The HIV/AIDS epidemic has hit the Zambia Defense Force (ZDF) disproportionately with an HIV/AIDS prevalencethat is two times higher than the national prevalenceof 14.3%Data collected in ZPS health centers show a high rate of HIV infection among police officers and their families. some factors unique to the uniformed population disproportionately predispose them to HIV infection. These factors include high mobility due to deployment to peace keeping missions and local operations, excessive consumption of alcohol, and engagement in transactional sex that is facilitated by high disposable income. PCI will continue to support ZDF to implement HIV/AIDS prevention, care and support services that link to the ZDF strategic plan and the ZASF in 52 ZDF units located in all the nine provinces of Zambia. PCI will also start a pilot capacity building and system strengthening program in five ZPS sites in Lusaka, Kitwe, Ndola and Livingstone districts and will tap on existing ZDF programs in these districts for a rapid scale up. The FY12 plan will be aligned to GHI and the PEPFAR Partnership Framework principles including: integration of GBV programs into prevention programs and integrating gender across the continuum of care; strengthening and leveraging key partnerships with the GRZ, UN agencies, Feed the Future (FTF) wrap around livelihood and economic strengthening programs for OVC and their caregivers, In FY 11, PCI focused on system strengthening and capacity building interventions to support ZDF to implement quality and sustainable HIV/AIDS programs. In 12/13, PCI will shift the focus to take a supervisory supportive role and will support DFMS to take the lead in planning, supervising, and monitoring and evaluating the implementation of HIV/AIDS activities in ZDF units.

PCI and DFMS will continue to support Home Based Care (HBC) caregivers to reach adult PLWHA, 18 years and above, with quality community-based care and support services that link to facility based services. PCI and DFMS will support 80 HBC caregivers to reach 2,370 adult PLWHA and other family members (18 years and above) enrolled in the HBC program with services including: ART drug and clinic appointment adherence; co-trimoxazole (CPT) and Isoniazid (INH) prophylaxis adherence; referral for prevention with positives services; GBV preventionin relation to how it precludes ART adherence and partner disclosure; opportunistic infections and side effects assessment and management; nutrition counseling; psychosocial and spiritual support, and death preparedness; and, early referral of pregnant clients to PMTCT services. PCI will support DFMS to maintain and sustain the robust referral linkage between community-based and facility-based services, and thus ensure that PLWHA are provided with continuum of care from facility to community.

PCI will continue to support 20 ART ZDF sites to provide quality Nutrition Assessment, Counseling and Support (NACS) services in 2012/2013. PCI and DFMS plan to reach 538 malnourished PLWHA and orphans and vulnerable children (OVC) with therapeutic feeding services. PCI will continue to assist ART sites to conduct nutrition assessments using anthropometric measurements and will support DFMS to fully integrate therapeutic feeding protocols as outlined in the 2011 national nutrition guidelines for PLWHA. PCI will continue to support DFMS to monitor the consistent supply of weighing scales and height boards, mid- upper Arm Circumference (MUAC) tapes and body mass index (BMI) charts, to aid anthropometric assessments. PCI will support DFMS to leverage NACS services and sustainable livelihood and economic strengthening programs for its clients from other USG NACS and FTF programs, and the World Food Program (WFP).

PCI and DFMS will support TB community-based treatment supporters to intensify TB case finding among PLWHA enrolled in the HBC programs and refer them to facilities for diagnosis and treatment. As MOH rolls out the provision of Isoniazid Prevention Therapy (IPT) for PLWHA with no active TB, PCI will support DFMS to ensure that community adherence follow up tools integrate monitoring of IPT access and uptake for PLWHA.

