The Partnership for Integrated Social Marketing (PRISM) program is a $65 million contract between USAID/Zambia and Population Services International to distribute health services and products in Zambia from August 1, 2009 to September 30, 2014. With FY12 funding, PRISM will implement 1) activities to prevent and/or control HIV infections, sexually transmitted diseases, diarrhea in children, malaria and 2) family planning services to promote child spacing.

PRISM will collaborate with the Ministry of Health and other in-country stakeholders to ensure equity of access to health services and products and country ownership. PRISM will target people living with HIV and those deemed to be at great risk of contracting HIV for HIV services, pregnant women and children for malaria prevention, males and females of reproductive age group for family planning, and children under the age of five for safe drinking water.

PRISM will implement the following HIV activities with FY12 funding:

1) Socially market male and female condoms, testing and counseling, and male circumcision,

2) increase awareness of and demand for aforementioned health products and services,

3) implement activities that promote abstinence, being faithful, and consistent and correct use of condoms, and

4) Provide care and support to people living with HIV/AIDS.

PRISM will make the program more cost-effective over time by adopting strategies for cost containment, including cost recovery, cost sharing and developing the ability of a commercial/private sector entity to produce and market Clorin, or any other socially marketed product in a sustainable, self-sufficient manner.

PRISM has devised a robust monitoring and evaluation plan, which utilizes service statistics, special surveys, and sales as data sources

PRISM will collaborate with Sustainability through Economic Strengthening and Support for Orphans and Vulnerable Children (STEPS OVC) to implement adult care and support activities described in this budget code narrative with FY 2012 funding. PRISM will provide adult care and support services in sites where STEPS OVC will operate their adult care and support programs across the entire country. These activities will target HIV-infected adults between the ages of 15 and 49 years, including those under home based care and in hospices.

The program will not have specific care and support sites, but will support STEPS OVC adult care and support programs to reduce the incidence of diarrheal diseases among people living with HIV/AIDS (PLWHA). PRISM will donate 200,000 bottles of Clorin to treat approximately 133,400,000 liters of drinking water to PLWHA through STEPS OVC.

To assure quality, PRISM will train 72 partner coordinators who will in turn train 8,500 caregivers on the benefits of consistent and correct use of Clorin in households with people infected with HIV. Further, PRISM will provide onsite demonstration to promote correct and consistent use of Clorin to community-based programs run by STEPS OVC.

To promote integration, the donation of Clorin will run alongside the safe water education campaigns conducted by the GRZ, other local and international Non-Governmental organizations, which promote good personal hygiene such as regular hand washing, boiling of drinking water, and proper storage of drinking water, and food.

. STEPS OVC will also be responsible for program monitoring and evaluation. The monitoring and evaluation will encompass all other activities that STEPS OVC will undertake. PRISM will participate in training of trainers and standardize all training materials for caregivers.

PRISM will collaborate with Sustainability through Economic Strengthening and Support for Orphans and Vulnerable Children (STEPS OVC) to implement pediatric care and support activities described in this budget code narrative with FY 2012 funding. PRISM will provide pediatric care and support services in sites where STEPS OVC will operate their pediatric care and support programs across the entire country. These activities will target HIV-infected children between the ages of 0 and 14 years, including those under home based care and in hospices.

The program will not have specific care and support sites, but will support STEPS OVC pediatric care and support programs to reduce the incidence of diarrheal diseases among children infected with HIV/AIDS. PRISM will donate 200,000 bottles of Clorin to treat approximately 133,400,000 liters of drinking water to PLWHA through STEPS OVC.

To assure quality, PRISM will train 72 partner coordinators who will in turn train 8,500 caregivers on the benefits of consistent and correct use of Clorin in households with people infected with HIV. Further, PRISM will provide onsite demonstration to promote correct and consistent use of Clorin to community-based programs run by STEPS OVC.

To promote integration, the donation of Clorin will run alongside the safe water education campaigns conducted by the GRZ, other local and international Non-Governmental organizations, which promote good personal hygiene such as regular hand washing, boiling of drinking water, and proper storage of drinking water, and food.

STEPS OVC will also be responsible for program monitoring and evaluation. The monitoring and evaluation will encompass all other activities that STEPS OVC will undertake. PRISM will participate in training of trainers and standardize all training materials for caregivers.

