PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
This activity links to other Zambia Prevention, Care, and Treatment Partnership (ZPCT) Counseling and
Testing (CT) as well as with the Government of the Republic of Zambia (GRZ) and other US Government
(USG) partners.
ZPCT will provide support to GRZ to strengthen and expand PMTCT services in 33 districts, many very
remote, in Central, Copperbelt, Luapula, Northern, and North-Western provinces, representing 80% of the
population in these five provinces. In FY 2007 ZPCT expanded to seven additional districts and covered all
the facilities in Ndola, Kitwe, Kabwe, Mansa, Mwense, and Nchelenge districts to support 175 facilities and
increase assess to PMTCT services. In FY 2007, ZPCT reached 63,000 PMTCT clients over the 12 month
target period, with 11,813 receiving ARV prophylaxis. Since FY 2005, ZPCT assessed and refurbished 175
PMTCT sites.
In FY 2008, ZPCT will continue to provide technical support to ensure quality services and build district
capacity to manage the HIV/AIDS services. During FY 2008 ZPCT will close out, handing over program
activities to the follow-on project, therefore targets are lower than FY 2007.
The six activity components include: 1) enhancing PMTCT service delivery; 2) promoting PMTCT services;
3) increasing access to CD4 testing services; 4) providing follow-up of HIV-infected mothers and their
children; 5) assisting the national PMTCT technical working group to support developing and disseminating
national PMTCT guidelines and protocols; and 6) increasing program sustainability with the GRZ.
In FY 2008, under the first component, enhancing PMTCT service delivery, ZPCT will expand support to
199 PMTCT facilities in 33 districts. ZPCT will reach 69,825 women with PMTCT services, and 11,813 of
these will receive a complete course of ARV prophylaxis. Program activities will monitor quality of services
in all facilities, with a focus on new facilities including the six districts where all health facilities are being
supported by ZPCT. All 199 sites will receive assistance to improve quality of PMTCT services, including
linkages to CT, ARV prophylaxis for mothers and infants, and infant feeding counseling. Support will be
provided to ensure accurate reporting and data collection (utilizing PMTCT Smart Care where a computer
and security is available), availability of basic medical equipment, and reliable supplies of ARV prophylaxis.
Commodity management will be coordinated with the GRZ, the USAID | DELIVER PROJECT, and the
Partnership for Supply Chain Management Systems (SCMS).
Technical assistance and training will be provided for MOH health care workers (HCWs), lay counselors,
and supervisors. In FY 2007, ZPCT trained 300 HCWs in GRZ's full PMTCT provision training course. In
FY 2008 ZPCT will train 120 HCWs in the full PMTCT course and 80 HCWs will receive the five-day
refresher training. Quality assurance, supervisory, and monitoring systems will also continue to be
strengthened.
Under the second component, promoting PMTCT services, ZPCT will continue to implement an intensive
strategy to reach pregnant women with comprehensive PMTCT services by strengthening universal
counseling of women in ante-natal (ANC) clinics; establishing and/or strengthening outreach of ANC
services to reach women in more rural areas; and increase male involvement and integration of PMTCT, CT
(with emphasis on reaching discordant couples); and providing clinical palliative care, family planning
services, long-lasting insecticide treated nets, ART services and referral for community (nutrition, OVC,
home based care) services, through the district referral networks. Same day test results in PMTCT clinics
are operational in all 199 facilities. ‘Testing corners' (minimal laboratories placed within or in close proximity
to the CT area to facilitate same-day test results) will be strengthened to ensure same day CT for pregnant
women. Lay counselors are posted at all sites to provide counseling services in support of the already
overworked facility staff and will continue to be supported. In FY 2008, ZPCT will also do additional health
facility renovations as needed.
The third component, increasing access to CD4 testing services, links PMTCT to ART services. ZPCT will
continue to support the linkage between PMTCT and ART services by offering expanded access to CD4
tests for HIV-positive pregnant women. In FY 2008, ZPCT will continue to fund transport of laboratory
samples for CD4 testing from ZPCT-supported facilities to sites with CD4 machines to increase access to
PMTCT and ART services.
In the fourth component, ZPCT will continue strengthening systems for follow-up of HIV-infected mothers
and their infants after delivery. ZPCT will work through under-five clinics, to strengthen the system to
provide support, and to ensure that infants of HIV-infected women are tested for HIV at nine and 18-months
as per the revised National PMTCT and ART Protocol Guidelines. A Polymerase Chain Reaction (PCR)
machine located at Arthur Davison Children's Hospital in Ndola (Copperbelt Province) will continue to
support the process of early diagnosis of HIV-infected infants, and will be coordinated with the PCR
activities supported by the Centers for Disease Control and Prevention (CDC) and in collaboration with the
Clinton Foundation HIV/AIDS Initiative. ZPCT will also link women with community groups that provide
nutritional, legal, and psychosocial support
In the fifth component, ZPCT will continue providing technical assistance to the national PMTCT Technical
Working Group in scale-up of PMTCT services and support for the development, revision, and
dissemination of PMTCT training materials, protocols, standard operating procedures, and policies.
