Zambias HIV prevalence rate is 14.3% and is highest among females and in urban areas (16.1% and 19.7%, respectively). 70% of new HIV infections are from sex with non-regular partners (MOT, 2009). Six key drivers of Zambias epidemic are: multiple concurrent partnerships, low and inconsistent condom use, low male circumcision, mobility and labor migration, high risk behavior among vulnerable and marginalized groups, mother-to-child transmission, and social and cultural norms contributing to the epidemic such as alcohol abuse, gender inequality, sexual and partner violence, transactional sex, stigma, and discrimination.

Project Concern International (PCI) works with Zambia Episcopal Conference (ZEC) and Evangelical Fellowship of Zambia (EFZ) to implement Church Partnerships for Positive Change (CPPC) Project in 12 compacts in Mongu and Mazabuka. CPPC will scale-up with 10 new communities in the two districts, totaling compacts to 22 in Year 3. Scaled-up will be community-led HIV prevention activities promoting health-seeking and risk reduction behaviours. Gender and economic empowerment will be integrated in programs.

For sustainability and ownership, CPPC will collaborate with and leverage resources with other USG partners, like New Start centers providing clinical and mobile services and with Government and other providers for condom social marketing and MC services, and, and in support of community compact incentives, private companies like Barclays Bank, Radio Christian Voice, Zambia Sugar Company, Munali Nickle Mine, Kapinga, and Syringa Dairy Farms in Mazabuka. CPPC will implement activities within all appropriate national frameworks, manuals, protocols and guidelines.

HVSI

The Church Partnership for Positive Change (CPPC) compact model is a highly participatory, cyclical and iterative process of building the capacity of compact communities to identify and analyze the key drivers of the local epidemic, identify enabling factors and barriers to reducing risk behaviors, and develop and implement community action plans that promote health-seeking and risk reduction behaviors.

In order to achieve this, CPPC will continue strengthen compact committee members skills in participatory approaches to monitoring and evaluation (M&E) by conducting basic M&E training which will include basic M&E concepts, developing simple M&E plans for the community action plans, using data collection tools, developing simple data analysis tools, and defining M&E roles and responsibilities and data flow from the community compacts, through the partner to PCI.

CPPC will provide on-going mentoring, and support the churches to collect, analyze and use data for key decision making and improvement of program activities. In addition, CPPC will support partners to track their performance against project indicators and targets that are linked to activities in the compact action plans, and will use quarterly and annual performance results to award incentives.

HVAB

This past year, CPPC has been successful in increasing the numbers reached with interventions that encourage risk reduction and promote HIV prevention. A total of 1,782 persons were reached with interventions primarily focused on Abstinence and Being Faithful. This success was due to the use of innovative strategies to reach young people like youth group meetings, church sermons, sports as well as increased cross-learning among the partners.

In COP13, CPPC activities will build upon the success of the past two years of the project, strengthening the capacity of ZEC/EFZ and church leadership to implement need-based community action plans that address increased knowledge, demand and uptake of HIV prevention services. AB activities will focus on providing youth with life skills, HIV prevention information which will enable individuals to practice abstinence and/or faithfulness, delaying of sexual activity, reducing MCP, and encouraging partner faithfulness. CPPC will continue to target young people aged 10-24 (10-14 and 15-24) with interventions promoting behaviors aimed at risk avoidance and risk reduction, including those in and out of school, in both rural and urban settings.

In addition to AB messages, CPPC will promote benefits of clinical prevention services such MC, CT and PMTCT; promote communication between young people and adults; gender equity and equality including, reducing gender based violence and establishing safe spaces for girls; address harmful social norms; and training young people in life skills according to national guidelines. The project will utilize existing church structures; mens, womens, youth and couples fellowships, and cell groups, as well as peer education to disseminate individual and small group messages.

CPPC will continue to facilitate linkages between community and the health facility for CT, PMTCT, MC, and STI services, but also to other providers for care and support. CPPC will also promote sexual and reproductive health education for youth which recognizes the churchs position, but at the same time provide adequate and accurate information. CPPC will also integrate structural interventions that address alcohol abuse, gender based violence (GBV), stigma and discrimination, and livelihood security.