Zambia is in the process of changing its male circumcision (MC) target of circumcising 2.5 million HIV-negative males by 2025 to 1.9m males by 2015. PRISM will collaborate with in-country US Government implementing partners, the Government of the Republic of Zambia (GRZ), the Bill and Melinda Gates foundation, and other stakeholders to support this ambitious goal. PRISM will perform 69,000 male circumcision (MC) procedures with FY 2012 funding in the Copperbelt, Eastern, Lusaka, Northwestern, Southern, and Western provinces. To promote efficiency, PRISM will continue to implement a comprehensive package of MC services, including female involvement, on-site testing and counseling for HIV, referral for care and support for individuals diagnosed with HIV in MC settings, treatment of incidental disorders such as sexually transmitted diseases, MC surgery, and care after surgery. PRISM will endeavor to raise the HIV testing rate pre-MC operation to 100% from the current average of 80% in its facilities.

The GRZ has realized that Zambia needs to do more to create demand for voluntary male circumcision if Zambia is to meet its ambitious MC target. PRISM will implement evidence-based demand creation efforts to support cost-efficient MC Service delivery, including inter-personal communications (IPC), mid-media such as workplace and school-based presentations, and mass media including live phone-in shows on popular community radio stations.

To assure quality of MC services, PRISM will implement the following training:

1) Eighty psychosocial counselors will be trained in MC-specific provider-initiated HIV counseling and testing services. This approach will use nationally recognized training materials designed by PRISM, which address issues related to post-MC risk behavior mitigation.

2) Twenty male circumcision providers will be trained as clinical trainers of trainers (TOTs) in diathermy, a specialized add-on clinical skill used for homeostasis during the MC procedure, using internationally recognized World Health Organization (WHO) training guidelines.

3) Sixteen MC providers will be trained as clinical Training of Trainers (TOT) using competency-based and internationally recognized WHO training guidelines to impart male circumcision clinical skills.

4) Ninety-six clinicians will be trained to in the provision of MC clinical services using competency-based and internationally recognized WHO training guidelines.

Other quality assurance activities will include provider supervision and quarterly health facility assessments, PRISM will endeavor to encourage female involvement as part of the counseling package.

PRISM will collaborate with in-country US Government implementing partners, the Government of the Republic of Zambia (GRZ), and other stakeholders to implement the abstinence and being faithful (AB) activities described in this budget code narrative. PRISM will use the male circumcision and counseling and testing platforms/services centers to reach 50,000 individuals will AB messages using interpersonal communication and group discussions. This approach will ensure that AB is provided as an integral part of a comprehensive package of HIV preventive services. The AB messages will center primarily on increasing individuals and groups primary and secondary abstinence, delayed sexual debut, fidelity, and avoiding multiple partnerships. PRISM AB services will be national, targeting females and males between the ages of 10 and 49 years, including adolescents and secondary and tertiary education students.

To assure quality of AB services, PRISM will train 60 individuals in HIV prevention with emphasis on AB, conduct supervisory visits to CT and MC sites and work with Communication Support for Health to develop and standardize communication materials.

The program will provide standard training and onsite mentorship to peer educators, schools, communities, and other affiliated organizations to maintain the quality of AB services. The program will collect data on the actual number of individuals reached with AB messages routinely and the impact of the interventions through special surveys.

The program will participate in national health and traditional events to enhance targeted communication

PRISM will collaborate with in-country US Government implementing partners, the Government of the Republic of Zambia (GRZ), and other stakeholders to implement the counseling and testing (T&C) activities described in this budget code narrative. T&C services will be implemented in eight provinces as part of a comprehensive package of HIV prevention services, including correct and consistent use of condoms, abstinence and being faithful (AB), male circumcision, and family planning. T&C services will include client-initiated T&C, provider-initiated T&C, couples testing, and special events highlighting T&C such as national CT day, world TB day, and World AIDS day. PRISM T&C services will target females and males above the age of 15, including individuals in multiple concurrent sexual partnerships, couples, and most-at-risk populations such as truck drivers, commercial sexual workers, migrant laborers, and uniformed personnel.

PRISM will primarily implement T&C services from 10 fixed service delivery points. In order to increase access to T&C services, each of these service delivery points will serve as hub for mobile activities. PRISM aims to provide T&C services to 180,000 clients, with emphasis on couples counseling (20% of the target) and mutual disclosure. The program will reach out to couples in remote areas through door-to door home based T&C, and will provide post- test sessions to discordant couples, and link them to care and treatment services. PRISM will provide T&C services to around 500 commercial sex workers and around 6000 long distance drivers, and uniformed personnel.