ZPCT will also work closely with other partners (community based organizations, non-governmental
organizations, faith-based organizations, the United Nations Population Fund), and other USG partners,
including Health Communications Partnership (HCP), Catholic Relief Services/SUCCESS, and RAPIDS, to
promote increased uptake of PMTCT services through community mobilization. ZPCT will continue to
collaborate with church networks to encourage pregnant women to access PMTCT services and to
establish support groups. Traditional leaders and male church leaders will be enlisted to encourage
partners and discordant couples to be involved in couples counseling and testing for PMTCT. Reduction of
stigma and discrimination, and equity of access to PMTCT and related HIV/AIDS services, will be discussed
and addressed with partners within a culturally-sensitive context.
In the final component, increasing program sustainability with the GRZ, ZPCT will work with Provincial
Health Offices (PHOs) and District Health Management Teams (DHMTs) to build on the quality assurance
activities started in FY 2006. In FY 2007, ZPCT graduated ten districts from intensive technical support. In
Activity Narrative: FY 2008, in collaboration with the GRZ, ZPCT will graduate another ten districts that are providing
consistent quality services and will only need limited technical support from ZPCT. The PHOs and DHMTs
will assume responsibility for the selected districts by providing all supervision and monitoring activities in
these districts in order to better sustain program activities.
By working directly with GRZ facilities, ZPCT is able to establish a sustainable program through training
health care workers, developing standard treatment protocols, strengthening physical and equipment
infrastructures, implementing facility-level quality assurance/quality improvement programs, improving
laboratory equipment and systems, and developing and strengthening health information systems. The lack
of human resources is the major barrier to sustainability and expansion.
All FY 2008 targets will be reached by June 30, 2009.
This activity links with the Zambia Prevention, Care, and Treatment Partnership (ZPCT) PMTCT, ART,
Counseling and Testing (CT), TB/HIV, and Laboratory Support activities as well as with the Government of
the Republic of Zambia (GRZ) and other US Government (USG) partners.
This activity will strengthen and expand clinical palliative care services in Central, Copperbelt, and the more
remote Luapula, Northern, and North-Western provinces. ZPCT is supporting 33 districts which represent
80% of the population in the five provinces and is covering all the facilities in Ndola, Kitwe, Kabwe, Mansa,
Mwense, and Nchlenge districts. In FY 2007, ZPCT reached 69,690 clients with clinical palliative care
services through support to 210 facilities in the 33 districts. In FY 2007, 300 HCWs were trained in the
ART/OI full and refresher curriculum. In FY 2008, ZPCT will train 120 HCWs in ART/OI management and
80 in the refresher ART/OI course. In addition, ZPCT initiated a comprehensive quality assurance/quality
improvement program to monitor and improve service provision in all 210 facilities. In FY 2008, 80,550
clients will receive palliative care services in 210 ZPCT supported facilities.
During FY 2008, ZPCT will consolidate the expansion of FY 2007 by providing technical support to ensure
quality services and build district capacity to manage the HIV/AIDS services. During FY 2008 ZPCT will
close out, handing over program activities to the follow-on project, therefore targets are lower than FY 2007.
Palliative care activities include four components: 1) strengthening palliative care services within health
facilities; 2) increasing referral linkages within and between health facilities and communities working
through local community leaders and organizations; 3) participating in and assisting the Ministry of Health
(MOH) and the National HIV/AIDS/STI/TB Council (NAC) to develop a strategy, guidelines, and standard
operating procedures; and 4) increasing program sustainability with the GRZ.
In the first component, strengthening palliative care services within health facilities, ZPCT will continue to
support 210 health facilities including all the facilities in Kabwe, Kitwe, Ndola, Mansa, Nchelenge, and
Mwense districts. In FY 2008, ZPCT will do additional health facility renovations as needed. In addition to
the ART/OI training mentioned above, HCWs will also be trained, using GRZ-approved curriculum, to
provide cotrimoxazole prophylaxis, symptom and pain assessment and management, patient and family
education and counseling, management of pediatric HIV in the home setting, referrals of HIV positive
PMTCT clients, and provision of basic nursing services as part of the overall package of palliative care
services. Pharmacy staff will be trained in data collection/reporting and ordering, tracking, and forecasting
HIV-related commodities to ensure availability of critical medical supplies and drugs. ZPCT will also liaise
closely with the USAID | DELIVER PROJECT and the Partnership for Supply Chain Management Systems
(SCMS) on forecasting drug supply requirements.
