Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 5016
Country/Region: Zambia
Year: 2007
Main Partner: U.S. Centers for Disease Control and Prevention
Main Partner Program: NA
Organizational Type: Own Agency
Funding Agency: HHS/CDC
Total Funding: $5,106,001

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $125,000

CDC-Zambia will continue providing technical assistance to the Ministry of Health (MOH), the National AIDS Council and implementing partners in the continued expansion of prevention of mother to child transmission of HIV (PMTCT) services nationally. In FY 2006, direct support was provided in terms of educational materials for the national program, job aids for health workers, an assessment on infant and young child feeding in the context of HIV/AIDS and national dissemination meetings for both national and international technical updates. In FY 2007, CDC-Zambia will assist MOH to strengthen the monitoring and data system from facility to national level reporting using the CDC developed PMTCT monitoring system.

In an effort to improve the national PMTCT program and provide HIV treatment to children before they become symptomatic, the U.S. Government (USG) supported the Government of the Republic of Zambia in FY 2006 to evaluate an inexpensive and less complex approach for use in the diagnosis of infant HIV-1 infection in Zambia. This targeted evaluation focuses on an inexpensive "boosted" p24 antigen and a much simplified dried blood spot total nucleic acid Polymerase Chain Reaction (PCR) assay recently developed at the CDC. Equipment for two different methods of infant HIV diagnosis has been installed by CDC at the newly established National Infant Diagnosis Reference Laboratory at the University Teaching Hospital (UTH) in Lusaka, using FY 2005 funds. These methods include the regular Roche Amplicor 1.5 DNA PCR assay and the TNA assay which detects both RNA and DNA. Both techniques have performed very well in preliminary quality assurance and quality control evaluations at the laboratory, including on dried blood spots collected from infant heel sticks at University Teaching Hospital (UTH). By the end of FY 2006, a number of PMTCT sites in three provinces will start sending infant dried blood spots routinely to the National Infant Diagnosis Reference Laboratory in Lusaka. Further roll-out of PCR testing on infant dried blood spots will be implemented nationwide in FY 2007. For difficult-to-reach rural districts, an evaluation of other potential infant diagnosis testing strategies such as the ultra-sensitive P24 antigen assay (a simple EIA technique) and/or other newer rapid antigen assays will be conducted. Work will be conducted in close collaboration with UTH and with the University of Nebraska-Lincoln.

In FY 2007, the USG will continue strengthening the national PMTCT program through the procurement of back-up (buffer) supplies in line with the USG Five-Year Emergency Strategy. As part of this activity, the USG will procure supplies that are vital in the provision of the national minimum package of PMTCT without national stock-outs. CDC will support the national PMTCT program with technical assistance and support for study tours and other relevant programmatic reviews.

This activity will support continued technical assistance to the MOH and Tropical Disease Research Center (TDRC) in the design of a public health evaluation (PHE) study of pregnant women to examine the impact of PMTCT programs on subsequent treatment outcomes in women and children (as well as a number of other related outcomes). This public health evaluation will take advantage of and contribute to several activities. These activities include: PMTCT, ART treatment, infant HIV diagnosis, pediatric antiretroviral therapy (ART), continuity of care, monitoring and evaluation of programs, outcomes, and surveillance of ART treatment and resistance in adults and children. The Global Fund will provide partial financial support for this research effort whilst CDC Global AIDS Program-Zambia staff will provide expertise in study design and facilitate the integration of available programs and services. Additional support focusing on malaria during pregnancy and operational research will be provided by the Gates Foundation and the World Health Organization. These efforts provide a timely and unique opportunity for TDRC and CDC-Zambia to leverage innovative developments in several strategic priorities supported by the Emergency Plan.

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $32,000

This activity is linked to activities for Counseling and Testing including HVCT (#9018), HVCT (#8883), HVCT new activity for USAID with SFH/PSI, and HVCT new activity for CDC with UTH-Clinic 3 and new activity for CDC with SFH/PSI. This activity is also linked to activities for ARV Services including HTXS (#9003) and the new CDC activity with Southern Province Provincial Health Office (#9760) with UTH-Clinic 3, and new activity for CDC with SFH/PSI.

