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 PLWHA with quality community-based care and support services that link to facility-based services. PCI and DFMS will support 300 HBC caregivers to reach 5,344 PLWHA and other family members 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 continue to 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 the community platform.

PCI will continue to support 30 ART ZDF sites to provide quality NACS services. PCI and DFMS plan to reach 565 malnourished PLWHA with therapeutic feeding services. PCI will continue to assist ART sites to conduct nutrition assessments using anthropometric measurements and will continue to 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 continue to 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.

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 FY 2013, PCI plans to support DFMS to reach 2,720 female military personnel and civilians in and around 20 ZDF units with cervical cancer screening services using visual inspection with acetic acid (VIA), provide on-site treatment using cryotherapy and refer advanced lesions to the University Teaching Hospital (UTH) center of excellence for diagnosis and further management. PCI will continue to provide technical support to DFMS to integrate routine provider initiated testing and counseling (PITC), rapid syphilis testing, and GBV prevention and men involvement in cervical cancer screening and promotion services. PCI will also strengthen the capacity of Maina Soko Military Hospital (MSMH) to serve as a cervical cancer referral site for loop electrosurgical excision procedure (LEEP). PCI will support the training of two obstetricians/gynecologists from MSMH in conducting LEEP procedures.

Through the PRRR initiative, PCI will support 300 peer educators to disseminate messages on cervical and breast cancer prevention and will support the Ministry of Community Development, Mother and Child Health (MCDMCH) to roll out the human papilloma virus (HPV) vaccination program in 35 schools in ZDF units.

In FY 2013, PCI will implement OVC programs in 35 ZDF units that focus on strengthening the economic capacity of families and households to provide for the essential needs of children in their care. PCI will support ZDF to integrate evidence-based Household Economic Strengthening (HES) interventions that will empower families to sustainably provide for the educational, nutritional and health needs of their children. The interventions that PCI will support will be child focused and family centered.

PCI will support ZDF to develop a Strategic Portfolio to be preceded by an assessment that will identify the most critical needs of children in ZDF units and surrounding communities. Based on that, ZDF context specific interventions will be identified and prioritized for support and implementation. The portfolio will also include other existing potential resources and structures in ZDF that can sustainably support the prioritized interventions. PCI will also continue to support all the ZDF OVC sites to conduct resource mappings in their catchment areas to identify other livelihood, economic strengthening and food security interventions for leveraged support. PCI will pilot social protection interventions, such as cash transfers, and Savings Group (SG) interventions whose success will be measured by families ability to invest in the education, nutrition and health of its children. Lessons learned and promising practices will be documented and disseminated before scale up.

Through community OVC caregivers, PCI will continue to support ZDF to implement OVC interventions according to ages and stages across the lifespan. For children in the prenatal to three age group, PCI will train and support 350 OVC caregivers to implement community-based child survival and early childhood development (ECD) interventions to reach 10,000 OVC. PCI will also support the lay cadres to refer OVC to facility-and community-based PMTCT, ART, NACS, immunization, and growth monitoring, adherence support and IYCF. PCI will continue to strengthen ZDF ECD centers and support 2,000, especially girls, enrollment in the centers. The centers will also serve as community platforms for PMTCT, ART, immunization, and psychosocial support programs, including disclosure and treatment adherence counseling.

For children in middle years, early and late adolescence, PCI will continue to work with ZDF to support the enrollment of children into formal schools, especially girls. PCI will facilitate the leverage of girls scholarships from other in-country organizations promoting girls education. PCI will train 75 teachers in 35 schools in integrated GBV and HIV prevention and psychosocial support and support them to create child-friendly, gender-sensitive classrooms. PCI will also train 350 OVC caregivers to raise awareness on birth registration and succession planning and prevention of child abuse and support them to reach 4,900 OVC with child protection services. PCI will also support the mobilization of school-based girls mentor groups through which 2,499 girls will be reached with life skills to enhance their ability to take responsibility for making healthier choices, resisting negative pressures, and avoiding risk behaviors. PCI will continue to strengthen youth friendly services in 30 ZDF health centers. PCI will work with ZDF to place older OVC and out-of-school youth in existing ZDF skills training programs such as the Kitwe ZNS Skills.