PCI will continue to provide technical assistance to DFMS to integrate cervical cancer screening for female military personnel and civilians into mobile CT services. In 2012/2013, DFMS plans to reach 3,000 female military personnel and civilians in and around 15 ZDF units with cervical cancer screening services, provide on-site treatment for pre-cancerous lesions, and refer advanced lesions to the University Teaching Hospital (UTH) centre of excellence for diagnosis and further management. PCI will continue to provide technical support to DFMS to integrate routine PICT, GBV prevention and men involvement in cervical cancer screening and promotion services.PCI will support DFMS to scale up the HBC income generating program and will support an additional 10 ZDF HBC groups with seed grants for income generating activities as a retention strategy

HIV Prevention, Care and Support Services for female and male OVC 15-18 years

In 2012, PCI will support DFMS to reach older OVC/youths in and around 20 ZDF units with BCC interventions that address factors presently driving the HIV epidemic among youths under this age bracket in Zambia, and social and cultural norms that predispose them to HIV infection and constrict them from accessing facility-based prevention and treatment services.

This includes support to forty youth peer educators from Anti AIDS clubs in schools in and around the 20 ZDF units to reach 3,000 youths with BCC interventions including: correct and consistent condom use promotion, influencing behavior change around abstinence and being faithful, CT promotion, MCP and inter-generational sex risk perception and prevention, STI prevention, prevention of unintended pregnancies, life skills education, and GBV awareness and prevention. Referral linkage will be strengthened between school-based BCC interventions and facility-based youth-friendly clinical services such as condom distribution, voluntary family planning, STI screening and syndromic management, CT and ART, and Post exposure prophylaxis (PEP) for sexually abused youths. In 2011, PCI supported DFMS to train 20 health workers from health facilities in the 20 ZDF units on youth friendly services and established youth-friendly corners.

Community based care and support services for female and male OVC 0-5 yearsThe program will support 100 HBC caregivers to reach 300 OVC, using the home based care platform, in 20 ZDF units with community-based services that link to facility based services including; collection of Dried Blood Spot (DBS) from HIV exposed children and referral to facilities for HIV diagnosis, CPT and IPT prophylaxis adherence support, OI assessment, management and referral, Infant and young child feeding (IYCF) counseling in line with the 2010 national PMTCT guidelines, active case finding of malnourished OVC, nutrition counseling and referral to facility-based therapeutic interventions.

Community based care and support services for OVC less than 18 yearsIn addition support to 100 HBC caregivers and 20 guidance teachers to reach 3,000 OVC with psychosocial support services that align to the 2011 national guidelines for HIV counseling and testing for children and using Say and Playa child focused counseling tool developed to reach younger children. This includes support to provide school scholarships to 2,000 OVC, 60% of whom will be girls, to promote retention in school. The program will continue linking OVC to leveraged wrap around services, including malaria prevention, education sponsorship, economic strengthening, livelihood, food, and security programs such as from FTF and WFP programs that were identified in a mapping exercise in 2011. DFMS will be supported to finalize the ZDF OVC policy that will provide for an institutionalized and sustainable system within ZDF to provide care and support services to OVC.

PCI will support DFMS to provide implement income generating activities in the 20 ZDF OVC sites to support OVC with sustainable services.

PCI will focus on strengthening the ZDF Health Information Management System and will focus on supporting the DFMS M&E unit to collect, analyze, and use timely, reliable data for planning, monitoring, and evaluating progress towards the achievement of program targets. PCI will continue to provide technical support to DFMS to disseminate information from program data to ZDF leaders, ZDF medical directorates, unit commanding officers, unit HIV/AIDS coordinators, service providers, and stakeholders and facilitate evidence-based design, management, and policy making.

PCI will support the DFMS M&E unit to conduct the annual M&E training for 52 unit HIV/AIDS Coordinators and Ward Mastersfield officers responsible for data collection and reporting. The training will address challenges and gaps in M&E and/or provide for an opportunity to modify and refine the ZDF performance monitoring plan (PMP) to integrate emerging issues. PCI will finalize the process to support all the 52 DFMS units to move from paper-based reporting to electronic reporting and will support DFMS to put in place a plan to sustain the operation of the central data base that PCI supported DFMS to set up in 2011. PCI will support DFMS to link the DFMS HMIS system to the national MOH HMIS system and the national M&E framework.