Zambia has a population of approximately 10 million citizens (US Department of State, 2006), and overall HIV prevalence is nearly 16% among the general population and 13% among men (Zambia Demographic Health Survey, 2002). Currently, it is unknown how many men who have sex with men are residing in Zambia, thus there are no HIV prevalence estimates specific to this population. However, anal sex remains a very high risk behavior for HIV transmission (Vittinghoff et al, 1999) and may be more prevalent in Africa than originally thought (Brody & Potterat, 2003). African female sex workers who engaged in anal sex were more than twice as likely to be HIV-infected compared to those who did not (Karim & Ramjee, 1998). There is also evidence that some African men have sex with both men and women (Brody & Potterat, 2003), suggesting potentially complex networks of transmission. It is important to investigate HIV prevalence and risk behaviors of men who have sex with men (MSM) and those who have sex with both men and women in order to design and develop effective and targeted prevention and treatment programs for this population.

Funds are requested to continue activities with MSM populations in Lusaka, Southern and Copperbelt provinces. In FY 2006, CDC-Zambia conducted an assessment to determine the feasibility of using Venue-Day-Time Sampling (VDTS) and Respondent-Driven Sampling (RDS) to reach MSM in Zambia. The assessment included discussions with key informants in three major cities, Lusaka, Livingstone and Ndola, including representatives from the Ministry of Health, the National AIDS Council, and various organizations with working knowledge of the population. The findings from this project support the feasibility of implementing an assessment of HIV infection and risk behaviors among MSM populations in Zambia using the RDS method. In addition, venues and networks were identified which meet the feasibility criteria necessary to implement this public health evaluation (PHE). The extent to which MSM access services for HIV is unknown because providers and Zambian culture overall, generally do not know about or acknowledge MSM populations. Therefore, this PHE will also examine the possible methods for establishing these services for MSM.

In FY 2007, CDC, in collaboration with the Society for Family Health (SFH), will conduct a PHE to estimate the HIV prevalence rates and risk behaviors among a sample of MSM in Zambia. Data will help determine how HIV prevention and care programs should be targeted to this vulnerable and underserved population. Findings from similar evaluations recently conducted in Kenya, Senegal, Uganda, and South Africa suggest the need to implement targeted prevention and treatment programs to MSM populations.

Unlike other settings where VDTS and RDS have been used to assess HIV infection and risk behavior among MSM (e.g., United States, Thailand), Zambia poses a different situation given the population's unfavorable legal and social structure for homosexuals (Behind the Mask, 2006). In Zambia, like other African countries, homosexuality is illegal and little data exist regarding the HIV epidemic among MSM populations. Some data, however, do exist for MSM behavior in certain exclusively male populations (e.g., men in prison (Simooya et al., 2001)). There is anecdotal and qualitative evidence of MSM populations in Zambia but due to fear of being stigmatized or publicly persecuted they appear to be predominantly underground (African Veil, 2006).

Biological and behavioral data will be collected to meet the objectives of this evaluation among at least 100 people in Lusaka, Southern and Copperbelt provinces. As part of the data collection process, participants will receive information and discuss their personal risk behaviors and how to change their behavior to keep themselves from becoming HIV infected or transmitting HIV to their partners. It is anticipated that at least 100 people will be reached through community outreach that promotes HIV/AIDS prevention through other behavior change beyond abstinence and/or being faithful. Participants will also be referred to counseling and testing programs and ARV services available in their area of Lusaka, Southern or Copperbelt province. These programs include HVCT programs

provided by the Southern Provincial Health Office (#9018), ZPCT in the Copperbelt (#8883), the new HVCT activity for USAID with SFH/PSI, and HVCT new activity for CDC with UTH-Clinic 3 in Lusaka. ARV service programs that will be available to participants include CIDRZ services in Lusaka (#9003) and the new ART service activity for Southern Provincial Health Office (#9760).

CDC Zambia and SFH will work in collaboration with the Ministry of Health staff, who have given official support for this work and special emphasis will be placed on ensuring confidentiality and anonymity. In addition to working with local contacts, a task order may be issued to contract with an expert or consultant either local or regional to develop a scope of work. Behavioral scientists from the Division of HIV/AIDS Prevention at CDC Atlanta will provide overall direction.

Funding for Care: Adult Care and Support (HBHC): $150,000

Since 2004, the USG has provided support for the purchase of back-up TB, OI, and STI drugs to supplement limited supplies available in the Zambia Defense Forces (ZDF) health facilities. In fiscal year (FY) 2006, Centers for Disease Control (CDC) provided technical assistance and building capacity of the Zambia Defense Force (ZDF) to provide effective and comprehensive palliative care to those in the armed forces and their families. These funds were used to provide technical assistance and treatment of opportunistic infections, tuberculosis and sexually transmitted diseases to 1200 patients in the Zambia Defense Force (ZDF). This activity, together with the support provided by the Zambia Defense Force, resulted in higher quality of care for People Living with HIV/AIDS these institutions. In FY 2006 this activity supported building capacity for 5 new voluntary counseling and testing (C&T) sites in Lusaka and Livingstone. The funds were used to provide technical assistance in setting up C&T sites and monitoring, furnishing these facilities to include the necessary lab equipments. In consultation with the District Health and hospital management teams, CDC procured basic furniture and equipment to bring the new sites into a functional state. The Ministry of Health is strengthening the supply chain management system for drugs, test kits and laboratory supplies with support from the USG (activity # 9524).