In FY 2013, PCI will support DFMS to build and strengthen referral linkages between community-based platforms and 30 ZDF health facilities that are providing early infant diagnosis (EID) and pediatric ART services. PCI will support maternal, neonatal, and child health lay cadres to refer 90 HIV positive and exposed infants and children and infants with underlying HIV infection to EID, ART, and reach them with other community-based pediatric care and support services.

To facilitate for this linkage, PCI will support DFMS to train 300 lay cadres in community-based pediatric care services and support them to deliver services including: testing 90 HIV exposed infant and children through the collection of DBS at community and facility level and facility-based rapid antibody testing to establish exposure; reaching 82 of the infants and childrens caretakers with IYCF, exclusive breastfeeding and nutrition counseling and support, and pediatric psychosocial support counseling with emphasis on disclosure; providing treatment and prophylaxis adherence support to 90 HIV positive and exposed infants and children; reaching 2,000 HIV positive, exposed and negative infants with community case management of childhood illnesses (CCMCI) including the identification of illnesses (diarrhea, pneumonia, HIV, malnutrition, TB and malaria), home-based management and referral to facility-based care for serious illnesses using the MOH protocols. PCI will leverage support from the Zambia Malaria Consortium for insecticide treated mosquito nets (ITNs) and deliver nets to 333 households with HIV positive, exposed, and negative infants and children.

PCI will support the cadres to work with health care providers to track the delivery of DBS samples to DNA PCR testing centers and take responsibility to deliver the results to the families once they have been sent back to the facilities in a timely manner. PCI will also support the cadres with tools to support and track adherence to treatment, cotrimoxazole and isoniazid prophylaxis. PCI will develop a tracking system for infants and children who are LTFU across the PMTCT-pediatric continuum and support the lay cadres to conduct timely follow ups in the community. PCI will also develop M&E tools to measure retention in treatment and care of the infant-mother pairs under their care.

PCI will support the cadres with job aids and anthropometric tools to conduct community-and facility-based pediatric NACS services. A total of 2,000 infants and children from 6-59 months of age accessing MCH, pediatric ART, TB, and community-based OVC services will be assessed for acute malnutrition and those found with severe or moderate acute malnutrition will be referred to therapeutic feeding services offered in ZDF sites and other USG funded NACS programs in the 30 ZDF facilities catchment areas. The caregivers will also be supported to provide breastfeeding counseling and support to 400 mothers/caretakers of infants 0-24 months of age and support HIV positive breastfeeding mothers with adherence counseling to avoid vertical transmission of HIV to their HIV negative and exposed infants. PCI will also support training of 40 health care providers in the 30 ZDF ART in NACS and IYCF to promote the harmonization of messages and care and to facilitate for the continuum of care between the community platform and the facilities.

PCI will continue to strengthen the ZDF Health Information Management System with a focus on strengthening the capacity of 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 continue to 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 continue to support all the 52 ZDF units to move from paper-based reporting to electronic reporting and will continue to strengthen DFMS to sustain the operation of the central data base that PCI supported DFMS to set up in 2012. PCI will continue to 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 also continue to 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 continue to 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.

In FY2013, PCI will support DFMS to integrate findings and recommendation from the final evaluation conducted in FY 2012 into the ZDF annual HIV/AIDS work plan and 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.

Prevention

MTCT (PMTCT): PCI will train 300 maternal, neonatal, and child health lay cadres in integrated ART/PMTCT community-based care and major modules include ART adherence counseling and support, family-centered home-based HIV counseling and testing including couple CT and referral; IYCF counseling and maternal nutrition, demand creation for facility-based ART, NACS, VMMC, and family planning services; and LTFUs tracing. PCI will also train 60 SMAGS in 4 ZDF units on community-based maternal and neonatal care including demand creation for antenatal care and skilled birth attendance. HVOP (Other Prevention): PCI will train 520 peer educators in all the 52 ZDF units to implement the ZDF minimum package of BCC interventions including promotion of consistent and correct condom use, MCP risk perception and prevention, alcohol screening and counseling, awareness raising and demand creation for biomedical HIV prevention servicesVMMC, lifelong ART to prevent HIV vertical transmission and sexual transmission to uninfected partnersCT and couples CT; and GBV prevention and mitigation. PWP: PCI will train 20 health workers and 300 lay cadres in the implementation of the minimum package of PWP services at facility and community level. HVCT (Counseling and Testing): PCI will train 10 ZDF health care and mobile CT providers in integrated HIV counseling and testing and rapid syphilis testing (RST) using the 2011 Guidelines for use of rapid syphilis tests in Zambia. PCI will also train 30 lay cadres from all the 53 ZDF units in conducting family-centered home-based CT, couples CT and referral.