To assure quality of T&C, PRISM will train 80 individuals in T&C, including aspects of MC, AB, condoms, and family planning. The program will provide onsite quality assessment to standardize CT services. PRISM will implement counselor assessments and client exit interviews/mystery client survey. PRISM will use information from these assessments to evaluate the quality of T&C and make recommendations to improve T&C services.

To improve linkages and integration, PRISM will provide post-test positive living sessions through its Horizon Program (a five-day training program) to all clients who test HIV positive and link them to other HIV services, including antiretroviral therapy, post-HIV test clubs, sexually transmitted infections screening, TB screening, and continued psychosocial support. PRISM will work closely with partners providing these services to collect information on the number of clients who were referred and managed to access the services. PRISM will procure CD4 machines and conduct CD4 count on clients who test HIV positive at five static sites and collaborate with partners providing Anti-Retroviral Treatment (ART) services to link the clients. The Ministry of Health will provide training, technical support and conduct quality control for CD4 point of care/service.

In order to create demand for T&C, PRISM will use a number of approaches including interpersonal communications, community events and mass media advertisements. These activities will target the general population with special emphasis on couples and most at risk populations (MARPs).

PRISM will collaborate with in-country US Government implementing partners, the Government of the Republic of Zambia (GRZ), and other stakeholders to implement the Other Sexual Prevention (HVOP) activities described in this budget code narrative. PRISM will implement HVOP services across the entire country, targeting females and males between the ages of 15 and 49 years, including individuals deemed to be most at risk of HIV such as discordant couples, individuals in concurrent partnerships, female and male sexual workers, long distance truck drivers, and people living with HIV and AIDS (PLWHA. PRISM will implement HVOP activities alongside other HIV prevention activities such as abstinence and being faithful (AB), male circumcision, and counseling and testing (combined prevention) to maximize impact on HIV prevention. For example, 1) all MC and CT service centers will provide information about HVOP and stock condoms for distribution.

The program will 1) distribute 18.2 million pieces of Maximum male condoms and 450,000 pieces of Care female condoms through 1,000 distribution outlets, comprising both traditional (wholesalers, groceries, supermarkets, etc.) and non-traditional (bars, hair salons, hotels/motels, lodges, pharmacies, and guest houses, community based agents etc.) outlets. PRISM will work with CARE International and Zambia Health Education and Communications Trust (ZHECT) to train 540 individuals to promote HIV/AIDS prevention through other behavior change beyond abstinence and/or being faithful, including consistent and correct use of condoms, addressing discontinuation and irregular use of condoms, and dual protection of condoms from HIV infection and pregnancy. PRISM will reach 132,000 individuals with HIV prevention messages through use of interpersonal communication. The program will air the Maximum Condom Trusted Protection, Its Triple Tested mass media campaign to create demand for condoms and encourage consistent condom use among target groups. PRISM will reach a further 20,000 individuals with comprehensive messages for HIV prevention (condoms use, counseling and testing, and male circumcision through community events (like traditional ceremonies, sports events, village concerts etc) and the use of mobile video units (MVUs), especially in areas where there is limited access to national radio and television. PRISM will utilize its MVUs to promote HIV prevention during national and traditional events like National VCT day.

In order to generate information for further programming, PRISM will undertake a number of research and evaluations related to determinants of condom use and multiple and concurrent relationships. PRISM will conduct the Consumer Insight Study on Care female condoms and the willingness to pay study to inform the pricing of condoms. The evidence from these studies will help inform the program for the development of activities to improve female condom use and help in determining the pricing structure for condoms. Using evidence from previous studies done in collaboration with the Harvard Business School, PRISM will expand condom distribution and promotion through hair salons and barbershops

PRISM will collaborate with in-country US Government implementing partners, the Government of the Republic of Zambia (GRZ), and other stakeholders to implement the PMTCT activities described in this budget code narrative. PRISM will use its existing Horizon Post-Test Program to expand Reproductive Health Services among people living with HIV/AIDS (PLWHA). The Horizon Post-Test Program is a comprehensive ten-module program that offers people newly-diagnosed with HIV, the education, support, and tools necessary to make positive life changes that protect their health and the health of others. The Horizon Program works intensively with HIV positive clients and their families (including discordant cupules) during the first five months after receiving their results. Topics covered include a wide range of medical, social, spiritual, and legal issues affecting PLWHA, focusing on the development of personal action plans, and linking participants to a variety of long-term support, care, treatment options, and reproductive health services. The linkage to reproductive health services will target to reduce risk sexual behaviors and unintended pregnancies.