PCI will continue to support HIV/AIDS Coordinators and Ward masters to develop decentralized and unit-based HIV/AIDS work plans and PMPs. PCI will support DFMS to provide quarterly supportive supervision visits to all the 52 units to monitor and track progress towards the implementation of activities in the plan and achievement of indicators in the PMPs. During the supportive visits, PCI will support the DFMS M&E team to conduct service delivery and data QA/QI and validation to ensure quality programming and quality data collection and management. PCI will support DFMS to refine and sustain the QA/QC monitoring systems integrated into all service delivery program areas and ensure there is a sustainable system for quality programming.

PCI will provide technical assistance to DFMS to apply for a small grant from the global fund round nine Zambia grant to support the implementation of ZDF HIV/AIDS workplace prevention programs. PCI will also provide technical support to DFMS to lobby ZDF leadership for the integration of HIV/AIDS activities into the ZDF budgetas outlined in the 2009-2014 ZDF Strategic Planand thus sustainably institutionalize funding for HIV/AIDS programs into the ZDF budget.

In FY2012, PCI and DFMS will conduct a final evaluation of the program, which will focus on documenting the achievement of project objectives, drawing inferences about the effectiveness of approaches used, analyzing the overarching lessons learned from the project, and documenting the impacts of project activities. PCI and DFMS will share evaluation findings with ZDF, donors, partner NGOs, key GRZ agencies, and experts in the field to maximize learning and disseminate lessons learned and promising practices.

PCI will also continue to support DFMS to integrate into the M&E system an on-going sharing and learning process for best practices and lessons learned during program implementation through documentation and sharing of lessons learned and promising practices in-country and across countries and adaptation of promising practices from other programs into their setting.

In FY 2012, PCI will start implementing pilot health system strengthening interventions in five ZPS pilot sites in Lusaka, Kitwe, Ndola, and Livingstone districts. PCI will support the ZPS Medical and Health Services department and the ZPS HIV/AIDS secretariat to conductCapacity assessments and a situation analysis to identify gaps in the implementation of quality HIV/AIDS prevention, treatment care and support programs. PCI and the ZPS HIV/AIDS secretariat will use results from the capacity assessment to develop capacity building plans which will include training of ZPS health workers in identified HIV/AIDS technical areas in partnership with the Ministry of Health, training in monitoring and evaluation and HIV/AIDS data management and data usage. PCI will also facilitate linkage of the ZPS HIV/AIDS data management system to the MOH HMIS system and the NAC M&E unit. PCI will also support the five ZPS health centers with equipment and tools that are necessary to deliver quality HIV/AIDS and nutrition services.

In their current workplan, the ZPS HIV/AIDS Secretariat has planned to train health workers in ART management and PMTCT in line with the revised MOH guidelines. PCI will support ZPS to train 20 health workers from the five pilot sites in adult and pediatric ART management and PMTCT in line with the 2010 MOH Adults and Adolescents ART protocols, the 2010 Guidelines for ART for HIV Infection in Infants and Children in Zambia, and the 2010 PMTCT protocols. PCI will also train 20 ZPS health workers in the five pilot sites in the implementation of a minimum package of PWP intervention. PCI will train the ZPS Nutritionist and 10 health workers in NACS and PCI will support the five ZPS pilot sites with equipment, tools and supplies necessary to implement NACS including nutrition counseling cards, BMI charts, height boards and scales and supplementary food for clinically malnourished PLWHA.

PCI will also support the ZPS HIV/AIDS Secretariat to train 50 community health workers from the existing home-based care groups in the five pilot sites in ART adherence support, PWP, palliative care, community-based PMTCT follow up and monitoring, community-based NACS, and psychosocial and spiritual counseling. PCI will support ZPS to build strong referral linkages between, community- based programs and facility-based programs for PLWHA and support them to offer a continuum of care for ZPS PLWHA from the facility to the community.