In the second component, increasing referral linkages within and between health facilities and communities,
ZPCT will build on Zambia's long history of working with Faith-Based Organizations (FBOs) and Community
-Based Organizations (CBOs) that provide home-based care for people living with HIV/AIDS (PLWHAs).
These organizations serve as critical partners for facility-based programs supported by GRZ and USG.
Therefore, as in FY 2007, ZPCT will work closely with these established entities to strengthen referral
networks linking clinical palliative care services with community-based programs. Through the referral
network, clients will be referred to home based care programs for nutrition, legal services, violence
prevention, and other HBC services. For example, ZPCT through its sub-partner Churches Health
Association of Zambia (CHAZ), is providing on-going technical assistance and training in clinical palliative
care and linking those services to local home-based care programs. ZPCT is also coordinating with the
Ndola Diocese home-based care program, Catholic Relief Services/SUCCESS, and RAPIDS to better link
clinical services to related community programs. In FY 2008, wrap around activities will include
collaboration with Tuberculosis Control Assistance Program (TB CAP) in training health care providers,
developing TB/HIV materials, renovating health facilities, and strengthening the patient referral system.
Community mobilization activities, implemented by ZPCT and partners, are another approach to strengthen
referrals in palliative care within and between health facilities and communities. ZPCT will continue to work
with existing community groups, such as Neighborhood Health Committees, for activities related to stigma
reduction, gender, male involvement, and promotion of clinical palliative care and support services. ZPCT
will also work with community-based care givers, traditional healers, and other key community leaders to
increase community involvement, build community volunteers' capacity, and involve PLWHA in palliative
care services at the community level to reduce stigma and discrimination and thereby improve quality and
efficiency of these services. ZPCT uses materials developed by or adapted from materials produced by the
Health Communication Partnership (HCP).
In the third component, ZPCT will continue its participation in and provision of assistance to the USG
Palliative Care Forum as well as coordinate with the Palliative Care Association of Zambia to develop a
national palliative care strategy, guidelines, and standard operating procedures. Through these efforts,
ZPCT aims to improve access to quality clinical palliative care services, promote use of evidence-based
practices, share lessons learned in project implementation, and support the revision of national palliative
care guidelines and protocols in accordance with GRZ policies.
activities started in FY 2006 in partnership with the MOH. In FY 2007, ZPCT graduated ten districts from
intensive technical support. In FY 2008, in collaboration with the GRZ, ZPCT will graduate another ten
districts that are providing consistent quality services and will only need limited technical support from
ZPCT. The PHOs and DHMTs will assume responsibility for the selected districts by providing all
supervision and monitoring activities in these districts in order to better sustain program activities.
By working with GRZ facilities, ZPCT is able to establish a sustainable program through training health care
workers, developing standard treatment protocols, strengthening physical and equipment infrastructures,
implementing facility-level quality assurance/quality improvement programs, improving laboratory equipment
and systems, and developing and strengthening the health information systems.
Counseling and Testing (CT), Palliative Care, and Laboratory Support activities as well as with the
Government of the Republic of Zambia (GRZ), and other US Government (USG) agencies and partners as
outlined below.
Approximately 62 percent of tuberculosis (TB) patients are HIV positive, and TB is the most common
opportunistic infection (OI) in HIV patients. However, very few TB patients are offered CT and related
services. For this reason, in FY 2005, ZPCT began a partnership with and will continue to support the
Centers for Disease Control and Prevention (CDC) and GRZ to ensure consistency in TB/HIV training and
service protocols and to improve availability of TB testing equipment and related commodities. ZPCT will
also continue its support to the GRZ in strengthening and expanding TB/HIV services in Central,
Copperbelt, and the more remote Luapula, Northern, and North-Western provinces. ZPCT is supporting 33
districts which represent 80% of the population in the five provinces and is covering all the facilities in
Ndola, Kitwe, Kabwe, Mansa, Mwense, and Nchelenge districts.
In FY 2007, ZPCT continued tracking TB/HIV clients, and through counseling and testing corners, provided
CT to 7,000 TB clients and TB treatment to 4,300 ART clients over the 12 month period. In addition, TB is
included in the ART/OI training program in which 300 providers were trained in TB/HIV treatment in FY
2007. In FY 2008 CT will be provided to an additional 5,250 TB clients and 3,225 clients in HIV care will
receive TB treatment over the nine month period. During FY 2008, ZPCT will close out, handing over
program activities to the follow-on project, therefore targets are lower than FY 2007. In FY 2008, ZPCT will
consolidate the expansion of FY 2007 activities by providing technical support to ensure quality services
and build district capacity to manage the HIV/AIDS services.
This activity includes four components: 1) integration of CT in TB clinics; 2) strengthening and expansion of
TB services among HIV-infected individuals; 3) training for health care workers and lay counselors in cross-
referral for TB/HIV and other opportunistic infections (OIs); and 4) increasing program sustainability with the
GRZ.