In FY 2007, the focus of activity will shift to providing technical assistance and capacity building to both the DOD and University Teaching Hospital (UTH) to address the wide range of opportunistic infections (OI); including support to the diagnosis and management of sexually transmitted infections and back up drugs for TB, STI and OI and laboratory supplies. The United States Government (USG) hopes to ensure a comprehensive and sustainable package of palliative care services to Zambian people living with and affected by AIDS and who are now living longer due to antiretroviral drugs. All palliative care services and activities funded by the USG in Zambia are now coordinated by the newly formed USG Palliative Care Forum. The forum, represented by all USG partners, was established to coordinate palliative care approaches and activities within the USG and at national level to work with and link closely with the Zambia Palliative Care Association tasked with the development of a national palliative care strategy, guidelines, and standard operating procedure.

Funding for Care: Adult Care and Support (HBHC): $0



Target Target Value Not Applicable Total number of service outlets providing HIV-related palliative care  (excluding TB/HIV) Total number of individuals provided with HIV-related palliative care  (excluding TB/HIV) Total number of individuals trained to provide HIV-related palliative  care (excluding TB/HIV)

Target Populations: HIV positive infants (0-4 years) HIV positive children (5 - 14 years)

Coverage Areas Lusaka


Table 3.3.06:

Funding for Care: TB/HIV (HVTB): $171,000

In FY07, a plus up request ($150,000) and a reprogramming request (-$305,000) are requested for this activity; the total amount requested for this activity is $321,000.

This activity relates to activities in counseling and testing, laboratory infrastructure, palliative care: basic health support activity, and HVTB (#9032, #9017, #8819, #8992, #9037, #9006, #9046, and #9010).

This activity provides for the following activities in support of the national implementation of TB/HIV activities; 1.) Technical assistance for development and evaluation of surveillance system for TB/HIV implementation; and 2.) Inclusion of TB/HIV data elements in the Continuity of Care: Patient Tracking System to improve patient care.

In FY 2006, the US Government (USG) provided support to the Ministry of Health (MOH) in the national integration of Tuberculosis (TB) and HIV services by providing support to a variety of areas at the national and local level, including support of TB policy processes, adaptation of guidelines and materials, and preparation of TB clinical decision support systems. A National level TB/HIV coordinating body within the MOH with the following membership; staff from the TB, HIV, counseling and testing (CT) units in MOH; multilateral organizations; research groups; faith-based organizations; non-governmental organizations; and community representatives. This body was tasked with developing and implementing a single, coherent TB/HIV strategy, policy, and communication message based on the best existing evidence. As a result national guidelines for the implementation of TB/HIV activities were developed based on the World Health Organization (WHO) Interim Guidelines for TB/HIV collaboration. Additional support was provided for the revision of TB data collection forms and registers, based on WHO forms that incorporate the collection of HIV data. The USG produced the revised patient treatment form, identification card, and registers that have been distributed to all provinces and districts. Technical support was provided for the orientation of health staff in the new forms. In addition the USG co-funded, with the MOH, WHO, and JHPIEGO, a training of trainers session for an initial group of 25 trainers in diagnostic counseling and testing using the national training module adapted by JHPIEGO (#9032).

In FY 2007, the USG will provide technical support to the Ministry of Health for the evaluation of surveillance systems for TB/HIV implementation. This support will be at National, Provincial and district levels to strengthen the scaling up of TB/HIV activities in Eastern, Southern, Western and Lusaka provinces. To improve the knowledge, skills and communication among health care workers and partners, a news letter on TB/HIV activities will be produced, printed and distributed to stake holders.