PCI will support ZPS and Zambia Prisons service to strengthen HIV/AIDS counseling and testing and TB screening, diagnosis and treatment services in four main prisons including Chimbokaila, Kamfinsa, Mukobeko, and Katombora Juvenile prisons. PCI will train 20 health workers from the four prison clinics in provider initiated counseling and testing, TB screening, diagnosis and treatment in line with MOH protocols. PCI will also train the 20 health workers in the management of HIV/TB co-infection. PCI will provide counseling and testing equipment and supplies to the four prison clinics.

PCI will train officers from the national ZPS Victim Support unit and decentralized units in the five pilot sites on the provision of post exposure prophylaxis (PEP) to victims of gender-based violence and will support the units to strengthen the referral system between the VSU units and health centers for gender-based violence victims.

During this funding period, PCI will continue to support DFMS to implement quality CT services in ZDF units. PCI will support DFMS to increase CT coverage through the continued integration of innovative approaches, such as quality home-based CT and mobile CT services. PCI and DFMS plan to reach 13,289 military personnel and civilians with quality CT services through the three platforms above. PCI will also support DFMS to place emphasis on couple counseling and will support them to integrate an indicator into their performance monitoring plan (PMP) to monitor and track the number of couples reached.

To increase demand for CT services, PCI will engage ZDF drama groups to conduct community mobilization in the 52 ZDF units and raise awareness on the benefits of CT couple counseling, GBV prevention in relation to CT access, and partner disclosure especially among women. PCI will further support the printing of flyers that will contain contact details of lay counselors providing home-based CT services and will support the printing of mobile CT calendars to be distributed widely in target communities prior to the implementation of services. PCI will support DFMS to develop and maintain a system and referral tools to track the provision of regular CT services for discordant couples and referral of positive partners to ART services regardless of clinical status as per national CT guidelines.

PCI will support DFMS to conduct refresher training for 20 ZDF health workers and 40 lay counselors on quality HIV testing and counseling using the national protocols. The training will also cover topics on couple counseling and testing, partner notification, discordant couple monitoring and referral, Provider Initiated Counseling and Testing (PICT) for health workers, and GBV prevention.

PCI will continue to support DFMS to maintain and sustain quality assurance and improvement (QA/QI) systems for facility based, mobile and home-based CT through regular joint supportive supervisory visits and program and data quality assessments. PCI will support DFMS to print CT algorithms and quality assurance protocols to aid QA/QI.

PCI will continue to support DFMS to monitor the effectiveness and efficient operation of the referral system between home/facility/mobile CT and facility based prevention, ART, and community based care and support services and will provide support to refine the referral tools and system as the need arises.

PCI will support DFMS to institutionalize a system for HIV test kits and condom supply chain management including strengthening linkages with the Ministry of Health (MOH) national supply chain system.

PCI, DFMS, and ZPS will support 275 peer educators, chaplains, drama groups, ZPS Positive Action Living (PALS) groups, and women clubs to reach 23,340 uniformed personnel and civilians (50% estimated to be uniformed personnel only) in and around the units with a behavior change and communication (BCC) minimum package of interventions developed in 2011 including: promotion of consistent and correct condom use; MCP risk perception and prevention; alcohol screening and counseling using the World Health Organization (WHO) AUDIT Tool; awareness raising on the benefits of male circumcision (MC), Prevention of Mother to Child Transmission (PMTCT), and counseling and testing (CT) with emphasis on couple counseling, partner notification, and facilitation of referral to clinic-based Male Circumcision (CT), PMTCT, and CT services; promote prompt health seeking behaviors for Sexually Transmitted Illnesses (STIs); and Gender based violence (GBV) prevention.

PCI, DFMS and the ZPS HIV/AIDS Secretariat will support the ZDF peer educators and ZPS PALS to use platforms most frequented by women and men such as Antenatal Care (ANC) and maternal child health (MCH)/ under-five clinics, the camp mess (pubs), unit indabas (large unit level informal meetings), and pre-deployment parades to communicate the BCC messages on HIV prevention and facilitate immediate referral to clinical services. PCI will also support DFMS and the ZPS HIV/AIDS Secretariat to supervise and mentor drama groups to conduct community mobilization and sensitization on the BCC minimum package and implement intensified campaigns as precursors to mobile CT and MC interventions. Support will be through existing structures in ZDF and ZPS unitssuch as the 30 women clubs trained on HIV and Gender Based Violence (GBV) prevention in 2011 and the ZPS Nkwazi women clubs in the five ZPS pilot sitesand use the clubs as hubs for reaching women in and around the camps with HIV prevention, GBV prevention and mitigation services, economic empowerment, and property and inheritance rights education. DFMS and the ZPS HIV/AIDS Secretariat will leverage support from GIDD and strengthen linkage to the ZPS Victim Support Unit to provide a sustainable source of technical and financial support for GBV programs.

