The COP 2012 goal is to support the provision of quality integrated services through capacity building and systems strengthening to promote sustainability and ownership. In Lundazi and Chadiza, we will continue integrated District Health Management Team(DHMT) andCenter for Infectious Disease Research (CIDRZ) technical support through on-site mentorship, supportive supervision and establishment of on-site quality assurance quality improvement (QA/QI) systems. Our focus is improving coverage of CD4+ screening through sample referral; integration of antiretroviral treatment (ART) services in maternal and child health departments (MCH); careful follow-up of mother baby pairs using community structures; and establishing strong monitoring and evaluation systems. In addition, we will strengthen follow up of HIV-exposedinfants; linkages to pediatric ART for infants identified as HIV infected;and nutritional care and support of HIV infected children.

In Chipata, we aim to reduce TB morbidity and mortality by improving diagnosis and co-management of TB and HIV co-infected patients; and reducing the spread of TB, particularly in HIV clinics. We intend to continue to strengthen the work of the DHO in intensified case finding; TB/HIV screening in TB, ART and MCH clinics; and also strengthen the linkages between these programs. Priority will be given to the use of simple screening forms and appropriate referral for TB testing. We will improve laboratory testing by facilitating training on fixed slide preparation and the use of bicycles and motor bikes in sputum sample transportation to TB diagnostic centers. Through our supportive supervision and mentorship activities, we will strengthen district ownership and stewardship of the TB/HV program.

Objective 1.0: Improve clinical screening and management of TB/HIV co-infected patients in HIV, TB, outpatient and maternal-child health clinicsWe will conduct training and facility based mentoring of 24 health workers in TB and HIV clinical management and Isoniazid Preventive Therapy (IPT). The trainings will cover TB screening, diagnosis, and management of co-treatment for TB and HIV; and provision of IPTWe will conduct training of 24 health workers in Provider Initiated Testing and Counseling (PITC)We will conduct training of 24 health workers in TB Infection Control (IC)We will pilot a TB screening program in antenatal clinics at two health centres.We will improve TB diagnostic capabilities at each site by conducting one central sputum fixing training for 24 health workers and lay microscopists; and procuring bicycles for sputum transportationObjective 2.0: To improve linkages to care between TB and HIV programmes and improve TB case detectionWe will conduct one linkages workshop for 24 health workers to improve the systems of referral and feedback between TB and HIV clinics.We will support Data Review and Coordinating Body meetings semi-annually.Objective 3.0: To support and mentor the provincial and district teams to develop local leadership and increase the consistent availability of TB logistics and data toolsWe will provide support for semi-annual data review meetings.We will conduct supervision in all sites three times a year. These visits will also be used to provide support for data management.Objective 4.0: To provide technical support to the MOH TB program including its surveillance and training initiativesWe will provide support to the district for the World TB Day celebrationsWe will provide support for orientations on new MOH guidelines

Major Goal: To improve the number of HIV infected infants and children initiating ART; improve their retention in care; and assess the feasibility of using nutritional supplements for malnourished HIV infected children on ART.Objective 1: We will increase the overall number of HIV infected infants and children initiating ART byTimely communication of infant HIV results to mothers/caregivers using active follow upImproving the linking of HIV positive infants from MCH to ART using peer educatorsActively following up no-show mother/baby pairsCounseling and testing siblings of unknown status and linking positive ones to ART care

Objective 2: We will improve the retention in care of HIV infected infants byIntensifying counseling using trained paediatric counselorsEmploying SMS technology for monitoring and follow-upActively following up defaulting clientsObjective 3: We will assess the feasibility and impact of using ready-to-use therapeutic foods to complement the treatment of HIV infected under five children with moderate to severe malnutrition at enrolment byTaking anthropometric measurements of all children on ART at each clinical visitDeveloping protocols based on national nutritional guidelines for use of nutritional supplements in management of malnourished children receiving ART careIntegrating nutritional supplementation for malnourished children within ART careAssessing the impact of nutritional supplementation for malnourished children on ART outcomesObjective 4: We will build the capacity of lay workers to help as a task-shifting activity to help manage paediatric ART patients byTraining lay workers in taking anthropometric measurements of childrenProviding supportive supervision to LHCW on an on-going basis

Objective 1: To provide family-centered, quality, integrated safe motherhood services.We will:Support provision of HIV counseling and testing; and syphilis screening for women and their partners throughout pregnancy and breastfeeding; placing emphasis on the provision of couples counselingIdentify HIV concordant and discordant couples and refer for HIV prevention, treatment and care services including male circumcision.Strengthen family planning services including the integration of HIV counseling and testing in family planning; provision of appropriate family planning counseling for HIV positive clients using MOH standard guidelines; and strengthening of supply chain management to ensure commodity securityIntegrateTb screening, gender based violence and youth friendly services in MCH through training and mentoring of health staff, lay community health workers and community structuresEstablish on-site PMTCT QA/QI systemsOrient and mentor community structures to promote early initiation of ANC services; couple counseling and testing; facility deliveries; and postnatal attendance throughout breastfeeding.

Objective 2: To provide more efficacious PMTCT regimens to ALL HIV positive womenWe will:Establish CD4 sample referral systemsIncrease integrated ART/ PMTCT sites from 2 to 4Introduce cell phone text messaging for active client referral to ART and follow-up of defaultersMentor health staff in integrated PMTCT/ART services, drugs and logistic systems; and HB and WHO clinical screeningTrain and mentor lay community health workers and community structures in PMTCT and ART; emphasizing initiation of ANC and timely ART initiation; adherence counseling; and follow up of defaultersObjective 3: To provide comprehensive HIV prevention, treatment and care services to HIV exposed babiesWe will:Provide HIV testing; Nevirapine and Cotrimoxazole prophylaxis; and infant feeding counseling in line with national guidelinesProvide HIV testing to siblings of HIV exposed infantsIntroduce cell phone text messaging for active referral of HIV positive babies to ARTMentor health staff to strengthen lost to follow up tracking and early infant diagnosis logistic and courier systemsIntroduce community registers for exposed baby trackingSupport outreach during child health weeks to identify and test HIV exposed babies

Objective 4: To strengthen monitoring and evaluation to enhance data quality and data use for decision making and strategic planningWe will:Support revision of HMIS registers in line with revised PMTCT and ART guidelinesSupport CDC epidemiology for data use training to enhance data useStrengthen and expand SMARTCARE and mentor health staff in its optimal useConduct data quality audits and data management mentoringOrient community structures in data appreciation and data use to improve demand and utilization of PMTCT and Pediatric HIV servicesProvide technical support to the Ministry of Health (MOH) Provincial and District Health Management teams during district planning and integrated review meetings

Goal: To support the provision of quality and uninterrupted ART to children in Lundazi and Chadiza.Objective 1: We will build the capacity of HCWs to manage paediatric ART patients byConducting one training in Paediatric ARTObjective 2: We will promote retention of HIV infected children on ART byPromoting health-seeking behavior through intensified counseling using trained paediatric counselorsEmploying SMS technology for monitoring and follow-upActively following up defaulting clientsObjective 3: We will promote equity of access to comprehensive ART services for children byEnrolling from a primarily rural community