Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 1075
Country/Region: Zambia
Year: 2008
Main Partner: FHI 360
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $13,456,000

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $4,200,000

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.

Funding for Care: Adult Care and Support (HBHC): $1,320,000

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.

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 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.

All FY 2008 targets will be reached by June 30, 2009.

Funding for Care: TB/HIV (HVTB): $1,500,000

This activity links with the Zambia Prevention, Care, and Treatment Partnership (ZPCT) PMTCT, ART,

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

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

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 these program activities.

By working with GRZ facilities, ZPCT is able to establish a sustainable program by training health care

workers, developing standard treatment protocols, strengthening physical and equipment infrastructures,

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.

All FY 2008 targets will be reached by June 30, 2009.

Funding for Testing: HIV Testing and Counseling (HVCT): $2,160,000

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

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.

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.

In the final component, increasing program sustainability with the GRZ, ZPCT will work with Provincial

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.

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 health information systems.

All FY 2008 targets will be reached by June 30, 2009.

Funding for Treatment: Adult Treatment (HTXS): $2,656,000

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.

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.

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

another ten districts that are providing consistent quality services and will only need limited technical

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.

By working with GRZ facilities, ZPCT is able to establish a sustainable program through training health care

workers, developing standard treatment protocols, strengthening infrastructures, implementing quality

assurance/quality improvement programs, improving laboratory systems, and developing/strengthening

health information systems.

All FY 2008 targets will be reached by June 30, 2009.

Funding for Laboratory Infrastructure (HLAB): $1,620,000

This activity links with the Zambia Prevention, Care, and Treatment Partnership (ZPCT) Counseling and

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).

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. 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.

By working with GRZ facilities, ZPCT is able to establish a sustainable program by training health care

Activity Narrative: 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. ZPCT's goal is to leave

behind sustained systems to ensure continuity of quality laboratory support after the program concludes.

All FY 2008 targets will be reached by June 30, 2009.

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.

Subpartners Total: $1,078,481
Management Sciences for Health: $682,000
Churches Health Association of Zambia: $245,729
Expanded Church Response: $60,752
Kara Counseling and Training Trust: $90,000