers to FP services and negative male partners to MC services; through assignment of lay counselors, SMAGs and peer educators to patients.

WPHO will strengthen syphilis control in Maternal and Neonatal and Child Health (MNCH) settings by ensuring that all pregnant mothers and their partners are screened and treated for syphilis; WPHO will procure testing kits and hemoglobin back-up supplies.

WPHO will continue salary support to PMTCT coordinator and 19counselors with the intention of future absorption into government payroll. WPHO will procure a motor vehicle and 20 motorbikes to facilitate mentoring and supportive supervision activities. WPHO will support DBS, CD4 and other specimen transportation in order to ensure timely enrollment and initiation of mother baby pairs on treatment.

WPHO will monitor program implementation through performance assessment, monthly reports, technical support visit reports, CoAg monthly meetings and bi-annual data audit review meetings.

Using the COP12 PMTCT PLUS UP funds will implement one-off activities intended to strengthen the base of the PMTCT program in the province. These activities will be designed to: Increase health worker retention in rural facilities; Increase utilization of maternity; continue to expand integration models for ANC and ART; Support development of integration models for PMTCT, pediatric HIV care, and routine MNCH services such as EPI, growth monitoring, nutritional support and post natal services; Continue to expand sustainable intra-district laboratory sample courier systems.

WPHO will continue contributing to Zambias HIV treatment goal of providing access to at least 85% of individuals who are eligible to take ARVs. Treatment of PLWHA with HAART is a key strategy in mitigating the impact of HIV/AIDS.

WPHO by the end of FY 2010 will have 22 ART CoAg supported sites. A total of 3,037 eligible patients have been initiated on ARVs by the end of March 2011 of which 13% were lost to follow up. The scaling-up of ART services has been challenged by a critical shortage of staff and inadequate infrastructure in health facilities.

WPHO will continue supporting 12 ART providers and a Coordinator on 100% salary support. WPHO will scale-up ART services to six new sites, take over two of CIDRZ ART site, recruit six Clinical Officers/Nurses and support training of nurse prescribers. WPHO will also renovate and refurbish six additional ART rooms.

WPHO will strengthen quality of ART services by training of 40 health providers in adult ART/OIs, and 20 health providers in adherence counseling. WPHO will train 80 community adherence counselors to ensure prophylaxis and treatment adherence, counsel and test family members, and promote prevention among positives and discordant couples.

WPHO will use SmartCare system to track treatment retention and evaluate clinical outcomes including mortality rates, immunological improvement and viral load reduction. WPHO, in collaboration with John Snow Incorporation, will continue training ART providers in logistics management.WPHO will continue mentoring health providers in new and old sites monthly and quarterly respectively to ensure adherence to ART accreditation guidelines. WPHO will continue supportive supervision, procure furniture, stationary and six motor bikes, and support transportation of specimens to district and provincial laboratories. WPHO will put in place a system to monitor and follow-up referrals.

WPHO will monitor and evaluate the program through monthly reports, technical review meetings, performance assessment, technical support, and progress reports.

The goal of pediatric treatment is mitigate the impact of HIV and improve the life of HIV infected children.

Pediatric treatment enrollment has increased from 6% in FY 2009 to 8% by mid FY 2010. The objective therefore is to increase treatment enrollment from 8% to 10% in FY 2012 by strengthening the DBS courier system, scaling-up to six new sites, and improving the treatment retention.

WPHO will ensure availability of ARVs with emphasis on fixed dose combinations by strengthening logistics management. WPHO will introduce short message service (SMS) technology to ensure reduction in turn-around time for PCR results, and strengthen EID in order to ensure immediate ART initiation for all HIV infected children.

WPHO will train 40 providers in pediatric ART and four nurse practitioners in ART prescription. WPHO will support mentoring of pediatric ART providers in clinical and laboratory monitoring (CD4% and biochemistry), early recognition, and management of treatment failure. WPHO in line with emerging evidence will update providers accordingly. WPHO will train 28 providers in adolescent ART and strengthen the process of transitioning to adult ART.

WPHO will support and strengthen treatment adherence and defaulter tracing. WPHO will train 20 pediatric counselors, support formation and training of adolescent support groups. WPHO will also support community treatment/adherence supporters in order to increase the treatment retention from 87% to 95% in CoAg supported sites.

WPHO will support integration of ART in antenatal and post-natal care to strengthen linkages and increase access to ART services for the mother-baby pairs. WPHO will support linkage of children and adolescents living with HIV and AIDS to nutrition support groups.

The program will contribute towards procurement of CD4 and biochemistry analyzer machines. WPHO will procure three speed boats and four motor bikes in order to facilitate ART mobile services and support transportation of specimens and results to and from the facilities and referral laboratories.WPHO will monitor and evaluate the program through monthly reports, performance assessment, technical review meetings, technical support, and progress reports.