To improve the knowledge, skills and communication among health care workers and partners, a news letter on TB/HIV activities will be produced, printed and distributed to stake holders. This activity is related to activity #9023. To sustain policy and clinical decision-making for future expansion of national TB activities, CDC has assisted the MOH in establishing an Electronic Medical Record (EMR) standard that will include TB data as well as HIV and other opportunistic infections (OIs) data. In the last year, this EMR, called "Continuity of Care and Patient Tracking System" (CCPTS) has established itself in the country and on April 5, 2006 was named as the national standard software. This remarkable achievement will be followed during the remainder of 2006 by the development of the out patient department (OPD) module that will include TB care. The CCPTS already addresses TB care in the context of antiretroviral (ART) services, but the next module will establish the systematic link between OPD TB services and ART TB services. The link is made either by a patient-carried smart card or via a periodic facility-by-facility database ‘merge'.

The EMR system and card carries a longitudinal record of a client's medical history, including prior illness, physical findings, lab results, symptoms, problem list with diagnoses, and treatment plan for all these services. A paper and electronic copy of patient information is maintained at all clinics visited, and paper records are still used for primary data capture in most settings. Accessible and integrated information provides one basis for improved TB care, and this will become available in the higher density settings in 2007. As the core element of the Continuity of Care and Patient Tracking System software, the EMR provides: 1) more fully informed local decision support; 2) reminder

reports to staff to help keep patients from "falling through the cracks" (to assure adherence and minimize resistance); and 3) improved management of general facility operations (such as drug utilization) by providing automation to key elements of local monitoring and evaluation and logistics support.

In FY 2007, the emphasis will be on refinement of the TB service module, addition of suitable decision support cross-referencing other health conditions, and scaling-up of this OPD functionality to clinics serving larger numbers of TB patients. Building on previous year's successes in HIV and antenatal clinic/prevention of mother to child transmission/CT services, CCPTS is now supporting 60,000 PLWHA. This year's funding will increasingly focus on building the capacity of the MOH and collaborators within Zambia to implement and scale-up the TB/HIV module of the CCPTS for purposes of sustainability, and to operationalize automatic links between increasing numbers of CCPTS service modules in order to better care for HIV patients with these concurrent illnesses and OIs. On Aug 31, 2006 the MOH held a national deployment "kick-off" meeting for the CCPTS EMR. Together with other activities, these funds will help assure that the OPD TB to HIV services link spreads throughout the country with this same deployment effort.

Funding for Treatment: Adult Treatment (HTXS): $708,000

This activity links to all ART activities

Implementation of the surveillance for ARV drug resistance and procurement of equipment for the activity is in process and technical assistance for the development of surveillance for HIV-1 antiretroviral drug mutations has been provided by the United States Government (USG).

The USG, through CDC, plans to support technical assistance to the Government of the Republic of Zambia on 1) surveillance of antiretroviral (ARV) drug resistance, 2) supervisory visits to project sites in four provinces to evaluate antiretroviral therapy (ART) service delivery and quality improvement, 3) a systems-theory-based analysis of essential services exercise, 4) collaboration with the World Health Organization (WHO), and 5) critical electronic medical record systems.

With the increased, widespread availability of ARV treatment in the public health sector, it is expected that with time the numbers of drug resistance cases will increase. In fiscal year (FY) 2005, in response to a specific request from the Ministry of Health, the USG provided technical assistance to the national ART program in the development of surveillance for HIV-1 antiretroviral drug mutations. In FY 2006, the USG provided support for the procurement of equipment and supplies, as well as training for laboratory staff in testing for ARV drug resistance, in collaboration with Japan International Cooperation Agency and the University of Nebraska-Lincoln. In FY 2007, the USG will continue to provide technical assistance to key sites to ensure ongoing monitoring of resistance, including support to the University Teaching Hospital Department of Pediatrics for the development of a Pediatric and Family HIV/AIDS Care Center. CDC provides technical support to the national ART program and its coordinator to include quality improvement, monitoring and evaluation, and health management information systems. FY 2007 funds will support technical assistance from CDC care and treatment and strategic information (SI) teams to the national program centering around a quality improvement initiative in coordination with SI activities such as the expansion of the Continuity of Care: Patient Tracking System (CC:PTS) and an ART cluster evaluation. CC:PTS was identified as the national electronic medical record system for ART and is to be used in all sites where a computer is used. CDC will use FY 2007 funds to support supervision of these installations, provide essential computer equipment, and enable system enhancements that support data use at the clinical level. CDC staff will conduct a systems-theory-based analysis to assess the linkages of supportive services to select ART sites to establish proposed minimum standards for essential services for care, treatment, and support. Using system dynamics modeling, sites with varying performance and success with ART implementation will be identified. Non-clinical supportive services outlets (e.g. nutrition, psychosocial counseling, PLWHA support groups) around the ART sites will be assessed to establish the volume and linkage of services to the ART site. Various scenarios will be modeled and shared with policy makers and clinical staff to interpret the influence of these services on the effectiveness of ART service delivery. The effectiveness of this kind of evaluation technique will also be assessed (see CDC entry under SI). CDC staff are engaged with WHO on ART quality and guideline development for pediatric and adult ART as well as medical information data standards. Occasional travel and local meetings are required on these tasks. In addition, funds within this activity will also used for staffing costs needed to monitor the scale-up of ARV services and infrastructure rehabilitation related to activities #s 9751, 9769 and 9016.