The program will leverage support from the Communication Support for Health (CSH) program to adapt and print specific BCC materials and campaign messages based lesson learnt from the ZDF program. Role model couples and opinion leaders, such as the service commanders and their spouses, and/or the commander-in-chiefalso the Republican Presidentand his spouse will be used to promote couple counseling. Five pilot sites will be used to refine and strengthen the referral system and tools to maintain and sustain the efficient and effective referral linkages between BCC interventions and clinic-based interventions such as CT, MC, and STI screening. PCI will support DFMS and the ZPS HIV/AIDS Secretariat to monitor and sustain the consistent supply of condoms in ZDF and ZPS camps and during mobile CT services.

PCI and DFMS will support health providers and home based care (HBC) caregivers trained in the implementation of the PWP minimum package in 2011 to reach 3,120 PLWHA with a minimum package of PWP interventions. PCI will also train 25 ZPS PALS in PWP and will support them to reach 300 PLWHA in the five pilot sites with a minimum package of PWP interventions.

During this funding period PCI will support the ZDF to scale up and increase access to community-based services which address maternal mortality reduction (MMR) through a prevention of mother-child transmission (PMTCT) program. Target participants will be service women and men as well as civilian women and men from the surrounding civilian communities in 20 of the supported 52 camps. PCI will build the capacity of the ZDF to initiate, improve and/or strengthen PMTCT services through training of community volunteers using available national training manuals, protocols and guidelines; to promote access to and uptake of PMTCT and MMR services through mobilization of communities for action; and to strengthen and/or establish referral systems for increased service access and continued follow up of mothers and their babies. The PMTCT training will integrate antenatal, early/safe delivery, postnatal, maternal and infant/young child nutrition, and family planning information in order to optimize contacts with participants and avoid missed opportunities for broader health messaging and behavior change.

PCI will use its existing presence and relationships in working with vulnerable community members, including women as a platform to strengthen and scale up PMTCT and MMR activities. PCI will build upon its experience in Zambia and elsewhere in promoting integrated health and nutrition with and for women and children, as well as its experience in linking household and community efforts with health system strengthening for more efficient and effective, comprehensive, life-cycle-oriented and family-centered interventions and impact.

At community level, PCI will support the ZDF to mobilize communities for support and promotion of PMTCT and MMR services through existing structures such as officers wives womens clubs, support groups of people living with HIV, and other existing groups. In particular, PCI will support the ZDF to facilitate formation of Safe Motherhood Action Groups (SMAGS), comprised of men and women, and Men Reaching out to Men (MRM) groups to spearhead reflective discussions around PMTCT and MMR, facilitate referrals for PMTCT and MMR, and conduct pre- and postnatal follow-up visits and ante-retroviral therapy (ART)/adherence support for mothers and their babies. PCI and the ZDF will also utilize the existing HBC structure of volunteers for group discussions and referrals for required services.

PCI and the ZDF will promote appropriate integration of messages on safe delivery, importance and benefits of antenatal and post-natal care, including optimal maternal and infant/young child feeding and nutrition, and family planning, as well as timely referral by community volunteers. PCI/ZDF will support the national maternal death reviews (MDR) system conducted by district health offices in collaboration with the SMAGS and other community action groups such as MRM groups, to track maternal deaths in the community, analyzing factors leading to the death, and using the information to improve provision of safe motherhood activities. The community volunteers will gain access to Ministry of Health registers for standardized data collection and reporting.