For sustainability and ownership, CPPC will develop and sustain public-private partnerships in support of the community compact incentives, continue to work through and build the capacity of religious leaders and their members through training and on-going mentoring in monitoring and evaluation, tracking performance on set indicators and targets, and using results to award incentives. CPPC will ensure program and data quality through quarterly on-site supportive supervision and quality assessments.

HVCT

Counselling, testing, and knowing ones HIV status is one critical element in behavior change and can also be an entry point for care, support, and treatment. In response to this, CPPC will continue to mobilize and support trained religious and other lay church leaders to mobilize congregations and communities on the risks of HIV, benefits of couples HCT, and to provide referrals and information about where additional services can be obtained.

To improve and promote the quality and uptake of couples counselling and testing, 50 more religious and lay church leaders from each community compact would be trained as lay counsellors according to national guidelines. Training will include quality assurance and appropriate post-test counseling with specific HIV prevention messages for discordant couples, positive clients and negative community members. These leaders will go door-to-door providing group counselling for family members followed by pre- and post-test counselling for household-members.

In addition to this, lay counsellors will also visit households with a known HIV-infected member and provide counselling and testing services to consenting adults and assenting children. This approach is effective in identifying discordant couples, children whose parents are living with HIV, and parents whose children are living with HIV. Moreover, CPPC will identify and encourage people who have been through couples testing to reach out to and refer other couples, disseminate messages about benefits of couples testing, the CHCT process, sero-discordance, and to provide referrals and information about location of HCT and related services.

CPPC will intensify referral and follow-up of clients who have been tested for HIV and diagnosed as HIV-positive to ensure access to care, treatment and prevention services. For those who test negative, counseling will focus on prevention messages tailored to clients behaviour and referral to prevention interventions, such as voluntary male circumcision and psychosocial support groups.

CPPC will use couples counselling to address issues of gender based violence (GBV) and discrimination that women who test alone and get an HIV positive result subsequently face. This will be achieved through conducting follow-up discussions on gender-based violence, encouraging disclosure of HIV test results between sexual partners, including referral for couples post-test counselling, and encouraging families and community leaders to play active roles in GBV prevention.

Furthermore, CPPC will partner with parish based home-based care providers and other USG-funded partners such as CHAMP as well as government CT sites, particularly in the more rural districts, to provide community-based HIV mobile voluntary counselling and testing that improves access to quality CT including couples testing and assisted mutual disclosure. This will be achieved through SBCC community events to ensure clients have access to same-day, opt-out HCT.

CPPC will continue to utilize existing church activities to disseminate individual and small group messages on partner/couples testing; partner HIV status disclosure, GBV and links to HIV/AIDS, and follow up care, such as antiretroviral therapy (ART) adherence support and MC. CPPC will also use this activity as an entry point to providing the minimum package of prevention with positives services through referrals to existing providers.

In order to promote ownership and sustain

HVOP

During the year FY12, PCI has been successful in increasing the number of individuals reached with interventions that promote positive attitude and behavior changes as well as discourage cultural norms, social values and sexual practices that predispose communities to HIV. A total of 6013 individuals were reached with individual and/or small-group HIV prevention interventions that are based on evidence and/or meet the minimum standards required: 319% of PCIs annual target for Other Sexual Prevention (HVOP). This success was due in part to the strong foundation established in year one, and intensive efforts by church leaders to implement innovative proactive outreach to communities and strong mentorship from the PCI/CPPC technical team.

For FY14, CPPC will continue to build the capacity of ZEC/EFZ and church leadership in 22 communities to facilitate critical reflections on risks involved in multiple and concurrent partnerships (MCP) and alcohol abuse, intensify social and behavior change and communication (SBCC) activities, and create demand for and uptake of services such as condoms by strengthening referral linkages with other programs that are able and willing to promote and provide condoms.

CPPC will mobilize and support trained church leaders to work with their congregations through existing church structures, door-to-door and mobile services and make referrals for individual and CHTC, PMTCT, prevention with positives (PwP), VMMC, and other components of comprehensive MC such as HIV testing, STI care, and condom utilization. CPPC will target adult and youth males and females including married couples.