In the first component, ZPCT will continue strengthening integration of HIV CT into TB clinics in the 210
ZPCT-supported facilities. TB clients are offered CT as part of the basic package of services within TB
clinics and, if necessary, referred for further testing and support services, such as determining ART
eligibility among HIV-infected TB patients. Those eligible will be offered ART on-site or referred to nearby
ART facilities if ART is not available at the facility. The TB/HIV link will be further strengthened in facilities
offering CT to ensure that all TB patients who are co-infected are identified and provided with appropriate
care and treatment services. Furthermore, CT services will be offered to the TB patient's family, with
emphasis on reducing stigma and discrimination associated with TB and HIV. In FY 2008, 5,250 TB clients
will receive CT services.
The second component, strengthening and expanding TB services for HIV-infected individuals, involves TB
diagnosis among all HIV-positive patients for reducing the incidence of TB Immune Reconstitution
Syndrome and for offering appropriate TB and/or ART services. ZPCT will train 200 clinical staff in ART/OI
management, including TB/HIV. Laboratory equipment, such as microscopes, will be procured as needed
to strengthen diagnosis of TB in selected ZPCT health facilities that currently have weak TB diagnostic
capacity. In FY 2008, ZPCT will do additional health facility renovations as needed, to assist with quality
control and infection prevention which is an integral part of the MOH ART/OI training. Through these
interventions, 3,225 HIV-TB co-infected persons will receive needed TB treatment over the nine months.
In the third component, training for health care workers and lay counselors in cross-referral for TB/HIV and
other OIs, ZPCT will continue to work with GRZ facility management personnel to ensure that counselors
are trained and available for TB clinics in ZPCT-supported facilities. Lay counselors will be trained and
assigned to provide support in these clinics, as needed. In addition to counseling skills, health care workers
(HCWs) and lay counselors will be trained in making referrals for appropriate HIV/AIDS services. Training
in cross-referrals between TB and HIV/AIDS services will be included in all CT and ART/OI management
training supported by ZPCT.
ZPCT will also continue to work at the national level with GRZ and USG partners, such as CDC, as well as
through the national TB and ART Technical Working Groups, to ensure that policies and guidelines
including quality assurance activities are optimal for TB/HIV linkages at all levels of the health care system
(e.g., national, provincial, district, and community). In addition, Family Health International is a partner with
The Royal Netherlands Tuberculosis Foundation (KNCV), Japanese Anti-Tuberculosis Association (JATA),
and World Health Organization (WHO) in the USAID Child Survival Fund's Tuberculosis Control Assistance
Program (TB CAP). In FY 2008, wrap around activities will include collaboration with Tuberculosis Control
Assistance Program (TB CAP) in training health care providers, developing TB/HIV materials, renovating
health facilities, and strengthening the patient referral system. This partnership is enhancing the existing
working relationship with the Ministry of Health (MOH) and reinforcing the National HIV/AIDS and TB
Strategic Plans by: 1) strengthening and expanding quality DOTS programs in Central, Copperbelt,
Luapula, Northern, and North-Western, provinces; 2) improving collaboration between TB and HIV partners
and programs; 3) increasing community involvement and awareness of TB; and 4) strengthening
public/private partnerships to combat TB and HIV. ZPCT will coordinate all TB/HIV activities with the MOH
and TB CAP, and collaborate with TB CAP in training health care providers, developing TB/HIV materials,
renovating health facilities, and strengthening the patient referral system, including linkages with TB/HIV
services such as community based palliative care and psychosocial support.
In the final component, increasing program sustainability with the GRZ, ZPCT will work with the Provincial
FY 2008, in collaboration with the GRZ, ZPCT will graduate another ten districts that are providing
these districts in order to better sustain these program activities.
By working with GRZ facilities, ZPCT is able to establish a sustainable program by training health care
Activity Narrative: implementing facility-level quality assurance/quality improvement programs, improving laboratory equipment
and systems, and developing and strengthening health information systems. ZPCT's goal is to leave
behind quality systems to ensure continuity of quality TB/HIV services after the program concludes.
This activity links to Zambia Prevention, Care, and Treatment Partnership (ZPCT) activities in ART, TB/HIV,
PMTCT, Palliative Care, and Laboratory Support, HCP VCT, PSI/SFH HVCT, Peace Corps,
CRS/SUCCESS II HBHC, RAPIDS HBHC, as well as with the Government of the Republic of Zambia
(GRZ), Japan International Cooperative Agency (JICA), and other US Government partners. Linkages with
USG and non-USG partners will increase the number of people reached with CT services and will avoid
duplication of services. Through collaborative efforts with the Health Communication Partnership,
Population Services International/Society for Family Health (PSI/SFH) and Peace Corps, ZPCT will continue
to provide targeted IEC materials, developed in local languages for use by community groups, and enhance
community mobilization for CT. ZPCT will seek opportunities to leverage resources by partnering with
organizations that provide CT/other HIV/AIDS services, such as SFH's New Start and mobile CT network,
TB CAP in training health care providers, developing TB/HIV materials, renovating health facilities, and
Catholic Relief Services/SUCCESS and RAPIDS in home-based/ palliative care services.