Funding for Laboratory Infrastructure (HLAB): $890,001

This activity is linked to all TB/HIV activities and #9015, CRDZ, JHPIEGO in ARV services.

A combination of material support and human capacity building is critical for putting in place sustainable laboratory capacity for HIV/AIDS. The Laboratory Infrastructure and Support Branch of CDC Zambia has made significant progress by placing automated laboratory testing systems in provincial laboratories and other strategic locations throughout the country to care and treat PLWHA. In fiscal year (FY) 2005/6, this activity supported placement of five automated chemistry analyzers in laboratory sites in three provincial hospitals; namely Livingstone, Lewanika and Chipata General, as well as Monze Mission hospital (district level) and Maina Soko Military Hospital. Automated full blood count analyzers and high-throughput CD4 analyzers were placed at both provincial and district sites in Eastern, Western, Southern and Lusaka Provinces. In addition, laboratory testing reagents and consumable supplies were provided to the national supply for the Medical Stores Facility. The year 2006 marked the first year that reagents were in continuous supply for care and treatment support to several laboratory sites.

This activity also currently supports; 1) expansion of laboratory technical expertise through training and quality assurance (QA) to the Ministry of Health (MOH) laboratories and the University Teaching Hospital (UTH); 2) renovation and support of laboratory care such as CD4 staging, liver and kidney function testing, and lithium assay analysis, and treatment services of training center at Chainama College in Lusaka; 3) implementation of a laboratory information system for data managemen to improve the documentation of patient test results, tracking of reagent procurements, and quality assurance (QA) efforts; 4) strengthen the palliative care system by improving detection and treatment of opportunistic infections commonly associated with HIV/AIDS; 5) provide technical support for infant HIV diagnosis with dried blood spot analysis in children at the Arthur Davison Children's Hospital in Ndola and other regions in Zambia; 6) support much needed renovations and improvements of laboratory infrastructure at key district-level health facilities in Eastern, Lusaka, Southern, and Western Provinces; and 7) provide travel support of Zambia CDC laboratory staff for training and supervisory visits to testing sites throughout the country to ensure proper equipment operations, provide feedback, and reinforce system strengthening.

In an effort to assess the quality of VCT and PMTCT, the World Health Organization (WHO) and CDC recently adopted the national algorithm for rapid HIV testing and an internal and external quality assurance plan formulated by UTH for documentation and monitoring programs throughout the country. A national rapid HIV quality assurance training program will be customized for Zambia, utilizing these guidelines. The training will be provided to both technical and non-technical laboratory persons in VCT and PMTCT programs. Additional technical support and training on infant diagnosis utilizing PCR dried blood spot techniques for sample collection will also be provided in FY 2007.

Transferring skills to Zambian nationals currently in the field is critical but so is building capacity of clinical personnel during training to ensure graduates going to the field are equipped with the necessary lab knowledge and skills. In this regard, the UGS is providing support to Chinama College to develop curricular for pre-service training for graduating clinical officers and ART curricular for advanced diplomas for clinical officers. Once graduated, in most case, clinical officers are the ones who provide direct care at districts and rural clinics. This will ensure that all graduating clinical officers going to the field have adequate knowledge of HIV care.

Chainama College is one of the only two colleges that through USG support is now able to offer pre-service training in laboratory, HIV care, and counseling to clinical officers and nurses. Further, the Chainama College facility is the only psychiatric hospital in Zambia offering mental health treatment services for its patients diagnosed with HIV. In FY 2006, in addition to curriculum development, funding was provided for the development of a training center at Chainama College to improve access to training. This activity will be completed by the end of FY 2006. Renovation of the training laboratory facility will expand testing capacity at the facility in addition to proving students with modern testing skills. This initiative is closely linked with HIV care and treatment training activities supported by CIDRZ and JHPIEGO.