CPPC will continue to mobilize and support trained church leaders to work with traditional leaders to discourage negative traditional norms such as prolonged sexual abstinence that occurs when a woman is pregnant; harmful practices such as ritual intercourse during girls initiation ceremonies and lessons on how to use corrosive herbs and other ingredients to dry out the vagina to increase male sexual pleasure as marriage preparation for girls; and instead promote beneficial attitudes and behaviours including risk reduction measures for alcohol consumption, partner reduction, CHTC, and consistent and correct male and female condom use among discordant couples through couples, mens and womens meetings.

CPPC will sensitize communities on sexually transmitted infections (STIs) including early recognition of symptoms, early and complete treatment, and partner notification and management. CPPC will promote discussions on topics such as HIV transmission, MC, couples CT, supportive partner disclosure of HIV status, MCP, stigma and discrimination, alcohol abuse, gender-based violence (GBV), and PwP to assist individuals to adopt low risk behaviors and increase their uptake of preventive services.

CPPC will enhance institutional ownership and sustainability of program interventions by working through church leadership/management structures; building church leaders technical, management, and facilitation skills; collaborating with existing government/private health facilities; and, building public-private partnerships for provision of compact incentives. CPPC will promote provision of quality services by training and mentoring church leaders in CPPC core technical areas, facilitation skills and basic monitoring and evaluation, and by conducting regular supportive supervision, and program and data qualit

The goal of this intervention is to promote improved health seeking behavior by pregnant women and their families through a family based approach, which includes involvement of spouses in ANC and PMTCT services, facilitation of partner and couple HIV testing and counselling (CHTC), and promotion of early infant diagnosis (EID). CPPC utilizes a variety of behavior change approaches to promote critical reflections, dialogue, and learning, and, ultimately, positive behaviour change.

CPPC will continue promoting early and complete ANC attendance; supervised delivery in PMTCT clinics, EID for HIV exposed infants, support for infant baby nutrition, and prevention of unintended pregnancies utilizing a family-based approach to education, identification of pregnant mothers, and referral for PMTCT services. Special sessions for expectant families will be held at churches. The sub-population will also be reached at cell group, couples fellowship and womens groups, door-to-door, mobile CT, and HBC services and through PLHIV support groups.

To improve uptake of CHTC, an additional 50 lay counsellors for CHTC will be trained to disseminate information about PMTCT, invite congregants, especially men and people who have been through CHTC themselves, to become peer educators who educate and mobilize their peers to access health care services. Training will include quality assurance and appropriate post-test counselling with specific prevention messages for discordant couples, positive and negative clients.

CPPC will continue to strengthen referral linkages the community compacts and health facilities, and linkages to care and support services, including maternal neonatal and child health (MNCH), and family planning (FP), ART, STIs, and voluntary medical male circumcision (VMMC) for HIV-negative male partners of HIV-positive pregnant and breastfeeding women. Gender and economic empowerment will be integrated into all activities.

CPPC will support quality improvement of church home-based care programs targeting HIV-positive mothers and their babies. The support will focus on infant feeding practices, postnatal care and newborn follow-up care, including EID. CPPC will work with trained church leaders to raise awareness and motivate women about the benefits of early cervical and breast cancer screening and treatment; provide information about where services can be obtained, referrals for eligible clients, and encourage women to complete follow-up care.

CPPC will work with safe motherhood action groups (SMAGs) to carry out community mobilization to raise awareness about maternal health, male involvement in FP and ANC, distribute birth plans, and encourage mothers to take their children to under five clinics using existing church structures. CPPC will work with MoH and CDC to use IEC materials developed at the national level in facilitating discussions on subjects including HIV/AIDS, malaria, family planning, MNCH and nutrition, breast and cervical cancer screening, and consistent and correct condom use among discordant couples.

CPPC will track PMTCT service uptake by coordinating with MOH and other private health facilities, and mobile partner providers to ensure two-way referrals between communities and facility level services. CPPC will ensure program and data quality through quarterly on-site supportive supervision, mentoring and quality assessments. CPPC will continue to engage in private sector partnerships in support of com