The focus is to improve counseling and testing (CT) services in Central, Copperbelt, and the more remote
Luapula, Northern, and North-Western provinces to reach 72,000 people with CT services in 200 facilities.
ZPCT is supporting 33 districts which represent 80% of the population in the five provinces and is covering
all the facilities in Ndola, Kitwe, Kabwe, Mansa, Mwense, and Nchelenge districts. In FY 2007, 210 GRZ
facilities were supported to provide CT services through training 500 health care workers (HCWs) and lay
counselors, providing same-day test results and facility refurbishments were needed. Nine-five percent of
clients received their test results on the same day, reaching 54,000 clients in FY 2007. In FY 2008 ZPCT
will reach 54,000 clients with CT services over the nine month period.
In FY 2008, ZPCT will consolidate the expansion of FY 2007 by providing technical support to ensure
Five activity components include: 1) provide comprehensive assistance to facility-based CT services; 2)
provide technical assistance to Neighborhood Health Committees, non-governmental organizations
(NGOs), faith-based organizations (FBOs), and community-based organizations (CBOs) to expand access
to CT via mobile outreach programs; 3) expand and strengthen CT referral systems; 4) provide technical
assistance to the national CT technical working group; and 5) increase program sustainability with the GRZ.
In the first component, assistance to facility-based CT services, ZPCT will continue to support and
consolidate 210 facilities to manage CT commodities (including HIV test kits), conduct moderate
refurbishments where needed, train and mentor, increase quality assurance mechanisms, build human
capacity, and improve systems for tracking patient flow, accessibility, and acceptability of CT services.
‘Testing Corners' (minimal laboratories placed within or in close proximity to CT sites to facilitate same day
test results) will continue to be supported in all 210 sites; this includes integrating CT into other clinical
services, such as TB and STI care. Staff capacity to forecast and procure HIV test kits and supplies and to
improve data entry will be enhanced. ZPCT will support the facilities and District Health Management
Teams (DHMTs) to maintain CT site accreditation status of these facilities, making them eligible to receive
supplies from Medical Stores Limited (MSL). In collaboration with GRZ, USAID/Deliver (#9522) and
Partnership for Supply Chain Management Systems (SCMS) (#9523), pharmacy, laboratory, and
counseling staff in the supported facilities will be trained in data collection and reporting, ordering, tracking,
and forecasting of CT-related commodities.
In the second component, ZPCT will work in the communities surrounding the CT sites to increase demand
and acceptance of CT services, including targeting discordant couples. ZPCT will work with facilities and
NGOs/FBOs/CBOs to deliver CT services through mobile teams of HCWs and lay counselors. This
integrated effort of bringing together NGOs/FBOs/CBOs, Neighborhood Health Committees, community
leaders, and facility health workers will greatly increase access to CT services in rural areas and will
mobilize overall demand for and acceptance of CT. For example, lay counselors will lead group discussions
and offer pre/post test individual counseling within communities and at facilities. HIV-infected individuals
will be referred for other services, including PMTCT, ART, and palliative care including TB.
In FY 2007, 220 HCWs received the GRZ counseling training course or the refresher course and 80 HCWs
the counseling supervision training. One hundred of these HCWs also received training on child counseling
and 200 lay counselors from CBOs and FBOs were trained. Training includes prevention for positives
(abstinence, be faithful, condom usage, encourage disclosure, treatment, family planning, and STI
prevention) and ABC messages for negatives. In FY 2008, ZPCT will train 100 HCWs in the initial CT
training, 90 HCWs will be trained as counseling supervisors, and 90 HCWs will receive extra training in
counseling for children. Sixty lay counselors from CBOs, FBOs and existing TB treatment supporters will be
trained to support CT services in health facilities and increase CT demand in communities. These
community representatives will also assist health facility management and staff to make CT services more
accessible and acceptable among the population they serve.
In the third component, ZPCT will work with facilities, communities, and partner organizations to establish,
strengthen, and widen referral linkages between CT and TB, STI, ante-natal care, in-patient, and out-patient
services. Existing community-based services will be integrated into an active referral system. A ZPCT
provincial referral officer works with organizations in each ZPCT-supported district and a contact person in
each supported facility to strengthen the district referral networks. FY 2008 support will also further reduce
stigma, discrimination and gender inequalities associated with ART by working with community leaders and
key stakeholders regarding the importance of CT and availability of ART.