Care

HBHC (Care and Support): PCI will train 300 home-based caregiver in palliative care and major modules will include pain assessment and management, psychosocial and spiritual counseling, adherence counseling and support, NACS, IYCF and community-based PWP. PCI will also train 10 ZDF health care providers in cervical cancer screening using VIA and treatment using cryotherapy and will train 2 obstetricians/gynecologists from MSMH in LEEP. To support the PRRR role out, PCI will train 300 peer educators in the dissemination of cervical and breast cancer awareness messages. HKID (OVC): PCI will train 350 OVC caregivers in CCMCI, integrated OVC caregiving to include modules on psychosocial support and Say and Play, prevention of child abuse and neglect, birth registration and succession planning, and GBV prevention and mitigation. PCI will also train 70 teachers in 35 schools on integrated psychosocial support, GBV and HIV prevention. PCI will train 350 girls (early and late adolescence) mentor group members in life skills approaches. PCI will also train 40 health care providers and 60 youth peer educators in youth friendly services. PDCS: (Pediatric Care and Support): PCI will train 300 maternal, neonatal, and child health lay cadres in integrated community-based pediatric care and major modules will include DBS collection and referral, rapid antibody testing, treatment and prophylaxis adherence support, LTFU follow-up, IYCF and exclusive breastfeeding promotion.

HVSI (Strategic Information)

PCI will conduct an annual training for 52 Ward Masters and 52 ZDFH HIV unit coordinators to update them on new program areas and indicators and address challenges and gaps in M&E, review and refine the ZDF standardized field data collection tool to integrate new program areas and indicators.

During this funding period, PCI will continue to support DFMS to implement quality home-based and mobile CT services in all the 52 ZDF units. PCI will continue to support DFMS to increase CT coverage through the continued integration of innovative approaches, such as cervical cancer screening and treatment. In FY 2013, and as prioritized by DFMS, PCI will support DFMS to integrate rapid syphilis testing into the integrated mobile CT and cervical cancer program. PCI and DFMS plan to reach 14,766 military personnel and civilians with quality CT services through the home-based and the integrated mobile CT program. PCI will also support DFMS to place emphasis on couples counseling and PCI and DFMS have planned to reach 3,000 couples with couples counseling and testing services through mobile and home-based CT.

To increase demand for CT services, PCI will engage ZDF drama groups to conduct community mobilization in the 52 ZDF units and reach 30,000 men and women with messages on the benefits of couples counseling and testing, cervical cancer and syphilis screening, GBV prevention in relation to service access, and partner disclosure especially among women. PCI will continue to 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 train 10 CT health care providers and counselors in integrated CT and rapid syphilis testing and referral to treatment. PCI will also support DFMS to train 30 lay counselors in conducting quality HIV counseling and testing using national protocols. The training will also cover topics on couples counseling and testing, partner notification, serodiscordant couple monitoring and referral to ART, and GBV prevention. PCI will continue to support DFMS to strengthen 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 guidelines.

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 continue to 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-based and mobile CT and facility based prevention, ART, PMTCT and community based care and support services and will continue to 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 will support 520 ZDF peer educators, chaplains, and drama groups to reach 28,393 uniformed personnel and civilians (50% estimated to be uniformed personnel only) in and around all the 52 ZDF with a behavior change and communication (BCC) minimum package of interventions developed in 2012 including: promotion of consistent and correct condom use; Multiple Concurrent Partnership (MCP) risk perception and prevention; alcohol screening and counseling using the World Health Organization (WHO) AUDIT Tool; awareness raising and demand creation for biomedical HIV prevention services including VMMC, antiretroviral therapy (ART) to prevent HIV vertical transmission and sexual transmission to uninfected partners, HTC and couples HTC; and Gender based violence (GBV) prevention and mitigation.

PCI and DFMS will support the ZDF peer educators 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 behavioral and biomedical prevention and facilitate immediate referral to clinical services. PCI will also support DFMS 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 HCT and VMMC interventions. PCI will continue to support DFMS to strengthen existing structures in ZDF units such as women clubs to diffuse messages on the prevention of GBV and support them to mitigate GBV cases in their units. PCI will continue to support DFMS to leverage support from the Ministry of Gender and strengthen linkage to the Zambia Police Victim Support Unit (VSU) to provide for a sustainable source of technical and financial support for GBV programs.