Developing a training center at Chainama College will increase training opportunities for

centers in Lusaka that currently do not have access to laboratory training facilities and build capacity in the rural areas by training community workers in laboratory techniques, such as HIV testing and acid fast smear microscopy for diagnosis of TB in HIV/TB programs. This is vital in addressing opportunistic infections which are a major threat to PLWHA. Major efforts toward detection of tuberculosis are currently being put in place. Training and support will be provided to clinicians and laboratory technologists on cost effective diagnostic testing and implementation strategies, guidance on antibiotic utilization to prevent avoidable resistance levels, and standardization of infection control practices in both medical and laboratory settings.

Information management is also crucial to laboratory procurement and monitoring the success of the ARV treatment programs. Currently, laboratory technologists and administrators depend on hand-written log entries and registries for monitoring information on laboratory tests for developing reports. Laboratory activities must be reported and accurately communicated across geographical regions, where travel is slow and limited, to increase the efficiency of the network of laboratories. The infrastructure modifications also rely on other information technology systems, enhanced maintenance services, modern equipment, and internet connectivity. Subsequently, the laboratory management tools will strengthen the capacity of the GRZ, USG and other laboratory partners in monitoring laboratory data for improving services and forecasting for procurement of reagents and supplies. An electronic information system will permit standardization of data collection and provide meaningful managerial data in a timely manner. CDC has supported more than ten MOH laboratory and medical staff to attend the six-week training course held in Atlanta and more than 60 Zambians have been trained through the follow-up activities in-country. In FY 2006 training was provided to 24 Zambians to form multidisciplinary teams to strengthen management of the laboratory supply chain.

In FY 2007, CDC will continue to provide support to all the activities listed above. Lessons learned in FY 2006 will provide guidance for developing and expanding lab capacity in districts hospitals and rural clinics for better care. In order to ensure sustainability of SMDP-based program in Zambia, efforts will be made to explore the possibility of institutionalizing the training program within the Ndola Biomedical School. Two CDC Zambian staff will travel to Atlanta for further training so they can increase their knowledge and skills as train-the-trainers in both general laboratory and PCR techniques. In FY 2007, funding will also be used to provide technical assistance to department of defense laboratory facilities in all the nine provinces. Through transferring skills, knowledge, and renovating and equipping facilities within the national health, sustainable laboratory services are being built that we hope will be sufficient to function post PEPFAR.

Funding for Strategic Information (HVSI): $2,240,000

This activity relates to EGPAF SI (#9001), JHPIEGO SI (#9034), AIDSRelief - Catholic Relief Services (CRS) (#8828), Ministry of Health (MOH) (#9008), National AIDS Council (NAC) (#9011), SI Central Statistical Office (CSO) (#8997), Tropical Disease Research Center (TDRC) (#9028), Eastern Provincial Health Office (EPHO) (#9693), Western Provincial Health Office (WPHO) (#9696), Zambia National Blood Transfusion Service (ZNBTS) (#9698), and CCPTS COMFORCE (#9691).

Continuing work from fiscal year (FY) 2006, CDC's SI activities provide critical support to information systems, building sustainable monitoring and evaluation (M&E) capacity, and ensuring that essential information from sentinel surveillance and targeted evaluations is obtained and used to improve quality of care. Core systems must be institutionalized to sustain improved quality of care, decision-making about resources, and improved service delivery mechanisms. CDC provides technical and financial support to the Ministry of Health (MOH) and the National HIV/AIDS/STI/TB Council (NAC) at central, provincial, district levels. Built around an anchor information system project, the Continuity of Care and Patient Tracking System (CCPTS), which has recently been adopted by the MOH as a national standard, CDC Zambia is helping institute durable systems for quality health services, disease surveillance, and M&E.

Approximately $830,000 supports official CDC office locations and collocated partners in Zambia which require one-time and on-going improvements to their information systems infrastructure. These office locations are at the U.S. Embassy, University Teaching Hospital (UTH), Chest Diseases Laboratory (CDL), Intercontinental Hotel in Lusaka, and a field office based at the Provincial Health Office in Livingstone. This activity will fund the following: (1) procurement of IT equipment for the new Pediatric and Family Center of Excellence at UTH to include computers for the offices and points of service, setting up communications systems, equipment for training and conference facilities, integrate power supply systems for server and core equipment; (2) maintenance contracts for printers & computers, continued network operability for remote sites, VSAT and terrestrial communication links, and network routing hardware; (3) training for CDC and partner IT staff in networking and server administration; (4) assistance to NAC for implementation of strategic information activities by hiring a short-term advisor (one year contract $150,000); (5) initial consultations and design support to the Zambia National Blood Transfusion Service (ZNBTS) on linking CCPTS to the national donor retention database.