In the fourth component, ZPCT will provide technical assistance to the national CT Technical Working
Group on strategies for scaling up CT services and developing, revising, and disseminating training
materials, protocols, and policies.
Linkages with USG and non-USG partners will increase the number of people reached with CT services and
will avoid duplication of services. Through collaborative efforts with the Health Communication Partnership
(#8901), Population Services International/Society for Family Health (PSI/SFH) (#8926), and Peace Corps
(#9629), ZPCT will continue to provide targeted IEC materials, developed in local languages for use by
community groups, and enhance community mobilization for CT. ZPCT will seek opportunities to leverage
resources by partnering with organizations that provide CT/other HIV/AIDS services, such as SFH's (#8926)
Activity Narrative: New Start and mobile CT network, TB CAP in training health care providers, developing TB/HIV materials,
renovating health facilities, and Catholic Relief Services/SUCCESS (#9180) and RAPIDS (#8946) in home-
based/palliative care services.
Health Offices (PHOs) and DHMTs to build on the quality assurance activities started in FY 2006. In FY
2007, ZPCT graduated ten districts from intensive technical support. In FY 2008, ZPCT will graduate
another ten districts that are providing consistent quality services and will only need limited technical
support from ZPCT. PHOs and DHMTs will assume responsibility for selected districts by providing all
supervision and monitoring activities in these districts in order to better sustain the program activities.
and systems, and developing and strengthening health information systems.
This activity links with the Zambia Prevention, Care, and Treatment Partnership (ZPCT) Counseling and
Testing (CT), PMTCT, TB/HIV, Palliative Care, and Laboratory Support activities, CRS/SUCCESS HBHC
and HTXS, Health Communication Partnership (HCP) HBHC and HTXS, RAPIDS HBHC and HTXS, and
Society for Family Health (SFH) HBHC as well as the Government of the Republic of Zambia (GRZ) and
other US Government (USG) partners as outlined below.
This activity will strengthen and expand the Ministry of Health (MOH) ART services in Central, Copperbelt,
and the more remote Luapula, Northern, and North-Western provinces. ZPCT is supporting 33 districts
which represent 80% of the population in the five provinces and is covering all the facilities in Ndola, Kitwe,
Kabwe, Mansa, Mwense, and Nchelenge districts. ZPCT expanded to 75 ART sites, 17 more than
expected in FY 2007. All 75 ART sites have been renovated, where renovations were required, and are
fully functioning.
In FY 2007, ZPCT supported the MOH to provide 51,300 patients (4,300 children) with ART services of
which 15,600 are new clients (including 1,560 children). As of September 30, 2008, the number of persons
who ever received ART is 54,300. In FY 2008, ZPCT will support 60,050 clients on ART (including 6,005
children) with 13,500 new clients (including 1,350 children) enrolled during the 9 month period. Other FY
2007 achievements are outlined in the component descriptions below.
The six key components of the ZPCT program are: 1) provide comprehensive support to strengthen ART
facilities and services; 2) expand implementation of the ART outreach model; 3) strengthen referral linkages
and increase demand for ART services; 4) participate in and support the national ART Technical Working
Group; 5) assist in scaling-up pediatric ART services; and 6) increase program sustainability with the GRZ.
Specifically, the first component of the ZPCT program will be to provide comprehensive support to
strengthen ART facilities and services, by continuing the FY 2007 assistance to 75 ART centers as they
expand. In FY 2007, ZPCT trained 300 health care workers (HCWs) in the full and refresher
ART/opportunistic infection (OI) management curriculum, and 200 HCWs in the management of pediatric
ART. In FY 2008, ZPCT will train 120 HCWs in ART/OI management, 80 in the refresher ART
management, and 50 HCWs in pediatric case management. In collaboration with the Health Services and
Systems Program (HSSP), all 75 ART sites will be assisted in developing quality assurance mechanisms
and supportive supervision systems to ensure implementation of standard operating procedures for ART
case management, conducting minor refurbishments, providing ART-related supplies, and linking ART
patients and their families to ante-natal care, PMTCT, TB, palliative care/home-based care, and other
appropriate treatment and support services.
As part of the second component, ZPCT will consolidate expansion of the ART outreach model. Through
this model, doctors trained in ART case management travel to non-ART health centers on selected days,
bringing with them mini-labs, to train facility staff and to provide HIV/AIDS clinical services to patients who
would not otherwise have access to these quality ART services.
As part of the third component, ZPCT will work with USG partners, such as CRS/SUCCESS, Health
Communication Partnership (HCP), RAPIDS, and Society for Family Health (SFH) to strengthen referral
linkages and community outreach efforts aimed at creating awareness of and demand for ART services and
supporting treatment adherence among ART patients. During FY 2007, ZPCT collaborated with the GRZ to
develop, pilot, and roll out an adherence counseling training curriculum for HCWs and adherence support
workers (ASWs). ASWs, many of whom are ART patients, were also trained to work in facilities and
communities with ART clients, particularly those persons initiating therapy. In FY 2007, 100 HCWs were
trained in adherence counseling and 100 ASWs in ART adherence counseling, treatment support, and
community outreach. In FY 2008, an additional 50 HCWs and 50 ASWs will be trained in adherence
counseling. FY 2008 support will also further reduce stigma and discrimination associated with ART by
working with community leaders and key stakeholders regarding the importance of CT and availability of
ART.