PCI will continue to support the HIV Secretariat to leverage support from the Communication Support for Health (CSH) USG project to adapt and print BCC materials and campaign messages based on the ZDF BCC strategy that was modified after a formative assessment conducted during FY 2012. PCI will also continue to support DFMS to use role model couples and opinion leaders, such as the service commanders and their spouses to promote couples counseling. PCI will continue to support DFMS to refine and strengthen linkages and referral systems in all the 52 units to maintain and sustain the efficient and effective referral linkages between behavioral interventions and facility-based biomedical interventions such as HCT, ART, prevention of mother to child (PMTCT), and STI screening. PCI will support DFMS to monitor and sustain the consistent supply of condoms in all the 52 ZDF units and during mobile CT services.

PCI will continue to support DFMS to integrate Prevention with People Living with HIV/AIDS (PWP) into routine care both at facility and community levels for pre ART and ART clients. PCI will support 40 PWP trained health providers and 300 lay cadres to reach 3,210 with a minimum package of behavioral and biomedical services to improve treatment outcome and reduce HIV vertical and sexual transmission. PCI will support the facility and community platforms with follow-up systems for pre ART clients to ensure that they are constantly followed up and reached with HIV prevention messages and services and are supported to enroll in ART services as soon as they are eligible.

PCI will support DFMS to identify and train 300 lay cadres who will focus on increasing community demand for facility-based PMTCT (Option B+), maternal, neonatal and child health services that will be implemented in 30 ZDF health facilities providing ART services. Male lay cadres will also be targeted for recruitment to increase male acceptance of the services. The cadres will be trained in an integrated community-based ART/PMTCT training focusing on family-centered and home-based HIV counseling and testing (CT), couples counseling and testing, infant and young child feeding (IYCF), and nutrition assessment, counseling and support (NACS). The trained cadres will be supported to identify 82 HIV positive pregnant women from the community and existing home-based care programs and refer them to facility-based PMTCT/ART services. Through family-centered CT, the cadres will be supported to reach 3,000 couples and refer negative male partners in serodiscordant couples to voluntary medical male circumcision (VMCC) services; while positive pregnant partners will be referred to ART services to prevent vertical transmission and HIV sexual transmission to the uninfected partner in line with the 2013 Ministry of Health (MOH) Policy Guidelines for Lifelong Antiretroviral Drugs for all HIV positive Pregnant Women in Zambia.

PCI will support the cadres to implement task sharing/shifting roles including facility-based CT for women accessing antenatal care (ANC) and maternal and child health (MCH) services and refer HIV positive clients to appropriate treatment, family planning and clinical care services. PCI will also support the cadres to provide facility- and home-based adherence and nutrition counseling service, exclusive breastfeeding (for the first six months) and IYCF counseling with intensified adherence counseling for breastfeeding HIV positive women clients. A total of 510 HIV positive women will be reached with community-and facility-based adherence and nutrition counseling services. PCI will support DFMS to develop tracking systems between the facility and community and support the lay cadres to track clients who are Loss-to-follow-up (LTFU). PCI will also support DFMS to develop M&E tools to measure retention of clients in community-and facility-based treatment and care programs. Quality standards and supervisory systems will be developed to ensure and track quality service delivery in community-based programs. PCI will integrate a remuneration system for the lay cadres to sustain their long-term engagement. PCI will identify external experts to conduct formative assessments in targeted ZDF sites to inform the development of BCC messages that address contextualized attitudes and socio cultural norms that prevent mother and children from accessing and retaining in treatment and care services. PCI will continue to integrate community-based maternal and neonatal care interventions based on the Saving Mothers, Giving Life (SMGL) initiative in ZDF units in SMGL districts in Zambia including Choma, Mansa, Nyimba and Lundazi. PCI will continue to strengthen community home-based care groups to integrate maternal and neonatal health interventions. PCI will train 60 lay cadres, including men, and safe motherhood action groups (SMAGs) to create demand for facility-based deliveries with skilled attendants, recognition of danger signs and provision of home-based emergency first aid and timely referral to facility-based obstetric care.