Approximately $360,000 will support M&E activities to: (1) continue technical support to the national M&E capacity and workforce building initiative in cooperation with NAC, MOH, SHARE, Peace Corps, the University of Zambia, and National Alliance of State & Territorial AIDS Directors to deliver performance-based ongoing training, mentoring, and scholarships to partners, Provincial AIDS Coordinators, District Planners, and District and Provincial AIDS Task Forces. United States Government support includes technical assistance and support to national meetings and dissemination of the "One" M&E Manual and Training kit develop with technical assistance from CDC Atlanta; (2) finalize the joint Government of the Republic of Zambia (GRZ) and USG ART cluster evaluation initiated in 2006 and take it from an information-gathering stage to intervention stage through the launch of the AIDS Quality Improvement Project. For additional ART evaluation support, CDC will conduct a systems theory-based evaluation of the linkages between ART treatment success and quality of ancillary services. This activity will map various ART service delivery sites and the existence of supportive services (e.g. food, psychosocial support) to gauge the effect of such services on treatment success. The result will be an estimation of the essential package of services required in a geographical area; (3) develop a companion training manual and toolbox for the CCPTS to build capacity at national, provincial and district levels to maximize data use for quality improvement by clinical staff and district, provincial, and national teams; and (4) continue to support Zambian M&E professionals and students to publish as well as present at regional and international conferences on operational and evaluation research.

For HIV/AIDS surveillance approximately $930,000 in FY 2007 will: (1) continue technical and material support to GRZ in its surveillance and reporting of HIV and syphilis prevalence through 24 antenatal clinic sentinel sites and three refugee camps. This activity is conducted in collaboration with the MOH, the Central Statistical Office (CSO), UTH, NAC, Tropical Diseases Research Centre (TDRC), and United Nations High Commission for Refugees (UNHCR); (2) support the GRZ in its surveillance of HIV

incidence over time by testing blood specimens from the antenatal clinic sentinel surveillance (1994-2006) and the Zambia Demographic and Health Survey using the BED-CEIA assay developed at the CDC to allow the estimation of recent HIV infections (incidence); (3) partner with the private sector in Zambia to strengthen surveillance and reporting of HIV prevalence and incidence among workers in the agricultural and other industries; continue our partnership with a major sugar estate to examine risk factors for HIV acquisition among migrant and non-migrant workers. FY 2007 funding will allow us to utilize the findings and to develop the methods and tools to strengthen the continuity of HIV care for migrant workers during the work season and to help establish linkage to care upon their return to home regions; (4) continue to strengthen and work towards sustaining the National Cancer Registry of Zambia in its surveillance and reporting of AIDS-related malignancies through technical and material assistance. Surveillance of AIDS-related cancers is important both for GRZ planning of cancer treatment needs and preventive interventions in the population, and for monitoring the impact of ART scale-up on the risk of AIDS complications and survival; (5) expand the Sample Vital Registration with Verbal Autopsy (SAVVY) System in selected regions in Zambia. This activity builds upon the Feasibility Study conducted in FY 2006 by the Central Statistics Office (CSO) in its surveillance and reporting of vital events in Zambia and will add coverage areas beyond the two FY 2006 pilot sites. The FY 2007 plan aims to strengthen and sustain the CSO office and expertise for vital registration in Zambia; (6) collaborate with the World Health Organization to provide assistance to the MOH in establishing a system to monitor HIV drug resistance (HIVDR) emerging during treatment. Such a system will include the initiation and coordination of a MOH HIVDR Working Group to develop a national strategy for HIVDR resistance monitoring, design and implementation of an appropriate prospective cohort in which to monitor HIVDR emerging during treatment and to collect information on behavioral and other risk factors associated with increased risk of HIVDR development, technical support to build laboratory capacity to perform genotypic HIV drug resistance testing, management and analysis of data on the magnitude of HIVDR in the selected study population, and the coordination of report dissemination to the GRZ, health professionals, the public, and the scientific literature; and (7) ensure the sustainability of HIV surveillance activities by providing expertise and coordinating training courses to increase long-term Zambian human resource capacity in data management, statistical analysis, data use and interpretation, scientific writing, and preparation of manuscripts for publications in scientific literature.