As part of the fourth component, ZPCT will coordinate with HSSP and JHPIEGO on technical assistance
that will continue to be provided to the national ART Technical Working Group for scaling-up ART services,
focusing on developing, updating, and disseminating training materials, protocols, and policies.
As part of the fifth component, ZPCT will provide assistance to the GRZ in scaling-up ART services and
treatment for pediatric patients to serve 5,650 (including 1,350 new) children in FY 2008. Building on the
pediatric training program mentioned above, ZPCT will continue to provide technical assistance to GRZ in
the five provinces to address limited HIV/AIDS pediatric expertise. Some of the challenges to
accomplishing this include building capacity in diagnosing HIV in children less than 18 months and providing
adherence counseling for children and their caregivers. To meet these challenges, in FY 2007, ZPCT
expanded coverage of the Polymerase Chain Reaction (PCR) laboratory at Arthur Davison Children's
Hospital in the Copperbelt Province, to reach all five provinces with a dry blood spot referral system for
pediatric diagnosis. This activity is closely linked to the Centers for Disease Control and Prevention
(CDC)/Centers of Excellence activity and partially supported by the Clinton Foundation HIV/AIDS Initiative.
ZPCT will continue to integrate innovative approaches to pediatric ART case management, including
mentoring, on-site training, and strengthening basic ART/OI pediatric management. ASWs will continue to
assist families in addressing ART adherence and other challenges to effective pediatric case management.
Sixty two ART sites provided pediatric ART services in FY 2007, with the ART sites in Ndola District
referring pediatric cases to Arthur Davison Children's Hospital and in Kitwe District to the Kitwe Central
Hospital.
ZPCT will also work with partners to strengthen referral networks within and between facilities and
communities to expand access to pediatric HIV care, including tracking of mothers and their infants for up to
18 months through the under-five clinics. ZPCT will continue to work with churches and local community
groups to reach families with information and referrals for CT and ART for children under 14 years of age.
Activity Narrative: In FY 2008, wrap around activities will include collaboration with the Tuberculosis Control Assistance
Program (TBCAP) in training health care providers, developing TB/HIV materials, renovating health
facilities, and strengthening the patient referral system
As part of the final component, increasing program sustainability with the GRZ, ZPCT will work with DHMTs
and PHOs to build on quality assurance activities started in FY 2006. In FY 2007, ZPCT graduated ten
districts from intensive technical support. In FY 2008, in collaboration with the GRZ, ZPCT will graduate
support from ZPCT. The DHMTs and PHOs will assume responsibility for the selected districts by providing
supervision and monitoring in order to better sustain program activities.
workers, developing standard treatment protocols, strengthening infrastructures, implementing quality
assurance/quality improvement programs, improving laboratory systems, and developing/strengthening
health information systems.
Testing (CT), PMTCT, ART, TB/HIV, and Palliative Care activities, DELIVER II HTSD as well as with the
Government of the Republic of Zambia (GRZ) and other US Government (USG) partners as outlined below.
This activity will provide support to the GRZ for strengthening and expanding laboratory services in the
delivery of HIV/AIDS care in Central, Copperbelt, and the more remote Luapula, Northern, and North-
Western provinces. ZPCT is supporting 33 districts which represent 80% of the population in the five
provinces and is covering all the facilities in Ndola, Kitwe, Kabwe, Mansa, Mwense, and Nchlenge districts.
During FY 2007, ZPCT continued to improve laboratory services in 108 laboratories through training 70
laboratory staff in laboratory standard operating procedures, quality assurance and equipment use; training
140 staff in commodity management; renovating 40 new laboratories, procuring essential laboratory
equipment and reagents; expanding quality assurance activities; developing and computerizing a
Laboratory Management Information System to track HIV-related laboratory tests; and providing technical
assistance and mentoring to laboratory staff.
In FY 2007, ZPCT continued supporting the laboratory specimen referral system with 175 facilities
(including all PMTCT sites) transporting specimens for PCR and/or CD4, hematology and chemistry from
health facilities, some with limited laboratory capacity to the referral laboratories, performing an estimated
610,139 essential laboratory tests over the 12 month period. The specimen referral system will continue in
FY 2008. This system is greatly improving the ability of more rural facilities to provide quality HIV/AIDS
services, and has led to same-day test results and an increase in new ART patients. ZPCT is working
closely on laboratory activities with CDC, the Clinton Foundation HIV/AIDS Initiative (CHAI) and Partnership
for Supply Chain Management Systems (SCMS).
quality services and build district capacity to manage the HIV/AIDS services. The ZPCT project will close
out in FY 2008, handing over program activities to the follow-on project; therefore, targets are lower than FY
2007.
In FY 2008, ZPCT will continue providing assistance to 108 GRZ laboratories providing CT, PMTCT, ART,
and/or clinical palliative care services. Forty-nine of the 108 supported facilities will have the capacity to
conduct more advanced HIV laboratory tests, such as CD4 and lymphocyte tests. More specifically,
laboratory support activities include: 1) strengthening laboratory infrastructure; 2) improving laboratory
quality assurance mechanisms, information systems, and personnel capacity; and 3) increasing program
sustainability with the GRZ. Eighty percent of the population in the five ZPCT-supported provinces is
reached through the ZPCT-supported laboratory services.
In the first component, strengthening laboratory infrastructure, all sites providing ART will have access to
the full complement of basic equipment for hematology and biochemistry (including total lymphocyte count
and liver and renal function testing for ART patient monitoring). Equipment purchased, such as hematology
and chemistry analyzers, will be in accordance with GRZ guidelines/policies. Other equipment, including
autoclaves, centrifuges, microscopes, and refrigerators will be provided as needed. ZPCT will continue to
link ART sites currently without access to CD4 testing to nearby ART facilities that have Facscount
machines, and will ensure availability of transport of samples from project-supported facilities to sites with
CD4 machines for proper ART patient monitoring. ZPCT will also work in close collaboration with the GRZ
to ensure provision of supplies for CD4 enumeration in the hard-to-reach areas. In addition, the laboratory
team will provide technical support for the utilization of the Polymerase Chain Reaction (PCR) machine
located at Arthur Davison Children's Hospital in the Copperbelt Province to support the process of early
diagnosis of HIV-infected infants. The PCR specimens will be collected, with assistance from CHAI, and
transported using the specimen referral system and express mail to Arthur Davison Children's Hospital.
These activities will be closely coordinated with the Centers for Disease Control and Prevention (CDC)
programs/Centers of Excellence. In FY 2008, the number of tests performed at ZPCT-supported
laboratories will be 536,672 over a 9 month time period.
In FY 2005, FY 2006, and FY 2007, ZPCT provided minor refurbishment, essential furniture, and fixtures for
selected laboratories to enable all facilities to provide the appropriate level of laboratory services. In FY
2008, ZPCT will continue to support the facilities to identify further renovations that may be needed. In FY
2008 wrap around activities will include collaboration with the Tuberculosis Control Assistance Program
(TBCAP) in training health care providers, developing TB/HIV materials, renovating health facilities, and
strengthening the patient referral system.
In the second component, ZPCT will work with GRZ and CDC to strengthen laboratory quality assurance
mechanisms, information systems, and laboratory personnel's capacity to ensure adherence to GRZ's
recommended laboratory standards. In FY 2007, 210 staff were trained in lab-related activities, and in FY
2008, another 60 staff will be trained. To improve quality assurance practices, approximately ten percent of
HIV test samples will be checked by trained laboratory staff from designated National Quality Assurance
Centers; samples from facilities without laboratories will be transported to the nearest laboratory site in
order to facilitate testing availability. ZPCT will also make certain that all sites follow laboratory standard
operating procedures to ensure that these facilities implement proper laboratory practices. Finally,
laboratory staff will continue to be trained in commodity management; this particular assistance will be
coordinated with the USAID | DELIVER PROJECT, the Supply Chain Management Systems project
(SCMS), CDC, and GRZ to avoid duplication of efforts and to ensure that facility-level forecasts and
quantifications are supplied with an adequate number of commodities.
As part of the final component, "Increasing program sustainability with the GRZ," ZPCT will support the
MOH laboratory quality assurance (QA) assistance plan in collaboration with CDC. ZPCT will work with the
GRZ to strengthen QA activities in the three Central Hospital laboratories and six General Hospital
laboratories in the five ZPCT supported provinces. To maintain consistent and high quality laboratory
services and improved supervisory support to the District Hospital laboratories, ZPCT will continue to
provide support to strengthen the capacity of the General Hospital laboratories. The MOH, through the
Provincial Health Offices, will then assume responsibility for the monitoring of the General and District
Hospital laboratory QA programs.
Activity Narrative: workers, developing standard treatment protocols, strengthening physical and equipment infrastructures,
behind sustained systems to ensure continuity of quality laboratory support after the program concludes.
Note on direct target breakdown: the number of tests performed during the reporting period: 1) 166,299 HIV
tests; 2) 46,286 TB diagnostic tests; 3) 53,997 syphilis tests; and 4) 270,090 HIV disease monitoring tests.