Funding for Health Systems Strengthening (OHSS): $500,000

CDC supports improved data management, dissemination, and data for decision-making in the delivery and management of health services in national and local institutions in Zambia. Systems beyond the realm of traditional strategic information activities require support to ensure efficient treatment and care capabilities in all facilities. Using FY 2005 and FY 2006 funds, CDC procured 662 desktop computers and 34 laptops for various institutions and affiliated United States Government projects focused on HIV/AIDS. In FY 2007, CDC will provide expanded support to laboratory informatics and also will remain responsive to equipment needs in local health offices in targeted provinces. For example, specific support to infrastructure enhancement is required for the Chest Diseases Laboratory (CDL) and the Tropical Disease Research Center (TDRC) TB laboratory. In addition to upgraded and new desktop computers, the installation of network capabilities will be funded by this activity. These enhancements will come in the form of servers, routers, hubs, broadband connections, wireless capabilities, and appropriate measures for network security. Software will also be purchased. CDC will also provide material support to targeted clinic and office facilities for provincial and district health facilities. In addition to equipment and infrastructure costs, CDC will provide technical support on installation, routine maintenance planning, software licensing, and input on establishing relationships between assisted organizations and technical support providers in Zambia. This will require occasional supportive supervision visits by CDC staff to active project sites or for CDC to engage other technical support as required.

Funding for Management and Operations (HVMS): $0

The funding for this activity was moved to Activities #10980 and #10981 to capture ICASS and CSCS costs.

Table 3.3.15:

Funding for Management and Operations (HVMS): $0

This activity was moved to its own mechanism.

Table 3.3.15:

Funding for Management and Operations (HVMS): $0

This activity was moved to its own mechanism

Table 3.3.15:

Funding for Management and Operations (HVMS): $290,000

Under the leadership of the Ambassador, the U.S. Embassy will continue to serve as the coordinating body of PEPFAR. The PEPFAR Office is comprised of four staff (one supported by CDC, and three supported by State): the PEPFAR Coordinator (CDC contract position) who oversees two technical staff, the State PEPFAR Projects Manager (EFM), the Ambassador's Small Grants Coordinator (EFM), and one administrative staff person (FSN). The PEPFAR Coordinator (supported through a CTS Global contract administered by CDC) reports directly to the Front Office. In FY2007, the PEPFAR Coordinator and three full time positions will manage the State PEPFAR programs and coordinate the overall USG effort. The PEPFAR Coordinator is the Ambassador's and Deputy Chief of Mission's principal advisor on PEPFAR, and works closely with all USG agency directors, senior technical staff, and the Government of the Republic of Zambia (GRZ) to develop and implement the PEPFAR program in Zambia. Based in the U.S. Embassy and reporting directly to the Deputy Chief of Mission, this position oversees the development and implementation of the $190M+ HIV/AIDS program by coordinating the five different USG agencies' planning, overall management, budgeting, and reporting processes.

The Coordinator ensures that all country program decisions abide by OGAC policy and requirements and with congressionally mandated budgetary earmarks. The Coordinator serves as the Mission's point of contact with the Office of the U.S. Global AIDS Coordinator (OGAC), USG agencies (CDC, DOD, Peace Corps, State, and USAID), the GRZ (including the Zambia Defense Force), and the donor community. This position takes the lead for the Mission in ensuring formal collaborations around HIV/AIDS with the UK, Dutch, and other major bilateral HIV/AIDS donors. The Coordinator is a member of the Mission's Country Team. The incumbent in this position also serves a key role in liaising with the donor community to ensure that PEPFAR programs complement and support other donors' work with appropriate GRZ governmental and nongovernmental entities. In addition, the Coordinator works closely with the National AIDS Council in ensuring that PEPFAR continues to support the national strategy and objectives for HIV and AIDS. This position was funded 100% in FY 2004, FY 2005, and FY 2006 through PEPFAR funds; the support for this position is included in the CDC budget in FY 2007 for contract administration purposes.

Table 5: Planned Data Collection

Is an AIDS indicator Survey(AIS) planned for fiscal year 2007?  Yes  No If yes, Will HIV testing be included?  Yes  No When will preliminary data be available? 8/1/2008

Is an Demographic and Health Survey(DHS) planned for fiscal year 2007?  Yes  No If yes, Will HIV testing be included?  Yes  No When will preliminary data be available? 8/1/2007

Is a Health Facility Survey planned for fiscal year 2007?  Yes  No When will preliminary data be available? Is an Anc Surveillance Study planned for fiscal year 2007?  Yes  No if yes, approximately how many service delivery sites will it cover? 22 When will preliminary data be available? 4/1/2008

Is an analysis or updating of information about the health care workforce or the  Yes  No workforce requirements corresponding to EP goals for your country planned for fiscal year 2007?